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Sample records for factor-15 predicts mortality

  1. Plasma growth differentiation factor 15 is associated with weight loss and mortality in cancer patients

    PubMed Central

    Lerner, Lorena; Hayes, Teresa G; Tao, Nianjun; Krieger, Brian; Feng, Bin; Wu, Zhenhua; Nicoletti, Richard; Chiu, M Isabel; Gyuris, Jeno; Garcia, Jose M

    2015-01-01

    Background Cancer-related weight loss is associated with increased inflammation and decreased survival. The novel inflammatory mediator growth differentiation factor (GDF)15 is associated with poor prognosis in cancer but its role in cancer-related weight loss (C-WL) remains unclear. Our objective was to measure GDF15 in plasma samples of cancer subjects and controls and establish its association with other inflammatory markers and clinical outcomes. Methods We measured body weight, appetite, plasma GDF15, and other inflammatory markers in men with cancer-related weight loss (C-WL, n = 58), weight stable patients with cancer (C-WS, n = 72), and non-cancer controls (Co, n = 59) matched by age and pre-illness body mass index. In a subset of patients we also measured handgrip strength, appendicular lean body mass (aLBM), Eastern Cooperative Oncology Group (ECOG), and Karnofsky performance scores. Results GDF15, interleukin (IL)-6 and IL-8 were increased in C-WL versus other groups. IL-1 receptor antagonist, IL-4, interferon–gamma, tumour necrosis factor alpha, and vascular endothelial growth factor A were increased in C-WL versus C-WS, and Activin A was significantly downregulated in Co versus other groups. C-WL patients had lower handgrip strength, aLBM, and fat mass, and Eastern Cooperative Oncology Group and Karnofsky performance scores were lower in both cancer groups. GDF15, IL-6, and IL-8 significantly correlated with weight loss; GDF15 negatively correlated with aLBM, handgrip strength, and fat mass. IL-8 and Activin A negatively correlated with aLBM and fat mass. GDF15 and IL-8 predicted survival adjusting for stage and weight change (Cox regression P < 0.001 for both). Conclusion GDF15 and other inflammatory markers are associated with weight loss, decreased aLBM and strength, and poor survival in patients with cancer. GDF15 may serve as a prognostic indicator in cancer patients and is being evaluated as a potential therapeutic target for

  2. Diabetes mellitus related biomarker: The predictive role of growth-differentiation factor-15.

    PubMed

    Berezin, Alexander E

    2016-01-01

    Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine, which belongs to super family of the transforming growth factor beta. GDF-15 is widely presented in the various cells (macrophages, vascular smooth muscle cells, adipocytes, cardiomyocytes, endothelial cells, fibroblasts), tissues (adipose tissue, vessels, tissues of central and peripheral nervous system) and organs (heart, brain, liver, placenta) and it plays an important role in the regulation of the inflammatory response, growth and cell differentiation. Elevated GDF-15 was found in patients with established CV diseases including hypertension, stable coronary artery disease, acute coronary syndrome, myocardial infarction, ischemic and none ischemic-induced cardiomyopathies, heart failure, atrial fibrillation, as well as stroke, type two diabetes mellitus (T2DM), chronic kidney disease, infection, liver cirrhosis, malignancy. Therefore, aging, smoking, and various environmental factors, i.e. chemical pollutants are other risk factors that might increase serum GDF-15 level. Although GDF-15 has been reported to be involved in energy homoeostasis and weight loss, to have anti-inflammatory properties, and to predict CV diseases and CV events in general or established CV disease population, there is no large of body of evidence regarding predictive role of elevated GDF-15 in T2DM subjects. The mini review is clarified the role of GDF-15 in T2DM subjects. PMID:26482961

  3. Prediction of Mortality Based on Facial Characteristics.

    PubMed

    Delorme, Arnaud; Pierce, Alan; Michel, Leena; Radin, Dean

    2016-01-01

    Recent studies have shown that characteristics of the face contain a wealth of information about health, age and chronic clinical conditions. Such studies involve objective measurement of facial features correlated with historical health information. But some individuals also claim to be adept at gauging mortality based on a glance at a person's photograph. To test this claim, we invited 12 such individuals to see if they could determine if a person was alive or dead based solely on a brief examination of facial photographs. All photos used in the experiment were transformed into a uniform gray scale and then counterbalanced across eight categories: gender, age, gaze direction, glasses, head position, smile, hair color, and image resolution. Participants examined 404 photographs displayed on a computer monitor, one photo at a time, each shown for a maximum of 8 s. Half of the individuals in the photos were deceased, and half were alive at the time the experiment was conducted. Participants were asked to press a button if they thought the person in a photo was living or deceased. Overall mean accuracy on this task was 53.8%, where 50% was expected by chance (p < 0.004, two-tail). Statistically significant accuracy was independently obtained in 5 of the 12 participants. We also collected 32-channel electrophysiological recordings and observed a robust difference between images of deceased individuals correctly vs. incorrectly classified in the early event related potential (ERP) at 100 ms post-stimulus onset. Our results support claims of individuals who report that some as-yet unknown features of the face predict mortality. The results are also compatible with claims about clairvoyance warrants further investigation. PMID:27242466

  4. Prediction of Mortality Based on Facial Characteristics

    PubMed Central

    Delorme, Arnaud; Pierce, Alan; Michel, Leena; Radin, Dean

    2016-01-01

    Recent studies have shown that characteristics of the face contain a wealth of information about health, age and chronic clinical conditions. Such studies involve objective measurement of facial features correlated with historical health information. But some individuals also claim to be adept at gauging mortality based on a glance at a person’s photograph. To test this claim, we invited 12 such individuals to see if they could determine if a person was alive or dead based solely on a brief examination of facial photographs. All photos used in the experiment were transformed into a uniform gray scale and then counterbalanced across eight categories: gender, age, gaze direction, glasses, head position, smile, hair color, and image resolution. Participants examined 404 photographs displayed on a computer monitor, one photo at a time, each shown for a maximum of 8 s. Half of the individuals in the photos were deceased, and half were alive at the time the experiment was conducted. Participants were asked to press a button if they thought the person in a photo was living or deceased. Overall mean accuracy on this task was 53.8%, where 50% was expected by chance (p < 0.004, two-tail). Statistically significant accuracy was independently obtained in 5 of the 12 participants. We also collected 32-channel electrophysiological recordings and observed a robust difference between images of deceased individuals correctly vs. incorrectly classified in the early event related potential (ERP) at 100 ms post-stimulus onset. Our results support claims of individuals who report that some as-yet unknown features of the face predict mortality. The results are also compatible with claims about clairvoyance warrants further investigation. PMID:27242466

  5. Predicting mortality based on body composition analysis.

    PubMed Central

    Tellado, J M; Garcia-Sabrido, J L; Hanley, J A; Shizgal, H M; Christou, N V

    1989-01-01

    The role of the Nae/Ke ratio (the ratio of exchangeable sodium to exchangeable potassium) was examined as a nutritional marker in surgical patients in relation to anthropometrical and biochemical indexes by its ability to identify patients at risk for mortality after hospitalization. In 73 patients with sepsis and malnutrition (Training Group, Madrid) the following were determined: percentage of recent weight loss, triceps skin fold, midarm muscle circumference, serum albumin, serum transferrin, delayed hypersensitivity skin test response, total lymphocytes, and Nae/Ke ratio by multiple isotope dilution. The predictive power of Nae/Ke ratio was so strong (F = 105.1; p less than 0.00001) that it displaced anthropometric, biochemical, and immunologic variables from the linear equation derived from stepwise discriminant analysis using hospital mortality as the dependent variable. A theoretical curve of expected deaths was developed, based on an equation obtained by logistic regression analysis: Pr/death/ = 1/(1 + e[11.8-5.2 Nae/Ke]). Pre- and post-test probabilities on that curve allowed us to determine two cut-off values, Nae/Ke ratios of 1.5 and 2.5, which were markers for nonrisk and mortality, respectively. The model was tested in a heterogeneous data base of surgical patients (n = 417) in another hospital (Validation Group, Montreal). For patients exhibiting an abnormal Nae/Ke ratio (greater than 1.2) and a greater than 10% of probability of death, 54 deaths were expected and 53 observed (X2 = 1.8 NS). Two tests confirmed the basic agreement between the model and its performance, a G statistic of -0.704 and the area beneath the "receiver-operating-characteristic" (ROC) curve (Az = 0.904 + 0.0516 for the Madrid group vs. Az = 0.915 + 0.0349 for the Montreal group, NS). It was concluded from this analysis that, compared with the usual anthropometric measurements, the Nae/Ke ratio, if available, is the best method for identifying malnourished patients at risk of

  6. Change in Growth Differentiation Factor 15, but Not C-Reactive Protein, Independently Predicts Major Cardiac Events in Patients with Non-ST Elevation Acute Coronary Syndrome

    PubMed Central

    Hernandez-Baldomero, Idaira F.; Bosa-Ojeda, Francisco

    2014-01-01

    Among the numerous emerging biomarkers, high-sensitivity C-reactive protein (hsCRP) and growth-differentiation factor-15 (GDF-15) have received widespread interest, with their potential role as predictors of cardiovascular risk. The concentrations of inflammatory biomarkers, however, are influenced, among others, by physiological variations, which are the natural, within-individual variation occurring over time. The aims of our study are: (a) to describe the changes in hsCRP and GDF-15 levels over a period of time and after an episode of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and (b) to examine whether the rate of change in hsCRP and GDF-15 after the acute event is associated with long-term major cardiovascular adverse events (MACE). Two hundred and Fifty five NSTE-ACS patients were included in the study. We measured hsCRP and GDF-15 concentrations, at admission and again 36 months after admission (end of the follow-up period). The present study shows that the change of hsCRP levels, measured after 36 months, does not predict MACE in NSTEACS-patients. However, the level of GDF-15 measured, after 36 months, was a stronger predictor of MACE, in comparison to the acute unstable phase. PMID:24839357

  7. Consistent Predictions of Future Forest Mortality

    NASA Astrophysics Data System (ADS)

    McDowell, N. G.

    2014-12-01

    We examined empirical and model based estimates of current and future forest mortality of conifers in the northern hemisphere. Consistent water potential thresholds were found that resulted in mortality of our case study species, pinon pine and one-seed juniper. Extending these results with IPCC climate scenarios suggests that most existing trees in this region (SW USA) will be dead by 2050. Further, independent estimates of future mortality for the entire coniferous biome suggest widespread mortality by 2100. The validity and assumptions and implications of these results are discussed.

  8. Mortality of atomic bomb survivors predicted from laboratory animals

    NASA Technical Reports Server (NTRS)

    Carnes, Bruce A.; Grahn, Douglas; Hoel, David

    2003-01-01

    Exposure, pathology and mortality data for mice, dogs and humans were examined to determine whether accurate interspecies predictions of radiation-induced mortality could be achieved. The analyses revealed that (1) days of life lost per unit dose can be estimated for a species even without information on radiation effects in that species, and (2) accurate predictions of age-specific radiation-induced mortality in beagles and the atomic bomb survivors can be obtained from a dose-response model for comparably exposed mice. These findings illustrate the value of comparative mortality analyses and the relevance of animal data to the study of human health effects.

  9. Prediction of mortality rates in the presence of missing values

    NASA Astrophysics Data System (ADS)

    Tan, Chon Sern; Pooi, Ah Hin

    2015-12-01

    A time series model based on multivariate power-normal distribution has been applied in the past literature on the United States (US) mortality data from the years 1933 to 2000 to forecast the future age-specific mortality rates of the years 2001 to 2010. In this paper, we show that the method based on multivariate power-normal distribution can still be used for an incomplete US mortality dataset that contains some missing values. The prediction intervals based on this incomplete training data are found to still have good ability of covering the observed future mortality rates although the interval lengths may become wider for long-range prediction.

  10. Mortality of atomic bomb survivors predicted from laboratory animals.

    PubMed

    Carnes, Bruce A; Grahn, Douglas; Hoel, David

    2003-08-01

    Exposure, pathology and mortality data for mice, dogs and humans were examined to determine whether accurate interspecies predictions of radiation-induced mortality could be achieved. The analyses revealed that (1) days of life lost per unit dose can be estimated for a species even without information on radiation effects in that species, and (2) accurate predictions of age-specific radiation-induced mortality in beagles and the atomic bomb survivors can be obtained from a dose-response model for comparably exposed mice. These findings illustrate the value of comparative mortality analyses and the relevance of animal data to the study of human health effects. PMID:12859226

  11. Tree mortality predicted from drought-induced vascular damage

    NASA Astrophysics Data System (ADS)

    Anderegg, William R. L.; Flint, Alan; Huang, Cho-Ying; Flint, Lorraine; Berry, Joseph A.; Davis, Frank W.; Sperry, John S.; Field, Christopher B.

    2015-05-01

    The projected responses of forest ecosystems to warming and drying associated with twenty-first-century climate change vary widely from resiliency to widespread tree mortality. Current vegetation models lack the ability to account for mortality of overstorey trees during extreme drought owing to uncertainties in mechanisms and thresholds causing mortality. Here we assess the causes of tree mortality, using field measurements of branch hydraulic conductivity during ongoing mortality in Populus tremuloides in the southwestern United States and a detailed plant hydraulics model. We identify a lethal plant water stress threshold that corresponds with a loss of vascular transport capacity from air entry into the xylem. We then use this hydraulic-based threshold to simulate forest dieback during historical drought, and compare predictions against three independent mortality data sets. The hydraulic threshold predicted with 75% accuracy regional patterns of tree mortality as found in field plots and mortality maps derived from Landsat imagery. In a high-emissions scenario, climate models project that drought stress will exceed the observed mortality threshold in the southwestern United States by the 2050s. Our approach provides a powerful and tractable way of incorporating tree mortality into vegetation models to resolve uncertainty over the fate of forest ecosystems in a changing climate.

  12. Vision impairment predicts five-year mortality.

    PubMed Central

    Taylor, H R; McCarty, C A; Nanjan, M B

    2000-01-01

    PURPOSE: To describe predictors of mortality in the 5-year follow-up of the Melbourne Visual Impairment Project (VIP) cohort. METHODS: The Melbourne VIP was a population-based study of the distribution and determinants of age-related eye disease in a cluster random sample of Melbourne residents aged 40 years and older. Baseline examinations were conducted between 1992 and 1994. In 1997, 5-year follow-up examinations of the original cohort commenced. Causes of death were obtained from the National Death Index for all reported deaths. RESULTS: Of the original 3,271 participants, 231 (7.1%) were reported to have died in the intervening 5 years. Of the remaining 3,040 participants eligible to return for follow-up examinations, 2,594 (85% of eligible) did participate, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. Best corrected visual acuity < 6/12 and cortical cataract were associated with a significantly increased risk of mortality, as were increasing age, male sex, increased duration of cigarette smoking, increased duration of hypertension, and arthritis. CONCLUSIONS: Even mild visual impairment increases the risk of death more than twofold. PMID:11190044

  13. Multiple biomarkers for mortality prediction in peripheral arterial disease.

    PubMed

    Amrock, Stephen M; Weitzman, Michael

    2016-04-01

    Few studies have assessed which biomarkers influence mortality risk among those with peripheral arterial disease (PAD). We analyzed data from 556 individuals identified to have PAD (i.e. ankle-brachial index ⩽0.9) with available measurements of C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), homocysteine, and the urinary albumin-to-creatinine ratio (UACR) in the 1999-2004 National Health and Nutrition Examination Survey. We investigated whether a combination of these biomarkers improved the prediction of all-cause and cardiovascular mortality beyond conventional risk factors. During follow-up (median, 8.1 years), 277 of 556 participants died; 63 deaths were attributed to cardiovascular disease. After adjusting for conventional risk factors, Cox proportional-hazards models showed the following to be most strongly associated with all-cause mortality (each is followed by the adjusted hazard ratio [HR] per 1 standard deviation increment in the log values): homocysteine (1.31), UACR (1.21), and NLR (1.20). UACR alone significantly predicted cardiovascular mortality (1.53). Persons in the highest quintile of multimarker scores derived from regression coefficients of significant biomarkers had elevated risks of all-cause mortality (adjusted HR, 2.45; 95% CI, 1.66-3.62; p for trend, <0.001) and cardiovascular mortality (adjusted HR, 2.20; 95% CI, 1.02-4.71; p for trend, 0.053) compared to those in the lowest two quintiles. The addition of continuous multimarker scores to conventional risk factors improved risk stratification of all-cause mortality (integrated discrimination improvement [IDI], 0.162; p<0.00001) and cardiovascular mortality (IDI, 0.058; p<0.00001). In conclusion, the addition of a continuous multimarker score to conventional risk factors improved mortality prediction among patients with PAD. PMID:26762418

  14. Using Highly Detailed Administrative Data to Predict Pneumonia Mortality

    PubMed Central

    Rothberg, Michael B.; Pekow, Penelope S.; Priya, Aruna; Zilberberg, Marya D.; Belforti, Raquel; Skiest, Daniel; Lagu, Tara; Higgins, Thomas L.; Lindenauer, Peter K.

    2014-01-01

    Background Mortality prediction models generally require clinical data or are derived from information coded at discharge, limiting adjustment for presenting severity of illness in observational studies using administrative data. Objectives To develop and validate a mortality prediction model using administrative data available in the first 2 hospital days. Research Design After dividing the dataset into derivation and validation sets, we created a hierarchical generalized linear mortality model that included patient demographics, comorbidities, medications, therapies, and diagnostic tests administered in the first 2 hospital days. We then applied the model to the validation set. Subjects Patients aged ≥18 years admitted with pneumonia between July 2007 and June 2010 to 347 hospitals in Premier, Inc.’s Perspective database. Measures In hospital mortality. Results The derivation cohort included 200,870 patients and the validation cohort had 50,037. Mortality was 7.2%. In the multivariable model, 3 demographic factors, 25 comorbidities, 41 medications, 7 diagnostic tests, and 9 treatments were associated with mortality. Factors that were most strongly associated with mortality included receipt of vasopressors, non-invasive ventilation, and bicarbonate. The model had a c-statistic of 0.85 in both cohorts. In the validation cohort, deciles of predicted risk ranged from 0.3% to 34.3% with observed risk over the same deciles from 0.1% to 33.7%. Conclusions A mortality model based on detailed administrative data available in the first 2 hospital days had good discrimination and calibration. The model compares favorably to clinically based prediction models and may be useful in observational studies when clinical data are not available. PMID:24498090

  15. Disgust sensitivity predicts defensive responding to mortality salience.

    PubMed

    Kelley, Nicholas J; Crowell, Adrienne L; Tang, David; Harmon-Jones, Eddie; Schmeichel, Brandon J

    2015-10-01

    Disgust protects the physical self. The present authors suggest that disgust also contributes to the protection of the psychological self by fostering stronger defensive reactions to existential concerns. To test this idea, 3 studies examined the link between disgust sensitivity and defensive responses to mortality salience or "terror management" processes (Greenberg, Solomon, & Pyszczynski, 1997). Each study included an individual difference measure of disgust sensitivity, a manipulation of mortality salience, and a dependent measure of defensive responding. In Study 1, disgust sensitivity predicted increases in worldview defense in the mortality salience condition but not in the control condition. In Study 2, disgust sensitivity predicted increases in optimistic perceptions of the future in the mortality salience condition but not in the control condition. In Study 3, disgust sensitivity predicted reductions in delay discounting for those in the mortality salience condition such that those higher in disgust sensitivity discounted the future less. This pattern did not occur in the control condition. These findings highlight disgust sensitivity as a key to understanding reactions to mortality salience, and they support the view that disgust-related responses protect against both physical (e.g., noxious substances) and psychological threats. PMID:25775230

  16. Frailty Predicts Wait-List Mortality in Liver Transplant Candidates

    PubMed Central

    Lai, Jennifer C.; Feng, Sandy; Terrault, Norah A.; Lizaola, Blanca; Hayssen, Hilary; Covinsky, Kenneth

    2014-01-01

    We aimed to determine whether frailty, a validated geriatric construct of increased vulnerability to physiologic stressors, predicts mortality in liver transplant (LT) candidates. Consecutive adult outpatients listed for LT with laboratory MELD≥12 at a single center (97% recruitment rate) underwent 4 frailty assessments: Fried Frailty, Short Physical Performance Battery (SPPB), Activities of Daily Living (ADL), and Instrumental ADL (IADL) scales. Competing risks models associated frailty with wait-list mortality (death/delisting for being too sick for LT). 294 listed LT patients with MELD≥12, median age 60y, and MELD 15 were followed for 12 months. By Fried Frailty score≥3, 17% were frail; 11/51 (22%) of the frail versus 25/243 (10%) of the not frail died/were delisted (p=0.03). Each 1-unit increase in the Fried Frailty score was associated with a 45% (95%CI, 4-202%) increased risk of wait-list mortality adjusted for MELD. Similarly, the adjusted risk of wait-list mortality associated with each 1-unit decrease (i.e., increasing frailty) in the SPPB (HR 1.19, 95%CI 1.07-1.32). Frailty is prevalent in LT candidates. It strongly predicts wait-list mortality, even after adjustment for liver disease severity demonstrating the applicability and importance of the frailty construct in this population. PMID:24935609

  17. Predicting discharge mortality after acute ischemic stroke using balanced data.

    PubMed

    Ho, King Chung; Speier, William; El-Saden, Suzie; Liebeskind, David S; Saver, Jeffery L; Bui, Alex A T; Arnold, Corey W

    2014-01-01

    Several models have been developed to predict stroke outcomes (e.g., stroke mortality, patient dependence, etc.) in recent decades. However, there is little discussion regarding the problem of between-class imbalance in stroke datasets, which leads to prediction bias and decreased performance. In this paper, we demonstrate the use of the Synthetic Minority Over-sampling Technique to overcome such problems. We also compare state of the art machine learning methods and construct a six-variable support vector machine (SVM) model to predict stroke mortality at discharge. Finally, we discuss how the identification of a reduced feature set allowed us to identify additional cases in our research database for validation testing. Our classifier achieved a c-statistic of 0.865 on the cross-validated dataset, demonstrating good classification performance using a reduced set of variables. PMID:25954451

  18. Predicting Mortality in Low-Income Country ICUs: The Rwanda Mortality Probability Model (R-MPM)

    PubMed Central

    Kiviri, Willy; Fowler, Robert A.; Mueller, Ariel; Novack, Victor; Banner-Goodspeed, Valerie M.; Weinkauf, Julia L.; Talmor, Daniel S.; Twagirumugabe, Theogene

    2016-01-01

    Introduction Intensive Care Unit (ICU) risk prediction models are used to compare outcomes for quality improvement initiatives, benchmarking, and research. While such models provide robust tools in high-income countries, an ICU risk prediction model has not been validated in a low-income country where ICU population characteristics are different from those in high-income countries, and where laboratory-based patient data are often unavailable. We sought to validate the Mortality Probability Admission Model, version III (MPM0-III) in two public ICUs in Rwanda and to develop a new Rwanda Mortality Probability Model (R-MPM) for use in low-income countries. Methods We prospectively collected data on all adult patients admitted to Rwanda’s two public ICUs between August 19, 2013 and October 6, 2014. We described demographic and presenting characteristics and outcomes. We assessed the discrimination and calibration of the MPM0-III model. Using stepwise selection, we developed a new logistic model for risk prediction, the R-MPM, and used bootstrapping techniques to test for optimism in the model. Results Among 427 consecutive adults, the median age was 34 (IQR 25–47) years and mortality was 48.7%. Mechanical ventilation was initiated for 85.3%, and 41.9% received vasopressors. The MPM0-III predicted mortality with area under the receiver operating characteristic curve of 0.72 and Hosmer-Lemeshow chi-square statistic p = 0.024. We developed a new model using five variables: age, suspected or confirmed infection within 24 hours of ICU admission, hypotension or shock as a reason for ICU admission, Glasgow Coma Scale score at ICU admission, and heart rate at ICU admission. Using these five variables, the R-MPM predicted outcomes with area under the ROC curve of 0.81 with 95% confidence interval of (0.77, 0.86), and Hosmer-Lemeshow chi-square statistic p = 0.154. Conclusions The MPM0-III has modest ability to predict mortality in a population of Rwandan ICU patients. The R

  19. Vitamin D status predicts 30 day mortality in hospitalised cats.

    PubMed

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F; Lalor, Stephanie M; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  20. Vitamin D Status Predicts 30 Day Mortality in Hospitalised Cats

    PubMed Central

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F.; Lalor, Stephanie M.; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X.; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J.

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  1. Postdischarge mortality in children with acute infectious diseases: derivation of postdischarge mortality prediction models

    PubMed Central

    Wiens, M O; Kumbakumba, E; Larson, C P; Ansermino, J M; Singer, J; Kissoon, N; Wong, H; Ndamira, A; Kabakyenga, J; Kiwanuka, J; Zhou, G

    2015-01-01

    Objectives To derive a model of paediatric postdischarge mortality following acute infectious illness. Design Prospective cohort study. Setting 2 hospitals in South-western Uganda. Participants 1307 children of 6 months to 5 years of age were admitted with a proven or suspected infection. 1242 children were discharged alive and followed up 6 months following discharge. The 6-month follow-up rate was 98.3%. Interventions None. Primary and secondary outcome measures The primary outcome was postdischarge mortality within 6 months following the initial hospital discharge. Results 64 children died during admission (5.0%) and 61 died within 6 months of discharge (4.9%). Of those who died following discharge, 31 (51%) occurred within the first 30 days. The final adjusted model for the prediction of postdischarge mortality included the variables mid-upper arm circumference (OR 0.95, 95% CI 0.94 to 0.97, per 1 mm increase), time since last hospitalisation (OR 0.76, 95% CI 0.61 to 0.93, for each increased period of no hospitalisation), oxygen saturation (OR 0.96, 95% CI 0.93 to 0·99, per 1% increase), abnormal Blantyre Coma Scale score (OR 2.39, 95% CI 1·18 to 4.83), and HIV-positive status (OR 2.98, 95% CI 1.36 to 6.53). This model produced a receiver operating characteristic curve with an area under the curve of 0.82. With sensitivity of 80%, our model had a specificity of 66%. Approximately 35% of children would be identified as high risk (11.1% mortality risk) and the remaining would be classified as low risk (1.4% mortality risk), in a similar cohort. Conclusions Mortality following discharge is a poorly recognised contributor to child mortality. Identification of at-risk children is critical in developing postdischarge interventions. A simple prediction tool that uses 5 easily collected variables can be used to identify children at high risk of death after discharge. Improved discharge planning and care could be provided for high-risk children. PMID

  2. Unified baseline and longitudinal mortality prediction in idiopathic pulmonary fibrosis.

    PubMed

    Ley, Brett; Bradford, Williamson Z; Weycker, Derek; Vittinghoff, Eric; du Bois, Roland M; Collard, Harold R

    2015-05-01

    The Gender-Age-Physiology (GAP) model is a validated, baseline-risk prediction model for mortality in idiopathic pulmonary fibrosis. Longitudinal variables have been shown to contribute to risk prediction in idiopathic pulmonary fibrosis and may improve the predictive performance of the baseline GAP model. Our aims were to further validate the GAP model and evaluate whether the addition of longitudinal variables improves its predictive performance. The study population was derived from a large clinical trials cohort of patients with idiopathic pulmonary fibrosis (n=1109). Model performance was determined by improvement in the C-statistic, net reclassification improvement, clinical net reclassification improvement, and a goodness-of-fit test. The GAP model had good discriminative performance with a C-statistic of 0.757 (95% CI 0.750-0.764). However, the original GAP model tended to overestimate risk in this cohort. A novel, easy to use model, consisting of the original GAP predictors plus history of respiratory hospitalisation and 24-week change in forced vital capacity (the longitudinal GAP model) improved model performance with a C-statistic of 0.785 (95% CI 0.780-0.790), net reclassification improvement of 8.5%, clinical net reclassification improvement of 25%, and a goodness-of-fit test of 0.929. The Longitudinal GAP model, along with the original GAP model, may unify baseline and longitudinal mortality risk prediction in idiopathic pulmonary fibrosis. PMID:25614172

  3. Prediction of the mortality dose-response relationship in man

    SciTech Connect

    Morris, M.D.; Jones, T.D.

    1987-01-01

    Based upon an extensive data base including 100 separate animal studies, an estimate of the mortality dose-response relationship due to continuous photon radiation is predicted for 70 kg man. The model used in this prediction exercise includes fixed terms accounting for effects of body weight and dose rate, and random terms accounting for inter- and intra-species variation and experimental error. Point predictions and 95% prediction intervals are given for the LD/sub 05/, LD/sub 10/, LD/sub 25/, LD/sub 50/, LD/sub 75/, LD/sub 90/, and LD/sub 95/, for dose rates ranging from 1 to 50 R/min. 6 refs., 5 tabs.

  4. Predictive Mortality Index for Community-Dwelling Elderly Koreans

    PubMed Central

    Kim, Nan H.; Cho, Hyun J.; Kim, Soriul; Seo, Ji H.; Lee, Hyun J.; Yu, Ji H.; Chung, Hye S.; Yoo, Hye J.; Seo, Ji A.; Kim, Sin Gon; Baik, Sei Hyun; Choi, Dong Seop; Shin, Chol; Choi, Kyung Mook

    2016-01-01

    Abstract There are very few predictive indexes for long-term mortality among community-dwelling elderly Asian individuals, despite its importance, given the rapid and continuous increase in this population. We aimed to develop 10-year predictive mortality indexes for community-dwelling elderly Korean men and women based on routinely collected clinical data. We used data from 2244 elderly individuals (older than 60 years of age) from the southwest Seoul Study, a prospective cohort study, for the development of a prognostic index. An independent longitudinal cohort of 679 elderly participants was selected from the Korean Genome Epidemiology Study in Ansan City for validation. During a 10-year follow-up, 393 participants (17.5%) from the development cohort died. Nine risk factors were identified and weighed in the Cox proportional regression model to create a point scoring system: age, male sex, smoking, diabetes, systolic blood pressure, triglyceride, total cholesterol, white blood cell count, and hemoglobin. In the development cohort, the 10-year mortality risk was 6.6%, 14.8%, 18.2%, and 38.4% among subjects with 1 to 4, 5 to 7, 8 to 9, and ≥10 points, respectively. In the validation cohort, the 10-year mortality risk was 5.2%, 12.0%, 16.0%, and 16.0% according to these categories. The C-statistic for the point system was 0.73 and 0.67 in the development and validation cohorts, respectively. The present study provides valuable information for prognosis among elderly Koreans and may guide individualized approaches for appropriate care in a rapidly aging society. PMID:26844511

  5. Using growth velocity to predict child mortality12

    PubMed Central

    Schwinger, Catherine; Van den Broeck, Jan

    2016-01-01

    Background: Growth assessment based on the WHO child growth velocity standards can potentially be used to predict adverse health outcomes. Nevertheless, there are very few studies on growth velocity to predict mortality. Objectives: We aimed to determine the ability of various growth velocity measures to predict child death within 3 mo and to compare it with those of attained growth measures. Design: Data from 5657 children <5 y old who were enrolled in a cohort study in the Democratic Republic of Congo were used. Children were measured up to 6 times in 3-mo intervals, and 246 (4.3%) children died during the study period. Generalized estimating equation (GEE) models informed the mortality risk within 3 mo for weight and length velocity z scores and 3-mo changes in midupper arm circumference (MUAC). We used receiver operating characteristic (ROC) curves to present balance in sensitivity and specificity to predict child death. Results: GEE models showed that children had an exponential increase in the risk of dying with decreasing growth velocity in all 4 indexes (1.2- to 2.4-fold for every unit decrease). A length and weight velocity z score of <−3 was associated with an 11.8- and a 7.9-fold increase, respectively, in the RR of death in the subsequent 3-mo period (95% CIs: 3.9, 35.5, and 3.9, 16.2, respectively). Weight and length velocity z scores had better predictive abilities [area under the ROC curves (AUCs) of 0.67 and 0.69] than did weight-for-age (AUC: 0.57) and length-for-age (AUC: 0.52) z scores. Among wasted children (weight-for-height z score <−2), the AUC of weight velocity z scores was 0.87. Absolute MUAC performed best among the attained indexes (AUC: 0.63), but longitudinal assessment of MUAC-based indexes did not increase the predictive value. Conclusion: Although repeated growth measures are slightly more complex to implement, their superiority in mortality-predictive abilities suggests that these could be used more for identifying children at

  6. Darcy's law predicts widespread forest mortality under climate warming

    NASA Astrophysics Data System (ADS)

    McDowell, Nathan G.; Allen, Craig D.

    2015-07-01

    Drought and heat-induced tree mortality is accelerating in many forest biomes as a consequence of a warming climate, resulting in a threat to global forests unlike any in recorded history. Forests store the majority of terrestrial carbon, thus their loss may have significant and sustained impacts on the global carbon cycle. We use a hydraulic corollary to Darcy’s law, a core principle of vascular plant physiology, to predict characteristics of plants that will survive and die during drought under warmer future climates. Plants that are tall with isohydric stomatal regulation, low hydraulic conductance, and high leaf area are most likely to die from future drought stress. Thus, tall trees of old-growth forests are at the greatest risk of loss, which has ominous implications for terrestrial carbon storage. This application of Darcy’s law indicates today’s forests generally should be replaced by shorter and more xeric plants, owing to future warmer droughts and associated wildfires and pest attacks. The Darcy’s corollary also provides a simple, robust framework for informing forest management interventions needed to promote the survival of current forests. Given the robustness of Darcy’s law for predictions of vascular plant function, we conclude with high certainty that today’s forests are going to be subject to continued increases in mortality rates that will result in substantial reorganization of their structure and carbon storage.

  7. Predicting postoperative mortality in patients undergoing colorectal surgery.

    PubMed

    Slim, Karem; Panis, Yves; Alves, Arnaud; Kwiatkowski, Fabrice; Mathieu, Pierre; Mantion, Georges

    2006-01-01

    Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas). PMID:16369701

  8. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers

    PubMed Central

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N. V.; Wetherell, Mark A.; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele

    2016-01-01

    Background Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. Objective We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Methods Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Results Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Conclusions Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival. PMID:27096609

  9. Mortality Risk Prediction by Application of Pediatric Risk of Mortality Scoring System in Pediatric Intensive Care Unit

    PubMed Central

    Khajeh, Ali; Noori, Noor Mohammad; Reisi, Mohsen; Fayyazi, Afshin; Mohammadi, Mahdi; Miri-Aliabad, Ghasem

    2013-01-01

    Objective The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. Methods In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15. Findings Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%. Conclusion PRISM score is a good predictor for evaluation of mortality risk in PICU. PMID:24800015

  10. Hemoglobin Screening Independently Predicts All-Cause Mortality.

    PubMed

    Fulks, Michael; Dolan, Vera F; Stout, Robert L

    2015-01-01

    Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .- Hemoglobin results for insurance applicants tested from 1993 to 2007, with vital status determined by Social Security Death Master File follow-up in 2011, were analyzed by age and sex with and without accounting for the contribution of other test results. Results .- Hemoglobin values ≤12.0 g/dL (and possibly ≤13.0 g/dL) in females age 50+ (but not age <50) and hemoglobin values ≤13.0 g/dL in all males are associated with progressively increasing mortality risk independent of the contribution of other test values. Increased risk is also noted for hemoglobin values >15.0 g/dL (and possibly >14.0 g/dL) for all females and for hemoglobin values >16.0 g/dL for males. Conclusion .- Hemoglobin testing can add additional independent risk assessment to that obtained from other laboratory testing, BP and build in this relatively healthy insurance applicant population. Multiple studies support this finding at older ages, but data (and the prevalence of diseases impacting hemoglobin levels) are limited at younger ages. PMID:27584842

  11. Improved Comorbidity Adjustment for Predicting Mortality in Medicare Populations

    PubMed Central

    Schneeweiss, Sebastian; Wang, Philip S; Avorn, Jerry; Glynn, Robert J

    2003-01-01

    Objective To define and improve the performance of existing comorbidity scores in predicting mortality in Medicare enrollees. Data Sources Study participants were two Medicare populations who had complete drug coverage either through Medicaid or a statewide pharmacy assistance program: New Jersey Medicare enrollees (NNJ=235,881) and Pennsylvania Medicare enrollees (NPA=230,913). Study Design Frequently used comorbidity scores were computed for all subjects during the baseline year (January 1, 1994, to December 31, 1994, and one year later in Pennsylvania). The study outcome was one-year mortality during the following year. Performance of scores was measured with the c-statistic derived from multivariate logistic regression models. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population. Principal Findings A score based on ICD-9-diagnoses (Romano) performed 60 percent better than one based on patterns of medication use (Chronic Disease Score, or CDS-1) (c=0.771 vs. c=0.703). The performance of the Romano score was further improved slightly by inclusion of the number of different prescription drugs used during the past year. Modeling the 17 conditions included in the Romano score as separate binary indicators increased its performance by 8 percent (c=0.781). We derived elderly-specific weights for these scores in the New Jersey sample, including negative weights for the use of some drugs, for example, lipid lowering drugs. Applying these weights, the performance of Romano and CDS-1 scores improved in an independent validation sample of Pennsylvania Medicare enrollees by 8.3 percent and 43 percent compared to the scores with the original weights. When we added an indicator of nursing home residency, age, and gender, the Romano score reached a performance of c=0.80. Conclusions We conclude that in epidemiologic studies of the elderly, a modified diagnosis-based score using

  12. Predicting mortality from burns: the need for age-group specific models.

    PubMed

    Taylor, Sandra L; Lawless, MaryBeth; Curri, Terese; Sen, Soman; Greenhalgh, David G; Palmieri, Tina L

    2014-09-01

    Traditional burn mortality models are derived using all age groups. We hypothesized that age variably impacts mortality after burn and that age-specific models for children, adults, and seniors will more accurately predict mortality than an all-ages model. We audited data from the American Burn Association (ABA) National Burn Repository (NBR) from 2000 to 2009 and used mixed effect logistic regression models to assess the influence of age, total body surface area (TBSA) burn, and inhalation injury on mortality. Mortality models were constructed for all ages and age-specific models: children (<18 years), adults (18-60 years), and seniors (>60 years). Model performance was assessed by area under the receiver operating curve (AUC). Main effect and two-way interactions were used to construct age-group specific mortality models. Each age-specific model was compared to the All Ages model. Of 286,293 records 100,051 had complete data. Overall mortality was 4% but varied by age (17% seniors, <1% children). Age, TBSA, and inhalation injury were significant mortality predictors for all models (p<0.05). Differences in predicted mortality between the All Ages model and the age-specific models occurred in children and seniors. In the age-specific pediatric model, predicted mortality decreased with age; inhalation injury had greater effect on mortality than in the All Ages model. In the senior model mortality increased with age. Seniors had greater increase in mortality per 1% increment in burn size and 1 year increase in age than other ages. The predicted mortality in seniors using the senior-specific model was higher than in the All Ages model. "One size fits all" models for predicting burn outcomes do not accurately reflect the outcomes for seniors and children. Age-specific models for children and seniors may be advisable. PMID:24846014

  13. Trends and predictions for gastric cancer mortality in Brazil

    PubMed Central

    de Souza Giusti, Angela Carolina Brandão; de Oliveira Salvador, Pétala Tuani Candido; dos Santos, Juliano; Meira, Karina Cardoso; Camacho, Amanda Rodrigues; Guimarães, Raphael Mendonça; Souza, Dyego L B

    2016-01-01

    AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029. METHODS: An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS: Progressive reduction of mortality rates was observed in the 1980’s, and then higher and lower mortality rates were verified in the 2000’s, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates. PMID:27605887

  14. Predicting drought-induced tree mortality in the western United States

    NASA Astrophysics Data System (ADS)

    Anderegg, W.; Wolf, A.; Shevliakova, E.; Pacala, S. W.

    2015-12-01

    Projected responses of forest ecosystems to warming and drying associated with 21st century climate change vary widely from resiliency to widespread dieback. A major shortcoming of current vegetation models is the inability to account for mortality of overstory trees during extreme drought due to uncertainties in mechanisms and thresholds. In this talk, I discuss two modeling efforts to predict drought-induced tree mortality in the western United States. In the first, we identify a lethal drought threshold in the loss of vascular transport capacity from xylem cavitation, which provides insight into what initiates mortality, in Populus tremuloides in the southwestern United States. We then use the hydraulic-based threshold to produce a hindcast of a drought-induced forest dieback and compare predictions against three independent regional mortality datasets. The hydraulic threshold predicted major regional patterns of tree mortality with high accuracy based on field plots and mortality maps derived from Landsat imagery. Climate model simulations project increasing drought stress in this region that exceeds the observed mortality threshold in the high emissions scenario by the 2050s, likely triggering further widespread diebacks. In the second approach, we build a dynamic plant hydraulic model into a land-surface model and compare predictions against observed mortality patterns across multiple species. These methods provide powerful and tractable approaches for incorporating tree mortality into vegetation models to resolve uncertainty over the fate of forest ecosystems in a changing climate.

  15. Acute Kidney Injury Predicts Mortality after Charcoal Burning Suicide

    PubMed Central

    Chen, Yu-Chin; Tseng, Yi-Chia; Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Cheng-Hao; Liu, Shou-Hsuan; Yang, Huang-Yu; Chen, Kuan-Hsin; Chen, Hui-Ling; Fu, Jen-Fen; Lin, Wey-Ran; Wang, I-Kuan; Yen, Tzung-Hai

    2016-01-01

    A paucity of literature exists on risk factors for mortality in charcoal burning suicide. In this observational study, we analyzed the data of 126 patients with charcoal burning suicide that seen between 2002 and 2013. Patients were grouped according to status of renal damage as acute kidney injury (N = 49) or non-acute kidney injury (N = 77). It was found that patients with acute kidney injury suffered severer complications such as respiratory failure (P = 0.002), myocardial injury (P = 0.049), hepatic injury (P < 0.001), rhabdomyolysis (P = 0.045) and out-of-hospital cardiac arrest (P = 0.028) than patients without acute kidney injury. Moreover, patients with acute kidney injury suffered longer hospitalization duration (16.9 ± 18.3 versus 10.7 ± 10.9, P = 0.002) and had higher mortality rate (8.2% versus 0%, P = 0.011) than patients without injury. In a multivariate Cox regression model, it was demonstrated that serum creatinine level (P = 0.019) and heart rate (P = 0.022) were significant risk factors for mortality. Finally, Kaplan-Meier analysis revealed that patients with acute kidney injury suffered lower cumulative survival than without injury (P = 0.016). In summary, the overall mortality rate of charcoal burning suicide population was 3.2%, and acute kidney injury was a powerful predictor of mortality. Further studies are warranted. PMID:27430168

  16. Acute Kidney Injury Predicts Mortality after Charcoal Burning Suicide.

    PubMed

    Chen, Yu-Chin; Tseng, Yi-Chia; Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Cheng-Hao; Liu, Shou-Hsuan; Yang, Huang-Yu; Chen, Kuan-Hsin; Chen, Hui-Ling; Fu, Jen-Fen; Lin, Wey-Ran; Wang, I-Kuan; Yen, Tzung-Hai

    2016-01-01

    A paucity of literature exists on risk factors for mortality in charcoal burning suicide. In this observational study, we analyzed the data of 126 patients with charcoal burning suicide that seen between 2002 and 2013. Patients were grouped according to status of renal damage as acute kidney injury (N = 49) or non-acute kidney injury (N = 77). It was found that patients with acute kidney injury suffered severer complications such as respiratory failure (P = 0.002), myocardial injury (P = 0.049), hepatic injury (P < 0.001), rhabdomyolysis (P = 0.045) and out-of-hospital cardiac arrest (P = 0.028) than patients without acute kidney injury. Moreover, patients with acute kidney injury suffered longer hospitalization duration (16.9 ± 18.3 versus 10.7 ± 10.9, P = 0.002) and had higher mortality rate (8.2% versus 0%, P = 0.011) than patients without injury. In a multivariate Cox regression model, it was demonstrated that serum creatinine level (P = 0.019) and heart rate (P = 0.022) were significant risk factors for mortality. Finally, Kaplan-Meier analysis revealed that patients with acute kidney injury suffered lower cumulative survival than without injury (P = 0.016). In summary, the overall mortality rate of charcoal burning suicide population was 3.2%, and acute kidney injury was a powerful predictor of mortality. Further studies are warranted. PMID:27430168

  17. Perceived extrinsic mortality risk and reported effort in looking after health: testing a behavioral ecological prediction.

    PubMed

    Pepper, Gillian V; Nettle, Daniel

    2014-09-01

    Socioeconomic gradients in health behavior are pervasive and well documented. Yet, there is little consensus on their causes. Behavioral ecological theory predicts that, if people of lower socioeconomic position (SEP) perceive greater personal extrinsic mortality risk than those of higher SEP, they should disinvest in their future health. We surveyed North American adults for reported effort in looking after health, perceived extrinsic and intrinsic mortality risks, and measures of SEP. We examined the relationships between these variables and found that lower subjective SEP predicted lower reported health effort. Lower subjective SEP was also associated with higher perceived extrinsic mortality risk, which in turn predicted lower reported health effort. The effect of subjective SEP on reported health effort was completely mediated by perceived extrinsic mortality risk. Our findings indicate that perceived extrinsic mortality risk may be a key factor underlying SEP gradients in motivation to invest in future health. PMID:24990431

  18. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes

    PubMed Central

    Morello, Fulvio; Ravetti, Anna; Nazerian, Peiman; Liedl, Giovanni; Veglio, Maria Grazia; Battista, Stefania; Vanni, Simone; Pivetta, Emanuele; Montrucchio, Giuseppe; Mengozzi, Giulio; Rinaldi, Mauro; Moiraghi, Corrado; Lupia, Enrico

    2016-01-01

    Abstract In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far. This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality. One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367–557) in patients with AAS and 383 U/L (IQR 331–460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37–51) and the specificity was 73% (95% CI 69–76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11–4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable

  19. A biological approach to the interspecies prediction of radiation-induced mortality risk

    SciTech Connect

    Carnes, B.A.; Grahn, D.; Olshansky, S.J.

    1997-08-01

    Evolutionary explanations for why sexually reproducing organisms grow old suggest that the forces of natural selection affect the ages when diseases occur that are subject to a genetic influence (referred to here as intrinsic diseases). When extended to the population level for a species, this logic leads to the general prediction that age-specific death rates from intrinsic causes should begin to rise as the force of selection wanes once the characteristic age of sexual maturity is attained. Results consistent with these predictions have been found for laboratory mice, beagles, and humans where, after adjusting for differences in life span, it was demonstrated that these species share a common age pattern of mortality for intrinsic causes of death. In quantitative models used to predict radiation-induced mortality, risks are often expressed as multiples of those observed in a control population. A control population, however, is an aging population. As such, mortality risks related to exposure must be interpreted relative to the age-specific risk of death associated with aging. Given the previous success in making interspecies predictions of age-related mortality, the purpose of this study was to determine whether radiation-induced mortality observed in one species could also be predicted quantitatively from a model used to describe the mortality consequences of exposure to radiation in a different species. Mortality data for B6CF{sub 1} mice and beagles exposed to {sup 60}Co {gamma}-rays for the duration of life were used for analysis.

  20. Factors predicting mortality in invasive pneumococcal disease in adults in Alberta.

    PubMed

    Marrie, Thomas James; Tyrrell, Gregory J; Garg, Sipi; Vanderkooi, Otto G

    2011-05-01

    To define the factors associated with 30-day mortality among adult patients with invasive pneumococcal disease (IPD), we conducted a retrospective review of all cases of IPD in Alberta from 2000 to 2004. We hypothesized that multiple factors would be predictive of such mortality. We also examined the factors predictive of early (within 5 days of admission) mortality. We identified 1154 patients who met our inclusion criteria, 163 (14.1%) of whom died within 30 days. Over half (62.6%) of the deaths occurred within 5 days of admission. Ten factors were independently associated with increased 30-day mortality: 3 comorbidity factors-cancer within 5 years of diagnosis of IPD, diabetes, and cirrhosis; 4 complications-requirement for supplemental oxygen, mechanical ventilation, alteration of mental status, and cardiac arrest; 2 microorganism-related factors-infection with high- or infection with intermediate-mortality serotypes; and 1 treatment-related factor-treatment with a single antibiotic. Age 18-40 years and treatment with 2 antibiotics concurrently were associated with lower 30-day mortality. Comorbid illnesses were not contributory to early mortality (within 5 days of admission); instead, complications (alteration of mental status, requirement for supplemental oxygen, mechanical ventilation, and cardiac arrest) as well as infection with high-mortality serotypes and treatment with a single antibiotic were important. Age 18-40 years, infection with serotypes in the polysaccharide vaccine, and treatment with 2 or more than 2 antibiotics were associated with decreased early mortality. Early mortality accounted for 62.6% of the deaths. In conclusion, we found that mortality in IPD is multifactorial, the factors differ for 5- and 30-day mortality, and mortality is associated with host (age and complications), microorganism (pneumococcal serotypes), and therapeutic factors. Our data indicate that treatment with 2 or more antibiotics effective against Streptococcus

  1. Mortality of Inshore Marine Mammals in Eastern Australia Is Predicted by Freshwater Discharge and Air Temperature

    PubMed Central

    Meager, Justin J.; Limpus, Colin

    2014-01-01

    Understanding environmental and climatic drivers of natural mortality of marine mammals is critical for managing populations effectively and for predicting responses to climate change. Here we use a 17-year dataset to demonstrate a clear relationship between environmental forcing and natural mortality of inshore marine mammals across a subtropical-tropical coastline spanning a latitudinal gradient of 13° (>2000 km of coastline). Peak mortality of inshore dolphins and dugongs followed sustained periods of elevated freshwater discharge (9 months) and low air temperature (3 months). At a regional scale, these results translated into a strong relationship between annual mortality and an index of El Niño-Southern Oscillation. The number of cyclones crossing the coastline had a comparatively weak effect on inshore marine mammal mortality, and only in the tropics. Natural mortality of offshore/migratory cetaceans was not predicted by freshwater discharge, but was related to lagged air temperature. These results represent the first quantitative link between environmental forcing and marine mammal mortality in the tropics, and form the basis of a predictive tool for managers to prepare responses to periods of elevated marine mammal mortality. PMID:24740149

  2. Mortality of inshore marine mammals in eastern Australia is predicted by freshwater discharge and air temperature.

    PubMed

    Meager, Justin J; Limpus, Colin

    2014-01-01

    Understanding environmental and climatic drivers of natural mortality of marine mammals is critical for managing populations effectively and for predicting responses to climate change. Here we use a 17-year dataset to demonstrate a clear relationship between environmental forcing and natural mortality of inshore marine mammals across a subtropical-tropical coastline spanning a latitudinal gradient of 13° (>2000 km of coastline). Peak mortality of inshore dolphins and dugongs followed sustained periods of elevated freshwater discharge (9 months) and low air temperature (3 months). At a regional scale, these results translated into a strong relationship between annual mortality and an index of El Niño-Southern Oscillation. The number of cyclones crossing the coastline had a comparatively weak effect on inshore marine mammal mortality, and only in the tropics. Natural mortality of offshore/migratory cetaceans was not predicted by freshwater discharge, but was related to lagged air temperature. These results represent the first quantitative link between environmental forcing and marine mammal mortality in the tropics, and form the basis of a predictive tool for managers to prepare responses to periods of elevated marine mammal mortality. PMID:24740149

  3. Do hassles and uplifts trajectories predict mortality? Longitudinal findings from the VA Normative Aging Study.

    PubMed

    Jeong, Yu-Jin; Aldwin, Carolyn M; Igarashi, Heidi; Spiro, Avron

    2016-06-01

    We examined whether longitudinal patterns of hassles and uplifts trajectories predicted mortality, using a sample of 1315 men from the VA Normative Aging Study (mean age = 65.31, SD = 7.6). In prior work, we identified different trajectory classes of hassles and uplifts exposure and intensity scores over a period of 16 years. In this study, we used the probabilities of these exposure and intensity class memberships to examine their ability to predict mortality. Men with higher probabilities of high hassle intensity trajectory class and high uplift intensity class had higher mortality risks. In a model combining the probabilities of hassle and uplift intensities, the probability of high intensity hassle class membership significantly increased the risk of mortality. This suggests that appraisals of hassles intensity are better predictors of mortality than simple exposure measures, and that uplifts have no independent effects. PMID:26721518

  4. Which metric of ambient ozone to predict daily mortality?

    NASA Astrophysics Data System (ADS)

    Moshammer, Hanns; Hutter, Hans-Peter; Kundi, Michael

    2013-02-01

    It is well known that ozone concentration is associated with daily cause specific mortality. But which ozone metric is the best predictor of the daily variability in mortality? We performed a time series analysis on daily deaths (all causes, respiratory and cardiovascular causes as well as death in elderly 65+) in Vienna for the years 1991-2009. We controlled for seasonal and long term trend, day of the week, temperature and humidity using the same basic model for all pollutant metrics. We found model fit was best for same day variability of ozone concentration (calculated as the difference between daily hourly maximum and minimum) and hourly maximum. Of these the variability displayed a more linear dose-response function. Maximum 8 h moving average and daily mean value performed not so well. Nitrogen dioxide (daily mean) in comparison performed better when previous day values were assessed. Same day ozone and previous day nitrogen dioxide effect estimates did not confound each other. Variability in daily ozone levels or peak ozone levels seem to be a better proxy of a complex reactive secondary pollutant mixture than daily average ozone levels in the Middle European setting. If this finding is confirmed this would have implications for the setting of legally binding limit values.

  5. Prediction of Cancer Incidence and Mortality in Korea, 2016

    PubMed Central

    Jung, Kyu-Won; Won, Young-Joo; Oh, Chang-Mo; Kong, Hyun-Joo; Cho, Hyunsoon; Lee, Jong-Keun; Lee, Duk Hyoung; Lee, Kang Hyun

    2016-01-01

    Purpose: To estimate of Korea’s current cancer burden, this study aimed to report on projected cancer incidence and mortality rates for the year 2016. Materials and Methods: Cancer incidence data from 1999 to 2013 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2014 were acquired from Statistics Korea. Cancer incidence in 2016 was projected by fitting a linear regression model to observed age-specific cancer incidence rates against observed years, then multiplying the projected age-specific rates by the age-specific population. The Joinpoint regression model was used to determine at which year the linear trend changed significantly. Results: A total of 254,962 new cancer cases and 75,172 cancer deaths are expected to occur in Korea in 2016. The five leading primary cancer incident sites in 2016 were estimated colorectal, stomach, lung, liver and thyroid cancer in men; thyroid, breast, colorectal, stomach, and lung cancer in women. Conclusion: Currently cancer is one of the foremost public health concerns in Korea. Although cancer rates are anticipated to decrease the nation’s cancer burden will continue to increase as the population ages. PMID:27034143

  6. Hearing, mobility, and pain predict mortality: a longitudinal population-based study

    PubMed Central

    Feeny, David; Huguet, Nathalie; McFarland, Bentson H.; Kaplan, Mark S.; Orpana, Heather; Eckstrom, Elizabeth

    2012-01-01

    Objective Measures of health-related quality of life (HRQL), including the Health Utilities Index Mark 3 (HUI3) are predictive of mortality. HUI3 includes eight attributes, vision, hearing, speech, ambulation, dexterity, cognition, emotion, and pain and discomfort, with five or six levels per attribute that vary from no to severe disability. This study examined associations between individual HUI3 attributes and mortality. Study Design and Setting Baseline data and 12 years of follow-up data from a closed longitudinal cohort study, the 1994/95 Canadian National Population Health Survey, consisting of 12,375 women and men aged 18 and older. A priori hypotheses were that ambulation, cognition, emotion, and pain would predict mortality. Cox proportional hazards regression models were applied controlling for standard determinants of health and risk factors. Results Single-attribute utility scores for ambulation (hazard ratio [HR] = 0.10; 0.04–0.22), hearing (HR = 0.18; 0.06–0.57), and pain (HR = 0.53; 0.29–0.96) were statistically significantly associated with an increased risk of mortality; ambulation and hearing were predictive for the 60+ cohort. Conclusion Few studies have identified hearing or pain as risk factors for mortality. This study is innovative because it identifies specific components of HRQL that predict mortality. Further research is needed to understand better the mechanisms through which deficits in hearing and pain affect mortality risks. PMID:22521576

  7. Pleural cancer mortality in Spain: time-trends and updating of predictions up to 2020

    PubMed Central

    2013-01-01

    Background A total of 2,514,346 metric tons (Mt) of asbestos were imported into Spain from 1906 until the ban on asbestos in 2002. Our objective was to study pleural cancer mortality trends as an indicator of mesothelioma mortality and update mortality predictions for the periods 2011–2015 and 2016–2020 in Spain. Methods Log-linear Poisson models were fitted to study the effect of age, period of death and birth cohort (APC) on mortality trends. Change points in cohort- and period-effect curvatures were assessed using segmented regression. Fractional power-link APC models were used to predict mortality until 2020. In addition, an alternative model based on national asbestos consumption figures was also used to perform long-term predictions. Results Pleural cancer deaths increased across the study period, rising from 491 in 1976–1980 to 1,249 in 2006–2010. Predictions for the five-year period 2016–2020 indicated a total of 1,319 pleural cancer deaths (264 deaths/year). Forecasts up to 2020 indicated that this increase would continue, though the age-adjusted rates showed a levelling-off in male mortality from 2001 to 2005, corresponding to the lower risk in post-1960 generations. Among women, rates were lower and the mortality trend was also different, indicating that occupational exposure was possibly the single factor having most influence on pleural cancer mortality. Conclusion The cancer mortality-related consequences of human exposure to asbestos are set to persist and remain in evidence until the last surviving members of the exposed cohorts have disappeared. It can thus be assumed that occupationally-related deaths due to pleural mesothelioma will continue to occur in Spain until at least 2040. PMID:24195451

  8. Multi-scale predictions of coniferous forest mortality in the northern hemisphere

    NASA Astrophysics Data System (ADS)

    McDowell, N. G.

    2015-12-01

    Global temperature rise and extremes accompanying drought threaten forests and their associated climatic feedbacks. Our incomplete understanding of the fundamental physiological thresholds of vegetation mortality during drought limits our ability to accurately simulate future vegetation distributions and associated climate feedbacks. Here we integrate experimental evidence with models to show potential widespread loss of needleleaf evergreen trees (NET; ~ conifers) within the Southwest USA by 2100; with rising temperature being the primary cause of mortality. Experimentally, dominant Southwest USA NET species died when they fell below predawn water potential (Ypd) thresholds (April-August mean) beyond which photosynthesis, stomatal and hydraulic conductance, and carbohydrate availability approached zero. Empirical and mechanistic models accurately predicted NET Ypd, and 91% of predictions (10/11) exceeded mortality thresholds within the 21st century due to temperature rise. Completely independent global models predicted >50% loss of northern hemisphere NET by 2100, consistent with the findings for Southwest USA. The global models disagreed with the ecosystem process models in regards to future mortality in Southwest USA, however, highlighting the potential underestimates of future NET mortality as simulated by the global models and signifying the importance of improving regional predictions. Taken together, these results from the validated regional predictions and the global simulations predict global-scale conifer loss in coming decades under projected global warming.

  9. A satellite mortality study to support space systems lifetime prediction

    NASA Astrophysics Data System (ADS)

    Fox, George; Salazar, Ronald; Habib-Agahi, Hamid; Dubos, Gregory F.

    Estimating the operational lifetime of satellites and spacecraft is a complex process. Operational lifetime can differ from mission design lifetime for a variety of reasons. Unexpected mortality can occur due to human errors in design and fabrication, to human errors in launch and operations, to random anomalies of hardware and software or even satellite function degradation or technology change, leading to unrealized economic or mission return. This study focuses on data collection of public information using, for the first time, a large, publically available dataset, and preliminary analysis of satellite lifetimes, both operational lifetime and design lifetime. The objective of this study is the illustration of the relationship of design life to actual lifetime for some representative classes of satellites and spacecraft. First, a Weibull and Exponential lifetime analysis comparison is performed on the ratio of mission operating lifetime to design life, accounting for terminated and ongoing missions. Next a Kaplan-Meier survivor function, standard practice for clinical trials analysis, is estimated from operating lifetime. Bootstrap resampling is used to provide uncertainty estimates of selected survival probabilities. This study highlights the need for more detailed databases and engineering reliability models of satellite lifetime that include satellite systems and subsystems, operations procedures and environmental characteristics to support the design of complex, multi-generation, long-lived space systems in Earth orbit.

  10. A Satellite Mortality Study to Support Space Systems Lifetime Prediction

    NASA Technical Reports Server (NTRS)

    Fox, George; Salazar, Ronald; Habib-Agahi, Hamid; Dubos, Gregory

    2013-01-01

    Estimating the operational lifetime of satellites and spacecraft is a complex process. Operational lifetime can differ from mission design lifetime for a variety of reasons. Unexpected mortality can occur due to human errors in design and fabrication, to human errors in launch and operations, to random anomalies of hardware and software or even satellite function degradation or technology change, leading to unrealized economic or mission return. This study focuses on data collection of public information using, for the first time, a large, publically available dataset, and preliminary analysis of satellite lifetimes, both operational lifetime and design lifetime. The objective of this study is the illustration of the relationship of design life to actual lifetime for some representative classes of satellites and spacecraft. First, a Weibull and Exponential lifetime analysis comparison is performed on the ratio of mission operating lifetime to design life, accounting for terminated and ongoing missions. Next a Kaplan-Meier survivor function, standard practice for clinical trials analysis, is estimated from operating lifetime. Bootstrap resampling is used to provide uncertainty estimates of selected survival probabilities. This study highlights the need for more detailed databases and engineering reliability models of satellite lifetime that include satellite systems and subsystems, operations procedures and environmental characteristics to support the design of complex, multi-generation, long-lived space systems in Earth orbit.

  11. Mortality Prediction in Patients Undergoing Non-Invasive Ventilation in Intermediate Care

    PubMed Central

    Martinez-Urbistondo, Diego; Alegre, Félix; Carmona-Torre, Francisco; Huerta, Ana; Fernandez-Ros, Nerea; Landecho, Manuel Fortún; García-Mouriz, Alberto; Núñez-Córdoba, Jorge M.; García, Nicolás; Quiroga, Jorge; Lucena, Juan Felipe

    2015-01-01

    Background Intermediate Care Units (ImCU) have become an alternative scenario to perform Non-Invasive Ventilation (NIV). The limited number of prognostic studies in this population support the need of mortality prediction evaluation in this context. Objective The objective of this study is to analyze the performance of Simplified Acute Physiology Score (SAPS) II and 3 in patients undergoing NIV in an ImCU. Additionally, we searched for new variables that could be useful to customize these scores, in order to improve mortality prediction. Design Cohort study with prospectively collected data from all patients admitted to a single center ImCU who received NIV. The SAPS II and 3 scores with their respective predicted mortality rates were calculated. Discrimination and calibration were evaluated by calculating the area under the receiver operating characteristic curve (AUC) and with the Hosmer-Lemeshow goodness of fit test for the models, respectively. Binary logistic regression was used to identify new variables to customize the scores for mortality prediction in this setting. Patients The study included 241 patients consecutively admitted to an ImCU staffed by hospitalists from April 2006 to December 2013. Key Results The observed in-hospital mortality was 32.4% resulting in a Standardized Mortality Ratio (SMR) of 1.35 for SAPS II and 0.68 for SAPS 3. Mortality discrimination based on the AUC was 0.73 for SAPS II and 0.69 for SAPS 3. Customized models including immunosuppression, chronic obstructive pulmonary disease (COPD), acute pulmonary edema (APE), lactic acid, pCO2 and haemoglobin levels showed better discrimination than old scores with similar calibration power. Conclusions These results suggest that SAPS II and 3 should be customized with additional patient-risk factors to improve mortality prediction in patients undergoing NIV in intermediate care. PMID:26436420

  12. Development and validation of a predictive mortality risk score from a European hemodialysis cohort

    PubMed Central

    Floege, Jürgen; Gillespie, Iain A; Kronenberg, Florian; Anker, Stefan D; Gioni, Ioanna; Richards, Sharon; Pisoni, Ronald L; Robinson, Bruce M; Marcelli, Daniele; Froissart, Marc; Eckardt, Kai-Uwe

    2015-01-01

    Although mortality risk scores for chronic hemodialysis (HD) patients should have an important role in clinical decision-making, those currently available have limited applicability, robustness, and generalizability. Here we applied a modified Framingham Heart Study approach to derive 1- and 2-year all-cause mortality risk scores using a 11,508 European incident HD patient database (AROii) recruited between 2007 and 2009. This scoring model was validated externally using similar-sized Dialysis Outcomes and Practice Patterns Survey (DOPPS) data. For AROii, the observed 1- and 2-year mortality rates were 13.0 (95% confidence interval (CI; 12.3–13.8)) and 11.2 (10.4–12.1)/100 patient years, respectively. Increasing age, low body mass index, history of cardiovascular disease or cancer, and use of a vascular access catheter during baseline were consistent predictors of mortality. Among baseline laboratory markers, hemoglobin, ferritin, C-reactive protein, serum albumin, and creatinine predicted death within 1 and 2 years. When applied to the DOPPS population, the predictive risk score models were highly discriminatory, and generalizability remained high when restricted by incidence/prevalence and geographic location (C-statistics 0.68–0.79). This new model offers improved predictive power over age/comorbidity-based models and also predicted early mortality (C-statistic 0.71). Our new model delivers a robust and reproducible mortality risk score, based on readily available clinical and laboratory data. PMID:25651366

  13. Modified IDSA/ATS Minor Criteria for Severe Community-Acquired Pneumonia Best Predicted Mortality

    PubMed Central

    Li, Hai-yan; Guo, Qi; Song, Wei-dong; Zhou, Yi-ping; Li, Ming; Chen, Xiao-ke; Liu, Hui; Peng, Hong-lin; Yu, Hai-qiong; Chen, Xia; Liu, Nian; Lü, Zhong-dong; Liang, Li-hua; Zhao, Qing-zhou; Jiang, Mei

    2015-01-01

    Abstract It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality. A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP. The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm. The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department. PMID:26356705

  14. Proteomics Improves the Prediction of Burns Mortality: Results from Regression Spline Modeling

    PubMed Central

    Finnerty, Celeste C.; Ju, Hyunsu; Spratt, Heidi; Victor, Sundar; Jeschke, Marc G.; Hegde, Sachin; Bhavnani, Suresh K.; Luxon, Bruce A.; Brasier, Allan R.; Herndon, David N.

    2012-01-01

    Prediction of mortality in severely burned patients remains unreliable. Although clinical covariates and plasma protein abundance have been used with varying degrees of success, the triad of burn size, inhalation injury, and age remains the most reliable predictor. We investigated the effect of combining proteomics variables with these three clinical covariates on prediction of mortality in burned children. Serum samples were collected from 330 burned children (burns covering >25% of the total body surface area) between admission and the time of the first operation for clinical chemistry analyses and proteomic assays of cytokines. Principal component analysis revealed that serum protein abundance and the clinical covariates each provided independent information regarding patient survival. To determine whether combining proteomics with clinical variables improves prediction of patient mortality, we used multivariate adaptive regression splines, since the relationships between analytes and mortality were not linear. Combining these factors increased overall outcome prediction accuracy from 52% to 81% and area under the receiver operating characteristic curve from 0.82 to 0.95. Thus, the predictive accuracy of burns mortality is substantially improved by combining protein abundance information with clinical covariates in a multivariate adaptive regression splines classifier, a model currently being validated in a prospective study. PMID:22686201

  15. Multi-scale predictions of massive conifer mortality due to chronic temperature rise

    USGS Publications Warehouse

    McDowell, Nathan G.; Williams, A.P.; Xu, C.; Pockman, W. T.; Dickman, L. T.; Sevanto, S.; Pangle, R.; Limousin, J.; Plaut, J.J.; Mackay, D.S.; Ogee, J.; Domec, Jean-Christophe; Allen, Craig D.; Fisher, Rosie A.; Jiang, X.; Muss, J.D.; Breshears, D.D.; Rauscher, Sara A.; Koven, C.

    2015-01-01

    Global temperature rise and extremes accompanying drought threaten forests and their associated climatic feedbacks. Our ability to accurately simulate drought-induced forest impacts remains highly uncertain in part owing to our failure to integrate physiological measurements, regional-scale models, and dynamic global vegetation models (DGVMs). Here we show consistent predictions of widespread mortality of needleleaf evergreen trees (NET) within Southwest USA by 2100 using state-of-the-art models evaluated against empirical data sets. Experimentally, dominant Southwest USA NET species died when they fell below predawn water potential (Ψpd) thresholds (April–August mean) beyond which photosynthesis, hydraulic and stomatal conductance, and carbohydrate availability approached zero. The evaluated regional models accurately predicted NET Ψpd, and 91% of predictions (10 out of 11) exceeded mortality thresholds within the twenty-first century due to temperature rise. The independent DGVMs predicted ≥50% loss of Northern Hemisphere NET by 2100, consistent with the NET findings for Southwest USA. Notably, the global models underestimated future mortality within Southwest USA, highlighting that predictions of future mortality within global models may be underestimates. Taken together, the validated regional predictions and the global simulations predict widespread conifer loss in coming decades under projected global warming.

  16. Multi-scale predictions of massive conifer mortality due to chronic temperature rise

    NASA Astrophysics Data System (ADS)

    McDowell, N. G.; Williams, A. P.; Xu, C.; Pockman, W. T.; Dickman, L. T.; Sevanto, S.; Pangle, R.; Limousin, J.; Plaut, J.; Mackay, D. S.; Ogee, J.; Domec, J. C.; Allen, C. D.; Fisher, R. A.; Jiang, X.; Muss, J. D.; Breshears, D. D.; Rauscher, S. A.; Koven, C.

    2016-03-01

    Global temperature rise and extremes accompanying drought threaten forests and their associated climatic feedbacks. Our ability to accurately simulate drought-induced forest impacts remains highly uncertain in part owing to our failure to integrate physiological measurements, regional-scale models, and dynamic global vegetation models (DGVMs). Here we show consistent predictions of widespread mortality of needleleaf evergreen trees (NET) within Southwest USA by 2100 using state-of-the-art models evaluated against empirical data sets. Experimentally, dominant Southwest USA NET species died when they fell below predawn water potential (Ψpd) thresholds (April-August mean) beyond which photosynthesis, hydraulic and stomatal conductance, and carbohydrate availability approached zero. The evaluated regional models accurately predicted NET Ψpd, and 91% of predictions (10 out of 11) exceeded mortality thresholds within the twenty-first century due to temperature rise. The independent DGVMs predicted >=50% loss of Northern Hemisphere NET by 2100, consistent with the NET findings for Southwest USA. Notably, the global models underestimated future mortality within Southwest USA, highlighting that predictions of future mortality within global models may be underestimates. Taken together, the validated regional predictions and the global simulations predict widespread conifer loss in coming decades under projected global warming.

  17. Predicted and observed mortality from vector-borne disease in small songbirds

    PubMed Central

    Kilpatrick, A. Marm; Peters, Ryan J.; Dupuis, Alan P.; Jones, Matthew J.; Marra, Peter P.; Kramer, Laura D.

    2013-01-01

    Numerous diseases of wildlife have recently emerged due to trade and travel. However, the impact of disease on wild animal populations has been notoriously difficult to detect and demonstrate, due to problems of attribution and the rapid disappearance of bodies after death. Determining the magnitude of avian mortality from West Nile virus (WNV) is emblematic of these challenges. Although correlational analyses may show population declines coincident with the arrival of the virus, strong inference of WNV as a cause of mortality or a population decline requires additional evidence. We show how integrating field data on mosquito feeding patterns, avian abundance, and seroprevalence can be used to predict relative mortality from vector-borne pathogens. We illustrate the method with a case study on WNV in three species of small songbirds, tufted titmouse (Baeolophus bicolor), Carolina wrens (Thryothorus ludovicianus), and northern cardinals (Cardinalis cardinalis). We then determined mortality, infectiousness, and behavioral response of wrens and titmouse following infection with WNV in laboratory experiments and compared them to a previous study on WNV mortality in cardinals. In agreement with predictions, we found titmouse had the highest mortality from WNV infection, with 100% of eleven birds perishing within seven days after infection. Mortality in wrens was significantly lower at 27% (3/11), but still substantial. Viremia profiles indicated that both species were highly infectious for WNV and could play roles in WNV amplification. These findings suggest that WNV may be killing many small-bodied birds, despite the absence of large numbers of dead birds testing positive for WNV. More broadly, they illustrate a framework for predicting relative mortality in hosts from vector-borne disease. PMID:23956457

  18. Which biomarkers are predictive specifically for cardiovascular or for non-cardiovascular mortality in men? Evidence from the Caerphilly Prospective Study (CaPS)

    PubMed Central

    Patterson, Christopher C.; Blankenberg, Stefan; Ben-Shlomo, Yoav; Heslop, Luke; Bayer, Antony; Lowe, Gordon; Zeller, Tanja; Gallacher, John; Young, Ian; Yarnell, John

    2015-01-01

    Objective To examine a panel of 28 biomarkers for prediction of cardiovascular disease (CVD) and non-CVD mortality in a population-based cohort of men. Methods Starting in 1979, middle-aged men in Caerphilly underwent detailed medical examination. Subsequently 2171 men were re-examined during 1989–1993, and fasting blood samples obtained from 1911 men (88%). Fibrinogen, viscosity and white cell count (WCC), routine biochemistry tests and lipids were analysed using fresh samples. Stored aliquots were later analysed for novel biomarkers. Statistical analysis of CVD and non-CVD mortality follow-up used competing risk Cox regression models with biomarkers in thirds tested at the 1% significance level after covariate adjustment. Results During an average of 15.4 years follow-up, troponin (subhazard ratio per third 1.71, 95% CI 1.46–1.99) and B-natriuretic peptide (BNP) (subhazard ratio per third 1.54, 95% CI 1.34–1.78) showed strong trends with CVD death but not with non-CVD death. WCC and fibrinogen showed similar weaker findings. Plasma viscosity, growth differentiation factor 15 (GDF-15) and interleukin-6 (IL-6) were associated positively with both CVD death and non-CVD death while total cholesterol was associated positively with CVD death but negatively with non-CVD death. C-reactive protein (C-RP), alkaline phosphatase, gamma-glutamyltransferase (GGT), retinol binding protein 4 (RBP-4) and vitamin B6 were significantly associated only with non-CVD death, the last two negatively. Troponin, BNP and IL-6 showed evidence of diminishing associations with CVD mortality through follow-up. Conclusion Biomarkers for cardiac necrosis were strong, specific predictors of CVD mortality while many inflammatory markers were equally predictive of non-CVD mortality. PMID:26298350

  19. Manic/hypomanic Symptom Burden Predicts Cardiovascular Mortality with Bipolar Disorder in the Collaborative Depression Study

    PubMed Central

    Fiedorowicz, Jess G.; Solomon, David A.; Endicott, Jean; Leon, Andrew C.; Li, Chunshan; Rice, John P.; Coryell, William H.

    2009-01-01

    Objectives Bipolar disorder conveys an increased risk of cardiovascular mortality. We compared the risk for cardiovascular mortality between bipolar I and bipolar II subtypes and determined correlates of cardiovascular mortality. Methods Participants with major affective disorders were recruited for the National Institute of Mental Health Collaborative Depression Study and followed prospectively for up to twenty-five years. A total of 435 participants met diagnostic criteria for bipolar I (N=288) or bipolar II (N=147) disorder based on Research Diagnostic Criteria at intake and measures of psychiatric symptoms during follow-up. Diagnostic subtypes were contrasted by cardiovascular mortality risk using Cox proportional-hazards regression. Affective symptom burden (the proportion of time with clinically significant manic/hypomanic or depressive symptoms) and treatment exposure were additionally included in the models. Results Thirty-three participants died from cardiovascular causes. Participants with bipolar I disorder had more than double the cardiovascular mortality risk of those with bipolar II disorder, after controlling for age and gender (HR=2.35, 95% C.I. 1.04–5.33, p=0.04). The observed difference in cardiovascular mortality between these subtypes was at least partially confounded by the burden of clinically significant manic/hypomanic symptoms which predicted cardiovascular mortality independent of diagnosis, treatment exposure, age, gender, and cardiovascular risk factors at intake. Selective serotonin uptake inhibitors appeared protective though were introduced late in follow-up. Depressive symptom burden was not related to cardiovascular mortality. Conclusions Participants with bipolar I disorder may face greater risk of cardiovascular mortality than those with bipolar II disorder. This difference in cardiovascular mortality risk may reflect manic/hypomanic symptom burden. PMID:19561163

  20. Variable selection and regression analysis for the prediction of mortality rates associated with foodborne diseases.

    PubMed

    Amene, E; Hanson, L A; Zahn, E A; Wild, S R; Döpfer, D

    2016-07-01

    The purpose of this study was to apply a novel statistical method for variable selection and a model-based approach for filling data gaps in mortality rates associated with foodborne diseases using the WHO Vital Registration mortality dataset. Correlation analysis and elastic net regularization methods were applied to drop redundant variables and to select the most meaningful subset of predictors. Whenever predictor data were missing, multiple imputation was used to fill in plausible values. Cluster analysis was applied to identify similar groups of countries based on the values of the predictors. Finally, a Bayesian hierarchical regression model was fit to the final dataset for predicting mortality rates. From 113 potential predictors, 32 were retained after correlation analysis. Out of these 32 predictors, eight with non-zero coefficients were selected using the elastic net regularization method. Based on the values of these variables, four clusters of countries were identified. The uncertainty of predictions was large for countries within clusters lacking mortality rates, and it was low for a cluster that had mortality rate information. Our results demonstrated that, using Bayesian hierarchical regression models, a data-driven clustering of countries and a meaningful subset of predictors can be used to fill data gaps in foodborne disease mortality. PMID:26785774

  1. Predicting exposure-response associations of ambient particulate matter with mortality in 73 Chinese cities.

    PubMed

    Madaniyazi, Lina; Guo, Yuming; Chen, Renjie; Kan, Haidong; Tong, Shilu

    2016-01-01

    Estimating the burden of mortality associated with particulates requires knowledge of exposure-response associations. However, the evidence on exposure-response associations is limited in many cities, especially in developing countries. In this study, we predicted associations of particulates smaller than 10 μm in aerodynamic diameter (PM10) with mortality in 73 Chinese cities. The meta-regression model was used to test and quantify which city-specific characteristics contributed significantly to the heterogeneity of PM10-mortality associations for 16 Chinese cities. Then, those city-specific characteristics with statistically significant regression coefficients were treated as independent variables to build multivariate meta-regression models. The model with the best fitness was used to predict PM10-mortality associations in 73 Chinese cities in 2010. Mean temperature, PM10 concentration and green space per capita could best explain the heterogeneity in PM10-mortality associations. Based on city-specific characteristics, we were able to develop multivariate meta-regression models to predict associations between air pollutants and health outcomes reasonably well. PMID:26452312

  2. Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD

    PubMed Central

    Echevarria, C; Steer, J; Heslop-Marshall, K; Stenton, SC; Hickey, PM; Hughes, R; Wijesinghe, M; Harrison, RN; Steen, N; Simpson, AJ; Gibson, GJ; Bourke, SC

    2016-01-01

    Background Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools. Methods The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve. Results In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality. Conclusions DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0–1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3–6) for escalation planning or appropriate early palliation. Trial registration number UKCRN ID 14214. PMID:26769015

  3. Predicting all-cause mortality from basic physiology in the Framingham Heart Study.

    PubMed

    Zhang, William B; Pincus, Zachary

    2016-02-01

    Using longitudinal data from a cohort of 1349 participants in the Framingham Heart Study, we show that as early as 28-38 years of age, almost 10% of variation in future lifespan can be predicted from simple clinical parameters. Specifically, we found diastolic and systolic blood pressure, blood glucose, weight, and body mass index (BMI) to be relevant to lifespan. These and similar parameters have been well-characterized as risk factors in the relatively narrow context of cardiovascular disease and mortality in middle to old age. In contrast, we demonstrate here that such measures can be used to predict all-cause mortality from mid-adulthood onward. Further, we find that different clinical measurements are predictive of lifespan in different age regimes. Specifically, blood pressure and BMI are predictive of all-cause mortality from ages 35 to 60, while blood glucose is predictive from ages 57 to 73. Moreover, we find that several of these parameters are best considered as measures of a rate of 'damage accrual', such that total historical exposure, rather than current measurement values, is the most relevant risk factor (as with pack-years of cigarette smoking). In short, we show that simple physiological measurements have broader lifespan-predictive value than indicated by previous work and that incorporating information from multiple time points can significantly increase that predictive capacity. In general, our results apply equally to both men and women, although some differences exist. PMID:26446764

  4. Gut Epithelial Barrier Dysfunction and Innate Immune Activation Predict Mortality in Treated HIV Infection

    PubMed Central

    Hunt, Peter W.; Sinclair, Elizabeth; Rodriguez, Benigno; Shive, Carey; Clagett, Brian; Funderburg, Nicholas; Robinson, Janet; Huang, Yong; Epling, Lorrie; Martin, Jeffrey N.; Deeks, Steven G.; Meinert, Curtis L.; Van Natta, Mark L.; Jabs, Douglas A.; Lederman, Michael M.

    2014-01-01

    Background. While inflammation predicts mortality in treated human immunodeficiency virus (HIV) infection, the prognostic significance of gut barrier dysfunction and phenotypic T-cell markers remains unclear. Methods. We assessed immunologic predictors of mortality in a case-control study within the Longitudinal Study of the Ocular Complications of AIDS (LSOCA), using conditional logistic regression. Sixty-four case patients who died within 12 months of treatment-mediated viral suppression were each matched to 2 control individuals (total number of controls, 128) by duration of antiretroviral therapy–mediated viral suppression, nadir CD4+ T-cell count, age, sex, and prior cytomegalovirus (CMV) retinitis. A similar secondary analysis was conducted in the SCOPE cohort, which had participants with less advanced immunodeficiency. Results. Plasma gut epithelial barrier integrity markers (intestinal fatty acid binding protein and zonulin-1 levels), soluble CD14 level, kynurenine/tryptophan ratio, soluble tumor necrosis factor receptor 1 level, high-sensitivity C-reactive protein level, and D-dimer level all strongly predicted mortality, even after adjustment for proximal CD4+ T-cell count (all P ≤ .001). A higher percentage of CD38+HLA-DR+ cells in the CD8+ T-cell population was a predictor of mortality before (P = .031) but not after (P = .10) adjustment for proximal CD4+ T-cell count. Frequencies of senescent (defined as CD28−CD57+ cells), exhausted (defined as PD1+ cells), naive, and CMV-specific T cells did not predict mortality. Conclusions. Gut epithelial barrier dysfunction, innate immune activation, inflammation, and coagulation—but not T-cell activation, senescence, and exhaustion—independently predict mortality in individuals with treated HIV infection with a history of AIDS and are viable targets for interventions. PMID:24755434

  5. Elevated neutrophil to lymphocyte ratio predicts mortality in medical inpatients with multiple chronic conditions.

    PubMed

    Isaac, Vivian; Wu, Chia-Yi; Huang, Chun-Ta; Baune, Bernhard T; Tseng, Chia-Lin; McLachlan, Craig S

    2016-06-01

    Neutrophil to lymphocyte ratio (NLR) is an easy measurable laboratory marker used to evaluate systemic inflammation. Elevated NLR is associated with poor survival and increased morbidity in cancer and cardiovascular disease. However, the usefulness of NLR to predict morbidity and mortality in a hospital setting for patients with multiple chronic conditions has not been previously examined. In this study, we investigate the association between NLR and mortality in multimorbid medical inpatients. Two hundred thirty medical in-patients with chronic conditions were selected from a single academic medical center in Taiwan. Retrospective NLRs were calculated from routine full blood counts previously obtained during the initial hospital admission and at the time of discharge. Self-rated health (using a single-item question), medical disorders, depressive symptoms, and medical service utilization over a 1-year period were included in the analyses. Mortality outcomes were ascertained by reviewing electronic medical records and follow-up. The mortality rate at 2-year follow-up was 23%. Depression (odds ratio [OR] 1.9 [95% CI 1.0-3.7]), poor self-rated health (OR 2.1 [95% CI 1.1-3.9]), being hospitalized 2 or more times in the previous year (OR 2.3 [95% CI 1.2-4.6]), metastatic cancer (OR 4.7 [95% CI 2.3-9.7]), and chronic liver disease (OR 4.3 [95% CI 1.5-12.1]) were associated with 2-year mortality. The median (interquartile range) NLR at admission and discharge were 4.47 (2.4-8.7) and 3.65 (2.1-6.5), respectively. Two-year mortality rates were higher in patients with an elevated NLR at admission (NLR <3 = 15.5%, NLR >3 = 27.6%) and discharge (NLR < 3 = 14.7%, NLR >3 = 29.1%). Multivariate logistic regression demonstrated that an elevated NLR >3.0 at admission (OR 2.3 [95% CI 1.0-5.2]) and discharge (OR 2.3 [95% CI 1.1-5.0]) were associated with mortality independent of baseline age, sex, education, metastatic cancer, liver disease, depression, and previous

  6. Development and Validation of a Clinical Risk-Assessment Tool Predictive of All-Cause Mortality

    PubMed Central

    Bello, Ghalib A; Dumancas, Gerard G; Gennings, Chris

    2015-01-01

    In clinical settings, the diagnosis of medical conditions is often aided by measurement of various serum biomarkers through the use of laboratory tests. These biomarkers provide information about different aspects of a patient’s health and overall function of multiple organ systems. We have developed a statistical procedure that condenses the information from a variety of health biomarkers into a composite index, which could be used as a risk score for predicting all-cause mortality. It could also be viewed as a holistic measure of overall physiological health status. This health status metric is computed as a function of standardized values of each biomarker measurement, weighted according to their empirically determined relative strength of association with mortality. The underlying risk model was developed using the biomonitoring and mortality data of a large sample of US residents obtained from the National Health and Nutrition Examination Survey (NHANES) and the National Death Index (NDI). Biomarker concentration levels were standardized using spline-based Cox regression models, and optimization algorithms were used to estimate the weights. The predictive accuracy of the tool was optimized by bootstrap aggregation. We also demonstrate how stacked generalization, a machine learning technique, can be used for further enhancement of the prediction power. The index was shown to be highly predictive of all-cause mortality and long-term outcomes for specific health conditions. It also exhibited a robust association with concurrent chronic conditions, recent hospital utilization, and current health status as assessed by self-rated health. PMID:26380550

  7. Multiple Brain Abscesses due to Streptococcus anginosus: Prediction of Mortality by an Imaging Severity Index Score

    PubMed Central

    2016-01-01

    An elderly patient with altered mental status, brain abscesses, ventriculitis, and empyemas died of septic shock and brain abscesses secondary to Streptococcus anginosus despite aggressive treatment. An imaging severity index score with a better prognostic value than the Glasgow coma scale predicted mortality in this patient. PMID:27034878

  8. Predicting perioperative mortality after oesophagectomy: a systematic review of performance and methods of multivariate models.

    PubMed

    Warnell, I; Chincholkar, M; Eccles, M

    2015-01-01

    Predicting risk of perioperative mortality after oesophagectomy for cancer may assist patients to make treatment choices and allow balanced comparison of providers. The aim of this systematic review of multivariate prediction models is to report their performance in new patients, and compare study methods against current recommendations. We used PRISMA guidelines and searched Medline, Embase, and standard texts from 1990 to 2012. Inclusion criteria were English language articles reporting development and validation of prediction models of perioperative mortality after open oesophagectomy. Two reviewers screened articles and extracted data for methods, results, and potential biases. We identified 11 development, 10 external validation, and two clinical impact studies. Overestimation of predicted mortality was common (5-200% error), discrimination was poor to moderate (area under receiver operator curves ranged from 0.58 to 0.78), and reporting of potential bias was poor. There were potentially important case mix differences between modelling and validation samples, and sample sizes were considerably smaller than is currently recommended. Steyerberg and colleagues' model used the most 'transportable' predictors and was validated in the largest sample. Most models have not been adequately validated and reported performance has been unsatisfactory. There is a need to clarify definition, effect size, and selection of currently available candidate predictors for inclusion in prediction models, and to identify new ones strongly associated with outcome. Adoption of prediction models into practice requires further development and validation in well-designed large sample prospective studies. PMID:25231768

  9. Growth rate predicts mortality of Abies concolor in both burned and unburned stands

    USGS Publications Warehouse

    van Mantgem, P.J.; Stephenson, N.L.; Mutch, L.S.; Johnson, V.G.; Esperanza, A.M.; Parsons, D.J.

    2003-01-01

    Tree mortality is often the result of both long-term and short-term stress. Growth rate, an indicator of long-term stress, is often used to estimate probability of death in unburned stands. In contrast, probability of death in burned stands is modeled as a function of short-term disturbance severity. We sought to narrow this conceptual gap by determining (i) whether growth rate, in addition to crown scorch, is a predictor of mortality in burned stands and (ii) whether a single, simple model could predict tree death in both burned and unburned stands. Observations of 2622 unburned and 688 burned Abies concolor (Gord. & Glend.) Lindl. (white fir) in the Sierra Nevada of California, U.S.A., indicated that growth rate was a significant predictor of mortality in the unburned stands, while both crown scorch and radial growth were significant predictors of mortality in the burned stands. Applying the burned stand model to unburned stands resulted in an overestimation of the unburned stand mortality rate. While failing to create a general model of tree death for A. concolor, our findings underscore the idea that similar processes may affect mortality in disturbed and undisturbed stands.

  10. Serum Gamma-Glutamyltransferase Levels Predict Mortality in Patients With Peritoneal Dialysis

    PubMed Central

    Park, Woo-Yeong; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong Lim; Kim, Yon Su; Kang, Shin Wook; Kim, Nam Ho; Yang, Chul Woo; Kim, Yong Kyun

    2015-01-01

    Abstract Serum gamma-glutamyltransferase (GGT) level has been considered marker of oxidative stress as well as liver function. Serum GGT level has been reported to be associated with the mortality in hemodialysis patients. However, it is not well established whether serum GGT level is associated with all-cause mortality in peritoneal dialysis (PD) patients. The aim of this study was to determine the association between serum GGT levels and all-cause mortality in PD patients. PD patients were included from the Clinical Research Center registry for end-stage renal disease cohort, a multicenter prospective observational cohort study in Korea. Patients were categorized into 3 groups by tertile of serum GGT levels as follows: tertile 1, GGT < 16 IU/L; tertile 2, GGT = 16 to 27 IU/L; and tertile 3, GGT > 27 IU/L. Primary outcome was all-cause mortality. A total of 820 PD patients were included. The median follow-up period was 34 months. Kaplan–Meier analysis showed that the all-cause mortality rate was significantly different according to tertiles of GGT (P = 0.001, log-rank). The multivariate Cox regression analysis showed that higher tertiles significantly associated with higher risk for all-cause mortality (tertile 2: hazard ratio [HR] 2.08, 95% confidence interval [CI], 1.17–3.72, P = 0.013; tertile 3: HR 1.83, 95% CI, 1.04–3.22, P = 0.035) in using tertile 1 as the reference group after adjusting for clinical variables. Our study demonstrated that high serum GGT levels were an independent risk factor for all-cause mortality in PD patients. Our findings suggest that serum GGT levels might be a useful biomarker to predict all-cause mortality in PD patients. PMID:26252286

  11. Prediction of Mortality in Nonagenarians Following the Surgical Repair of Hip Fractures

    PubMed Central

    Fansa, Ashraf; Ebraheim, Nabil

    2016-01-01

    Background The purpose of this study is to report on the mortality of nonagenarians who underwent surgical treatment for a hip fracture, specifically in regards to preexisting comorbidities. Furthermore, we assessed the effectiveness of the Deyo score in predicting such mortality. Methods Thirty-nine patients over the age of 90 who underwent surgical repair of a hip fracture were retrospectively analyzed. Twenty-six patients (66.7%) suffered femoral neck fractures, while the remaining 13 (33.3%) presented with trochanteric type fractures. Patient charts were examined to determine previously diagnosed patient comorbidities as well as living arrangements and mobility before and after surgery. Results Deyo index scores did not demonstrate statistically significant correlations with postoperative mortality or functional outcomes. The hazard of in-hospital mortality was found to be 91% (p = 0.036) and 86% (p = 0.05) less in patients without a history of congestive heart failure (CHF) and chronic pulmonary disease (CPD), respectively. Additionally, the hazard of 90-day mortality was 88% (p = 0.01) and 81% (p = 0.024) less in patients without a history of dementia and CPD, respectively. The hazard of 1-year mortality was also found to be 75% (p = 0.01) and 80% (p = 0.01) less in patients without a history of dementia and CPD, respectively. Furthermore, dementia patients stayed in-hospital postoperatively an average of 5.3 days (p = 0.013) less than nondementia patients and only 38.5% returned to preoperative living conditions (p = 0.036). Conclusions Nonagenarians with a history of CHF and CPD have a higher risk of in-hospital mortality following the operative repair of hip fractures. CPD and dementia patients over 90 years old have higher 90-day and 1-year mortality hazards postoperatively. Dementia patients are also discharged more quickly than nondementia patients. PMID:27247737

  12. Life span decrements in fluid intelligence and processing speed predict mortality risk.

    PubMed

    Aichele, Stephen; Rabbitt, Patrick; Ghisletta, Paolo

    2015-09-01

    We examined life span changes in 5 domains of cognitive performance as predictive of mortality risk. Data came from the Manchester Longitudinal Study of Cognition, a 20-plus-year investigation of 6,203 individuals ages 42-97 years. Cognitive domains were general crystallized intelligence, general fluid intelligence, verbal memory, visuospatial memory, and processing speed. Life span decrements were evident across these domains, controlling for baseline performance at age 70 and adjusting for retest effects. Survival analyses stratified by sex and conducted independently by cognitive domain showed that lower baseline performance levels in all domains-and larger life span decrements in general fluid intelligence and processing speed-were predictive of increased mortality risk for both women and men. Critically, analyses of the combined predictive power of cognitive performance variables showed that baseline levels of processing speed (in women) and general fluid intelligence (in men), and decrements in processing speed (in women and in men) and general fluid intelligence (in women), accounted for most of the explained variation in mortality risk. In light of recent evidence from brain-imaging studies, we speculate that cognitive abilities closely linked to cerebral white matter integrity (such as processing speed and general fluid intelligence) may represent particularly sensitive markers of mortality risk. In addition, we presume that greater complexity in cognition-survival associations observed in women (in analyses incorporating all cognitive predictors) may be a consequence of longer and more variable cognitive declines in women relative to men. PMID:26098167

  13. Comparison of risk-scoring systems in predicting hospital mortality after abdominal aortic aneurysm repair

    PubMed Central

    Supsamutchai, Chaiyarat; Wilasrusmee, Chumpon; Lertsithichai, Panuwat; Proprom, Napaphat; Kittur, Dilip S

    2008-01-01

    OBJECTIVE: To compare the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity, Portsmouth adjustment (P-POSSUM), the Hardman index and the Glasgow aneurysm score (GAS) in the prediction of hospital mortality after abdominal aortic aneurysm (AAA) repair. METHODS: Medical charts of 146 AAA patients treated between January 1996 and January 2007 were reviewed. The P-POSSUM, Hardman index and GAS were calculated for each patient. The scores were tested and compared for their discriminatory ability to predict hospital death. RESULTS: Of the 146 patients with ruptured and unruptured AAAs (133 underwent open repair, five underwent extra-anatomical bypass and eight underwent endovascular aneurysm repair), 18 died (12%) after AAA repair. The areas under the receiver operating characteristic curves for the GAS, Hardman index and P-POSSUM for predicting hospital mortality were 0.740, 0.730 and 0.886, respectively. The area under the receiver operating characteristic curve for the P-POSSUM was significantly higher than those of other scores. CONCLUSION: In the present study, the P-POSSUM was the best predictor of hospital mortality for patients undergoing AAA repair. PMID:22477446

  14. Prediction of mortality in patients in acute medical wards using basic laboratory and anthropometric data.

    PubMed Central

    Woo, J.; Mak, Y. T.; Lau, J.; Swaminathan, R.

    1992-01-01

    The value of anthropometric and biochemical indices in predicting short-term mortality among patients in general medical wards was assessed in 294 patients admitted consecutively to a district hospital over a one month period. Using a stepwise logistic regression model and supported by the linear discriminant analysis method, mortality within 3 months could be predicted with sensitivity of 83% and specificity of 84% using the following variables: sex, functional ability, urea, total protein, alkaline phosphatase and albumin-adjusted calcium. Addition of anthropometric values and biochemical nutritional indices did little to improve the accuracy of the prediction, contrary to previous findings among surgical patients and elderly residents of long-term care institutions. PMID:1494524

  15. Non-linear feature extraction from HRV signal for mortality prediction of ICU cardiovascular patient.

    PubMed

    Karimi Moridani, Mohammad; Setarehdan, Seyed Kamaledin; Motie Nasrabadi, Ali; Hajinasrollah, Esmaeil

    2016-04-01

    Intensive care unit (ICU) patients are at risk of in-ICU morbidities and mortality, making specific systems for identifying at-risk patients a necessity for improving clinical care. This study presents a new method for predicting in-hospital mortality using heart rate variability (HRV) collected from the times of a patient's ICU stay. In this paper, a HRV time series processing based method is proposed for mortality prediction of ICU cardiovascular patients. HRV signals were obtained measuring R-R time intervals. A novel method, named return map, is then developed that reveals useful information from the HRV time series. This study also proposed several features that can be extracted from the return map, including the angle between two vectors, the area of triangles formed by successive points, shortest distance to 45° line and their various combinations. Finally, a thresholding technique is proposed to extract the risk period and to predict mortality. The data used to evaluate the proposed algorithm obtained from 80 cardiovascular ICU patients, from the first 48 h of the first ICU stay of 40 males and 40 females. This study showed that the angle feature has on average a sensitivity of 87.5% (with 12 false alarms), the area feature has on average a sensitivity of 89.58% (with 10 false alarms), the shortest distance feature has on average a sensitivity of 85.42% (with 14 false alarms) and, finally, the combined feature has on average a sensitivity of 92.71% (with seven false alarms). The results showed that the last half an hour before the patient's death is very informative for diagnosing the patient's condition and to save his/her life. These results confirm that it is possible to predict mortality based on the features introduced in this paper, relying on the variations of the HRV dynamic characteristics. PMID:27028609

  16. Predicting mortality in acutely hospitalized older patients: a retrospective cohort study.

    PubMed

    de Gelder, Jelle; Lucke, Jacinta A; Heim, Noor; de Craen, Antonius J M; Lourens, Shantaily D; Steyerberg, Ewout W; de Groot, Bas; Fogteloo, Anne J; Blauw, Gerard J; Mooijaart, Simon P

    2016-06-01

    Acutely hospitalized older patients have an increased risk of mortality, but at the moment of presentation this risk is difficult to assess. Early identification of patients at high risk might increase the awareness of the physician, and enable tailored decision-making. Existing screening instruments mainly use either geriatric factors or severity of disease for prognostication. Predictive performance of these instruments is moderate, which hampers successive interventions. We conducted a retrospective cohort study among all patients aged 70 years and over who were acutely hospitalized in the Acute Medical Unit of the Leiden University Medical Center, the Netherlands in 2012. We developed a prediction model for 90-day mortality that combines vital signs and laboratory test results reflecting severity of disease with geriatric factors, represented by comorbidities and number of medications. Among 517 patients, 94 patients (18.2 %) died within 90 days after admission. Six predictors of mortality were included in a model for mortality: oxygen saturation, Charlson comorbidity index, thrombocytes, urea, C-reactive protein and non-fasting glucose. The prediction model performs satisfactorily with an 0.738 (0.667-0.798). Using this model, 53 % of the patients in the highest risk decile (N = 51) were deceased within 90 days. In conclusion, we are able to predict 90-day mortality in acutely hospitalized older patients using a model with directly available clinical data describing disease severity and geriatric factors. After further validation, such a model might be used in clinical decision making in older patients. PMID:26825335

  17. Accuracy and Calibration of Computational Approaches for Inpatient Mortality Predictive Modeling

    PubMed Central

    Nakas, Christos T.; Schütz, Narayan; Werners, Marcus; Leichtle, Alexander B.

    2016-01-01

    Electronic Health Record (EHR) data can be a key resource for decision-making support in clinical practice in the “big data” era. The complete database from early 2012 to late 2015 involving hospital admissions to Inselspital Bern, the largest Swiss University Hospital, was used in this study, involving over 100,000 admissions. Age, sex, and initial laboratory test results were the features/variables of interest for each admission, the outcome being inpatient mortality. Computational decision support systems were utilized for the calculation of the risk of inpatient mortality. We assessed the recently proposed Acute Laboratory Risk of Mortality Score (ALaRMS) model, and further built generalized linear models, generalized estimating equations, artificial neural networks, and decision tree systems for the predictive modeling of the risk of inpatient mortality. The Area Under the ROC Curve (AUC) for ALaRMS marginally corresponded to the anticipated accuracy (AUC = 0.858). Penalized logistic regression methodology provided a better result (AUC = 0.872). Decision tree and neural network-based methodology provided even higher predictive performance (up to AUC = 0.912 and 0.906, respectively). Additionally, decision tree-based methods can efficiently handle Electronic Health Record (EHR) data that have a significant amount of missing records (in up to >50% of the studied features) eliminating the need for imputation in order to have complete data. In conclusion, we show that statistical learning methodology can provide superior predictive performance in comparison to existing methods and can also be production ready. Statistical modeling procedures provided unbiased, well-calibrated models that can be efficient decision support tools for predicting inpatient mortality and assigning preventive measures. PMID:27414408

  18. Postoperative Nomogram for Predicting Cancer-Specific Mortality in Medullary Thyroid Cancer

    PubMed Central

    Ho, Allen S.; Wang, Lu; Palmer, Frank L.; Yu, Changhong; Toset, Arnbjorn; Patel, Snehal; Kattan, Michael W.; Tuttle, R. Michael; Ganly, Ian

    2016-01-01

    Background Medullary thyroid cancer (MTC) is a rare thyroid cancer accounting for 5 % of all thyroid malignancies. The purpose of our study was to design a predictive nomogram for cancer-specific mortality (CSM) utilizing clinical, pathological, and biochemical variables in patients with MTC. Methods MTC patients managed entirely at Memorial Sloan-Kettering Cancer Center between 1986 and 2010 were identified. Patient, tumor, and treatment characteristics were recorded, and variables predictive of CSM were identified by univariable analyses. A multivariable competing risk model was then built to predict the 10-year cancer specific mortality of MTC. All predictors of interest were added in the starting full model before selection, including age, gender, pre- and postoperative serum calcitonin, pre- and postoperative CEA, RET mutation status, perivascular invasion, margin status, pathologic T status, pathologic N status, and M status. Stepdown method was used in model selection to choose predictive variables. Results Of 249 MTC patients, 22.5 % (56/249) died from MTC, whereas 6.4 % (16/249) died secondary to other causes. Mean follow-up period was 87 ± 67 months. The seven variables with the highest predictive accuracy for cancer specific mortality included age, gender, postoperative calcitonin, perivascular invasion, pathologic T status, pathologic N status, and M status. These variables were used to create the final nomogram. Discrimination from the final nomogram was measured at 0.77 with appropriate calibration. Conclusions We describe the first nomogram that estimates cause-specific mortality in individual patients with MTC. This predictive nomogram will facilitate patient counseling in terms of prognosis and subsequent clinical follow up. PMID:25366585

  19. Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

    PubMed Central

    Silva, Leonardo Sinnott; Caramori, Paulo Ricardo Avancini; Nunes Filho, Antonio Carlos Bacelar; Katz, Marcelo; Guaragna, João Carlos Vieira da Costa; Lemos, Pedro; Lima, Valter; Abizaid, Alexandre; Tarasoutchi, Flavio; de Brito Jr, Fabio S.

    2015-01-01

    Background Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. Objectives To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. Methods The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)]. Results The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05). Conclusions In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required. PMID:26247244

  20. Should We Use the Model for End-Stage Liver Disease (MELD) to Predict Mortality After Colorectal Surgery?

    PubMed

    Pantel, Haddon Jacob; Stensland, Kristian D; Nelson, Jason; Francone, Todd D; Roberts, Patricia L; Marcello, Peter W; Read, Thomas; Ricciardi, Rocco

    2016-08-01

    We sought to determine the accuracy of the Model for End-Stage Liver Disease and the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator in patients with ascites who underwent colorectal surgery. The National Surgical Quality Improvement Program database was queried for patients with ascites who underwent a major colorectal operation. Predicted 90-day mortality rate based on the Model for End-Stage Liver Disease and 30-day mortality based on the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator were compared with observed 30-day mortality. The cohort contained 3137 patients with ascites who underwent a colorectal operation. The Model for End-Stage Liver Disease predicted that 252 (8 %) of patients with ascites undergoing colorectal operations would die within 90 days postoperatively, yet we observed 821 deaths (26 % mortality) within 30 days after surgery (p < 0.001). The Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator predicted that 491 (16.6 % mortality) of patients with ascites undergoing colorectal operations would die within 30 days postoperatively, yet we observed 707 (23.9 % mortality) at 30 days (p < 0.01). We concluded that the current risk prediction models significantly under predict mortality in patients with ascites who underwent colorectal surgery. PMID:27216407

  1. The Kind of Student You Were in Elementary School Predicts Mortality.

    PubMed

    Spengler, Marion; Roberts, Brent W; Lüdtke, Oliver; Martin, Romain; Brunner, Martin

    2016-08-01

    We examined the association of self-reported and teacher-rated student characteristics assessed at the end of primary school with all-cause mortality assessed through age 52. Data stem from a representative sample of students from Luxembourg assessed in 1968 (N = 2,543; M = 11.9 years, SD = 0.6; 49.9% female; N = 166 participants died). Results from logistic regression analyses showed that the self-reported responsible student scale (OR = .81; CI = [.70; .95]) and the teacher rating of studiousness (OR = .80; CI = [.67; .96]) were predictive for all-cause mortality even after controlling for IQ, parental SES, and sex. These findings indicate that both observer-rated and self-reported student behaviors are important life-course predictors for mortality and are perhaps more important than childhood IQ. PMID:25941045

  2. Psychological Language on Twitter Predicts County-Level Heart Disease Mortality

    PubMed Central

    Eichstaedt, Johannes C.; Schwartz, Hansen Andrew; Kern, Margaret L.; Park, Gregory; Labarthe, Darwin R.; Merchant, Raina M.; Jha, Sneha; Agrawal, Megha; Dziurzynski, Lukasz A.; Sap, Maarten; Weeg, Christopher; Larson, Emily E.; Ungar, Lyle H.; Seligman, Martin E. P.

    2015-01-01

    Hostility and chronic stress are known risk factors for heart disease, but they are costly to assess on a large scale. We used language expressed on Twitter to characterize community-level psychological correlates of age-adjusted mortality from atherosclerotic heart disease (AHD). Language patterns reflecting negative social relationships, disengagement, and negative emotions—especially anger—emerged as risk factors; positive emotions and psychological engagement emerged as protective factors. Most correlations remained significant after controlling for income and education. A cross-sectional regression model based only on Twitter language predicted AHD mortality significantly better than did a model that combined 10 common demographic, socioeconomic, and health risk factors, including smoking, diabetes, hypertension, and obesity. Capturing community psychological characteristics through social media is feasible, and these characteristics are strong markers of cardiovascular mortality at the community level. PMID:25605707

  3. Factors That Predict Short-term Intensive Care Unit Mortality in Patients With Cirrhosis

    PubMed Central

    BAHIRWANI, RANJEETA; GHABRIL, MARWAN; FORDE, KIMBERLY A.; CHATRATH, HEMANT; WOLF, KAREN M.; URIBE, LINDSAY; REDDY, K. RAJENDER; FUCHS, BARRY; CHALASANI, NAGA

    2013-01-01

    BACKGROUND & AIMS Despite advances in critical care medicine, the mortality rate is high among critically ill patients with cirrhosis. We aimed to identify factors that predict early (7 d) mortality among patients with cirrhosis admitted to the intensive care unit (ICU) and to develop a risk-stratification model. METHODS We collected data from patients with cirrhosis admitted to the ICU at Indiana University (IU–ICU) from December 1, 2006, through December 31, 2009 (n = 185), or at the University of Pennsylvania (Penn–ICU) from May 1, 2005, through December 31, 2010 (n = 206). Factors associated with mortality within 7 days of admission (7-d mortality) were determined by logistic regression analyses. A model was constructed based on the predictive parameters available on the first day of ICU admission in the IU–ICU cohort and then validated in the Penn–ICU cohort. RESULTS Median Model for End-stage Liver Disease (MELD) scores at ICU admission were 25 in the IU–ICU cohort (interquartile range, 23–34) and 32 in the Penn–ICU cohort (interquartile range, 26–41); corresponding 7-day mortalities were 28.3% and 53.6%, respectively. MELD score (odds ratio, 1.13; 95% confidence interval [CI], 1.07–1.2) and mechanical ventilation (odds ratio, 5.7; 95% CI, 2.3–14.1) were associated independently with 7-day mortality in the IU–ICU. A model based on these 2 variables separated IU–ICU patients into low-, medium-, and high-risk groups; these groups had 7-day mortalities of 9%, 27%, and 74%, respectively (concordance index, 0.80; 95% CI, 0.72– 0.87; P < 10−8). The model was applied to the Penn–ICU cohort; the low-, medium-, and high-risk groups had 7-day mortalities of 33%, 56%, and 71%, respectively (concordance index, 0.67; 95% CI, 0.59–0.74; P < 10−4). CONCLUSIONS A model based on MELD score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the ICU. More studies are needed to

  4. Practical prediction model for the risk of 2-year mortality of individuals in the general population.

    PubMed

    Goldfarb-Rumyantzev, Alexander; Gautam, Shiva; Brown, Robert S

    2016-04-01

    This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria >30 mg/g of creatinine, add 0.7; for stage ≥3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999-2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9±18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0-1.0), low intermediate risk (R>1.0-3.0), high intermediate risk (R>3.0-5.0) or high-risk (R>5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions. PMID:26951378

  5. To Operate or Not: Prediction of 3-Month Postoperative Mortality in Geriatric Cancer Patients

    PubMed Central

    Chou, Wen-Chi; Liu, Keng-Hao; Lu, Chang-Hsien; Hung, Yu-Shin; Chen, Miao-Fen; Cheng, Yu-Fan; Wang, Cheng-Hsu; Lin, Yung-Chang; Yeh, Ta-Sen

    2016-01-01

    Context: Appropriate selection of aging patient who fit for cancer surgery is an art-of-state. Objectives: This study aimed to identify predictive factors pertinent to 3-month postoperative mortality in geriatric cancer patients. Methods: A total of 8,425 patients over 70 years old with solid cancer received radical surgery between 2007 and 2012 at four affiliated hospitals of the Chang Gung Memorial Hospital were included. The clinical variables of patients who died within 3 months post-surgery were analyzed retrospectively. Recursive partitioning analysis (RPA) was performed by randomly selecting 50% of the patients (testing set) to identify specific groups of patients with the lowest and highest probability of 3-month postoperative mortality. The remaining 50% were used as validation set of the model. Results: Patients' gender, Eastern Cooperative Oncology Group performance (ECOG scale), Charlson comorbidity index (CCI), American Society of Anesthesiologist physical status, age, tumor staging, and mode of admission were independent variables that predicted 3-month postoperative mortality. The RPA model identified patients with an ECOG scale of 0-2, localized tumor stage, and a CCI of 0-2 as having the lowest probability of 3-month postoperative mortality (1.1% and 1.3% in the testing set and validation set, respectively). Conversely, an ECOG scale of 3-4 and a CCI >2 were associated with the highest probability of 3-month postoperative mortality (55.2% and 47.8% in the testing set and validation set, respectively). Conclusion: We identified ECOG scale and CCI score were the two most influencing factors that determined 3-month postoperative mortality in geriatric cancer patients. PMID:26722355

  6. New consensus definition for acute kidney injury accurately predicts 30-day mortality in cirrhosis with infection

    PubMed Central

    Wong, Florence; O’Leary, Jacqueline G; Reddy, K Rajender; Patton, Heather; Kamath, Patrick S; Fallon, Michael B; Garcia-Tsao, Guadalupe; Subramanian, Ram M.; Malik, Raza; Maliakkal, Benedict; Thacker, Leroy R; Bajaj, Jasmohan S

    2015-01-01

    Background & Aims A consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined as an increase in serum creatinine by >50% from the stable baseline value in <6 months or by ≥0.3mg/dL in <48 hrs. We prospectively evaluated the ability of these criteria to predict mortality within 30 days among hospitalized patients with cirrhosis and infection. Methods 337 patients with cirrhosis admitted with or developed an infection in hospital (56% men; 56±10 y old; model for end-stage liver disease score, 20±8) were followed. We compared data on 30-day mortality, hospital length-of-stay, and organ failure between patients with and without AKI. Results 166 (49%) developed AKI during hospitalization, based on the consensus criteria. Patients who developed AKI had higher admission Child-Pugh (11.0±2.1 vs 9.6±2.1; P<.0001), and MELD scores (23±8 vs17±7; P<.0001), and lower mean arterial pressure (81±16mmHg vs 85±15mmHg; P<.01) than those who did not. Also higher amongst patients with AKI were mortality in ≤30 days (34% vs 7%), intensive care unit transfer (46% vs 20%), ventilation requirement (27% vs 6%), and shock (31% vs 8%); AKI patients also had longer hospital stays (17.8±19.8 days vs 13.3±31.8 days) (all P<.001). 56% of AKI episodes were transient, 28% persistent, and 16% resulted in dialysis. Mortality was 80% among those without renal recovery, higher compared to partial (40%) or complete recovery (15%), or AKI-free patients (7%; P<.0001). Conclusions 30-day mortality is 10-fold higher among infected hospitalized cirrhotic patients with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure. PMID:23999172

  7. Risk Prediction of One-Year Mortality in Patients with Cardiac Arrhythmias Using Random Survival Forest

    PubMed Central

    Miao, Fen; Cai, Yun-Peng; Zhang, Yu-Xiao; Li, Ye; Zhang, Yuan-Ting

    2015-01-01

    Existing models for predicting mortality based on traditional Cox proportional hazard approach (CPH) often have low prediction accuracy. This paper aims to develop a clinical risk model with good accuracy for predicting 1-year mortality in cardiac arrhythmias patients using random survival forest (RSF), a robust approach for survival analysis. 10,488 cardiac arrhythmias patients available in the public MIMIC II clinical database were investigated, with 3,452 deaths occurring within 1-year followups. Forty risk factors including demographics and clinical and laboratory information and antiarrhythmic agents were analyzed as potential predictors of all-cause mortality. RSF was adopted to build a comprehensive survival model and a simplified risk model composed of 14 top risk factors. The built comprehensive model achieved a prediction accuracy of 0.81 measured by c-statistic with 10-fold cross validation. The simplified risk model also achieved a good accuracy of 0.799. Both results outperformed traditional CPH (which achieved a c-statistic of 0.733 for the comprehensive model and 0.718 for the simplified model). Moreover, various factors are observed to have nonlinear impact on cardiac arrhythmias prognosis. As a result, RSF based model which took nonlinearity into account significantly outperformed traditional Cox proportional hazard model and has great potential to be a more effective approach for survival analysis. PMID:26379761

  8. Usefulness of Glycemic Gap to Predict ICU Mortality in Critically Ill Patients With Diabetes

    PubMed Central

    Liao, Wen-I.; Wang, Jen-Chun; Chang, Wei-Chou; Hsu, Chin-Wang; Chu, Chi-Ming; Tsai, Shih-Hung

    2015-01-01

    Abstract Stress-induced hyperglycemia (SIH) has been independently associated with an increased risk of mortality in critically ill patients without diabetes. However, it is also necessary to consider preexisting hyperglycemia when investigating the relationship between SIH and mortality in patients with diabetes. We therefore assessed whether the gap between admission glucose and A1C-derived average glucose (ADAG) levels could be a predictor of mortality in critically ill patients with diabetes. We retrospectively reviewed the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores and clinical outcomes of patients with diabetes admitted to our medical intensive care unit (ICU) between 2011 and 2014. The glycosylated hemoglobin (HbA1c) levels were converted to the ADAG by the equation, ADAG = [(28.7 × HbA1c) − 46.7]. We also used receiver operating characteristic (ROC) curves to determine the optimal cut-off value for the glycemic gap when predicting ICU mortality and used the net reclassification improvement (NRI) to measure the improvement in prediction performance gained by adding the glycemic gap to the APACHE-II score. We enrolled 518 patients, of which 87 (17.0%) died during their ICU stay. Nonsurvivors had significantly higher APACHE-II scores and glycemic gaps than survivors (P < 0.001). Critically ill patients with diabetes and a glycemic gap ≥80 mg/dL had significantly higher ICU mortality and adverse outcomes than those with a glycemic gap <80 mg/dL (P < 0.001). Incorporation of the glycemic gap into the APACHE-II score increased the discriminative performance for predicting ICU mortality by increasing the area under the ROC curve from 0.755 to 0.794 (NRI = 13.6%, P = 0.0013). The glycemic gap can be used to assess the severity and prognosis of critically ill patients with diabetes. The addition of the glycemic gap to the APACHE-II score significantly improved its ability to predict ICU mortality. PMID

  9. Application of an autoregressive integrated moving average model for predicting injury mortality in Xiamen, China

    PubMed Central

    Lin, Yilan; Chen, Min; Chen, Guowei; Wu, Xiaoqing; Lin, Tianquan

    2015-01-01

    Objective Injury is currently an increasing public health problem in China. Reducing the loss due to injuries has become a main priority of public health policies. Early warning of injury mortality based on surveillance information is essential for reducing or controlling the disease burden of injuries. We conducted this study to find the possibility of applying autoregressive integrated moving average (ARIMA) models to predict mortality from injuries in Xiamen. Method The monthly mortality data on injuries in Xiamen (1 January 2002 to 31 December 2013) were used to fit the ARIMA model with the conditional least-squares method. The values p, q and d in the ARIMA (p, d, q) model refer to the numbers of autoregressive lags, moving average lags and differences, respectively. The Ljung–Box test was used to measure the ‘white noise’ and residuals. The mean absolute percentage error (MAPE) between observed and fitted values was used to evaluate the predicted accuracy of the constructed models. Results A total of 8274 injury-related deaths in Xiamen were identified during the study period; the average annual mortality rate was 40.99/100 000 persons. Three models, ARIMA (0, 1, 1), ARIMA (4, 1, 0) and ARIMA (1, 1, (2)), passed the parameter (p<0.01) and residual (p>0.05) tests, with MAPE 11.91%, 11.96% and 11.90%, respectively. We chose ARIMA (0, 1, 1) as the optimum model, the MAPE value for which was similar to that of other models but with the fewest parameters. According to the model, there would be 54 persons dying from injuries each month in Xiamen in 2014. Conclusion The ARIMA (0, 1, 1) model could be applied to predict mortality from injuries in Xiamen. PMID:26656013

  10. Predictive factors of mortality within 30 days in patients with nonvariceal upper gastrointestinal bleeding

    PubMed Central

    Lee, Yoo Jin; Min, Bo Ram; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok; Jeon, Seong Woo

    2016-01-01

    Background/Aims: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. Methods: A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. Results: Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age ≥ 65 years, and hypotension (systolic pressure < 90 mmHg) during hospitalization were significant predictive factors of 30-day mortality. Conclusions: Comorbidity of DM or metastatic malignancy, age ≥ 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition. PMID:26767858

  11. Mortality Prediction Model of Septic Shock Patients Based on Routinely Recorded Data

    PubMed Central

    Carrara, Marta; Baselli, Giuseppe; Ferrario, Manuela

    2015-01-01

    We studied the problem of mortality prediction in two datasets, the first composed of 23 septic shock patients and the second composed of 73 septic subjects selected from the public database MIMIC-II. For each patient we derived hemodynamic variables, laboratory results, and clinical information of the first 48 hours after shock onset and we performed univariate and multivariate analyses to predict mortality in the following 7 days. The results show interesting features that individually identify significant differences between survivors and nonsurvivors and features which gain importance only when considered together with the others in a multivariate regression model. This preliminary study on two small septic shock populations represents a novel contribution towards new personalized models for an integration of multiparameter patient information to improve critical care management of shock patients. PMID:26557154

  12. Venovenous extracorporeal membrane oxygenation in adult respiratory failure: Scores for mortality prediction.

    PubMed

    Hsin, Chun-Hsien; Wu, Meng-Yu; Huang, Chung-Chi; Kao, Kuo-Chin; Lin, Pyng-Jing

    2016-06-01

    Despite a potentially effective therapy for adult respiratory failure, a general agreement on venovenous extracorporeal membrane oxygenation (VV-ECMO) has not been reached among institutions due to its invasiveness and high resource usage. To establish consensus on the timing of intervention, large ECMO organizations have published the respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and the ECMOnet score, which allow users to predict hospital mortality for candidates with their pre-ECMO presentations. This study was aimed to test the predictive powers of these published scores in a medium-sized cohort enrolling adults treated with VV-ECMO for acute respiratory failure, and develop an institutional prediction model under the framework of the 3 scores if a superior predictive power could be achieved. This retrospective study included 107 adults who received VV-ECMO for severe acute respiratory failure (a PaO2/FiO2 ratio <70 mm Hg) in a tertiary referral center from 2007 to 2015. Essential demographic and clinical data were collected to calculate the RESP score, the ECMOnet score, and the sequential organ failure assessment (SOFA) score before VV-ECMO. The predictive power of hospital mortality of each score was presented as the area under receiver-operating characteristic curve (AUROC). The multivariate logistic regression was used to develop an institutional prediction model. The surviving to discharge rate was 55% (n = 59). All of the 3 published scores had a real but poor predictive power of hospital mortality in this study. The AUROCs of RESP score, ECMOnet score, and SOFA score were 0.662 (P = 0.004), 0.616 (P = 0.04), and 0.667 (P = 0.003), respectively. An institutional prediction model was established from these score parameters and presented as follows: hospital mortality (Y) = -3.173 + 0.208 × (pre-ECMO SOFA score) + 0.148 × (pre-ECMO mechanical ventilation day) + 1.021

  13. TI-59 programmable calculator program for calculating predicted operative mortality in general surgery.

    PubMed

    Haddad, M; Reiss, R; Lilos, P; Fuchs, C

    1986-01-01

    A program for the TI-59 programmable calculator for calculating predicted postoperative mortality is presented. Input data are based on handy, clinical, non-invasive pre-operative and operative parameters retrieved mostly significant in this respect by former multivariate logistic regression analysis of a broad data-base; their relative weights are incorporated into the program data base as basic coefficients. Considerations employed in its usage are discussed, as well as possible future technical and/or environmental modifications. PMID:3791971

  14. Temperature multiscale entropy analysis: a promising marker for early prediction of mortality in septic patients.

    PubMed

    Papaioannou, V E; Chouvarda, I G; Maglaveras, N K; Baltopoulos, G I; Pneumatikos, I A

    2013-11-01

    A few studies estimating temperature complexity have found decreased Shannon entropy, during severe stress. In this study, we measured both Shannon and Tsallis entropy of temperature signals in a cohort of critically ill patients and compared these measures with the sequential organ failure assessment (SOFA) score, in terms of intensive care unit (ICU) mortality. Skin temperature was recorded in 21 mechanically ventilated patients, who developed sepsis and septic shock during the first 24 h of an ICU-acquired infection. Shannon and Tsallis entropies were calculated in wavelet-based decompositions of the temperature signal. Statistically significant differences of entropy features were tested between survivors and non-survivors and classification models were built, for predicting final outcome. Significantly reduced Tsallis and Shannon entropies were found in non-survivors (seven patients, 33%) as compared to survivors. Wavelet measurements of both entropy metrics were found to predict ICU mortality better than SOFA, according to a combination of area under the curve, sensitivity and specificity values. Both entropies exhibited similar prognostic accuracy. Combination of SOFA and entropy presented improved the outcome of univariate models. We suggest that reduced wavelet Shannon and Tsallis entropies of temperature signals may complement SOFA in mortality prediction, during the first 24 h of an ICU-acquired infection. PMID:24149496

  15. Endothelial Progenitor Cells Predict Long-Term Mortality in Hemodialysis Patients

    PubMed Central

    Lu, Chien-Lin; Leu, Jyh-Gang; Liu, Wen-Chih; Zheng, Cai-Mei; Lin, Yuh-Feng; Shyu, Jia-Fwu; Wu, Chia-Chao; Lu, Kuo-Cheng

    2016-01-01

    Background: The endothelial progenitor cells (EPCs) dysfunction is a critical event in the initiation of atherosclerotic plaque development and the level of circulating EPCs can be considered a biomarker of cardiovascular events. The level and functional change in EPCs has been investigated in hemodialysis patients, but the effect of absolute number of EPCs on risk of death has not yet been explored. We hypothesized that the number of EPCs predicted death from cardiovascular and all-cause mortality in hemodialysis patients. Methods: We evaluate the association between endothelial progenitor cells and clinical outcome in 154 patients on maintenance hemodialysis. The blood sample was drawn at the time of patient enrollment and EPCs were identified by flow cytometry using triple staining for CD34/CD133/KDR. Results: The median duration of follow-up was 4.19 years. There were 79 (51.3%) deaths during the follow-up period, 41 of whom died due to a confirmed cardiovascular cause. The cumulative survival was greater in the high-EPC group than the low-EPC group for all-cause and cardiovascular mortality. Decreased EPCs levels were associated with a significant increase in the risk of cardiovascular and all-cause mortality after adjusting for age, gender, current smokers, diabetes mellitus, and hypertension. Conclusions: The level of circulating EPCs independently predicts the clinical outcome in patients on maintenance hemodialysis. Thus, the EPCs levels may be a useful predictive tool for evaluating the risk of death in maintenance hemodialysis patients. PMID:26941585

  16. Using Wind Tunnels to Predict Bird Mortality in Wind Farms: The Case of Griffon Vultures

    PubMed Central

    de Lucas, Manuela; Ferrer, Miguel; Janss, Guyonne F. E.

    2012-01-01

    Background Wind farms have shown a spectacular growth during the last 15 years. Avian mortality through collision with moving rotor blades is well-known as one of the main adverse impacts of wind farms. In Spain, the griffon vulture incurs the highest mortality rates in wind farms. Methodology/Principal Findings As far as we know, this study is the first attempt to predict flight trajectories of birds in order to foresee potentially dangerous areas for wind farm development. We analyse topography and wind flows in relation to flight paths of griffon vultures, using a scaled model of the wind farm area in an aerodynamic wind tunnel, and test the difference between the observed flight paths of griffon vultures and the predominant wind flows. Different wind currents for each wind direction in the aerodynamic model were observed. Simulations of wind flows in a wind tunnel were compared with observed flight paths of griffon vultures. No statistical differences were detected between the observed flight trajectories of griffon vultures and the wind passages observed in our wind tunnel model. A significant correlation was found between dead vultures predicted proportion of vultures crossing those cells according to the aerodynamic model. Conclusions Griffon vulture flight routes matched the predominant wind flows in the area (i.e. they followed the routes where less flight effort was needed). We suggest using these kinds of simulations to predict flight paths over complex terrains can inform the location of wind turbines and thereby reduce soaring bird mortality. PMID:23152764

  17. Does Parsonnet scoring model predict mortality following adult cardiac surgery in India?

    PubMed Central

    Srilata, Moningi; Padhy, Narmada; Padmaja, Durga; Gopinath, Ramachandran

    2015-01-01

    Aims and Objectives: To validate the Parsonnet scoring model to predict mortality following adult cardiac surgery in Indian scenario. Materials and Methods: A total of 889 consecutive patients undergoing adult cardiac surgery between January 2010 and April 2011 were included in the study. The Parsonnet score was determined for each patient and its predictive ability for in-hospital mortality was evaluated. The validation of Parsonnet score was performed for the total data and separately for the sub-groups coronary artery bypass grafting (CABG), valve surgery and combined procedures (CABG with valve surgery). The model calibration was performed using Hosmer–Lemeshow goodness of fit test and receiver operating characteristics (ROC) analysis for discrimination. Independent predictors of mortality were assessed from the variables used in the Parsonnet score by multivariate regression analysis. Results: The overall mortality was 6.3% (56 patients), 7.1% (34 patients) for CABG, 4.3% (16 patients) for valve surgery and 16.2% (6 patients) for combined procedures. The Hosmer–Lemeshow statistic was <0.05 for the total data and also within the sub-groups suggesting that the predicted outcome using Parsonnet score did not match the observed outcome. The area under the ROC curve for the total data was 0.699 (95% confidence interval 0.62–0.77) and when tested separately, it was 0.73 (0.64–0.81) for CABG, 0.79 (0.63–0.92) for valve surgery (good discriminatory ability) and only 0.55 (0.26–0.83) for combined procedures. The independent predictors of mortality determined for the total data were low ejection fraction (odds ratio [OR] - 1.7), preoperative intra-aortic balloon pump (OR - 10.7), combined procedures (OR - 5.1), dialysis dependency (OR - 23.4), and re-operation (OR - 9.4). Conclusions: The Parsonnet score yielded a good predictive value for valve surgeries, moderate predictive value for the total data and for CABG and poor predictive value for combined

  18. Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients

    PubMed Central

    Hwang, Seun Deuk; Kim, Su-Hyun; Kim, Young Ok; Jin, Dong Chan; Song, Ho Chul; Choi, Euy Jin; Kim, Yong-Lim; Kim, Yon-Su; Kang, Shin-Wook; Kim, Nam-Ho; Yang, Chul Woo; Kim, Yong Kyun

    2016-01-01

    Background Serum alkaline phosphatase (ALP) levels have been reported to be associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. However, it is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients. Methods PD patients from the Clinical Research Center registry for end-stage renal disease, a multicenter prospective observational cohort study in Korea, were included in the present study. Patients were categorized into three groups by serum ALP tertiles as follows: Tertile 1, ALP <78 U/L; Tertile 2, ALP = 78–155 U/L; Tertile 3, ALP >155 U/L. Tertile 1 was used as the reference category. The primary outcomes were infection-related mortality and hospitalization. Results A total of 1,455 PD patients were included. The median follow-up period was 32 months. The most common cause of infection-related mortality and hospitalization was PD-related peritonitis. Multivariate Cox regression analyses showed that patients in the highest tertiles of serum ALP levels were at higher risk of infection-related mortality (HR 2.29, 95% CI, 1.42–5.21, P = 0.008) after adjustment for clinical variables. Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: HR 1.56, 95% CI, 1.18–2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03–2.62, P = 0.031). Conclusions Our data showed that elevated serum ALP levels were independently associated with a higher risk of infection-related mortality and hospitalization in PD patients. PMID:27310428

  19. Usefulness of Psoas Muscle Area to Predict Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.

    PubMed

    Saji, Mike; Lim, D Scott; Ragosta, Michael; LaPar, Damien J; Downs, Emily; Ghanta, Ravi K; Kern, John A; Dent, John M; Ailawadi, Gorav

    2016-07-15

    Frailty has become high-priority theme in cardiovascular diseases because of aging and increasingly complex nature of patients. Low muscle mass is characteristic of frailty, in which invasive interventions are avoided if possible because of decreased physiological reserve. This study aimed to determine if the psoas muscle area (PMA) could predict mortality and to investigate its utility in patients who underwent transcatheter aortic valve replacement (TAVR). We retrospectively reviewed 232 consecutive patients who underwent TAVR. Cross-sectional areas of the psoas muscles at the level of fourth lumbar vertebra were measured by computed tomography and normalized to body surface area. Patients were divided into tertiles according to the normalized PMA for each gender (men: tertile 1, 1,708 to 1,178 mm(2)/m(2); tertile 2, 1,176 to 1,011 mm(2)/m(2); and tertile 3, 1,009 to 587 mm(2)/m(2); women: tertile 1, 1,436 to 962 mm(2)/m(2); tertile 2, 952 to 807 mm(2)/m(2); and tertile 3, 806 to 527 mm(2)/m(2)). Smaller normalized PMA was independently correlated with women and higher New York Heart Association classification. After adjustment for multiple confounding factors, the normalized PMA tertile was independently associated with mortality at 6 months (adjusted hazard ratio 1.53, 95% confidence interval 1.06 to 2.21). Kaplan-Meier analysis showed that tertile 3 had higher mortality rates than tertile 1 at 6 months (14% and 31%, respectively, p = 0.029). Receiver-operating characteristic analysis showed that normalized PMA provided the increase of C-statistics for predicting mortality for a clinical model and gait speed. In conclusion, PMA is an independent predictor of mortality after TAVR and can complement a clinical model and gait speed. PMID:27236254

  20. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    PubMed Central

    de Araujo, Ana Carla Pereira; Santos, Bruno F. de Oliveira; Calasans, Flavia Ricci; Pinto, Ibraim M. Francisco; de Oliveira, Daniel Pio; Melo, Luiza Dantas; Andrade, Stephanie Macedo; Tavares, Irlaneide da Silva; Sousa, Antonio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2014-01-01

    Background Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all‑cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 – 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 – 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia. PMID:25352460

  1. Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: a pilot study.

    PubMed

    Shah, Trushil G; Wadia, Subeer K; Kovach, Julie; Fogg, Louis; Tandon, Rajive

    2016-06-01

    Right ventricular (RV) dysfunction in acute respiratory distress syndrome (ARDS) contributes to increased mortality. Our aim is to identify reproducible transthoracic echocardiography (TTE) parameters of RV dysfunction that can be used to predict outcomes in ARDS. We performed a retrospective single-center cohort pilot study measuring tricuspid annular plane systolic excursion (TAPSE), Tei index, RV-fractional area change (RV-FAC), pulmonary artery systolic pressure (PASP), and septal shift, reevaluated by an independent blinded cardiologist (JK). Thirty-eight patients were included. Patients were divided on the basis of 30-day survival. Thirty-day mortality was 47%. Survivors were younger than nonsurvivors. Survivors had a higher pH, PaO2∶FiO2 ratio, and TAPSE. Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) scores were lower in survivors. TAPSE has the strongest association with increased 30-day mortality from date of TTE. Accordingly, TAPSE has a strong positive correlation with PaO2∶FiO2 ratios, and Tei index has a strong negative correlation with PaO2∶FiO2 ratios. Septal shift was associated with lower PaO2∶FiO2 ratios. Decrease in TAPSE, increase in Tei index, and septal shift were seen in the severe ARDS group. In multivariate logistic regression models, TAPSE maintained a significant association with mortality independent of age, pH, PaO2∶FiO2 ratios, positive end expiratory pressure, PCO2, serum bicarbonate, plateau pressures, driving pressures, APACHE II, SAPS II, and SOFA scores. In conclusion, TAPSE and other TTE parameters should be used as novel predictive indicators for RV dysfunction in ARDS. These parameters can be used as surrogate noninvasive RV hemodynamic measurements to be manipulated to improve mortality in patients with ARDS and contributory RV dysfunction. PMID:27252840

  2. Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: a pilot study

    PubMed Central

    Wadia, Subeer K.; Kovach, Julie; Fogg, Louis; Tandon, Rajive

    2016-01-01

    Abstract Right ventricular (RV) dysfunction in acute respiratory distress syndrome (ARDS) contributes to increased mortality. Our aim is to identify reproducible transthoracic echocardiography (TTE) parameters of RV dysfunction that can be used to predict outcomes in ARDS. We performed a retrospective single-center cohort pilot study measuring tricuspid annular plane systolic excursion (TAPSE), Tei index, RV-fractional area change (RV-FAC), pulmonary artery systolic pressure (PASP), and septal shift, reevaluated by an independent blinded cardiologist (JK). Thirty-eight patients were included. Patients were divided on the basis of 30-day survival. Thirty-day mortality was 47%. Survivors were younger than nonsurvivors. Survivors had a higher pH, PaO2∶FiO2 ratio, and TAPSE. Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) scores were lower in survivors. TAPSE has the strongest association with increased 30-day mortality from date of TTE. Accordingly, TAPSE has a strong positive correlation with PaO2∶FiO2 ratios, and Tei index has a strong negative correlation with PaO2∶FiO2 ratios. Septal shift was associated with lower PaO2∶FiO2 ratios. Decrease in TAPSE, increase in Tei index, and septal shift were seen in the severe ARDS group. In multivariate logistic regression models, TAPSE maintained a significant association with mortality independent of age, pH, PaO2∶FiO2 ratios, positive end expiratory pressure, PCO2, serum bicarbonate, plateau pressures, driving pressures, APACHE II, SAPS II, and SOFA scores. In conclusion, TAPSE and other TTE parameters should be used as novel predictive indicators for RV dysfunction in ARDS. These parameters can be used as surrogate noninvasive RV hemodynamic measurements to be manipulated to improve mortality in patients with ARDS and contributory RV dysfunction. PMID:27252840

  3. BNP, NTproBNP, CMBK, and MMP-2 predict mortality in severe Chagas cardiomyopathy

    PubMed Central

    Sherbuk, Jacqueline E.; Okamoto, Emi E.; Marks, Morgan A.; Fortuny, Enzo; Clark, Eva H.; Galdos-Cardenas, Gerson; Vasquez-Villar, Angel; Fernandez, Antonio B.; Crawford, Thomas C.; Do, Rose Q.; Flores-Franco, Jorge Luis; Colanzi, Rony; Gilman, Robert H.; Bern, Caryn

    2015-01-01

    Background Chagas cardiomyopathy is a chronic sequela of infection by the parasite, Trypanosoma cruzi. Advanced cardiomyopathy is associated with a high mortality rate, and clinical characteristics have been used to predict mortality risk. Though multiple biomarkers have been associated with Chagas cardiomyopathy, it is unknown how these are related to survival. Objectives Our study aimed to identify biomarkers associated with mortality in individuals with severe Chagas cardiomyopathy in an urban Bolivian hospital. Methods The population included individuals with and without T. cruzi infection recruited in an urban hospital in Santa Cruz, Bolivia. Baseline characteristics, ECG findings, medications, and serum cardiac biomarker levels (BNP, NTproBNP, CKMB, troponin I, MMP-2, MMP-9, TIMP-1, TIMP-2, TGFb1, and TGFb2) were ascertained. Echocardiograms were preferentially performed on those with cardiac symptoms or electrocardiogram abnormalities. Participants were contacted by phone approximately 1 year after initial evaluation; deaths were reported by family members. Receiver operating characteristic curves were used to optimize cut-off values for each marker. For markers with area under curve > 0.55, Cox proportional hazards models were performed to determine the hazards ratio (HR) and 95% confidence interval (CI) for the association of each marker with mortality. Results The median follow-up time was 14.1 months (interquartile range 12.5- 16.7 months). Of 254 individuals with complete cardiac data, 220 (87%) had follow-up data. Of 50 patients with severe Chagas cardiomyopathy, 20 (40%) had died. Higher baseline levels of BNP (HR[95% CI]:3.1 [1.2, 8.4]), NTproBNP (4.4[1.8,11.0]), CKMB (3.3[1.3, 8.0]), and MMP-2 (4.2[1.5, 11.8]) were significantly associated with subsequent mortality. Conclusions Severe Chagas cardiomyopathy is associated with high short-term mortality. BNP, NTproBNP, CKMB and MMP2 have added predictive value for mortality, even in the presence of

  4. Exercise Ventilatory Inefficiency Adds to Lung Function in Predicting Mortality in COPD.

    PubMed

    Neder, J Alberto; Alharbi, Abdullah; Berton, Danilo C; Alencar, Maria Clara N; Arbex, Flavio F; Hirai, Daniel M; Webb, Katherine A; O'Donnell, Denis E

    2016-08-01

    Severity of resting functional impairment only partially predicts the increased risk of death in chronic obstructive pulmonary disease (COPD). Increased ventilation during exercise is associated with markers of disease progression and poor prognosis, including emphysema extension and pulmonary vascular impairment. Whether excess exercise ventilation would add to resting lung function in predicting mortality in COPD, however, is currently unknown. After an incremental cardiopulmonary exercise test, 288 patients (forced expiratory volume in one second ranging from 18% to 148% predicted) were followed for a median (interquartile range) of 57 (47) months. Increases in the lowest (nadir) ventilation to CO2 output (VCO2) ratio determined excess exercise ventilation. Seventy-seven patients (26.7%) died during follow-up: 30/77 (38.9%) deaths were due to respiratory causes. Deceased patients were older, leaner, had a greater co-morbidity burden (Charlson Index) and reported more daily life dyspnea. Moreover, they had poorer lung function and exercise tolerance (p < 0.05). A logistic regression analysis revealed that ventilation/VCO2 nadir was the only exercise variable that added to age, body mass index, Charlson Index and resting inspiratory capacity (IC)/total lung capacity (TLC) ratio to predict all-cause and respiratory mortality (p < 0.001). Kaplan-Meier analyses showed that survival time was particularly reduced when ventilation/VCO2 nadir > 34 was associated with IC/TLC ≤ 0.34 or IC/TLC ≤ 0.31 for all-cause and respiratory mortality, respectively (p < 0.001). Excess exercise ventilation is an independent prognostic marker across the spectrum of COPD severity. Physiological abnormalities beyond traditional airway dysfunction and lung mechanics are relevant in determining the course of the disease. PMID:27077955

  5. Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients.

    PubMed

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Kashani, Kianoush

    2016-05-01

    Serum creatinine (SCr) has been widely used to estimate glomerular filtration rate (GFR). Creatinine generation could be reduced in the setting of low skeletal muscle mass. Thus, SCr has also been used as a surrogate of muscle mass. Low muscle mass is associated with reduced survival in hospitalized patients, especially in the intensive care unit (ICU) settings. Recently, studies have demonstrated high mortality in ICU patients with low admission SCr levels, reflecting that low muscle mass or malnutrition, are associated with increased mortality. However, SCr levels can also be influenced by multiple GFR- and non-GFR-related factors including age, diet, exercise, stress, pregnancy, and kidney disease. Imaging techniques, such as computed tomography (CT) and ultrasound, have recently been studied for muscle mass assessment and demonstrated promising data. This article aims to present the perspectives of the uses of SCr and other methods for prediction of muscle mass and outcomes of ICU patients. PMID:27162688

  6. Serum creatinine level, a surrogate of muscle mass, predicts mortality in critically ill patients

    PubMed Central

    Thongprayoon, Charat; Cheungpasitporn, Wisit

    2016-01-01

    Serum creatinine (SCr) has been widely used to estimate glomerular filtration rate (GFR). Creatinine generation could be reduced in the setting of low skeletal muscle mass. Thus, SCr has also been used as a surrogate of muscle mass. Low muscle mass is associated with reduced survival in hospitalized patients, especially in the intensive care unit (ICU) settings. Recently, studies have demonstrated high mortality in ICU patients with low admission SCr levels, reflecting that low muscle mass or malnutrition, are associated with increased mortality. However, SCr levels can also be influenced by multiple GFR- and non-GFR-related factors including age, diet, exercise, stress, pregnancy, and kidney disease. Imaging techniques, such as computed tomography (CT) and ultrasound, have recently been studied for muscle mass assessment and demonstrated promising data. This article aims to present the perspectives of the uses of SCr and other methods for prediction of muscle mass and outcomes of ICU patients. PMID:27162688

  7. Development and validation of a risk calculator for prediction of mortality after infrainguinal bypass surgery

    PubMed Central

    Gupta, Prateek K.; Ramanan, Bala; Lynch, Thomas G.; Sundaram, Abhishek; MacTaggart, Jason N.; Gupta, Himani; Fang, Xiang; Pipinos, Iraklis I.

    2012-01-01

    Objective For peripheral arterial disease, infrainguinal bypass grafting (BPG) carries a higher perioperative risk compared with peripheral endovascular procedures. The choice between the open and endovascular therapies is to an extent dependent on the expected periprocedural risk associated with each. Tools for estimating the periprocedural risk in patients undergoing BPG have not been reported in the literature. The objective of this study was to develop and validate a calculator to estimate the risk of perioperative mortality ≤30 days of elective BPG. Methods We identified 9556 patients (63.9% men) who underwent elective BPG from the 2007 to 2009 National Surgical Quality Improvement Program data sets. Multivariable logistic regression analysis was performed to identify risk factors associated with 30-day perioperative mortality. Bootstrapping was used for internal validation. The risk factors were subsequently used to develop a risk calculator. Results Patients had a median age of 68 years. The 30-day mortality rate was 1.8% (n = 170). Multivariable logistic regression analysis identified seven preoperative predictors of 30-day mortality: increasing age, systemic inflammatory response syndrome, chronic corticosteroid use, chronic obstructive pulmonary disease, dependent functional status, dialysis dependence, and lower extremity rest pain. Bootstrapping was used for internal validation. The model demonstrated excellent discrimination (C statistic, 0.81; bias-corrected C statistic, 0.81) and calibration. The validated risk model was used to develop an interactive risk calculator using the logistic regression equation. Conclusions The validated risk calculator has excellent predictive ability for 30-day mortality in a patient after an elective BPG. It is anticipated to aid in surgical decision making, informed patient consent, preoperative optimization, and consequently, risk reduction. PMID:22632800

  8. Diastolic myocardial dysfunction by tissue Doppler imaging predicts mortality in patients with cerebral infarction.

    PubMed

    Olsen, Flemming J; Jørgensen, Peter G; Møgelvang, Rasmus; Jensen, Jan S; Fritz-Hansen, Thomas; Bech, Jan; Sivertsen, Jacob; Biering-Sørensen, Tor

    2015-10-01

    Several clinical prediction score models have been investigated for predicting mortality in patients with cerebral infarction. However, none of these include echocardiographic measures. Our objective was to evaluate the prognostic value of tissue Doppler imaging (TDI) of the myocardium in patients with cerebral infarction. Two hundred forty-four patients with cerebral infarction and subsequent echocardiographic examination in sinus rhythm were identified. Using TDI in three apical projections, longitudinal mitral annular velocities were obtained in six segments. Cox regression models, C-statistics and reclassification analysis were performed for global and segmental e'. During a median follow-up of 3 years 42 patients died. Patients who died had significantly impaired systolic and diastolic function (determined by LVEF and E/e'). The risk of dying increased with decreasing global e', being approximately 13 times higher for patients in the lowest tertile compared to patients in the highest tertile (HR 13.4 [3.2;56.3], p < 0.001). Patients with significantly impaired global e' showed increased mortality after multivariable adjustment for: LVEF, E/e', age, gender, heart failure, chronic obstructive pulmonary disease, prior cerebral infarction, ischemic heart disease, cancer, hypertension, hypercholesterolemia, carotid stenosis, mitral regurgitation, liver disease and thromboembolisms (HR 1.9 [1.1;3.2]), per 1 cm/s decrease, p < 0.05). Similar pattern was seen in segmental analyses of the e'. In contrast to e', no conventional echocardiographic parameters remained independent predictors of mortality after multivariable adjustment. Diastolic myocardial dysfunction determined as e' by TDI is a significant predictor of mortality in patients with cerebral infarction. Applying this parameter can aid the prognostic assessment after cerebral infarction. PMID:26195231

  9. MELD score can predict early mortality in patients with rebleeding after band ligation for variceal bleeding

    PubMed Central

    Chen, Wei-Ting; Lin, Chun-Yen; Sheen, I-shyan; Huang, Chang-Wen; Lin, Tsung-Nan; Lin, Chun-Jung; Jeng, Wen-Juei; Huang, Chien-Hao; Ho, Yu-Pin; Chiu, Cheng-Tang

    2011-01-01

    AIM: To investigate the outcomes, as well as risk factors for 6-wk mortality, in patients with early rebleeding after endoscopic variceal band ligation (EVL) for esophageal variceal hemorrhage (EVH). METHODS: Among 817 EVL procedures performed for EVH between January 2007 and December 2008, 128 patients with early rebleeding, defined as rebleeding within 6 wk after EVL, were enrolled for analysis. RESULT: The rate of early rebleeding after EVL for acute EVH was 15.6% (128/817). The 5-d, 6-wk, 3-mo, and 6-mo mortality rates were 7.8%, 38.3%, 55.5%, and 58.6%, respectively, in these early rebleeding patients. The use of beta-blockers, occurrence of hypovolemic shock, and higher model for end-stage liver disease (MELD) score at the time of rebleeding were independent predictors for 6-wk mortality. A cut-off value of 21.5 for the MELD score was found with an area under ROC curve of 0.862 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value were 77.6%, 81%, 71.7%, and 85.3%, respectively. As for the 6-mo survival rate, patients with a MELD score ≥ 21.5 had a significantly lower survival rate than patients with a MELD score < 21.5 (P < 0.001). CONCLUSION: This study demonstrated that the MELD score is an easy and powerful predictor for 6-wk mortality and outcomes of patients with early rebleeding after EVL for EVH. PMID:21547132

  10. Fatty liver disease: Disparate predictive ability for cardiometabolic risk and all-cause mortality

    PubMed Central

    Onat, Altan; Can, Günay; Kaya, Ayşem; Akbaş, Tuğba; Özpamuk-Karadeniz, Fatma; Şimşek, Barış; Çakır, Hakan; Yüksel, Hüsniye

    2015-01-01

    AIM: To assess the association of a surrogate of fatty liver disease (FLD) with incident type-2 diabetes, coronary heart disease, and all-cause mortality. METHODS: In a prospective population-based study on 1822 middle-aged adults, stratified to gender, we used an algorithm of fatty liver index (FLI) to identify associations with outcomes. An index ≥ 60 indicated the presence of FLD. In Cox regression models, adjusted for age, smoking status, high-density lipoprotein cholesterol, and systolic blood pressure, we assessed the predictive value of FLI for incident diabetes, coronary heart disease (CHD), and all-cause mortality. RESULTS: At a mean 8 year follow-up, 218 and 285 incident cases of diabetes and CHD, respectively, and 193 deaths were recorded. FLD was significantly associated in each gender with blood pressure, total cholesterol, apolipoprotein B, uric acid, and C-reactive protein; weakly with fasting glucose; and inversely with high-density lipoprotein-cholesterol and sex hormone-binding globulin. In adjusted Cox models, FLD was (with a 5-fold HR) the major determinant of diabetes development. Analyses further disclosed significant independent prediction of CHD by FLD in combined gender [hazard ratio (HR) = 1.72, 95% confidence interval (CI): 1.17-2.53] and men (HR = 2.35, 95%CI: 1.25-4.43). Similarly-adjusted models for all-cause mortality proved, however, not to confer risk, except for a tendency in prediabetics and diabetic women. CONCLUSION: A surrogate of FLD conferred significant high risk of diabetes and coronary heart disease, independent of some metabolic syndrome traits. All-cause mortality was not associated with FLD, except likely in the prediabetic state. Such a FLI may reliably be used in epidemiologic studies. PMID:26730168

  11. High-Sensitivity C-Reactive Protein Predicts Mortality and Technique Failure in Peritoneal Dialysis Patients

    PubMed Central

    Liu, Shou-Hsuan; Li, Yi-Jung; Wu, Hsin-Hsu; Lee, Cheng-Chia; Lin, Chan-Yu; Weng, Cheng-Hao; Chen, Yung-Chang; Chang, Ming-Yang; Hsu, Hsiang-Hao; Fang, Ji-Tseng; Hung, Cheng-Chieh; Yang, Chih-Wei; Tian, Ya-Chung

    2014-01-01

    Introduction An elevated level of serum C-reactive protein (CRP) is widely considered an indicator of an underlying inflammatory disease and a long-term prognostic predictor for dialysis patients. This cross-sectional cohort study was designed to assess the correlation between the level of high-sensitivity CRP (HS-CRP) and the outcome of peritoneal dialysis (PD) patients. Methods A total of 402 patients were stratified into 3 tertiles (lower, middle, upper) according to serum HS-CRP level and and followed up from October 2009 to September 2011. During follow-up, cardiovascular events, infection episodes, technique failure, and mortality rate were recorded. Results During the 24-month follow-up, 119 of 402 patients (29.6%) dropped out from PD, including 28 patients (7.0%) who died, 81 patients (20.1%) who switched to hemodialysis, and 10 patients (2.5%) who underwent kidney transplantation. The results of Kaplan–Meier analysis and log-rank test demonstrated a significant difference in the cumulative patient survival rate across the 3 tertiles (the lowest rate in upper tertile). On multivariate Cox regression analysis, only higher HS-CRP level, older age, the presence of diabetes mellitus (DM), lower serum albumin level, and the occurrence of cardiovascular events during follow-up were identified as independent predictors of mortality. Every 1 mg/L increase in HS-CRP level was independently predictive of a 1.4% increase in mortality. Multivariate Cox regression analysis also showed that higher HS-CRP level, the presence of DM, lower hemoglobin level, lower serum albumin level, higher dialysate/plasma creatinine ratio, and the occurrence of infective episodes and cardiovascular events during follow-up were independent predictors of technique failure. Conclusions The present study shows the importance of HS-CRP in the prediction of 2-year mortality and technique survival in PD patients independent of age, diabetes, hypoalbuminemia, and the occurrence of

  12. Hematological Parameters Improve Prediction of Mortality and Secondary Adverse Events in Coronary Angiography Patients

    PubMed Central

    Gijsberts, Crystel M.; den Ruijter, Hester M.; de Kleijn, Dominique P.V.; Huisman, Albert; ten Berg, Maarten J.; van Wijk, Richard H.A.; Asselbergs, Folkert W.; Voskuil, Michiel; Pasterkamp, Gerard; van Solinge, Wouter W.; Hoefer, Imo E.

    2015-01-01

    Abstract Prediction of primary cardiovascular events has been thoroughly investigated since the landmark Framingham risk score was introduced. However, prediction of secondary events after initial events of coronary artery disease (CAD) poses a new challenge. In a cohort of coronary angiography patients (n = 1760), we examined readily available hematological parameters from the UPOD (Utrecht Patient Oriented Database) and their addition to prediction of secondary cardiovascular events. Backward stepwise multivariable Cox regression analysis was used to test their ability to predict death and major adverse cardiovascular events (MACE). Continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) measures were calculated for the hematological parameters on top of traditional risk factors to assess prediction improvement. Panels of 3 to 8 hematological parameters significantly improved prediction of death and adverse events. The IDIs ranged from 0.02 to 0.07 (all P < 0.001) among outcome measures and the cNRIs from 0.11 to 0.40 (P < 0.001 in 5 of 6 outcome measures). In the hematological panels red cell distribution width (RDW) appeared most often. The multivariable adjusted hazard ratio of RDW per 1 standard deviation (SD) increase for MACE was 1.19 [1.08–1.32], P < 0.001. Routinely measured hematological parameters significantly improved prediction of mortality and adverse events in coronary angiography patients. Accurately indicating high-risk patients is of paramount importance in clinical decision-making. PMID:26559287

  13. Delirium and other clinical factors with Clostridium difficile infection that predict mortality in hospitalized patients

    PubMed Central

    Archbald-Pannone, Laurie R.; McMurry, Timothy L.; Guerrant, Richard L.; Warren, Cirle A.

    2015-01-01

    Background Clostridium difficile infection (CDI) severity has increased, especially among hospitalized elderly. We evaluated clinical factors to predict mortality following CDI. Methods We collected data from inpatients diagnosed with CDI at US academic medical center (HSR-IRB# 13630). We evaluated age, Charlson comorbidity index (CCI), admission from a long-term care facility (LTCF), intensive care unit (ICU) at time of diagnosis, white blood cell count (WBC), blood urea nitrogen (BUN), low body mass index (BMI), and delirium as possible predictors. A parsimonious predictive model was chosen using Akaike information criterion (AIC) and a best subsets model selection algorithm. Area under the ROC curve was used to assess the model’s comparative; with AIC as selection criterion for all subsets to measure fit and control for over-fitting. Results From 362 subjects, the selected model included CCI, WBC, BUN, ICU, and delirium. The logistic regression coefficients were converted to a points scale and calibrated so that each unit on the CCI contributed 2 points, ICU contributed 5, unit of WBC (natural log scale) contributed 3, unit of BUN contributed 5, and delirium contributed 11. Discussion Our model shows substantial ability to predict short term mortality in patients hospitalized with CDI. Conclusion Patients who were diagnosed in the ICU and developed delirium are at highest risk for dying within 30 days of CDI diagnosis. PMID:25920706

  14. An Integrated Framework for Improved Stream Temperature Predictions to Mitigate Fish Mortality

    NASA Astrophysics Data System (ADS)

    Caldwell, R. J.; Danner, E.; Pike, A.; Rajagopalan, B.; Melton, F. S.; Lindley, S.; Nemani, R. R.

    2009-12-01

    In 2004, the National Marine Fisheries Service (NMFS) issued a Biological Opinion (BiOp) to outline the decision support system for water allocations in the Central Valley Project (CVP) with respect to impacts on threatened and endangered species in the Sacramento River Basin. Peer-review of the BiOp identified fundamental flaws in two critical components, the stream temperature and fish mortality models, due to limitations of the proposed methods in both temporal and spatial resolution. To address these issues, an integrated framework was proposed that would result in the development of a suite of decision support tools (DSTs) for resource managers. The overall approach is to utilize satellite-derived inputs in ecological and numerical weather prediction models to provide environmental inputs to the stream temperature models at increased temporal and spatial resolutions. The higher-resolution stream temperature forecasts can then be implemented in the fish mortality models. Additionally, the framework includes the development of stochastic weather generator software and statistical modeling tools to address both short- (e.g., daily) and long-term (e.g., seasonal, annual) predictions of a suite of hydrometeorological variables, including stream temperature. By integrating state-of-the-art modeling systems with statistical analysis and prediction methods, a comprehensive set of DSTs can be developed that will best guide water resource management decisions in the CVP. We will describe the proposed decision support system framework in an overview fashion to highlight the integrated and easily-transferable design of the project.

  15. Depth of Bacterial Invasion in Resected Intestinal Tissue Predicts Mortality in Surgical Necrotizing Enterocolitis

    PubMed Central

    Remon, Juan I.; Amin, Sachin C.; Mehendale, Sangeeta R.; Rao, Rakesh; Luciano, Angel A.; Garzon, Steven A.; Maheshwari, Akhil

    2015-01-01

    Objective Up to a third of all infants who develop necrotizing enterocolitis (NEC) require surgical resection of necrotic bowel. We hypothesized that the histopathological findings in surgically-resected bowel can predict the clinical outcome of these infants. Study design We reviewed the medical records and archived pathology specimens from all patients who underwent bowel resection/autopsy for NEC at a regional referral center over a 10-year period. Pathology specimens were graded for the depth and severity of necrosis, inflammation, bacteria invasion, and pneumatosis, and histopathological findings were correlated with clinical outcomes. Results We performed clinico-pathological analysis on 33 infants with confirmed NEC, of which 18 (54.5%) died. Depth of bacterial invasion in resected intestinal tissue predicted death from NEC (odds ratio 5.39 per unit change in the depth of bacterial invasion, 95% confidence interval 1.33-21.73). The presence of transmural necrosis and bacteria in the surgical margins of resected bowel was also associated with increased mortality. Conclusions Depth of bacterial invasion in resected intestinal tissue predicts mortality in surgical NEC. PMID:25950918

  16. Nurse-led risk assessment/management clinics reduce predicted cardiac morbidity and mortality in claudicants.

    PubMed

    Hatfield, Josephine; Gulati, Sumit; Abdul Rahman, Morhisham N A; Coughlin, Patrick A; Chetter, Ian C

    2008-12-01

    Nurse-led assessment/management of risk factors is effective in many chronic medical conditions. We aimed to evaluate whether this finding was true for patients with intermittent claudication and to analyze its impact on patient-reported quality of life and predicted mortality due to coronary heart disease. We prospectively studied a series of 78 patients (51 men; median age, 65 years [IQR: 56-74 years]), diagnosed with intermittent claudication and referred to a nurse-led risk assessment/management clinic (NLC) from a consultant-led vascular surgical clinic. The NLC used clinical care pathways to manage antiplatelet medication, smoking cessation, hyperlipidemia, hypertension, and diabetes and to provide exercise advice. All patients were reassessed at a 3 months. Medication compliance, smoking status, fasting lipid profiles, blood pressure, and HbA1c were recorded. Disease-specific quality of life was assessed using King's College VascuQoL and predicted cardiac morbidity and mortality were calculated using the PROCAM and Framingham risk scores. We found that NLC enrollment produced an antiplatelet and a statin compliance of 100%, a smoking cessation rate of 17% (9 patients) and significant improvements in total cholesterol (median, 5.2-4.5 mmol/l), LDL (median, 3.1-2.5 mmol/l) and triglyceride (median, 1.7-1.4 mmol/l) levels. Significant disease-specific quality of life improvements and significant reduction in both the PROCAM (14% to 10%) and Framingham (14% to 11%) coronary risk scores were observed. Providing care at NLCs for claudicants is effective in assessing and managing risk factors, improves disease-specific quality of life and reduces predicted morbidity and mortality due to coronary heart disease. PMID:19022170

  17. Using data-driven rules to predict mortality in severe community acquired pneumonia.

    PubMed

    Wu, Chuang; Rosenfeld, Roni; Clermont, Gilles

    2014-01-01

    Prediction of patient-centered outcomes in hospitals is useful for performance benchmarking, resource allocation, and guidance regarding active treatment and withdrawal of care. Yet, their use by clinicians is limited by the complexity of available tools and amount of data required. We propose to use Disjunctive Normal Forms as a novel approach to predict hospital and 90-day mortality from instance-based patient data, comprising demographic, genetic, and physiologic information in a large cohort of patients admitted with severe community acquired pneumonia. We develop two algorithms to efficiently learn Disjunctive Normal Forms, which yield easy-to-interpret rules that explicitly map data to the outcome of interest. Disjunctive Normal Forms achieve higher prediction performance quality compared to a set of state-of-the-art machine learning models, and unveils insights unavailable with standard methods. Disjunctive Normal Forms constitute an intuitive set of prediction rules that could be easily implemented to predict outcomes and guide criteria-based clinical decision making and clinical trial execution, and thus of greater practical usefulness than currently available prediction tools. The Java implementation of the tool JavaDNF will be publicly available. PMID:24699007

  18. Using Data-Driven Rules to Predict Mortality in Severe Community Acquired Pneumonia

    PubMed Central

    Wu, Chuang; Rosenfeld, Roni; Clermont, Gilles

    2014-01-01

    Prediction of patient-centered outcomes in hospitals is useful for performance benchmarking, resource allocation, and guidance regarding active treatment and withdrawal of care. Yet, their use by clinicians is limited by the complexity of available tools and amount of data required. We propose to use Disjunctive Normal Forms as a novel approach to predict hospital and 90-day mortality from instance-based patient data, comprising demographic, genetic, and physiologic information in a large cohort of patients admitted with severe community acquired pneumonia. We develop two algorithms to efficiently learn Disjunctive Normal Forms, which yield easy-to-interpret rules that explicitly map data to the outcome of interest. Disjunctive Normal Forms achieve higher prediction performance quality compared to a set of state-of-the-art machine learning models, and unveils insights unavailable with standard methods. Disjunctive Normal Forms constitute an intuitive set of prediction rules that could be easily implemented to predict outcomes and guide criteria-based clinical decision making and clinical trial execution, and thus of greater practical usefulness than currently available prediction tools. The Java implementation of the tool JavaDNF will be publicly available. PMID:24699007

  19. Low platelet activity predicts 30 days mortality in patients undergoing heart surgery.

    PubMed

    Kuliczkowski, Wiktor; Sliwka, Joanna; Kaczmarski, Jacek; Zysko, Dorota; Zembala, Michal; Steter, Dawid; Zembala, Marian; Gierlotka, Marek; Kim, Moo Hyun; Serebruany, Victor

    2016-03-01

    Despite advanced techniques and improved clinical outcomes, patient survival following coronary artery bypass grafting (CABG) is still a major concern. Therefore, predicting future CABG mortality represents an unmet medical need and should be carefully explored. The objective of this study is to assess whether pre-CABG platelet activity corresponds with 30 days mortality post-CABG. Retrospective analyses of platelet biomarkers and death at 30 days in 478 heart surgery patients withdrawn from aspirin or/and clopidogrel. Platelet activity was assessed prior to CABG for aspirin (ASPI-test) with arachidonic acid and clopidogrel (ADP-test) utilizing Multiplate impedance aggregometer. Most patients (n = 198) underwent conventional CABG, off-pump (n = 162), minimally invasive (n = 30), artificial valve implantation (n = 48) or valves in combination with CABG (n = 40). There were 22 deaths at 30 days, including 10 in-hospital fatalities. With the cut-off value set below 407 area under curve (AUC) for the ASPI-test, the 30-day mortality was 5.90% for the lower cohort and 2.66% for patients with significantly higher platelet reactivity (P = 0.038). For the ADP-test with a cut-off at 400AUC, the 30-day mortality was 9.68% for the lower cohort and 3.66% for patients with higher platelet reactivity, representing a borderline significant difference (P = 0.046). Aside from the platelet indices, patients who received red blood cell (RBC) concentrate had a highly significant (P < 0.0001) risk of death at 30 days. Both aspirin and clopidogrel tests were useful in predicting 30 days mortality following heart surgery, suggesting the danger of diminished platelet activity prior to CABG in such high-risk patients. These preliminary evidence supports early discontinuation of antiplatelet therapy for elective CABG and requires adequately powered randomized trials to test the hypothesis and potentially improve survival. PMID:26366827

  20. Time Preferences Predict Mortality among HIV-Infected Adults Receiving Antiretroviral Therapy in Kenya

    PubMed Central

    Thirumurthy, Harsha; Hayashi, Kami; Linnemayr, Sebastian; Vreeman, Rachel C.; Levin, Irwin P.; Bangsberg, David R.; Brewer, Noel T.

    2015-01-01

    Background Identifying characteristics of HIV-infected adults likely to have poor treatment outcomes can be useful for targeting interventions efficiently. Research in economics and psychology suggests that individuals’ intertemporal time preferences, which indicate the extent to which they trade-off immediate vs. future cost and benefits, can influence various health behaviors. While there is empirical support for the association between time preferences and various non-HIV health behaviors and outcomes, the extent to which time preferences predict outcomes of those receiving antiretroviral therapy (ART) has not been examined previously. Methods HIV-infected adults initiating ART were enrolled at a health facility in Kenya. Participants’ time preferences were measured at enrollment and used to classify them as having either a low or high discount rate for future benefits. At 48 weeks, we assessed mortality and ART adherence, as measured by Medication Event Monitoring System (MEMS). Logistic regression models adjusting for socio-economic characteristics and risk factors were used to determine the association between time preferences and mortality as well as MEMS adherence ≥90%. Results Overall, 44% (96/220) of participants were classified as having high discount rates. Participants with high discount rates had significantly higher 48-week mortality than participants with low discount rates (9.3% vs. 3.1%; adjusted odds ratio 3.84; 95% CI 1.03, 14.50). MEMS adherence ≥90% was similar for participants with high vs. low discount rates (42.3% vs. 49.6%, AOR 0.70; 95% CI 0.40, 1.25). Conclusion High discount rates were associated with significantly higher risk of mortality among HIV-infected patients initiating ART. Greater use of time preference measures may improve identification of patients at risk of poor clinical outcomes. More research is needed to further identify mechanisms of action and also to build upon and test the generalizability of this finding

  1. CIBMTR Chronic GVHD Risk Score Predicts Mortality in an Independent Validation Cohort

    PubMed Central

    Arora, Mukta; Hemmer, Michael T.; Ahn, Kwang Woo; Klein, John P.; Cutler, Corey S.; Urbano-Ispizua, Alvaro; Couriel, Daniel R.; Alousi, Amin M.; Gale, Robert Peter; Inamoto, Yoshihiro; Weisdorf, Daniel J.; Li, Peigang; Antin, Joseph H.; Bolwell, Brian J.; Boyiadzis, Michael; Cahn, Jean-Yves; Cairo, Mitchell S.; Isola, Luis M.; Jacobsohn, David A.; Jagasia, Madan; Klumpp, Thomas R.; Petersdorf, Effie W.; Santarone, Stella; Schouten, Harry C.; Wingard, John R.; Spellman, Stephen R.; Pavletic, Steven Z.; Lee, Stephanie J.; Horowitz, Mary M.; Flowers, Mary E.D.

    2015-01-01

    We previously reported a risk score that predicted mortality in patients with chronic graft-versus-host disease (CGVHD) after hematopoietic stem cell transplant (HCT) between 1995–2004 and reported to the Center for International Blood and Marrow Transplant Registry (CIBMTR). We sought to validate this risk score in an independent CIBMTR cohort of 1128 patients with CGVHD transplanted between 2005–2007 using the same inclusion criteria and risk-score calculations. According to the sum of the overall risk score (range 1 to 12), patients were assigned to 4 risk-groups (RGs): RG1 (0–2), RG2 (3–6), RG3 (7–8) and RG4 (9–10). RG3 and 4 were combined as RG4 comprised only 1% of the total cohort. Cumulative incidences of non relapse mortality (NRM) and probability of overall survival (OS) were significantly different between each RG (all p<0.01). NRM and OS at five years after CGVHD for each RG were 17% and 72% in RG1, 26% and 53% in RG2, and 44% and 25% in RG 3, respectively (all p<0.01). Our study validates the prognostic value of the CIBMTR CGVHD RGs for OS and NRM in a contemporary transplant population. The CIBMTR CGVHD RGs can be used to predict major outcomes, tailor treatment planning, and enrollment in clinical trials. PMID:25528390

  2. Quantitative and Morphological Measures May Predict Growth and Mortality During Prenatal Growth in Japanese Quails

    PubMed Central

    Arora, Kashmiri L.; Vatsalya, Vatsalya

    2014-01-01

    Growth pattern and mortality rate during the embryonic phase of avian species are difficult to recognize and predict. Determination of such measures and associated events may enhance our understanding of characteristics involved in the growth and hatching process. Furthermore, some quantitative measures could validate morphological determinants during the embryonic phase and predict the course of normal growth and alterations. Our aim was to characterize quantitative growth of embryos and to establish baseline embryonic standards for use in comparative and pathological research during the prenatal life of Japanese quail. Day 10 was a landmark timeline for initiation of extensive anatomical changes in growth and transformation. Wet and dry weights were positively correlated with each other and inversely correlated with water content (p = 0.05). Following d10, the water content decreased progressively, whereas, dry and wet weights increased with increasing age. Velocity of growth in wet and dry weights was evident starting d6, spiked at d11 and d15 and then declined before hatching on d16. Organic and inorganic contents of embryos were positively associated with age. Progressive increase in the organic to inorganic ratio with age was evident after d5, spiked on d9, d13 and d16. Accurate determinations of prenatal growth processes could serve as valuable tools in identifying morphological developments and characterization of prenatal growth and mortality, thus enhancing the reproductive efficiency of the breeding colony and the postnatal robustness of the offspring. PMID:25285101

  3. Nomogram Predicting Prostate Cancer–specific Mortality for Men with Biochemical Recurrence After Radical Prostatectomy

    PubMed Central

    Brockman, John A.; Alanee, Shaheen; Vickers, Andrew J.; Scardino, Peter T.; Wood, David P.; Kibel, Adam S.; Lin, Daniel W.; Bianco, Fernando J.; Rabah, Danny M.; Klein, Eric A.; Ciezki, Jay P.; Gao, Tianming; Kattan, Michael W.; Stephenson, Andrew J.

    2016-01-01

    Background The natural history of prostate-specific antigen (PSA)-defined biochemical recurrence (BCR) of prostate cancer (PCa) after definitive local therapy is highly variable. Validated prediction models for PCa-specific mortality (PCSM) in this population are needed for treatment decision-making and clinical trial design. Objective To develop and validate a nomogram to predict the probability of PCSM from the time of BCR among men with rising PSA levels after radical prostatectomy. Design, setting, and participants Between 1987 and 2011, 2254 men treated by radical prostatectomy at one of five high-volume hospitals experienced BCR, defined as three successive PSA rises (final value >0.2 ng/ml), single PSA >0.4 ng/ml, or use of secondary therapy administered for detectable PSA >0.1 ng/ml. Clinical information and follow-up data were modeled using competing-risk regression analysis to predict PCSM from the time of BCR. Intervention Radical prostatectomy for localized prostate cancer and subsequent PCa BCR. Outcome measurements and statistical analysis PCSM. Results and limitations The 10-yr PCSM and mortality from competing causes was 19% (95% confidence interval [CI] 16–21%) and 17% (95% CI 14–19%), respectively. A nomogram predicting PCSM for all patients had an internally validated concordance index of 0.774. Inclusion of PSA doubling time (PSADT) in a nomogram based on standard parameters modestly improved predictive accuracy (concordance index 0.763 vs 0.754). Significant parameters in the models were preoperative PSA, pathological Gleason score, extraprostatic extension, seminal vesicle invasion, time to PCa BCR, PSA level at PCa BCR, and PSADT (all p < 0.05). Conclusions We constructed and validated a nomogram to predict the risk of PCSM at 10 yr among men with PCa BCR after radical prostatectomy. The nomogram may be used for patient counseling and the design of clinical trials for PCa. Patient summary For men with biochemical recurrence of prostate

  4. Personalized Mortality Prediction Driven by Electronic Medical Data and a Patient Similarity Metric

    PubMed Central

    Lee, Joon; Maslove, David M.; Dubin, Joel A.

    2015-01-01

    Background Clinical outcome prediction normally employs static, one-size-fits-all models that perform well for the average patient but are sub-optimal for individual patients with unique characteristics. In the era of digital healthcare, it is feasible to dynamically personalize decision support by identifying and analyzing similar past patients, in a way that is analogous to personalized product recommendation in e-commerce. Our objectives were: 1) to prove that analyzing only similar patients leads to better outcome prediction performance than analyzing all available patients, and 2) to characterize the trade-off between training data size and the degree of similarity between the training data and the index patient for whom prediction is to be made. Methods and Findings We deployed a cosine-similarity-based patient similarity metric (PSM) to an intensive care unit (ICU) database to identify patients that are most similar to each patient and subsequently to custom-build 30-day mortality prediction models. Rich clinical and administrative data from the first day in the ICU from 17,152 adult ICU admissions were analyzed. The results confirmed that using data from only a small subset of most similar patients for training improves predictive performance in comparison with using data from all available patients. The results also showed that when too few similar patients are used for training, predictive performance degrades due to the effects of small sample sizes. Our PSM-based approach outperformed well-known ICU severity of illness scores. Although the improved prediction performance is achieved at the cost of increased computational burden, Big Data technologies can help realize personalized data-driven decision support at the point of care. Conclusions The present study provides crucial empirical evidence for the promising potential of personalized data-driven decision support systems. With the increasing adoption of electronic medical record (EMR) systems, our

  5. IL-6 predicts organ dysfunction and mortality in patients with multiple injuries

    PubMed Central

    Frink, Michael; van Griensven, Martijn; Kobbe, Philipp; Brin, Thomas; Zeckey, Christian; Vaske, Bernhard; Krettek, Christian; Hildebrand, Frank

    2009-01-01

    Background Although therapeutic concepts of patients with major trauma have improved during recent years, organ dysfunction still remains a frequent complication during clinical course in intensive care units. It has previously been shown that cytokines are upregulated under stress conditions such as trauma or sepsis. However, it is still debatable if cytokines are adequate parameters to describe the current state of trauma patients. To elucidate the relevance of cytokines, we investigated if cytokines predict development of multiple organ dysfunction syndrome (MODS) or outcome. Methods A total of 143 patients with an injury severity score ≥ 16, between 16 and 65 years, admitted to the Hannover Medical School Level 1 Trauma Center between January 1997 and December 2001 were prospectively included in this study. Marshall Score for MODS was calculated for at least 14 days and plasma levels of TNF-α, IL-1β, IL-6, IL-8 and IL-10 were measured. To determine the association between cytokine levels and development of MODS the Spearman rank correlation coefficient was calculated and logistic regression and analysis were performed. Results and Discussion Patients with MODS had increased plasma levels of IL-6, IL-8 and IL-10. IL-6 predicted development of MODS with an overall accuracy of 84.7% (specificity: 98.3%, sensitivity: 16.7%). The threshold value for development of MODS was 761.7 pg/ml and 2176.0 pg/ml for mortality during the in patient time. Conclusion We conclude that plasma IL-6 levels predict mortality and that they are a useful tool to identify patients who are at risk for development of MODS. PMID:19781105

  6. AST to Platelet Ratio Index Predicts Mortality in Hospitalized Patients With Hepatitis B-Related Decompensated Cirrhosis

    PubMed Central

    Mao, Weilin; Sun, Qinqin; Fan, Jian; Lin, Sha; Ye, Bo

    2016-01-01

    Abstract Aspartate aminotransferase to platelet ratio index (APRI) has originally been considered as a noninvasive marker for detecting hepatic fibrosis in patients with chronic hepatitis B and C. APRI has been used for predicting liver-related mortality in patients with chronic hepatitis C virus infection or alcoholic liver disease. However, whether APRI could be useful for predicting mortality in chronic hepatitis B virus (HBV) infection remains unevaluated. This study aims to address this knowledge gap. A total of 193 hospitalized chronic HBV-infected patients (cirrhosis, n = 100; noncirrhosis, n = 93) and 88 healthy subjects were retrospectively enrolled. All patients were followed up for 4 months. Mortality that occurred within 90 days of hospital stay was compared among patients with different APRI. APRI predictive value was evaluated by univariate and multivariate regression embedded in a Cox proportional hazards model. APRI varied significantly in our cohort (range, 0.16–10.00). Elevated APRI was associated with increased severity of liver disease and 3-month mortality in hospitalized patients with HBV-related cirrhosis. Multivariate analysis demonstrated that APRI (odds ratio: 1.456, P < 0.001) and the model for end-stage liver disease score (odds ratio: 1.194, P < 0.001) were 2 independent markers for predicting mortality. APRI is a simple marker that may serve as an additional predictor of 3-month mortality in hospitalized patients with HBV-related decompensated cirrhosis. PMID:26945406

  7. Observable impairments predict mortality of captured and released sockeye salmon at various temperatures.

    PubMed

    Gale, Marika Kirstin; Hinch, Scott G; Cooke, Steven J; Donaldson, Michael R; Eliason, Erika J; Jeffries, Ken M; Martins, Eduardo G; Patterson, David A

    2014-01-01

    Migrating adult sockeye salmon frequently encounter commercial and recreational fishing gear, from which they may be landed, escape or be intentionally released. In this experiment, migratory adult sockeye salmon were exposed to simulated capture-release in fresh water, including 3 min of exhaustive exercise and 60 s of air exposure at three ecologically relevant water temperatures (13, 16 and 19°C) to understand how thermal and capture-release stressors may interact to increase mortality risk. Water temperature and sex were the factors that best predicted 24 and 48 h survival, with females in the warmest temperature group experiencing the greatest mortality. Capture-release treatment including air exposure was associated with equilibrium loss and depressed ventilation rates at release; the probability of fish surviving for 24 h after simulated capture-release was >50% if the duration of equilibrium loss was <2 min or ventilation frequency was >1 breath s(-1). Higher haematocrit and plasma lactate as well as lower mean cell haemoglobin concentration and plasma sodium and chloride 30 min after simulated capture-release were also significant predictors of 24 h survival. Together, the results demonstrate that simple observations that are consistent with physiological disturbance can be used as predictors for post-release short-term survival for sockeye salmon. The markedly higher post-stressor mortality observed in females demonstrates that managers should consider sex-specific variation in response to different fisheries interactions, particularly in the face of climate change. PMID:27293650

  8. Observable impairments predict mortality of captured and released sockeye salmon at various temperatures

    PubMed Central

    Gale, Marika Kirstin; Hinch, Scott G.; Cooke, Steven J.; Donaldson, Michael R.; Eliason, Erika J.; Jeffries, Ken M.; Martins, Eduardo G.; Patterson, David A.

    2014-01-01

    Migrating adult sockeye salmon frequently encounter commercial and recreational fishing gear, from which they may be landed, escape or be intentionally released. In this experiment, migratory adult sockeye salmon were exposed to simulated capture–release in fresh water, including 3 min of exhaustive exercise and 60 s of air exposure at three ecologically relevant water temperatures (13, 16 and 19°C) to understand how thermal and capture–release stressors may interact to increase mortality risk. Water temperature and sex were the factors that best predicted 24 and 48 h survival, with females in the warmest temperature group experiencing the greatest mortality. Capture–release treatment including air exposure was associated with equilibrium loss and depressed ventilation rates at release; the probability of fish surviving for 24 h after simulated capture–release was >50% if the duration of equilibrium loss was <2 min or ventilation frequency was >1 breath s−1. Higher haematocrit and plasma lactate as well as lower mean cell haemoglobin concentration and plasma sodium and chloride 30 min after simulated capture–release were also significant predictors of 24 h survival. Together, the results demonstrate that simple observations that are consistent with physiological disturbance can be used as predictors for post-release short-term survival for sockeye salmon. The markedly higher post-stressor mortality observed in females demonstrates that managers should consider sex-specific variation in response to different fisheries interactions, particularly in the face of climate change. PMID:27293650

  9. Trajectories of physiological dysregulation predicts mortality and health outcomes in a consistent manner across three populations.

    PubMed

    Milot, Emmanuel; Morissette-Thomas, V; Li, Qing; Fried, Linda P; Ferrucci, Luigi; Cohen, Alan A

    2014-01-01

    Mechanistic and evolutionary perspectives both agree that aging involves multiple integrated biochemical networks in the organism. In particular, the homeostatic physiological dysregulation (PD) hypothesis contends that aging is caused by the progressive breakdown of key regulatory processes. However, nothing is yet known about the specifics of how PD changes with age and affects health. Using a recently validated measure of PD involving the calculation of a multivariate distance (DM) from biomarker data, we show that PD trajectories predict mortality, frailty, and chronic diseases (cancer, cardiovascular diseases, and diabetes). Specifically, relative risks of outcomes associated with individual slopes in (i.e. rate of) dysregulation range 1.20-1.40 per unit slope. We confirm the results by replicating the analysis using two suites of biomarkers selected with markedly different criteria and, for mortality, in three longitudinal cohort-based studies. Overall, the consistence of effect sizes (direction and magnitude) across data sets, biomarker suites and outcomes suggests that the positive relationship between DM and health outcomes is a general phenomenon found across human populations. Therefore, the study of dysregulation trajectories should allow important insights into aging physiology and provide clinically meaningful predictors of outcomes. PMID:25454986

  10. Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes

    PubMed Central

    Pezold, Michael; Moore, Ernest E.; Wohlauer, Max; Sauaia, Angela; Gonzalez, Eduardo; Banerjee, Anirban; Silliman, Christopher C.

    2015-01-01

    Background Predicting refractory coagulopathy early in resuscitation of injured patients may decrease a leading cause of preventable death. We hypothesized that clot strength (G) measured by point-of-care rapid thrombelastography (r-TEG) on arrival in the emergency department can predict massive transfusion (MT) and coagulation-related mortality (MT-death). Methods Trauma alerts/activations from May 2008 to September 2010 were reviewed. The variables included the following: age, sex, injury severity score (ISS), systolic blood pressure (SBP), base deficit (BD), traditional coagulation tests (international normalized ratio ([INR], partial thromboplastin time [PTT]), TEG-derived G, and blood products transfused within the first 6 hours. Independent predictors of 2 outcomes (MT [≥10 packed red blood cells units/6 h] and MT-related death) were identified using logistic regression. The individual predictive values of BD, INR, PTT, and G were assessed comparing the areas under the receiver operating characteristic curves (AUC ROC), while adjusting for age, ISS, and SBP. Results Among the 80 study patients, 48% required MT, and 21% died of MT-related complications. INR, ISS, and G were independent predictors of MT, whereas age, ISS, SBP, and G were independently associated with MT-death. The predictive power for outcome MT did not differ among INR (adjusted AUC ROC = 0.92), PTT (AUC ROC = 0.90, P = .41), or G (AUC ROC = 0.89, P = .39). For outcome MT-death, G had the greatest adjusted AUC ROC (0.93) compared with the AUC ROC for BD (0.87, P = .05), INR (0.88, P = .11), and PTT (0.89; P = .19). Conclusion These data suggest that the point-of-care TEG parameter clot strength (G) provides consistent, independent prediction of MT and MT-death early in the resuscitation of injured patients. PMID:21899867

  11. Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease

    PubMed Central

    Smeeth, Liam; Pearce, Neil; Herrett, Emily; Timmis, Adam; Hemingway, Harry; Wedzicha, Jadwiga; Quint, Jennifer K

    2016-01-01

    Objective To assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with chronic obstructive pulmonary disease (COPD) and to investigate how it might be improved. Methods Data were obtained on 481 849 patients with acute coronary syndrome admitted to UK hospitals between January 2003 and June 2013 from the Myocardial Ischaemia National Audit Project (MINAP) database. We compared risk of death between patients with COPD and those without COPD at 6 months, adjusting for predicted risk of death. We then assessed whether several modifications improved the accuracy of the GRACE score for people with COPD. Results The risk of death after adjusting for GRACE score predicted that risk of death was higher for patients with COPD than that for other patients (RR 1.29, 95% CI 1.28 to 1.33). Adding smoking into the GRACE score model did not improve accuracy for patients with COPD. Either adding COPD into the model (relative risk (RR) 1.00, 0.94 to 1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96 to 1.01). Conclusions GRACE scores underestimate risk of death for people with COPD. A more accurate prediction of risk of death can be obtained by adding COPD into the GRACE score equation, or by multiplying the GRACE score predicted risk of death by 1.3 for people with COPD. This means that one third of patients with COPD currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-segment elevation myocardial infarction or unstable angina. PMID:27177534

  12. Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score.

    PubMed

    Ghabaee, Mojdeh; Zandieh, Ali; Mohebbi, Shahrzad; Fakhri, Mohammad; Sadeghian, Homa; Divani, Fatemeh; Amirifard, Hamed; Mousavi-Mirkala, Mohammadreza; Ghaffarpour, Majid

    2014-03-01

    We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r (2) = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05-1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction. PMID:23975559

  13. Development and Validation of Predictive Models of Cardiac Mortality and Transplantation in Resynchronization Therapy

    PubMed Central

    Rocha, Eduardo Arrais; Pereira, Francisca Tatiana Moreira; Abreu, José Sebastião; Lima, José Wellington O.; Monteiro, Marcelo de Paula Martins; Rocha Neto, Almino Cavalcante; Goés, Camilla Viana Arrais; Farias, Ana Gardênia P.; Rodrigues Sobrinho, Carlos Roberto Martins; Quidute, Ana Rosa Pinto; Scanavacca, Maurício Ibrahim

    2015-01-01

    Background 30-40% of cardiac resynchronization therapy cases do not achieve favorable outcomes. Objective This study aimed to develop predictive models for the combined endpoint of cardiac death and transplantation (Tx) at different stages of cardiac resynchronization therapy (CRT). Methods Prospective observational study of 116 patients aged 64.8 ± 11.1 years, 68.1% of whom had functional class (FC) III and 31.9% had ambulatory class IV. Clinical, electrocardiographic and echocardiographic variables were assessed by using Cox regression and Kaplan-Meier curves. Results The cardiac mortality/Tx rate was 16.3% during the follow-up period of 34.0 ± 17.9 months. Prior to implantation, right ventricular dysfunction (RVD), ejection fraction < 25% and use of high doses of diuretics (HDD) increased the risk of cardiac death and Tx by 3.9-, 4.8-, and 5.9-fold, respectively. In the first year after CRT, RVD, HDD and hospitalization due to congestive heart failure increased the risk of death at hazard ratios of 3.5, 5.3, and 12.5, respectively. In the second year after CRT, RVD and FC III/IV were significant risk factors of mortality in the multivariate Cox model. The accuracy rates of the models were 84.6% at preimplantation, 93% in the first year after CRT, and 90.5% in the second year after CRT. The models were validated by bootstrapping. Conclusion We developed predictive models of cardiac death and Tx at different stages of CRT based on the analysis of simple and easily obtainable clinical and echocardiographic variables. The models showed good accuracy and adjustment, were validated internally, and are useful in the selection, monitoring and counseling of patients indicated for CRT. PMID:26559987

  14. Darcy’s law predicts widespread forest mortality under climate warming

    USGS Publications Warehouse

    McDowell, Nate G.; Allen, Craig D.

    2015-01-01

    Drought and heat-induced tree mortality is accelerating in many forest biomes as a consequence of a warming climate, resulting in a threat to global forests unlike any in recorded history1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Forests store the majority of terrestrial carbon, thus their loss may have significant and sustained impacts on the global carbon cycle11,12. We use a hydraulic corollary to Darcy’s law, a core principle of vascular plant physiology13, to predict characteristics of plants that will survive and die during drought under warmer future climates. Plants that are tall with isohydric stomatal regulation, low hydraulic conductance, and high leaf area are most likely to die from future drought stress. Thus, tall trees of old-growth forests are at the greatest risk of loss, which has ominous implications for terrestrial carbon storage. This application of Darcy’s law indicates today’s forests generally should be replaced by shorter and more xeric plants, owing to future warmer droughts and associated wildfires and pest attacks. The Darcy’s corollary also provides a simple, robust framework for informing forest management interventions needed to promote the survival of current forests. Given the robustness of Darcy’s law for predictions of vascular plant function, we conclude with high certainty that today’s forests are going to be subject to continued increases in mortality rates that will result in substantial reorganization of their structure and carbon storage.

  15. Echocardiographic Assessment of Estimated Right Atrial Pressure and Size Predicts Mortality in Pulmonary Arterial Hypertension

    PubMed Central

    Austin, Christopher; Alassas, Khadija; Burger, Charles; Safford, Robert; Pagan, Ricardo; Duello, Katherine; Kumar, Preetham; Zeiger, Tonya

    2015-01-01

    BACKGROUND: Elevated mean right atrial pressure (RAP) measured by cardiac catheterization is an independent risk factor for mortality. Prior studies have demonstrated a modest correlation with invasive and noninvasive echocardiographic RAP, but the prognostic impact of estimated right atrial pressure (eRAP) has not been previously evaluated in patients with pulmonary arterial hypertension (PAH). METHODS: A retrospective analysis of 121 consecutive patients with PAH based on right-sided heart catheterization and echocardiography was performed. The eRAP was calculated by inferior vena cava diameter and collapse using 2005 and 2010 American Society of Echocardiography (ASE) definitions. Accuracy and correlation of eRAP to RAP was assessed. Kaplan-Meier survival analysis by eRAP, right atrial area, and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry) risk criteria as well as univariate and multivariate analysis of echocardiographic findings was performed. RESULTS: Elevation of eRAP was associated with decreased survival time compared with lower eRAP (P < .001, relative risk = 7.94 for eRAP > 15 mm Hg vs eRAP ≤ 5 mm Hg). Univariate analysis of echocardiographic parameters including eRAP > 15 mm Hg, right atrial area > 18 cm2, presence of pericardial effusion, right ventricular fractional area change < 35%, and at least moderate tricuspid regurgitation was predictive of poor survival. However, multivariate analysis revealed that eRAP > 15 mm Hg was the only echocardiographic risk factor that was predictive of mortality (hazard ratio = 2.28, P = .037). CONCLUSIONS: Elevation of eRAP by echocardiography at baseline assessment was strongly associated with increased risk of death or transplant in patients with PAH. This measurement may represent an important prognostic component in the comprehensive echocardiographic evaluation of PAH. PMID:25211049

  16. Anhedonia Predicts Major Adverse Cardiac Events and Mortality in Patients 1 Year After Acute Coronary Syndrome

    PubMed Central

    Davidson, Karina W.; Burg, Matthew M.; Kronish, Ian M.; Shimbo, Daichi; Dettenborn, Lucia; Mehran, Roxana; Vorchheimer, David; Clemow, Lynn; Schwartz, Joseph E.; Lespérance, Francois; Rieckmann, Nina

    2010-01-01

    Context Depression is a consistent predictor of recurrent events and mortality in ACS patients, but it has 2 core diagnostic criteria with distinct biological correlates—depressed mood and anhedonia. Objective To determine if depressed mood and/or anhedonia (loss of pleasure or interest) predict 1-year medical outcomes for patients with Acute Coronary Syndrome (ACS). Design Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within one week of admission, patients underwent a structured psychiatric interview to assess clinically impairing depressed mood, anhedonia, and major depressive episode (MDE); also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity. Setting Coronary care and cardiac care step-down units of 3 university hospitals in New York and Connecticut. Participants Consecutive sample of 453 ACS patients (aged 25–93 years; 42% women). Main Outcomes Measures All-cause mortality (ACM) and documented major adverse cardiac events (MACE; myocardial infarction, hospitalization for unstable angina, or urgent revascularization) were actively surveyed for 1 year after admission. Results There were 67 events (16 deaths and 51 MACE; 14.8%). 108 (24%) and 77 (17%) patients with anhedonia and depressed mood, respectively. After controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16–2.14; P<.01) and MDE (adjusted hazard ratio, 1.48; 95% confidence interval, 1.07–2.04; P=.02) were significant predictors of combined MACE/ACM, but depressed mood was not. Anhedonia continued to significantly predict outcomes controlling for MDE diagnosis and depressive symptom severity, each of which were no longer significant. Conclusions Anhedonia identifies risk for MACE/ACM beyond that of established medical prognostic indicators

  17. Post-Exercise Heart Rate Recovery Independently Predicts Mortality Risk in Patients with Chronic Heart Failure

    PubMed Central

    Tang, Yi-Da; Dewland, Thomas A.; Wencker, Detlef; Katz, Stuart D.

    2009-01-01

    Background Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcomes in populations with and without documented coronary heart disease. Decreased parasympathetic activity is thought to be associated with disease progression in chronic heart failure (HF), but an independent association between post-exercise HRR and clinical outcomes among such patients has not been established. Methods and Results We measured HRR (calculated as the difference between heart rate at peak exercise and after 1 minute of recovery) in 202 HF subjects and recorded 17 mortality and 15 urgent transplantation outcome events over 624 days of follow-up. Reduced post-exercise HRR was independently associated with increased event risk after adjusting for other exercise-derived variables (peak oxygen uptake and VE/VCO2 slope), for the Heart Failure Survival Score (adjusted HR 1.09 for one beat/min reduction, 95% CI 1.05-1.13, p<0.0001) and the Seattle Heart Failure Model score (adjusted HR 1.08 for one beat/min reduction, 95% CI 1.05-1.12, p<0.0001). Subjects in the lowest risk tertile based on post-exercise HRR (≥30 beats/min) had low risk of events irrespective of the risk predicted by the survival scores. In a subgroup of 15 subjects, reduced post-exercise HRR was associated with increased serum markers of inflammation (interleukin-6 r=0.58, p=0.024, high sensitivity C-reactive protein r=0.66, p=0.007). Conclusions Post-exercise HRR predicts mortality risk in patients with HF and provides prognostic information independent of previously described survival models. Pathophysiologic links between autonomic function and inflammation may be mediators of this association. PMID:19944361

  18. Comparison of acid-base models for prediction of hospital mortality after trauma.

    PubMed

    Kaplan, Lewis J; Kellum, John A

    2008-06-01

    This study determines whether mortality after major trauma is predicted by the strong ion gap (SIG) and whether recent refinements in the calculation of SIG improve its predictive value. The design was an observational, retrospective review of trauma patients admitted on a single service at a level 1 facility. The setting was an urban level 1 trauma facility. An unselected cohort of patients sustaining blunt and/or penetrating injury requiring intensive care unit care was chosen. There were no interventions. Age, injury mechanism, survival, arterial blood gases, hemoglobin, albumin, electrolytes, lactate, standard base deficit, strong ion difference (SID), buffer base, and SIG were analyzed. Patients were grouped into survivors and nonsurvivors according to in-hospital survival truncated to 28 days. Multivariate logistic regression was used for further analysis of univariate predictors of mortality, and receiver-operator characteristic curves were generated for mortality. Both nonsurvivors (n = 26) and survivors (n = 52) were similar with respect to age (31.9 +/- 11.5 vs. 33.5 +/- 11.6 years) and injury mechanism (blunt 61% vs. 58%) Nonsurvivors were more likely to have multicavity injury (54% vs. 26%; P < 0.01) than survivors. Nonsurvivor and survivor pH (7.36 +/- 0.15 vs. 7.38 +/- 0.09), HCO3(-) (20.4 +/- 3.9 vs. 21.7 +/- 2.5 mEq/L; P = 0.11), albumin (3.6 +/- 0.7 vs. 3.5 +/- 0.5 gm/dL), lactate (2.9 +/- 2.5 vs. 2.3 +/- 1.3 mmol/L; P = 0.24), and phosphate (3.1 +/- 0.9 vs. 3.4 +/- 0.8 mEq/L; P = 0.26) were similar. Forty-two percent of nonsurvivors had normal lactate levels, whereas 33% of survivors had lactic acidosis. However, the apparent SID (41.0 +/- 4.2 vs. 36.7 +/- 5.5 mEq/L; P < 0.001), effective SID (32.7 +/- 4.2 vs. 35.4 +/- 4.9 mEq/L; P = 0.019), and SIG (8.3 +/- 4.4 vs. 1.3 +/- 3.6 mEq/L; P < 0.001) were all significantly different between nonsurvivors and survivors. Only one (2%) survivor had an SIG greater than 5 mEq/L, and only two (7

  19. Heart rate multiscale entropy at three hours predicts hospital mortality in 3,154 trauma patients.

    PubMed

    Norris, Patrick R; Anderson, Steven M; Jenkins, Judith M; Williams, Anna E; Morris, John A

    2008-07-01

    Complexity is a measure of variation and randomness potentially indicating improvement or deterioration in critically ill patients. Previously, we have shown integer heart rate (HR) multiscale entropy (MSE), an indicator of complexity, predicts death based on long duration (12 h) and dense (>or=0.4 Hz) windows of HR data. However, such restrictions reduce the use of MSE in the clinical setting. We hypothesized MSE predicts death using HR data of shorter duration and lower density. During the initial 24 h of intensive care unit stay, 3,154 patients had at least 3 h of continuous integer HR sampled. The first continuous window of 3, 6, 9, and 12 h was selected for each patient regardless of density, and an open-source MSE algorithm was applied (M. Costa, www.physionet.org; m = 2; r = 0.15). Risk of death based on MSE, alone and with covariates (age, sex, injury severity score), was assessed using randomly selected logistic regression in half of the cases. Area under the receiver operator curve (AUC) was computed in the other half in subgroups having various durations and densities of HR data. At days 2.3 (median) and 4.9 (mean), 441 patients (14%) died. Multiscale entropy stratified patients by mortality and was an independent predictor of death using 3 h or more of data. Multiscale entropy alone (AUC = 0.66 - 0.71) predicted death comparably to covariates alone (AUC = 0.72). We conclude: (1) Heart rate MSE within hours of admission predicts death occurring days later. (2) Multiscale entropy is robust to variation in bedside data duration and density occurring in a working intensive care unit. (3) Complexity may be a new clinical biomarker of outcome. PMID:18323736

  20. Predictive Value of Carotid Distensibility Coefficient for Cardiovascular Diseases and All-Cause Mortality: A Meta-Analysis

    PubMed Central

    Yuan, Chuang; Wang, Jing; Ying, Michael

    2016-01-01

    Aims The aim of the present study is to determine the pooled predictive value of carotid distensibility coefficient (DC) for cardiovascular (CV) diseases and all-cause mortality. Background Arterial stiffness is associated with future CV events. Aortic pulse wave velocity is a commonly used predictor for CV diseases and all-cause mortality; however, its assessment requires specific devices and is not always applicable in all patients. In addition to the aortic artery, the carotid artery is also susceptible to atherosclerosis, and is highly accessible because of the surficial property. Thus, carotid DC, which indicates the intrinsic local stiffness of the carotid artery and may be determined using ultrasound and magnetic resonance imaging, is of interest for the prediction. However, the role of carotid DC in the prediction of CV diseases and all-cause mortality has not been thoroughly characterized, and the pooled predictive value of carotid DC remains unclear. Methods A meta-analysis, which included 11 longitudinal studies with 20361 subjects, was performed. Results Carotid DC significantly predicted future total CV events, CV mortality and all-cause mortality. The pooled risk ratios (RRs) of CV events, CV mortality and all-cause mortality were 1.19 (1.06–1.35, 95%CI, 9 studies with 18993 subjects), 1.09 (1.01–1.18, 95%CI, 2 studies with 2550 subjects) and 1.65 (1.15–2.37, 95%CI, 6 studies with 3619 subjects), respectively, for the subjects who had the lowest quartile of DC compared with their counterparts who had higher quartiles. For CV events, CV mortality and all-cause mortality, a decrease in DC of 1 SD increased the risk by 13%, 6% and 41% respectively, whereas a decrease in DC of 1 unit increased the risk by 3%, 1% and 6% respectively. Conclusions Carotid DC is a significant predictor of future CV diseases and all-cause mortality, which may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CV diseases

  1. Mortality Prediction in ICUs Using A Novel Time-Slicing Cox Regression Method

    PubMed Central

    Wang, Yuan; Chen, Wenlin; Heard, Kevin; Kollef, Marin H.; Bailey, Thomas C.; Cui, Zhicheng; He, Yujie; Lu, Chenyang; Chen, Yixin

    2015-01-01

    Over the last few decades, machine learning and data mining have been increasingly used for clinical prediction in ICUs. However, there is still a huge gap in making full use of the time-series data generated from ICUs. Aiming at filling this gap, we propose a novel approach entitled Time Slicing Cox regression (TS-Cox), which extends the classical Cox regression into a classification method on multi-dimensional time-series. Unlike traditional classifiers such as logistic regression and support vector machines, our model not only incorporates the discriminative features derived from the time-series, but also naturally exploits the temporal orders of these features based on a Cox-like function. Empirical evaluation on MIMIC-II database demonstrates the efficacy of the TS-Cox model. Our TS-Cox model outperforms all other baseline models by a good margin in terms of AUC_PR, sensitivity and PPV, which indicates that TS-Cox may be a promising tool for mortality prediction in ICUs. PMID:26958269

  2. Early Standard Electroencephalogram Abnormalities Predict Mortality in Septic Intensive Care Unit Patients

    PubMed Central

    Azabou, Eric; Magalhaes, Eric; Braconnier, Antoine; Yahiaoui, Lyria; Moneger, Guy; Heming, Nicholas; Annane, Djillali; Mantz, Jean; Chrétien, Fabrice; Durand, Marie-Christine; Lofaso, Frédéric; Porcher, Raphael; Sharshar, Tarek

    2015-01-01

    Introduction Sepsis is associated with increased mortality, delirium and long-term cognitive impairment in intensive care unit (ICU) patients. Electroencephalogram (EEG) abnormalities occurring at the acute stage of sepsis may correlate with severity of brain dysfunction. Predictive value of early standard EEG abnormalities for mortality in ICU septic patients remains to be assessed. Methods In this prospective, single center, observational study, standard EEG was performed, analyzed and classified according to both Synek and Young EEG scales, in consecutive patients acutely admitted in ICU for sepsis. Delirium, coma and the level of sedation were assessed at the time of EEG recording; and duration of sedation, occurrence of in-ICU delirium or death were assessed during follow-up. Adjusted analyses were carried out using multiple logistic regression. Results One hundred ten patients were included, mean age 63.8 (±18.1) years, median SAPS-II score 38 (29–55). At the time of EEG recording, 46 patients (42%) were sedated and 22 (20%) suffered from delirium. Overall, 54 patients (49%) developed delirium, of which 32 (29%) in the days after EEG recording. 23 (21%) patients died in the ICU. Absence of EEG reactivity was observed in 27 patients (25%), periodic discharges (PDs) in 21 (19%) and electrographic seizures (ESZ) in 17 (15%). ICU mortality was independently associated with a delta-predominant background (OR: 3.36; 95% CI [1.08 to 10.4]), absence of EEG reactivity (OR: 4.44; 95% CI [1.37–14.3], PDs (OR: 3.24; 95% CI [1.03 to 10.2]), Synek grade ≥ 3 (OR: 5.35; 95% CI [1.66–17.2]) and Young grade > 1 (OR: 3.44; 95% CI [1.09–10.8]) after adjustment to Simplified Acute Physiology Score (SAPS-II) at admission and level of sedation. Delirium at the time of EEG was associated with ESZ in non-sedated patients (32% vs 10%, p = 0.037); with Synek grade ≥ 3 (36% vs 7%, p< 0.05) and Young grade > 1 (36% vs 17%, p< 0.001). Occurrence of delirium in the days after

  3. Infant Maltreatment-Related Mortality in Alaska: Correcting the Count and Using Birth Certificates to Predict Mortality

    ERIC Educational Resources Information Center

    Parrish, Jared W.; Gessner, Bradford D.

    2010-01-01

    Objectives: To accurately count the number of infant maltreatment-related fatalities and to use information from the birth certificates to predict infant maltreatment-related deaths. Methods: A population-based retrospective cohort study of infants born in Alaska for the years 1992 through 2005 was conducted. Risk factor variables were ascertained…

  4. Developing a simple preinterventional score to predict hospital mortality in adult venovenous extracorporeal membrane oxygenation: A pilot study.

    PubMed

    Cheng, Yu-Ting; Wu, Meng-Yu; Chang, Yu-Sheng; Huang, Chung-Chi; Lin, Pyng-Jing

    2016-07-01

    Despite gaining popularity, venovenous extracorporeal membrane oxygenation (VV-ECMO) remains a controversial therapy for acute respiratory failure (ARF) in adult patients due to its equivocal survival benefits. The study was aimed at identifying the preinterventional prognostic predictors of hospital mortality in adult VV-ECMO patients and developing a practical mortality prediction score to facilitate clinical decision-making.This retrospective study included 116 adult patients who received VV-ECMO for severe ARF in a tertiary referral center, from 2007 to 2015. The definition of severe ARF was PaO2/ FiO2 ratio < 70 mm Hg under advanced mechanical ventilation (MV). Preinterventional variables including demographic characteristics, ventilatory parameters, and severity of organ dysfunction were collected for analysis. The prognostic predictors of hospital mortality were generated with multivariate logistic regression and transformed into a scoring system. The discriminative power on hospital mortality of the scoring system was presented as the area under receiver operating characteristic curve (AUROC).The overall hospital mortality rate was 47% (n = 54). Pre-ECMO MV day > 4 (OR: 4.71; 95% CI: 1.98-11.23; P < 0.001), pre-ECMO sequential organ failure assessment (SOFA) score >9 (OR: 3.16; 95% CI: 1.36-7.36; P = 0.01), and immunocompromised status (OR: 2.91; 95% CI: 1.07-7.89; P = 0.04) were independent predictors of hospital mortality of adult VV-ECMO. A mortality prediction score comprising of the 3 binary predictors was developed and named VV-ECMO mortality score. The total score was estimated as follows: VV-ECMO mortality score = 2 × (Pre-ECMO MV day > 4) + 1 × (Pre-ECMO SOFA score >9) + 1 × (immunocompromised status). The AUROC of VV-ECMO mortality score was 0.76 (95% CI: 0.67-0.85; P < 0.001). The corresponding hospital mortality rates to VV-ECMO mortality scores were 18% (Score 0), 35% (Score 1), 56% (Score 2), 75% (Score

  5. Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis

    PubMed Central

    Xie, Jun; Huang, Wei; Xu, Biao

    2015-01-01

    Background A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. Methods PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. Results Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. Conclusions Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected. PMID:26284799

  6. Sympathetic activity–associated periodic repolarization dynamics predict mortality following myocardial infarction

    PubMed Central

    Rizas, Konstantinos D.; Nieminen, Tuomo; Barthel, Petra; Zürn, Christine S.; Kähönen, Mika; Viik, Jari; Lehtimäki, Terho; Nikus, Kjell; Eick, Christian; Greiner, Tim O.; Wendel, Hans P.; Seizer, Peter; Schreieck, Jürgen; Gawaz, Meinrad; Schmidt, Georg; Bauer, Axel

    2014-01-01

    Background. Enhanced sympathetic activity at the ventricular myocardium can destabilize repolarization, increasing the risk of death. Sympathetic activity is known to cluster in low-frequency bursts; therefore, we hypothesized that sympathetic activity induces periodic low-frequency changes of repolarization. We developed a technique to assess the sympathetic effect on repolarization and identified periodic components in the low-frequency spectral range (≤0.1 Hz), which we termed periodic repolarization dynamics (PRD). Methods. We investigated the physiological properties of PRD in multiple experimental studies, including a swine model of steady-state ventilation (n = 7) and human studies involving fixed atrial pacing (n = 10), passive head-up tilt testing (n = 11), low-intensity exercise testing (n = 11), and beta blockade (n = 10). We tested the prognostic power of PRD in 908 survivors of acute myocardial infarction (MI). Finally, we tested the predictive values of PRD and T-wave alternans (TWA) in 2,965 patients undergoing clinically indicated exercise testing. Results. PRD was not related to underlying respiratory activity (P < 0.001) or heart-rate variability (P = 0.002). Furthermore, PRD was enhanced by activation of the sympathetic nervous system, and pharmacological blockade of sympathetic nervous system activity suppressed PRD (P ≤ 0.005 for both). Increased PRD was the strongest single risk predictor of 5-year total mortality (hazard ratio 4.75, 95% CI 2.94–7.66; P < 0.001) after acute MI. In patients undergoing exercise testing, the predictive value of PRD was strong and complementary to that of TWA. Conclusion. We have described and identified low-frequency rhythmic modulations of repolarization that are associated with sympathetic activity. Increased PRD can be used as a predictor of mortality in survivors of acute MI and patients undergoing exercise testing. Trial registration. ClinicalTrials.gov NCT00196274. Funding. This study was funded by

  7. Abdominal aortic calcification is not superior over other vascular calcification in predicting mortality in hemodialysis patients: a retrospective observational study

    PubMed Central

    2013-01-01

    Background KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend that a lateral abdominal radiograph should be performed to assess vascular calcification (VC) in dialysis patients. However, abdominal aortic calcification is a prevalent finding, and it remains unclear whether other anatomical areas of VC can predict mortality more accurately. Methods A total of 217 maintenance hemodialysis patients were enrolled at the Sichuan Provincial People’s Hospital between July 2010 and March 2011. Radiographs of the abdomen, pelvis and hands were evaluated by a radiologist to evaluate the presence of VC. The correlation between different areas of VC and all-cause or cardiovascular mortality was analyzed using univariate and multivariate models. Results The prevalence of VC was 70.0% (152 patients), and most had abdominal aortic calcification (90.1%). During 26 ± 7 months of follow-up, 37 patients died. The VC score was independently associated with patient mortality. VC observed on abdominal radiographs (abdominal aortic calcification) was associated with all-cause mortality in models adjusted for cardiovascular risk factors (HR, 4.69; 95%CI, 1.60-13.69) and dialysis factors (HR, 3.38; 95%CI, 1.18-9.69). VC in the pelvis or hands was associated with all-cause mortality in the model adjusted for dialysis factors. When three combinations of VC in different radiographs were included in models, the presence of abdominal VC was only significantly associated with all-cause mortality in the integrated model. VC in the abdomen and pelvis was associated with all-cause mortality in the model adjusted for cardiovascular factors and the integrated model, but neither was significantly associated with cardiovascular mortality. VC in all radiographs was significantly associated with a more than 6-fold risk of all-cause mortality and a more than 5-fold risk of cardiovascular mortality compared to patients without VC. Conclusions VC in different arteries as shown on

  8. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia.

    PubMed

    Araujo, Ana Carla Pereira de; Santos, Bruno F de Oliveira; Calasans, Flavia Ricci; Pinto, Ibraim M Francisco; Oliveira, Daniel Pio de; Melo, Luiza Dantas; Andrade, Stephanie Macedo; Tavares, Irlaneide da Silva; Sousa, Antonio Carlos Sobral; Oliveira, Joselina Luzia Menezes

    2014-11-01

    Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1) or positive (G2) for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016). The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022) and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.Fundamento: Estudos têm demonstrado a acurácia diagnóstica e o valor prognóstico da ecocardiografia com estresse f

  9. The Heartmate Risk Score Predicts Morbidity and Mortality in Unselected LVAD Recipients and Risk Stratifies INTERMACS Class 1 Patients

    PubMed Central

    Adamo, Luigi; Nassif, Michael; Tibrewala, Anjan; Novak, Eric; Vader, Justin; Silvestry, Scott C.; Itoh, Akinobu; Ewald, Gregory A.; Mann, Douglas L.; LaRue, Shane J.

    2016-01-01

    Objectives Evaluation of the Heartmate Risk Score and of its potential benefits in clinical practice. Background The Heartmate Risk Score (HMRS) has been shown to correlate with mortality in the cohort of patients enrolled in the Heartmate II trials but its validity in unselected, “real world” populations remains unclear. Methods We identified a cohort of 269 consecutive patients who received a Heartmate II left ventricular assist device at our institution between June 2005 and June 2013. 90-day and two year mortality rates as well as frequency of several morbid events were compared by retrospectively assigned HMRS category groups. The analysis was repeated within the subgroup of INTERMACS class 1 patients. Results Receiver Operating Curve (ROC) analysis showed that the HMRS correlated with 90-day mortality with an AUC of 0.70. Stratification in low, mid and high HMRS groups identified patients with increasing hazard of 90-day mortality, increasing long term mortality, increasing rate of GI bleeding events and increasing median number of days spent in the hospital in the first year post implant. Within INTERMACS class 1 patients, those in the highest HMRS group were found to have a relative risk of 90-day mortality 5.7 times higher than those in the lowest HMRS group (39.1% vs 6.9%, p=0.029). Conclusions HMRS is a valid clinical tool to stratify risk of morbidity and mortality after implant of Heartmate II devices in unselected patients and can be used to predict short term mortality risk in INTERMACS class 1 patients. PMID:25770410

  10. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

    PubMed Central

    2014-01-01

    Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better

  11. Factors Predicting Mortality in Midlife Adults with and without Down Syndrome Living with Family

    ERIC Educational Resources Information Center

    Esbensen, A. J.; Seltzer, M. M.; Greenberg, J. S.

    2007-01-01

    Background: Little is known about the mortality of individuals with Down syndrome who have lived at home with their families throughout their lives. The current study evaluates the predictors, causes and patterns of mortality among co-residing individuals in midlife with Down syndrome as compared with co-residing individuals with ID owing to other…

  12. Multivariate prediction of total and cardiovascular mortality in an obese Polynesian population.

    PubMed

    Crews, D E

    1989-08-01

    The effects of body weight and blood pressure on the risk of total mortality and mortality from cardiovascular diseases (CVD) were examined in a prospective sample of 5,866 adult residents of American Samoa, a Polynesian population noted for exhibiting high levels of obesity. Data collected during 1975-76 were linked to mortality records from 1976 through 1981. In logistic regression models which did not include blood pressure, percent of desirable weight was an important risk factor for mortality from CVD, but it was not an important risk factor when diastolic blood pressure was included in the model. Percent of desirable weight was not related to mortality from all causes combined in either Samoan men or women. Age and diastolic blood pressure were predictors of total and CVD mortality in men and women. These results, in an obese population, suggest that body weight and obesity are not independently related to excess mortality in the very obese, although they may associate with high blood pressure. These results also suggest that relations between physiological characteristics and mortality may vary with cultural, genetic, or other factors not examined in this study. PMID:2751036

  13. Do pre-hospital anaesthesiologists reliably predict mortality using the NACA severity score? A retrospective cohort study

    PubMed Central

    RAATINIEMI, L; MIKKELSEN, K; FREDRIKSEN, K; WISBORG, T

    2013-01-01

    Introduction The National Advisory Committee on Aeronautics' (NACA) severity score is widely used in pre-hospital emergency medicine to grade the severity of illness or trauma in patient groups but is scarcely validated. The aim of this study was to assess the score's ability to predict mortality and need for advanced in-hospital interventions in a cohort from one anaesthesiologist-manned helicopter service in Northern Norway. Methods All missions completed by one helicopter service during January 1999 to December 2009 were reviewed. One thousand eight hundred forty-one patients were assessed by the NACA score. Pre-hospital and in-hospital interventions were collected from patient records. The relationship between NACA score and the outcome measures was assessed using receiver operating characteristic (ROC) curves. Results A total of 1533 patients were included in the analysis; uninjured and dead victims were excluded per protocol. Overall mortality rate of the patients with NACA score 1–6 was 5.2%. Trauma patients with NACA score 1–6 had overall mortality rate of 1.9% (12/625) and non-trauma patients 7.4% (67/908). The NACA score's ability to predict mortality was assessed by using ROC area under curve (AUC) and was 0.86 for all, 0.82 for non-trauma and 0.98 for trauma patients. The NACA score's ability to predict a need for respiratory therapy within 24 h revealed an AUC of 0.90 for all patients combined. Conclusion The NACA score had good discrimination for predicting mortality and need for respiratory therapy. It is thus useful as a tool to measure overall severity of the patient population in this kind of emergency medicine system. PMID:24134443

  14. The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis

    PubMed Central

    Alves, Arnaud; Panis, Yves; Mantion, Georges; Slim, Karem; Kwiatkowski, Fabrice; Vicaut, Eric

    2007-01-01

    Objective: The aim of the present prospective study was to validate externally a 4-item predictive score of mortality after colorectal surgery (the AFC score) by testing its generalizability on a new population. Summary Background Data: We have recently reported, in a French prospective multicenter study, that age older than 70 years, neurologic comorbidity, underweight (body weight loss >10% in <6 months), and emergency surgery significantly increased postoperative mortality after resection for cancer or diverticulitis. Patients and Methods: From June to September 2004, 1049 consecutive patients (548 men and 499 women) with a mean age of 67 ± 14 years, undergoing open or laparoscopic colorectal resection, were prospectively included. The AFC score was validated in this population. We assessed also the predictive value of other scores, such as the “Glasgow” score and the ASA score. To express and compare the predictive value of the different scores, a receiver operating characteristic curve was calculated. Results: Postoperative mortality rate was 4.6%. Variables already identified as predictors of mortality and used in the AFC score were also found to be associated with a high odds ratio in this study: emergency surgery, body weight loss >10%, neurologic comorbidity, and age older than 70 years in a multivariate logistic model. The validity of the AFC score in this population was found very high based both on the Hosmer-Lemeshow goodness of fit test (P = 0.37) and on the area under the ROC curve (0.89). We also found that discriminatory capacity was higher than other currently used risk scoring systems such as the Glasgow or ASA score. Conclusion: The present prospective study validated the AFC score as a pertinent predictive score of postoperative mortality after colorectal surgery. Because it is based on only 4 risk factors, the AFC score can be used in daily practice. PMID:17592296

  15. Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery.

    PubMed

    Kim, Kwang-Il; Park, Kay-Hyun; Koo, Kyung-Hoi; Han, Ho-Seong; Kim, Cheol-Ho

    2013-01-01

    The proportion of elderly patients who undergo surgery has rapidly increased; however, clinical indicators predicting outcomes are limited. Our aim was to evaluate the significance of comprehensive geriatric assessment (CGA) in elderly patients undergoing elective surgery. We studied 141 consecutive elderly patients (age: 78.0±6.5 years old, male: 41.1%) who were referred to our geriatric department for surgical risk evaluation. CGA was performed to evaluate physical health, functional status, psychological health, and social support. The primary composite outcome of this study was in-hospital death or post-discharge institutionalization. In-hospital adverse events, such as delirium, pressure ulcers, pneumonia, and urinary tract infections, were also evaluated. The associations between CGA and in-hospital adverse events, in-hospital death, and post-discharge institutionalization were investigated. There were 32 adverse outcomes (6 in-hospital deaths and 26 post-discharge institutionalizations). Compared with the patients who were discharged to their homes, patients with adverse outcomes were characterized by poor nutritional status and prior strokes. However, there was no significant difference in surgical risk or anesthesia type. The CGA results showed that patients with adverse outcomes were associated with functional dependency and poor nutrition. The cumulative number of impairments in the CGA domain was significantly associated with adverse outcomes, in-hospital events, and prolonged hospital stays. In multiple logistic regression analysis, cumulative impairment in CGA was independently associated with surgical outcomes in elderly patients undergoing elective surgery. Preoperative CGA can identify elderly patients at greater risk for mortality, post-discharge institutionalization, adverse in-hospital events, and prolonged length of hospital stay. PMID:23246499

  16. Spiritual Peace Predicts 5-Year Mortality in Congestive Heart Failure Patients

    PubMed Central

    Park, Crystal L.; George, Login; Aldwin, Carolyn M.; Choun, Soyoung; Suresh, D. P.; Bliss, Deborah

    2015-01-01

    Objective Spirituality is favorably related to depression, quality of life, hospitalizations, and other important outcomes in congestive heart failure (CHF) patients but has not been examined as a predictor of mortality risk in this population. Given the well-known difficulties in managing CHF, we hypothesized that spirituality would be associated with lower mortality risk, controlling for baseline demographics, functional status, health behaviors, and religiousness. Method Participants were 191 CHF patients (64% male; Mage = 68.6 years, SD = 10.1) who completed a baseline survey and were then followed for five years. Results Nearly one third of the sample (32%) died during the study period. Controlling for demographics and health status, smoking more than doubled the risk of mortality, while alcohol consumption was associated with slightly lower risk of mortality. Importantly, adherence to healthy lifestyle recommendations was associated with halved mortality risk. While both religion and spirituality were associated with better health behaviors at baseline in bivariate analyses, a proportional hazard model showed that only spirituality was significantly associated with reduced mortality risk (by 20%), controlling for demographics, health status, and health behaviors. Conclusions Experiencing spiritual peace, along with adherence to a healthy lifestyle, were better predictors of mortality risk in this sample of CHF patients than were physical health indicators such as functional status and comorbidity. Future research might profitably examine the efficacy of attending to spiritual issues along with standard lifestyle interventions. PMID:26414488

  17. Predictive Factors of Hospital Mortality Due to Myocardial Infarction: A Multilevel Analysis of Iran's National Data

    PubMed Central

    Ahmadi, Ali; Soori, Hamid; Mehrabi, Yadollah; Etemad, Koorosh; Sajjadi, Homeira; Sadeghi, Mehraban

    2015-01-01

    Background: Regarding failure to establish the statistical presuppositions for analysis of the data by conventional approaches, hierarchical structure of the data as well as the effect of higher-level variables, this study was conducted to determine the factors independently associated with hospital mortality due to myocardial infarction (MI) in Iran using a multilevel analysis. Methods: This study was a national, hospital-based, and cross-sectional study. In this study, the data of 20750 new MI patients between April, 2012 and March, 2013 in Iran were used. The hospital mortality due to MI was considered as the dependent variable. The demographic data, clinical and behavioral risk factors at the individual level and environmental data were gathered. Multilevel logistic regression models with Stata software were used to analyze the data. Results: Within 1-year of study, the frequency (%) of hospital mortality within 30 days of admission was derived 2511 (12.1%) patients. The adjusted odds ratio (OR) of mortality with (95% confidence interval [CI]) was derived 2.07 (95% CI: 1.5–2.8) for right bundle branch block, 1.5 (95% CI: 1.3–1.7) for ST-segment elevation MI, 1.3 (95% CI: 1.1–1.4) for female gender, and 1.2 (95% CI: 1.1–1.3) for humidity, all of which were considered as risk factors of mortality. But, OR of mortality was 0.7 for precipitation (95% CI: 0.7–0.8) and 0.5 for angioplasty (95% CI: 0.4–0.6) were considered as protective factors of mortality. Conclusions: Individual risk factors had independent effects on the hospital mortality due to MI. Variables in the province level had no significant effect on the outcome of MI. Increasing access and quality to treatment could reduce the mortality due to MI. PMID:26730342

  18. The Low Fall as a Surrogate Marker of Frailty Predicts Long-Term Mortality in Older Trauma Patients

    PubMed Central

    Wong, Ting Hway; Nguyen, Hai V.; Chiu, Ming Terk; Chow, Khuan Yew; Ong, Marcus Eng Hock; Lim, Gek Hsiang; Nadkarni, Nivedita Vikas; Bautista, Dianne Carrol Tan; Cheng, Jolene Yu Xuan; Loo, Lynette Mee Ann; Seow, Dennis Chuen Chai

    2015-01-01

    Background Frailty is associated with adverse outcomes including disability, mortality and risk of falls. Trauma registries capture a broad range of injuries. However, frail patients who fall comprise a large proportion of the injuries occurring in ageing populations and are likely to have different outcomes compared to non-frail injured patients. The effect of frail fallers on mortality is under-explored but potentially significant. Currently, many trauma registries define low falls as less than three metres, a height that is likely to include non-frailty falls. We hypothesized that the low fall from less than 0.5 metres, including same-level falls, is a surrogate marker of frailty and predicts long-term mortality in older trauma patients. Methods Using data from the Singapore National Trauma Registry, 2011–2013, matched till September 2014 to the death registry, we analysed adults aged over 45 admitted via the emergency department in public hospitals sustaining blunt injuries with an injury severity score (ISS) of 9 or more, excluding isolated hip fractures from same-level falls in the over 65. Patients injured by a low fall were compared to patients injured by high fall and other blunt mechanisms. Logistic regression was used to analyze 12-month mortality, controlling for mechanism of injury, ISS, revised trauma score (RTS), co-morbidities, gender, age and age-gender interaction. Different low fall height definitions, adjusting for injury regions, and analyzing the entire adult cohort were used in sensitivity analyses and did not change our findings. Results Of the 8111 adults in our cohort, patients who suffered low falls were more likely to die of causes unrelated to their injuries (p<0.001), compared to other blunt trauma and higher fall heights. They were at higher risk of 12-month mortality (OR 1.75, 95% CI 1.18–2.58, p = 0.005), independent of ISS, RTS, age, gender, age-gender interaction and co-morbidities. Falls that were higher than 0.5m did not

  19. Inclusion of ‘ICU-Day’ in a Logistic Scoring System Improves Mortality Prediction in Cardiac Surgery

    PubMed Central

    Doerr, Fabian; Heldwein, Matthias B.; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M.; Wahlers, Thorsten; Hekmat, Khosro

    2015-01-01

    Background Prolonged intensive care unit (ICU) stay is a predictor of mortality. The length of ICU stay has never been considered as a variable in an additive scoring system. How could this variable be integrated into a scoring system? Does this integration improve mortality prediction? Material/Methods The ‘modified CArdiac SUrgery Score’ (CASUS) was generated by implementing the length of stay as a new variable to the ‘additive CASUS’. The ‘logistic CASUS’ already considers this variable. We defined outcome as ICU mortality and statistically compared the three CASUS models. Discrimination, comparison of receiver operating characteristic curves (DeLong’s method), and calibration (observed/expected ratio) were analyzed on days 1–13. Results Between 2007 and 2010, we included 5207 cardiac surgery patients in this prospective study. The mean age was 67.2±10.9 years. The mean length of ICU stay was 4.6±7.0 days and ICU mortality was 5.9%. All scores had good discrimination, with a mean area under the curve of 0.883 for the additive and modified, and 0.895 for the ‘logistic CASUS’. DeLong analysis showed superiority in favor of the logistic model as from day 5. The calibration of the logistic model was good. We identified overestimation (days 1–5) and accurate (days 6–9) calibration for the additive and ‘modified CASUS’. The ‘modified CASUS’ remained accurate but the ‘additive CASUS’ tended to underestimate the risk of mortality (days 10–13). Conclusions The integration of length of ICU stay as a variable improves mortality prediction significantly. An ‘ICU-day’ variable should be included into a logistic but not an additive model. PMID:26137928

  20. Usefulness of Fragmented QRS Complex to Predict Arrhythmic Events and Cardiovascular Mortality in Patients With Noncompaction Cardiomyopathy.

    PubMed

    Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Canpolat, Ugur; Cay, Serkan; Topaloglu, Serkan; Temizhan, Ahmet; Aydogdu, Sinan

    2016-05-01

    We aimed to evaluate the prevalence and prognostic role of fragmented QRS complex (fQRS) in predicting arrhythmic events and cardiovascular mortality in patients with noncompaction cardiomyopathy (NCC). A total of 88 patients (64.8% men, mean age 38.6 ± 17.7 years) with the diagnosis of NCC were enrolled. Median follow-up time was 42.4 months. The fQRS was defined as the presence of ≥1 additional R wave (R') or notch on the R/S waves in ≥2 contiguous leads representing anterior (V1 to V5), inferior (II, III, and aVF), or lateral (I, aVL, and V6) myocardial segments. Compared to patients without fQRS group, patients with fQRS (fQRS (+) group) showed higher rates for total arrhythmic events, ventricular tachycardia, bradyarrhythmia requiring pacemaker, sudden cardiac death, cardiovascular mortality, and all-cause mortality. The cut-off point of ≥3 leads for the fQRS was the optimal point discriminating an arrhythmic event and cardiovascular mortality. In Kaplan-Meier survival analysis, total arrhythmic events and cardiovascular mortality occurred more frequently in the fQRS (+) group. In multivariate Cox proportional hazard regression analysis, after adjusting for other confounding factors, the presence of fQRS were found to be as an independent predictor of arrhythmic events (hazard ratio 3.850, 95% CI 1.062 to 9.947, p = 0.002) and cardiovascular mortality (hazard ratio 2.719, 95% CI 1.494 to 9.262, p = 0.005). In conclusion, the presence of fQRS complex, as a simple and feasible electrocardiographic marker, seems to be a novel predictor of arrhythmic events and cardiovascular mortality in patients with NCC. This simple parameter may be used in identifying patients at high risk for arrhythmic events and so individualization of specific therapies can be applied. PMID:26979479

  1. Height loss starting in middle age predicts increased mortality in the elderly.

    PubMed

    Masunari, Naomi; Fujiwara, Saeko; Kasagi, Fumiyoshi; Takahashi, Ikuno; Yamada, Michiko; Nakamura, Toshitaka

    2012-01-01

    The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age-stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline--including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases--were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all-cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow-up period. Participants were followed for 20,787 person-years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all-cause mortality among the study participants (HR = 1.76, 95% CI 1.31 to 2.38, p = 0.0002), after adjustment was made for sex, attained age, atomic-bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR = 3.35, 95% CI 1.63 to 6.86, p = 0.0010), as well as respiratory-disease death (HR = 2.52, 95% CI 1.25 to 5.22, p = 0.0130), but not cancer death. Continuous HL also was associated with all-cause mortality and CHD- or stroke-caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age

  2. Usefulness of a single-item measure of depression to predict mortality: the GAZEL prospective cohort study

    PubMed Central

    Lefèvre, Thomas; Singh-Manoux, Archana; Stringhini, Silvia; Dugravot, Aline; Lemogne, Cédric; Consoli, Silla M.; Goldberg, Marcel; Zins, Marie

    2012-01-01

    Background: It remains unknown whether short measures of depression perform as well as long measures in predicting adverse outcomes such as mortality. The present study aims to examine the predictive value of a single-item measure of depression for mortality. Methods: A total of 14 185 participants of the GAZEL cohort completed the 20-item Center-for-Epidemiologic-Studies-Depression (CES-D) scale in 1996. One of these items (I felt depressed) was used as a single-item measure of depression. All-cause mortality data were available until 30 September 2009, a mean follow-up period of 12.7 years with a total of 650 deaths. Results: In Cox regression model adjusted for baseline socio-demographic characteristics, a one-unit increase in the single-item score (range 0–3) was associated with a 25% higher risk of all-cause mortality (95% CI: 13–37%, P < 0.001). Further adjustment for health-related behaviours and physical chronic diseases reduced this risk by 36% and 8%, respectively. After adjustment for all these variables, every one-unit increase in the single-item score predicted a 15% increased risk of death (95% CI: 5–27%, P < 0.01). There is also an evidence of a dose–reponse relationship between reponse scores on the single-item measure of depression and mortality. Conclusion: This study shows that a single-item measure of depression is associated with an increased risk of death. Given its simplicity and ease of administration, a very simple single-item measure of depression might be useful for identifying middle-aged adults at risk for elevated depressive symptoms in large epidemiological studies and clinical settings. PMID:21840893

  3. Childhood-Onset Disease Predicts Mortality in an Adult Cohort of Patients with Systemic Lupus Erythematosus

    PubMed Central

    Hersh, Aimee O.; Trupin, Laura; Yazdany, Jinoos; Panopalis, Peter; Julian, Laura; Katz, Patricia; Criswell, Lindsey A.; Yelin, Edward

    2013-01-01

    Objective To examine childhood-onset disease as a predictor of mortality in a cohort of adult patients with systemic lupus erythematosus (SLE). Methods Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 957 adult subjects with SLE that includes 98 subjects with childhood-onset SLE. Baseline and follow-up data were obtained via telephone interviews conducted between 2002-2007. The number of deaths during 5 years of follow-up was determined and standardized mortality ratios (SMRs) for the cohort, and across age groups, were calculated. Kaplan-Meier life table analysis was used to compare mortality rates between childhood (defined as SLE diagnosis <18 years) and adult-onset SLE. Multivariate Cox proportional hazard models were used to determine predictors of mortality. Results During the median follow-up period of 48 months, 72 deaths (7.5% of subjects) occurred, including 9 (12.5%) among those with childhood-onset SLE. The overall SMR was 2.5 (CI 2.0-3.2). In Kaplan-Meier survival analysis, after adjusting for age, childhood-onset subjects were at increased risk for mortality throughout the follow-up period (p<0.0001). In a multivariate model adjusting for age, disease duration and other covariates, childhood-onset SLE was independently associated with an increased mortality risk (hazard ratio [HR]: 3.1; 95% confidence interval [CI]: 1.3-7.3), as was low socioeconomic status measured by education (HR: 1.9; 95% CI 1.1-3.2) and end stage renal disease (HR: 2.1; 95% CI 1.1-4.0). Conclusion Childhood-onset SLE was a strong predictor of mortality in this cohort. Interventions are needed to prevent early mortality in this population. PMID:20235215

  4. Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients.

    PubMed

    Dubljanin-Raspopović, Emilija; Markovic Denić, Ljiljana; Marinković, Jelena; Grajić, Mirko; Tomanovic Vujadinović, Sanja; Bumbaširević, Marko

    2012-01-01

    Hip fractures remain one of the most devastating injuries in the elderly. Early prediction of outcome following hip fracture potentially results in more efficient health care. The aims of this study were to explore predictors of ambulation status at hospital discharge in patients ≥65 years of age operated on for fracture of the hip, and to investigate the impact of ambulation status at hospital discharge on 1-year mortality after hip fracture. We studied 344 patients who underwent surgery for hip fracture during a 12 month period. Multivariate regression analysis was used to explore predictive factors for ambulatory status at discharge, and 1-year mortality adjusted on important baseline variables. Cumulative 1-year mortality was significantly lower for patients in the ambulatory group when compared to patients in the non-ambulatory group. Patients who were older, had severe cognitive impairment, lower functional level before injury, and in whom postoperative delirium and pressure ulcers occurred had a higher chance of not recovering their gait ability at hospital discharge, and being dead 1 year after hip fracture. Inability to walk at hospital discharge and presence of delirium are independent predictors of 1-year mortality. Every effort should be made to assure early mobilisation after hip fracture surgery, and prevention, prompt recognition and treatment of postoperative complications is important in order to facilitate better short-and long-term outcome. PMID:23233176

  5. Mortality prediction in patients with severe septic shock: a pilot study using a target metabolomics approach.

    PubMed

    Ferrario, Manuela; Cambiaghi, Alice; Brunelli, Laura; Giordano, Silvia; Caironi, Pietro; Guatteri, Luca; Raimondi, Ferdinando; Gattinoni, Luciano; Latini, Roberto; Masson, Serge; Ristagno, Giuseppe; Pastorelli, Roberta

    2016-01-01

    Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis study (ALBIOS, NCT00707122). Our purpose was to evaluate the changes of circulating metabolites in relation to mortality as a pilot study to be extended in a larger cohort. Patients were analyzed according to their 28-days and 90-days mortality. Metabolites were measured using a targeted mass spectrometry-based quantitative metabolomic approach that included acylcarnitines, aminoacids, biogenic amines, glycerophospholipids, sphingolipids, and sugars. Data-mining techniques were applied to evaluate the association of metabolites with mortality. Low unsaturated long-chain phosphatidylcholines and lysophosphatidylcholines species were associated with long-term survival (90-days) together with circulating kynurenine. Moreover, a decrease of these glycerophospholipids was associated to the event at 28-days and 90-days in combination with clinical variables such as cardiovascular SOFA score (28-day mortality model) or renal replacement therapy (90-day mortality model). Early changes in the plasma levels of both lipid species and kynurenine associated with mortality have potential implications for early intervention and discovering new target therapy. PMID:26847922

  6. Use of Life Course Work–Family Profiles to Predict Mortality Risk Among US Women

    PubMed Central

    Guevara, Ivan Mejía; Glymour, M. Maria; Berkman, Lisa F.

    2015-01-01

    Objectives. We examined relationships between US women’s exposure to midlife work–family demands and subsequent mortality risk. Methods. We used data from women born 1935 to 1956 in the Health and Retirement Study to calculate employment, marital, and parenthood statuses for each age between 16 and 50 years. We used sequence analysis to identify 7 prototypical work–family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work–family sequences, with adjustment for covariates and potentially explanatory later-life factors. Results. Married women staying home with children briefly before reentering the workforce had the lowest mortality rates. In comparison, after adjustment for age, race/ethnicity, and education, HRs for mortality were 2.14 (95% confidence interval [CI] = 1.58, 2.90) among single nonworking mothers, 1.48 (95% CI = 1.06, 1.98) among single working mothers, and 1.36 (95% CI = 1.02, 1.80) among married nonworking mothers. Adjustment for later-life behavioral and economic factors partially attenuated risks. Conclusions. Sequence analysis is a promising exposure assessment tool for life course research. This method permitted identification of certain lifetime work–family profiles associated with mortality risk before age 75 years. PMID:25713976

  7. Mortality prediction in patients with severe septic shock: a pilot study using a target metabolomics approach

    PubMed Central

    Ferrario, Manuela; Cambiaghi, Alice; Brunelli, Laura; Giordano, Silvia; Caironi, Pietro; Guatteri, Luca; Raimondi, Ferdinando; Gattinoni, Luciano; Latini, Roberto; Masson, Serge; Ristagno, Giuseppe; Pastorelli, Roberta

    2016-01-01

    Septic shock remains a major problem in Intensive Care Unit, with high lethality and high-risk second lines treatments. In this preliminary retrospective investigation we examined plasma metabolome and clinical features in a subset of 20 patients with severe septic shock (SOFA score >8), enrolled in the multicenter Albumin Italian Outcome Sepsis study (ALBIOS, NCT00707122). Our purpose was to evaluate the changes of circulating metabolites in relation to mortality as a pilot study to be extended in a larger cohort. Patients were analyzed according to their 28-days and 90-days mortality. Metabolites were measured using a targeted mass spectrometry-based quantitative metabolomic approach that included acylcarnitines, aminoacids, biogenic amines, glycerophospholipids, sphingolipids, and sugars. Data-mining techniques were applied to evaluate the association of metabolites with mortality. Low unsaturated long-chain phosphatidylcholines and lysophosphatidylcholines species were associated with long-term survival (90-days) together with circulating kynurenine. Moreover, a decrease of these glycerophospholipids was associated to the event at 28-days and 90-days in combination with clinical variables such as cardiovascular SOFA score (28-day mortality model) or renal replacement therapy (90-day mortality model). Early changes in the plasma levels of both lipid species and kynurenine associated with mortality have potential implications for early intervention and discovering new target therapy. PMID:26847922

  8. Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS)

    PubMed Central

    Pye, Stephen R.; Vanderschueren, Dirk; Boonen, Steven; Gielen, Evelien; Adams, Judith E.; Ward, Kate A.; Lee, David M.; Bartfai, György; Casanueva, Felipe F.; Finn, Joseph D.; Forti, Gianni; Giwercman, Aleksander; Han, Thang S.; Huhtaniemi, Ilpo T.; Kula, Krzysztof; Lean, Michael E.; Pendleton, Neil; Punab, Margus; Wu, Frederick C.; O'Neill, Terence W.

    2015-01-01

    Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 40–79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic—SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0–1.4). Compared with those in higher quintiles (2nd–5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1–2.3 and SOS: HR = 1.6; 95% CI = 1.2–2.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men. PMID:26162912

  9. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study.

    PubMed

    Lassale, Camille; Gunter, Marc J; Romaguera, Dora; Peelen, Linda M; Van der Schouw, Yvonne T; Beulens, Joline W J; Freisling, Heinz; Muller, David C; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K; Katzke, Verena A; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H Bas; Boer, Jolanda M A; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G M; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72-0.79) to 0.88 (0.84-0.92) for all-cause, 0.76 (0.69-0.83) to 0.84 (0.76-0.92) for CVD and 0.78 (0.73-0.83) to 0.91 (0.85-0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  10. Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study

    PubMed Central

    Lassale, Camille; Gunter, Marc J.; Romaguera, Dora; Peelen, Linda M.; Van der Schouw, Yvonne T.; Beulens, Joline W. J.; Freisling, Heinz; Muller, David C.; Ferrari, Pietro; Huybrechts, Inge; Fagherazzi, Guy; Boutron-Ruault, Marie-Christine; Affret, Aurélie; Overvad, Kim; Dahm, Christina C.; Olsen, Anja; Roswall, Nina; Tsilidis, Konstantinos K.; Katzke, Verena A.; Kühn, Tilman; Buijsse, Brian; Quirós, José-Ramón; Sánchez-Cantalejo, Emilio; Etxezarreta, Nerea; Huerta, José María; Barricarte, Aurelio; Bonet, Catalina; Khaw, Kay-Tee; Key, Timothy J.; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Palli, Domenico; Agnoli, Claudia; Tumino, Rosario; Fasanelli, Francesca; Panico, Salvatore; Bueno-de-Mesquita, H. Bas; Boer, Jolanda M. A.; Sonestedt, Emily; Nilsson, Lena Maria; Renström, Frida; Weiderpass, Elisabete; Skeie, Guri; Lund, Eiliv; Moons, Karel G. M.; Riboli, Elio; Tzoulaki, Ioanna

    2016-01-01

    Scores of overall diet quality have received increasing attention in relation to disease aetiology; however, their value in risk prediction has been little examined. The objective was to assess and compare the association and predictive performance of 10 diet quality scores on 10-year risk of all-cause, CVD and cancer mortality in 451,256 healthy participants to the European Prospective Investigation into Cancer and Nutrition, followed-up for a median of 12.8y. All dietary scores studied showed significant inverse associations with all outcomes. The range of HRs (95% CI) in the top vs. lowest quartile of dietary scores in a composite model including non-invasive factors (age, sex, smoking, body mass index, education, physical activity and study centre) was 0.75 (0.72–0.79) to 0.88 (0.84–0.92) for all-cause, 0.76 (0.69–0.83) to 0.84 (0.76–0.92) for CVD and 0.78 (0.73–0.83) to 0.91 (0.85–0.97) for cancer mortality. Models with dietary scores alone showed low discrimination, but composite models also including age, sex and other non-invasive factors showed good discrimination and calibration, which varied little between different diet scores examined. Mean C-statistic of full models was 0.73, 0.80 and 0.71 for all-cause, CVD and cancer mortality. Dietary scores have poor predictive performance for 10-year mortality risk when used in isolation but display good predictive ability in combination with other non-invasive common risk factors. PMID:27409582

  11. The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma*

    PubMed Central

    2010-01-01

    Background There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest during intensive care unit stay. We intended to develop a sequential trauma score (STS) that allows prognosis at several early stages based on the information that is available at a particular time. Study design In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006), we identified the most relevant prognostic factors from the patients basic data (P), prehospital phase (A), early (B1), and late (B2) trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated. Results A total of 2,354 patients with complete data were identified. From the patients basic data (P), logistic regression showed that age was a significant predictor of survival (AUCmodel p, area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUCmodel A = 0.76; AUCmodel P + A = 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUCmodel B1 = 0.78; AUCmodel P +A + B1 = 0.85). Multivariate analysis of the late trauma room phase (B2) detected cardiac massage, abbreviated injury score (AIS) of the head ≥ 3, the maximum AIS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUCmodel B2 = 0.84; AUCfinal model P + A + B1 + B2 = 0.90). The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma score is

  12. ECG low QRS voltage and wide QRS complex predictive of centenarian 360-day mortality.

    PubMed

    Szewieczek, Jan; Gąsior, Zbigniew; Duława, Jan; Francuz, Tomasz; Legierska, Katarzyna; Batko-Szwaczka, Agnieszka; Hornik, Beata; Janusz-Jenczeń, Magdalena; Włodarczyk, Iwona; Wilczyński, Krzysztof

    2016-04-01

    We examined the electrocardiographic (ECG) findings of centenarians and associated them with >360-day survival. Physical and functional assessment, resting electrocardiogram and laboratory tests were performed on 86 study participants 101.9 ± 1.2 years old (mean ± SD) (70 women, 16 men) and followed for at least 360 days. Centenarian ECGs were assessed for left ventricular hypertrophy (LVH) according to the Romhilt-Estes score, Sokolow-Lyon criteria and Cornell voltage criteria which were positive for 12.8, 6.98, and 10.5 % of participants, respectively. Fifty-two study participants (60 %) survived ≥360 days. Multivariate logistic regression analysis revealed a negative relationship between 360-day survival and the following: R II <0.45 mV adjusted for CRP (odds ratio (OR) = 0.108, 95 % confidence interval (CI) = 0.034-0.341, P < .001), R aVF < 0.35 mV adjusted for CRP (OR = 0.151, 95 % CI = 0.039-0.584, P < .006), Sokolow-Lyon voltage <1.45 mV adjusted for CRP (OR = 0.178, 95 % CI = 0.064-0.492, P = .001), QRS ≥90 ms adjusted for CRP (OR = 0.375, 95 % CI = 0.144-0.975, P = .044), and Romhilt-Estes score ≥5 points adjusted for sex and Barthel Index (OR = 0.459, 95 % CI = 0.212-0.993, P = .048) in single variable ECG models. QRS voltage correlated positively with systolic and pulse pressure, serum vitamin B12 level, sodium, calcium, phosphorous, TIMP-1, and eGFR. QRS voltage correlated negatively with BMI, WHR, serum leptin, IL-6, TNF-α, and PAI-1 levels. QRS complex duration correlated positively with CRP; QTc correlated positively with TNF-α. Results suggest that Romhilt-Estes LVH criteria scores ≥5 points, low ECG QRS voltages (Sokolow-Lyon voltage <1.45 mV), and QRS complexes ≥90 ms are predictive of centenarian 360-day mortality. PMID:27039197

  13. A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort

    PubMed Central

    Kim, Bae Keun; Kim, Yu-Mi; Lee, Youngu; Lim, Young-Hyo

    2013-01-01

    An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (<0% drop in systolic BP; n=107), and others included dippers and non-dippers (≥0% drop, n=294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P=0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea. PMID:24133351

  14. Role of sTREM-1 in predicting mortality of infection: a systematic review and meta-analysis

    PubMed Central

    Su, Longxiang; Liu, Dan; Chai, Wenzhao; Liu, Dawei; Long, Yun

    2016-01-01

    Objectives Several studies have investigated the prognostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in patients with infection. However, the result was controversial. Thus, the purpose of the present meta-analysis was to determine the prognostic value of the sTREM-1 level in predicting mortality at the initial stage of infection. Methods The literature was searched in the PubMed, EMBASE, Web of Knowledge and Cochrane databases. A 2×2 contingency table was constructed on the basis of mortality and sTREM-1 levels in patients with infection. 2 authors independently judged study eligibility and extracted data. The prognostic value of sTREM-1 in predicting mortality was determined using a bivariate meta-analysis model. Q-test and I2 index were used to test heterogeneity. Results 9 studies were selected from 803 studies. An elevated sTREM-1 level was associated with a higher risk of death in infection, with pooled risk ratio (RR) was 2.54 (95% CI 1.77 to 3.65) using a random-effects model (I2=53.8%). With the bivariate random-effects regression model, the pooled sensitivity and specificity of sTREM-1 to predict mortality in infection were 0.75 (95% CI 0.61 to 0.86) and 0.66 (95% CI 0.54 to 0.75), respectively. The diagnostic OR was 6 (95% CI 3 to 10). The overall area under the summary receiver operator characteristic (SROC) curve was 0.76 (95% CI 0.72 to 0.79). When we calculated the sepsis subgroup, the pooled RR was 2.98 (95% CI 2.19 to 4.40). The pooled sensitivity and specificity were 0.74 (95% CI 0.58 to 0.85) and 0.72 (95% CI 0.62 to 0.80), respectively. The overall area under the SROC curve was 0.78 (95% CI 0.74 to 0.81). Conclusions Elevated sTREM-1 concentrations had a moderate prognostic significance in assessing the mortality of infection in adult patients. However, sTREM-1 alone is insufficient to predict mortality as a biomarker. PMID:27178971

  15. The Value of BISAP Score for Predicting Mortality and Severity in Acute Pancreatitis: A Systematic Review and Meta-Analysis

    PubMed Central

    Ma, Cheng-En

    2015-01-01

    Purpose The Bedside Index for Severity in Acute Pancreatitis (BISAP) score has been developed to identify patients at high risk for mortality or severe disease early during the course of acute pancreatitis. We aimed to undertake a meta-analysis to quantify the accuracy of BISAP score for predicting mortality and severe acute pancreatitis (SAP). Materials and Methods We searched the databases of Pubmed, Embase, and the Cochrane Library to identify studies using the BISAP score to predict mortality or SAP. The pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) were calculated from each study and were compared with the traditional scoring systems. Results Twelve cohorts from 10 studies were included. The overall sensitivity of a BISAP score of ≥3 for mortality was 56% (95% CI, 53%-60%), with a specificity of 91% (95% CI, 90%-91%). The positive and negative likelihood ratios were 5.65 (95% CI, 4.23-7.55) and 0.48 (95% CI, 0.41-0.56), respectively. Regarding the outcome of SAP, the pooled sensitivity was 51% (43%-60%), and the specificity was 91% (89%-92%). The pooled positive and negative likelihood ratios were 7.23 (4.21-12.42) and 0.56 (0.44-0.71), respectively. Compared with BISAP score, the Ranson criteria and APACHEⅡscore showed higher sensitivity and lower specificity for both outcomes. Conclusions The BISAP score was a reliable tool to identify AP patients at high risk for unfavorable outcomes. Compared with the Ranson criteria and APACHEⅡscore, BISAP score outperformed in specificity, but having a suboptimal sensitivity for mortality as well as SAP. PMID:26091293

  16. A predictive risk model for electroshock-induced mortality of the endangered Cape Fear shiner

    USGS Publications Warehouse

    Holliman, F.M.; Reynolds, J.B.; Kwak, T.J.

    2003-01-01

    We evaluated the effects of a single electroshock on injury and mortality of hatchery-reared Cape Fear shiners Notropis mekistocholas (N = 517), an endangered cyprinid. Groups of 18-22 Cape Fear shiners were exposed to DC, 120-Hz pulsed DC (PDC), or 60-Hz PDC at voltage gradients of 1.1, 1.9, or 2.7 V/cm for 3 s. Mortality occurred only among fish exposed to 120-Hz PDC (25%) and DC (38%) applied at 2.7 V/cm. Because no mortality occurred in Cape Fear shiners exposed to 60-Hz PDC, this waveform was selected for further study of electroshock duration (3, 6, 12, 24, or 48 s) and voltage gradient (0.9, 1.6, or 2.3 V/cm). Most fish electroshocked in the experiments were immobilized (ceased swimming motion). No physical injury was detected by necropsy or radiography in any fish. Electroshock-induced mortality of Cape Fear shiners showed a strong multivariable relationship to voltage gradient, electroshock duration, and fish length. Fish subjected to 60-Hz PDC at 0.9 or 1.6 V/cm for 6 s experienced low mortality (<10%). Our results demonstrate that Cape Fear shiners can be immobilized by 60-Hz PDC electroshock without injury or significant risk of mortality. We propose that electrofishing may be safely used to sample similar small cyprinids, imperiled or otherwise, when electrofishers select an appropriate waveform (DC pulsed at 60-Hz or less) and use it judiciously (minimal exposure at, or below, the immobilization threshold).

  17. Factors Predicting and Reducing Mortality in Patients with Invasive Staphylococcus aureus Disease in a Developing Country

    PubMed Central

    Nickerson, Emma K.; Wuthiekanun, Vanaporn; Wongsuvan, Gumphol; Limmathurosakul, Direk; Srisamang, Pramot; Mahavanakul, Weera; Thaipadungpanit, Janjira; Shah, Krupal R.; Arayawichanont, Arkhom; Amornchai, Premjit; Thanwisai, Aunchalee; Day, Nicholas P.; Peacock, Sharon J.

    2009-01-01

    Background Invasive Staphylococcus aureus infection is increasingly recognised as an important cause of serious sepsis across the developing world, with mortality rates higher than those in the developed world. The factors determining mortality in developing countries have not been identified. Methods A prospective, observational study of invasive S. aureus disease was conducted at a provincial hospital in northeast Thailand over a 1-year period. All-cause and S. aureus-attributable mortality rates were determined, and the relationship was assessed between death and patient characteristics, clinical presentations, antibiotic therapy and resistance, drainage of pus and carriage of genes encoding Panton-Valentine Leukocidin (PVL). Principal Findings A total of 270 patients with invasive S. aureus infection were recruited. The range of clinical manifestations was broad and comparable to that described in developed countries. All-cause and S. aureus-attributable mortality rates were 26% and 20%, respectively. Early antibiotic therapy and drainage of pus were associated with a survival advantage (both p<0.001) on univariate analysis. Patients infected by a PVL gene-positive isolate (122/248 tested, 49%) had a strong survival advantage compared with patients infected by a PVL gene-negative isolate (all-cause mortality 11% versus 39% respectively, p<0.001). Multiple logistic regression analysis using all variables significant on univariate analysis revealed that age, underlying cardiac disease and respiratory infection were risk factors for all-cause and S. aureus-attributable mortality, while one or more abscesses as the presenting clinical feature and procedures for infectious source control were associated with survival. Conclusions Drainage of pus and timely antibiotic therapy are key to the successful management of S. aureus infection in the developing world. Defining the presence of genes encoding PVL provides no practical bedside information and draws attention

  18. Plasma biomarkers of acute GVHD and nonrelapse mortality: predictive value of measurements before GVHD onset and treatment.

    PubMed

    McDonald, George B; Tabellini, Laura; Storer, Barry E; Lawler, Richard L; Martin, Paul J; Hansen, John A

    2015-07-01

    We identified plasma biomarkers that presaged outcomes in patients with gastrointestinal graft-versus-host disease (GVHD) by measuring 23 biomarkers in samples collected before initiation of treatment. Six analytes with the greatest accuracy in predicting grade 3-4 GVHD in the first cohort (74 patients) were then tested in a second cohort (76 patients). The same 6 analytes were also tested in samples collected at day 14 ± 3 from 167 patients free of GVHD at the time. Logistic regression and calculation of an area under a receiver-operating characteristic (ROC) curve for each analyte were used to determine associations with outcome. Best models in the GVHD onset and landmark analyses were determined by forward selection. In samples from the second cohort, collected a median of 4 days before start of treatment, levels of TIM3, IL6, and sTNFR1 had utility in predicting development of peak grade 3-4 GVHD (area under ROC curve, 0.88). Plasma ST2 and sTNFR1 predicted nonrelapse mortality within 1 year after transplantation (area under ROC curve, 0.90). In the landmark analysis, plasma TIM3 predicted subsequent grade 3-4 GVHD (area under ROC curve, 0.76). We conclude that plasma levels of TIM3, sTNFR1, ST2, and IL6 are informative in predicting more severe GVHD and nonrelapse mortality. PMID:25987657

  19. Physical Activity Related to Depression and Predicted Mortality Risk: Results from the Americans' Changing Lives Study

    ERIC Educational Resources Information Center

    Lee, Pai-Lin; Lan, William; Lee, Charles C.-L.

    2012-01-01

    This study examined the association between three types of physical activities (PA) and depression, and the relationship between PA and later mortality. Previous studies rarely assessed these associations in one single study in randomly selected population samples. Few studies have assessed these relations by adjusting the covariate of…

  20. Dietary patterns predict mortality in a national cohort: the National Health Interview Surveys, 1987 and 1992.

    PubMed

    Kant, Ashima K; Graubard, Barry I; Schatzkin, Arthur

    2004-07-01

    We examined the association of mortality and dietary patterns using data from the National Health Interview Surveys of 1987 and 1992 (n = 10,084), aged >/=45 y at baseline (with 2287 deaths due to all causes over 5.9 median years of follow-up). The approximately 60-item FFQ administered at baseline was examined for mentions of foods and dietary behaviors recommended in current dietary guidance (fruits, vegetables, lean poultry and alternates, low-fat dairy, and whole grains), and the resulting patterns were expressed as follows: 1) a Recommended Foods and Behavior Score (RFBS), 2) factor scores from factor analysis, and 3) clusters from cluster analysis. The multivariate-adjusted relative risk (RR) of mortality for each of the 3 types of dietary patterns was examined using Cox proportional hazards regression analysis. In men, RR of all-cause mortality was 0.72 (95% CI: 0.56, 0.92, P for trend < 0.001) for RFBS, and 0.74 (95% CI: 0.57, 0.95, P for trend = 0.002) for the fruit-vegetable-whole grain factor score when comparing extreme quartiles. Membership in 1 of the 4 clusters also was associated with lower risk in men (RR = 0.82, 95% CI: 0.66, 1.01). For women, the RFBS was a modest inverse predictor of mortality after multivariate adjustment (RR = 0.80, 95% CI: 0.61, 1.04, P for trend = 0.04), but estimates for factor and cluster patterns were attenuated. The population-attributable fraction due to diet was 0.16 in men and 0.09 in women. Dietary patterns characterized by compliance with prevailing food-based dietary guidance were associated with a lower risk of all-cause mortality. PMID:15226471

  1. Abnormal Heart Rate Turbulence Predicts Cardiac Mortality in Low, Intermediate and High Risk Older Adults

    PubMed Central

    Stein, Phyllis K.; Barzilay, Joshua I.

    2011-01-01

    Introduction We examined whether heart rate turbulence (HRT) adds to traditional risk factors for cardiac mortality in older adults at low, intermediate and high risk. Methods and Results N=1298, age ≥65 years, with 24-hour Holter recordings were studied. HRT, which quantifies heart rate response to ventricular premature contractions, was categorized as: both turbulence onset (TO) and turbulence slope (TS) normal; TO abnormal; TS abnormal; or both abnormal. Independent risks for cardiac mortality associated with HRT or, for comparison, elevated C-reactive protein (CRP) (>3.0 mg/L), were calculated using Cox regression analysis adjusted for traditional cardiovascular disease risk factors and stratified by the presence of no, isolated subclinical (i.e., intermediate risk) or clinical CVD. Having both TS and TO abnormal compared to both normal was associated with cardiac mortality in the low risk group [HR 7.9, 95% CI 2.8–22.5, (p<0.001)]. In the high and intermediate risk groups, abnormal TS and TO ([HR 2.2, 95% CI 1.5–4.0, p=0.016] and [HR 2.7, 95% CI 1.2–5.9, p=0.012]), respectively, were also significantly associated with cardiac mortality. In contrast, elevated CRP was associated with increased cardiac mortality risk only in low risk individuals [HR 2.5, 95% CI 1.3–5.1, p=0.009]. In the low risk group, the c-statistic was 0.706 for the base model, 0.725 for the base model with CRP, and 0.767 for the base model with HRT. Conclusions Abnormal HRT independently adds to risk stratification of low, intermediate and high risk individuals but appears to add especially to the stratification of those considered at low risk. PMID:21134026

  2. Cardiac Infarction Injury Score predicts cardiovascular mortality in apparently healthy men and women.

    PubMed Central

    Dekker, J M; Schouten, E G; Pool, J; Kok, F J

    1994-01-01

    OBJECTIVE--The Cardiac Infarction Injury Score (CIIS) is an electrocardiogram classification system that was developed to identify ischaemic heart disease. As well as being of diagnostic value, the CIIS may also be of prognostic value. DESIGN--The prognostic value of the CIIS for mortality of coronary heart disease and cardiovascular disease was assessed in a 28 year follow up study of 3091 apparently healthy middle aged men and women (Dutch Civil Servants Study). RESULTS--The rates of coronary heart disease and cardiovascular disease mortality during the first 15 years of follow up were significantly higher in men and women with a CIIS of > 10 than in those with a CIIS of < or = 0 (rate ratio of coronary heart disease mortality 2.9 (95% confidence interval 1.5 to 5.8) for men and 5.6 (2.0 to 15.5) for women). Coronary heart disease mortality was also higher in men with a CIIS of 1-10 than in men with CIIS of < or = 0. When individuals with major Minnesota code items were excluded, the associations were weaker and no longer statistically significant. CONCLUSION--These results indicate that a high CIIS is a risk indicator for coronary heart disease mortality in the general population. Classification of electrocardiograms by means of the CIIS seems to be equivalent to classification by a combination of Minnesota code items. Because CIIS coding is simpler and can be performed by computer it may be more efficient than the Minnesota code for classifying cardiac injury in epidemiological studies. PMID:8068467

  3. Predicting One-Year Mortality in Peritoneal Dialysis Patients: An Analysis of the China Peritoneal Dialysis Registry

    PubMed Central

    Cao, Xue-Ying; Zhou, Jian-Hui; Cai, Guang-Yan; Tan, Ni-Na; Huang, Jing; Xie, Xiang-Cheng; Tang, Li; Chen, Xiang-Mei

    2015-01-01

    This study aims to investigate basic clinical features of peritoneal dialysis (PD) patients, their prognostic risk factors, and to establish a prognostic model for predicting their one-year mortality. A national multi-center cohort study was performed. A total of 5,405 new PD cases from China Peritoneal Dialysis Registry in 2012 were enrolled in model group. All these patients had complete baseline data and were followed for one year. Demographic and clinical features of these patients were collected. Cox proportional hazards regression model was used to analyze prognostic risk factors and establish prognostic model. A validation group was established using 1,764 new PD cases between January 1, 2013 and July 1, 2013, and to verify accuracy of prognostic model. Results indicated that model group included 4,453 live PD cases and 371 dead cases. Multivariate survival analysis showed that diabetes mellitus (DM), residual glomerular filtration rate (rGFR), , SBP, Kt/V, high PET type and Alb were independently associated with one-year mortality. Model was statistically significant in both within-group verification and outside-group verification. In conclusion, DM, rGFR, SBP, Kt/V, high PET type and Alb were independent risk factors for short-term mortality in PD patients. Prognostic model established in this study accurately predicted risk of short-term death in PD patients. PMID:26019685

  4. Predictive value of weight loss on mortality of HIV-positive mothers in a prolonged breastfeeding setting.

    PubMed

    Koyanagi, Ai; Humphrey, Jean H; Moulton, Lawrence H; Ntozini, Robert; Mutasa, Kuda; Iliff, Peter; Ruff, Andrea J

    2011-11-01

    HIV-positive lactating women may be at high risk of weight loss due to increased caloric requirements and postpartum physiological weight loss. Ten percent weight loss is associated with a higher risk of mortality in HIV-positive patients and this alone is a criterion for highly active antiretroviral therapy (HAART) initiation where CD4 counts are not available. However, no study has investigated this association in lactating postpartum women. We investigated whether 10% weight loss predicts death in postpartum HIV-positive women. A total of 9207 HIV-negative and 4495 HIV-positive mothers were recruited at delivery. Women were weighed at 6 weeks, 3 months, and every 3 months thereafter for up to 24 months postpartum and data on mortality up to 2 years were collected. The median duration of breastfeeding was longer than 18 months. Among HIV-positive women, the independent predictors of ≥10% weight loss were CD4 cell count, body mass index, and household income. Mortality was up to 7.12 (95% CI 3.47-14.61) times higher in HIV-positive women with ≥10% weight loss than those without weight loss. Ten percent weight loss in postpartum lactating HIV-positive women was significantly predictive of death. Our findings suggest that 10% weight loss is an appropriate criterion for HAART initiation among postpartum breastfeeding women. PMID:21226627

  5. Predicting Short-term Mortality and Long-term Survival of Hospitalized U.S. Patients with Alcoholic Hepatitis

    PubMed Central

    Cuthbert, Jennifer A.; Arslanlar, Sami; Yepuri, Jay; Montrose, Marc; Ahn, Chul W.; Shah, Jessica P.

    2014-01-01

    Background No study has evaluated current scoring systems for their accuracy in predicting short- and long-term outcome of alcoholic hepatitis in a U.S. population. Methods We reviewed electronic records for patients with ALD admitted to Parkland Memorial Hospital between January 2002 and August 2005. Data and outcomes for 148 of 1761 admissions meeting pre-defined criteria were collected. The discriminant function (DF) was revised (INRdf) to account for changes in prothrombin time reagents that could potentially affect identification of risk using the prior DF threshold of > 32. Admission and theoretical peak scores using the Model for End-stage Liver Disease (MELD) were calculated. Analysis models compared 5 different scoring systems. Results INRdf was closely correlated with the old DF (r2 = 0.95). Multivariate analysis of data showed that survival at 28 days was significantly associated with admission values for white blood cell count (p = 0.006), a scoring system using a combination of age, bilirubin, coagulation status and creatinine (p < 0.001) as well as an elevated ammonia result within 2 days of admission (p = 0.006). When peak values for MELD were included, they were the most significant predictor of short-term mortality (p < 0.001) followed by INRdf (p = 0.006 Conclusion On admission, 2 scoring systems that identify a subset of patients with severe alcoholic liver disease are able to predict > 50% mortality at 4 weeks as well as > 80% mortality at 6 months without specific treatment. PMID:24445730

  6. Multi-scale heart rate dynamics detected by phase-rectified signal averaging predicts mortality after acute myocardial infarction

    PubMed Central

    Kisohara, Masaya; Stein, Phyllis K.; Yoshida, Yutaka; Suzuki, Mari; Iizuka, Narushi; Carney, Robert M.; Watkins, Lana L.; Freedland, Kenneth E.; Blumenthal, James A.; Hayano, Junichiro

    2013-01-01

    Aims Acceleration and deceleration capacity (AC and DC) for beat-to-beat short-term heart rate dynamics are powerful predictors of mortality after acute myocardial infarction (AMI). We examined if AC and DC for minute-order long-term heart rate dynamics also have independent predictive value. Methods and results We studied 24-hr Holter electrcardiograms in 708 post-AMI patients who were followed up for up to 30 months thereafter. Acceleration capacity and DC was calculated with the time scales of T (window size defining heart rate) and s (wavelet scale) from 1 to 500 s and compared their prognostic values with conventional measures (ACconv and DCconv) that were calculated with (T,s) = [1,2 (beat)]. During the follow-up, 47 patients died. Both increased ACconv and decreased DCconv predicted mortality (C statistic, 0.792 and 0.797). Concordantly, sharp peaks of C statistics were observed at (T,s) = [2,7 (sec)] for both increased AC and decreased DC (0.762 and 0.768), but there were larger peaks of C statistics at around [30,60 (sec)] for both (0.783 and 0.796). The C statistic was greater for DC than AC at (30,60) (P = 0.0012). Deceleration capacity at (30,60) was a significant predictor even after adjusted for ACconv (P = 0.020) and DCconv (P = 0.028), but the predictive power of AC at (30,60) was no longer significant. Conclusion A decrease in DC for minute-order long-term heart rate dynamics is a strong predictor for post-AMI mortality and the predictive power is independent of ACconv and DCconv for beat-to-beat short-term heart rate dynamics. PMID:23248218

  7. Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs

    PubMed Central

    Lin, Shu-Yu; Lee, Wei-Ju; Chou, Ming-Yueh; Peng, Li-Ning; Chiou, Shu-Ti; Chen, Liang-Kung

    2016-01-01

    Background Frailty Index, defined as an individual’s accumulated proportion of listed health-related deficits, is a well-established metric used to assess the health status of old adults; however, it has not yet been developed in Taiwan, and its local related structure factors remain unclear. The objectives were to construct a Taiwan Frailty Index to predict mortality risk, and to explore the structure of its factors. Methods Analytic data on 1,284 participants aged 53 and older were excerpted from the Social Environment and Biomarkers of Aging Study (2006), in Taiwan. A consensus workgroup of geriatricians selected 159 items according to the standard procedure for creating a Frailty Index. Cox proportional hazard modeling was used to explore the association between the Taiwan Frailty Index and mortality. Exploratory factor analysis was used to identify structure factors and produce a shorter version–the Taiwan Frailty Index Short-Form. Results During an average follow-up of 4.3 ± 0.8 years, 140 (11%) subjects died. Compared to those in the lowest Taiwan Frailty Index tertile (< 0.18), those in the uppermost tertile (> 0.23) had significantly higher risk of death (Hazard ratio: 3.2; 95% CI 1.9–5.4). Thirty-five items of five structure factors identified by exploratory factor analysis, included: physical activities, life satisfaction and financial status, health status, cognitive function, and stresses. Area under the receiver operating characteristic curves (C-statistics) of the Taiwan Frailty Index and its Short-Form were 0.80 and 0.78, respectively, with no statistically significant difference between them. Conclusion Although both the Taiwan Frailty Index and Short-Form were associated with mortality, the Short-Form, which had similar accuracy in predicting mortality as the full Taiwan Frailty Index, would be more expedient in clinical practice and community settings to target frailty screening and intervention. PMID:27537684

  8. Plasma Amino Acid Concentrations Predict Mortality in Patients with End-Stage Liver Disease

    PubMed Central

    Kinny-Köster, Benedict; Bartels, Michael; Becker, Susen; Scholz, Markus; Thiery, Joachim

    2016-01-01

    Background The liver plays a key role in amino acid metabolism. In former studies, a ratio between branched-chain and aromatic amino acids (Fischer’s ratio) revealed associations with hepatic encephalopathy. Furthermore, low concentrations of branched-chain amino acids were linked to sarcopenia in literature. Encephalopathy and sarcopenia are known to dramatically worsen the prognosis. Aim of this study was to investigate a complex panel of plasma amino acids in the context of mortality in patients with end-stage liver disease. Methods 166 patients evaluated for orthotopic liver transplantation were included. 19 amino acids were measured from citrated plasma samples using mass spectrometry. We performed survival analysis for plasma amino acid constellations and examined the relationship to established mortality predictors. Results 33/166 (19.9%) patients died during follow-up. Lower values of valine (p<0.001), Fischer’s ratio (p<0.001) and valine to phenylalanine ratio (p<0.001) and higher values of phenylalanine (p<0.05) and tyrosine (p<0.05) were significantly associated with mortality. When divided in three groups, the tertiles discriminated cumulative survival for valine (p = 0.016), phenylalanine (p = 0.024) and in particular for valine to phenylalanine ratio (p = 0.003) and Fischer’s ratio (p = 0.005). Parameters were also significantly correlated with MELD and MELD-Na score. Conclusions Amino acids in plasma are valuable biomarkers to determine increased risk of mortality in patients with end-stage liver disease. In particular, valine concentrations and constellations composed of branched-chain and aromatic amino acids were strongly associated with prognosis. Due to their pathophysiological importance, the identified amino acids could be used to examine individual dietary recommendations to serve as potential therapeutic targets. PMID:27410482

  9. Development of a metabolites risk score for one-year mortality risk prediction in pancreatic adenocarcinoma patients

    PubMed Central

    Fontana, Andrea; Mazza, Tommaso; Tavano, Francesca; Gioffreda, Domenica; Mattivi, Fulvio; Andriulli, Angelo; Vrhovsek, Urska; Pazienza, Valerio

    2016-01-01

    Purpose Survival among patients with adenocarcinoma pancreatic cancer (PDCA) is highly variable, which ranges from 0% to 20% at 5 years. Such a wide range is due to tumor size and stage, as well other patients' characteristics. We analyzed alterations in the metabolomic profile, of PDCA patients, which are potentially predictive of patient's one-year mortality. Experimental design A targeted metabolomic assay was conducted on serum samples of patients diagnosed with pancreatic cancer. Statistical analyses were performed only for those 27 patients with information on vital status at follow-up and baseline clinical features. Random Forest analysis was performed to identify all metabolites and clinical variables with the best capability to predict patient's mortality risk at one year. Regression coefficients were estimated from multivariable Weibull survival model, which included the most associated metabolites. Such coefficients were used as weights to build a metabolite risk score (MRS) which ranged from 0 (lowest mortality risk) to 1 (highest mortality risk). The stability of these weights were evaluated performing 10,000 bootstrap resamplings. Results MRS was built as a weighted linear combination of the following five metabolites: Valine (HR = 0.62, 95%CI: 0.11–1.71 for each standard deviation (SD) of 98.57), Sphingomyeline C24:1 (HR = 2.66, 95%CI: 1.30–21.09, for each SD of 20.67), Lysine (HR = 0.36, 95%CI: 0.03–0.77, for each SD of 51.73), Tripentadecanoate TG15 (HR = 0.25, 95%CI: 0.01–0.82, for each SD of 2.88) and Symmetric dimethylarginine (HR = 2.24, 95%CI: 1.28–103.08, for each SD of 0.62), achieving a very high discrimination ability (survival c-statistic of 0.855, 95%CI: 0.816–0.894). Such association was still present even after adjusting for the most associated clinical variables (confounders). Conclusions The mass spectrometry-based metabolomic profiling of serum represents a valid tool for discovering novel candidate biomarkers with

  10. Predicting mortality in patients treated differently: updating and external validation of a prediction model for nursing home residents with dementia and lower respiratory infections

    PubMed Central

    Heymans, Martijn W; Mehr, David R; Kruse, Robin L; Lane, Patricia; Kowall, Neil W; Volicer, Ladislav; van der Steen, Jenny T

    2016-01-01

    Objective To evaluate whether a model that was previously developed to predict 14-day mortality for nursing home residents with dementia and lower respiratory tract infection who received antibiotics could be applied to residents who were not treated with antibiotics. Specifically, in this same data set, to update the model using recalibration methods; and subsequently examine the historical, geographical, methodological and spectrum transportability through external validation of the updated model. Design 1 cohort study was used to develop the prediction model, and 4 cohort studies from 2 countries were used for the external validation of the model. Setting Nursing homes in the Netherlands and the USA. Participants 157 untreated residents were included in the development of the model; 239 untreated residents were included in the external validation cohorts. Outcome Model performance was evaluated by assessing discrimination: area under the receiver operating characteristic curves; and calibration: Hosmer and Lemeshow goodness-of-fit statistics and calibration graphs. Further, reclassification tables allowed for a comparison of patient classifications between models. Results The original prediction model applied to the untreated residents, who were sicker, showed excellent discrimination but poor calibration, underestimating mortality. Adjusting the intercept improved calibration. Recalibrating the slope did not substantially improve the performance of the model. Applying the updated model to the other 4 data sets resulted in acceptable discrimination. Calibration was inadequate only in one data set that differed substantially from the other data sets in case-mix. Adjusting the intercept for this population again improved calibration. Conclusions The discriminative performance of the model seems robust for differences between settings. To improve calibration, we recommend adjusting the intercept when applying the model in settings where different mortality rates

  11. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients

    PubMed Central

    Masiá, Mar; Padilla, Sergio; Fernández, Marta; Rodríguez, Carmen; Moreno, Ana; Oteo, Jose A.; Antela, Antonio; Moreno, Santiago; del Amo, Julia; Gutiérrez, Félix

    2016-01-01

    Objective We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients. Methods We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs) and malondialdehyde (MDA) plasma levels in the first blood sample obtained after cohort engagement. Results 54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP), the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23–4.47], P = 0.009). The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI) per 1 log10 increase, 2.05 [0.91–4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI) per 1 log10 increase, 1.39 (1.01–1.91), P = 0.043; and OR (95% CI) per 1 log10 increase, 1.46 (1.07–1.99), P = 0.014, respectively, when adjustment included F2-IsoPs and MDA. Conclusion Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation. PMID:27111769

  12. Artificial Neural Networks for Early Prediction of Mortality in Patients with Non Variceal Upper GI Bleeding (UGIB)

    PubMed Central

    Grossi, Enzo; Marmo, Riccardo; Intraligi, Marco; Buscema, Massimo

    2008-01-01

    Background Mortality for non variceal upper gastrointestinal bleeding (UGIB) is clinically relevant in the first 12–24 hours of the onset of haemorrhage and therefore identification of clinical factors predictive of the risk of death before endoscopic examination may allow for early corrective therapeutic intervention. Aim 1) Identify simple and early clinical variables predictive of the risk of death in patients with non variceal UGIB; 2) assess previsional gain of a predictive model developed with conventional statistics vs. that developed with artificial neural networks (ANNs). Methods and results Analysis was performed on 807 patients with nonvariceal UGIB (527 males, 280 females), as a part of a multicentre Italian study. The mortality was considered “bleeding-related” if occurred within 30 days from the index bleeding episode. A total of 50 independent variables were analysed, 49 of which clinico-anamnestic, all collected prior to endoscopic examination plus the haemoglobin value measured on admission in the emergency department. Death occurred in 42 (5.2%). Conventional statistical techniques (linear discriminant analysis) were compared with ANNs (Twist® system-Semeion) adopting the same result validation protocol with random allocation of the sample in training and testing subsets and subsequent cross-over. ANNs resulted to be significantly more accurate than LDA with an overall accuracy rate near to 90%. Conclusion Artificial neural networks technology is highly promising in the development of accurate diagnostic tools designed to recognize patients at high risk of death for UGIB. PMID:27429551

  13. Usefulness of serum interleukin-18 in predicting cardiovascular mortality in patients with chronic kidney disease – systems and clinical approach

    PubMed Central

    Formanowicz, Dorota; Wanic-Kossowska, Maria; Pawliczak, Elżbieta; Radom, Marcin; Formanowicz, Piotr

    2015-01-01

    The aim of this study was to check if serum interleukin-18 (IL-18) predicts 2-year cardiovascular mortality in patients at various stages of chronic kidney disease (CKD) and history of acute myocardial infarction (AMI) within the previous year. Diabetes mellitus was one of the key factors of exclusion. It was found that an increase in serum concentration of IL-18 above the cut-off point (1584.5 pg/mL) was characterized by 20.63-fold higher risk of cardiovascular deaths among studied patients. IL-18 serum concentration was found to be superior to the well-known cardiovascular risk parameters, like high sensitivity C-reactive protein (hsCRP), carotid intima media thickness (CIMT), glomerular filtration rate, albumins, ferritin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in prognosis of cardiovascular mortality. The best predictive for IL-18 were 4 variables, such as CIMT, NT-proBNP, albumins and hsCRP, as they predicted its concentration at 89.5%. Concluding, IL-18 seems to be important indicator and predictor of cardiovascular death in two-year follow-up among non-diabetic patients suffering from CKD, with history of AMI in the previous year. The importance of IL-18 in the process of atherosclerotic plaque formation has been confirmed by systems analysis based on a formal model expressed in the language of Petri nets theory. PMID:26669254

  14. Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey

    PubMed Central

    2012-01-01

    Background Under-5 mortality is a major public health challenge in developing countries. It is essential to identify determinants of under-five mortality (U5M) childhood mortality because these will assist in formulating appropriate health programmes and policies in order to meet the United Nations MDG goal. The objective of this study was to develop a predictive model and identify maternal, child, family and other risk factors associated U5M in Nigeria. Methods Population-based cross-sectional study which explored 2008 demographic and health survey of Nigeria (NDHS) with multivariable logistic regression. Likelihood Ratio Test, Hosmer-Lemeshow Goodness-of-Fit and Variance Inflation Factor were used to check the fit of the model and the predictive power of the model was assessed with Receiver Operating Curve (ROC curve). Results This study yielded an excellent predictive model which revealed that the likelihood of U5M among the children of mothers that had their first marriage at age 20-24 years and ≥ 25 years declined by 20% and 30% respectively compared to children of those that married before the age of 15 years. Also, the following factors reduced odds of U5M: health seeking behaviour, breastfeeding children for > 18 months, use of contraception, small family size, having one wife, low birth order, normal birth weight, child spacing, living in urban areas, and good sanitation. Conclusions This study has revealed that maternal, child, family and other factors were important risk factors of U5M in Nigeria. This study has identified important risk factors that will assist in formulating policies that will improve child survival. PMID:22373182

  15. Artificial neural network models for predicting 1-year mortality in elderly patients with intertrochanteric fractures in China

    PubMed Central

    Shi, L.; Wang, X.C.; Wang, Y.S.

    2013-01-01

    The mortality rate of older patients with intertrochanteric fractures has been increasing with the aging of populations in China. The purpose of this study was: 1) to develop an artificial neural network (ANN) using clinical information to predict the 1-year mortality of elderly patients with intertrochanteric fractures, and 2) to compare the ANN's predictive ability with that of logistic regression models. The ANN model was tested against actual outcomes of an intertrochanteric femoral fracture database in China. The ANN model was generated with eight clinical inputs and a single output. ANN's performance was compared with a logistic regression model created with the same inputs in terms of accuracy, sensitivity, specificity, and discriminability. The study population was composed of 2150 patients (679 males and 1471 females): 1432 in the training group and 718 new patients in the testing group. The ANN model that had eight neurons in the hidden layer had the highest accuracies among the four ANN models: 92.46 and 85.79% in both training and testing datasets, respectively. The areas under the receiver operating characteristic curves of the automatically selected ANN model for both datasets were 0.901 (95%CI=0.814-0.988) and 0.869 (95%CI=0.748-0.990), higher than the 0.745 (95%CI=0.612-0.879) and 0.728 (95%CI=0.595-0.862) of the logistic regression model. The ANN model can be used for predicting 1-year mortality in elderly patients with intertrochanteric fractures. It outperformed a logistic regression on multiple performance measures when given the same variables. PMID:24270906

  16. Predicting cumulative risk of bovine respiratory disease complex (BRDC) using feedlot arrival data and daily morbidity and mortality counts

    PubMed Central

    Babcock, Abram H.; White, Brad J.; Renter, David G.; Dubnicka, Suzanne R.; Scott, H. Morgan

    2013-01-01

    Although bovine respiratory disease complex (BRDC) is common in post-weaning cattle, BRDC prediction models are seldom analyzed. The objectives of this study were to assess the ability to predict cumulative cohort-level BRDC morbidity using on-arrival risk factors and to evaluate whether or not adding BRDC risk classification and daily BRDC morbidity and mortality data to the models enhanced their predictive ability. Retrospective cohort-level and individual animal health data were used to create mixed negative binomial regression (MNBR) models for predicting cumulative risk of BRDC morbidity. Logistic regression models were used to illustrate that the percentage of correctly (within |5%| of actual) classified cohorts increased across days, but the effect of day was modified by arrival weight, arrival month, and feedlot. Cattle arriving in April had the highest (77%) number of lots correctly classified at arrival and cattle arriving in December had the lowest (28%). Classification accuracy at arrival varied according to initial weight, ranging from 17% (< 182 kg) to 91% (> 409 kg). Predictive accuracy of the models improved from 64% at arrival to 74% at 8 days on feed (DOF) when risk code was known compared to 56% accuracy at arrival and 69% at 8 DOF when risk classification was not known. The results of this study demonstrate how the predictive ability of models can be improved by utilizing more refined data on the prior history of cohorts, thus making these models more useful to operators of commercial feedlots. PMID:23814354

  17. Mortality and functional disability after spontaneous intracranial hemorrhage: the predictive impact of overall admission factors.

    PubMed

    Mansouri, Behnam; Heidari, Kamran; Asadollahi, Shadi; Nazari, Maryam; Assarzadegan, Farhad; Amini, Afshin

    2013-11-01

    To determine the effects of different prognostic factors, including previous antiplatelet therapy, admission data, and radiographic findings on discharge and 3-month neurological condition using modified Rankin scale (mRS) and mortality at 30 days and 3-month follow-up in patients presenting to the emergency department with spontaneous intracranial hemorrhage (sICH). Between January and July 2012, 120 consecutive patients (males 62%, females 38%), who were admitted within 48 h of symptoms onset, were included. We recorded the following data on admission: demographics; functional scores of ICH, Glasgow Coma Scale, and National Institutes of Health Stroke Scale; vital signs; smoking status; use of illicit drug; preadmission antiplatelet treatment; results of laboratory tests (platelet count, serum glucose, sodium and creatinine levels, and prothrombin time); and primary neuroimaging findings [intraventricular hemorrhage (IVH), midline shift, and hydrocephalus]. In multivariate analysis using adjusted model for demographics and prior antiplatelet therapy; functional scores, laboratory results, and diabetes history correlated with mortality during 30 days after the event. Moreover, the parameters on the initial computed tomography scan significantly increased 30-day fatality rate and was correlated with increase in the discharge mRS score of survivors. The odds ratio (OR) and 95% confidence interval (CI) of early mortality associated with IVH presentation was 2.34 (CI 1.76-3.02, p = 0.003). The corresponding ORs in those with midline shift displacement and hydrocephalus were 2.18 (95% CI 2.08-3.80, p = 0.01) and 1.62 (95% CI 1.01-2.63, p = 0.02), respectively. In patients with ICH, prognostic factors, include various clinical parameters and paraclinical findings of admission time. PMID:23543380

  18. Evaluation of Circulating Proteins and Hemodynamics Towards Predicting Mortality in Children with Pulmonary Arterial Hypertension

    PubMed Central

    Wagner, Brandie D.; Takatsuki, Shinichi; Accurso, Frank J.; Ivy, David Dunbar

    2013-01-01

    Background Although many predictors have been evaluated, a set of strong independent prognostic mortality indicators has not been established in children with pediatric pulmonary arterial hypertension (PAH). The aim of this study was to identify a combination of clinical and molecular predictors of survival in PAH. Methods This single-center, retrospective cohort study was performed from children with PAH between 2001 and 2008 at Children's Hospital Colorado. Blood samples from 83 patients (median age of 8.3 years-old) were obtained. We retrospectively analyzed 46 variables, which included 27 circulating proteins, 7 demographic variables and 12 hemodynamic and echocardiographic variables for establishing the best predictors of mortality. A data mining approach was utilized to evaluate predictor variables and to uncover complex data structures while performing variable selection in high dimensional problems. Results Thirteen children (16%) died during follow-up (median; 3.1 years) and survival rates from time of sample collection at 1 year, 3 years and 5 years were 95%, 85% and 79%, respectively. A subset of potentially informative predictors were identified, the top four are listed here in order of importance: Tissue inhibitors of metalloproteinases-1 (TIMP-1), apolipoprotein-AI, RV/LV diastolic dimension ratio and age at diagnosis. In univariate analysis, TIMP-1 and apolipoprotein-AI had significant association with survival time (hazard ratio [95% confidence interval]: 1.25 [1.03, 1.51] and 0.70 [0.54–0.90], respectively). Patients grouped by TIMP-1 and apolipoprotein-AI values had significantly different survival risks (p<0.01). Conclusion Important predictors of mortality were identified from a large number of circulating proteins and clinical markers in this cohort. If confirmed in other populations, measurement of a subset of these predictors could aid in management of pediatric PAH by identifying patients at risk for death. These findings also further

  19. Using machine learning methods for predicting inhospital mortality in patients undergoing open repair of abdominal aortic aneurysm.

    PubMed

    Monsalve-Torra, Ana; Ruiz-Fernandez, Daniel; Marin-Alonso, Oscar; Soriano-Payá, Antonio; Camacho-Mackenzie, Jaime; Carreño-Jaimes, Marisol

    2016-08-01

    An abdominal aortic aneurysm is an abnormal dilatation of the aortic vessel at abdominal level. This disease presents high rate of mortality and complications causing a decrease in the quality of life and increasing the cost of treatment. To estimate the mortality risk of patients undergoing surgery is complex due to the variables associated. The use of clinical decision support systems based on machine learning could help medical staff to improve the results of surgery and get a better understanding of the disease. In this work, the authors present a predictive system of inhospital mortality in patients who were undergoing to open repair of abdominal aortic aneurysm. Different methods as multilayer perceptron, radial basis function and Bayesian networks are used. Results are measured in terms of accuracy, sensitivity and specificity of the classifiers, achieving an accuracy higher than 95%. The developing of a system based on the algorithms tested can be useful for medical staff in order to make a better planning of care and reducing undesirable surgery results and the cost of the post-surgical treatments. PMID:27395372

  20. Tree-Based Models for Predicting Mortality in Gram-Negative Bacteremia: Avoid Putting the CART before the Horse

    PubMed Central

    O'Donnell, J. Nicholas; Lizza, Bryan D.; McLaughlin, Milena M.; Esterly, John S.

    2015-01-01

    Increasingly, infectious disease studies employ tree-based approaches, e.g., classification and regression tree modeling, to identify clinical thresholds. We present tree-based-model-derived thresholds along with their measures of uncertainty. We explored individual and pooled clinical cohorts of bacteremic patients to identify modified acute physiology and chronic health evaluation (II) (m-APACHE-II) score mortality thresholds using a tree-based approach. Predictive performance measures for each candidate threshold were calculated. Candidate thresholds were examined according to binary logistic regression probabilities of the primary outcome, correct classification predictive matrices, and receiver operating characteristic curves. Three individual cohorts comprising a total of 235 patients were studied. Within the pooled cohort, the mean (± standard deviation) m-APACHE-II score was 13.6 ± 5.3, with an in-hospital mortality of 16.6%. The probability of death was greater at higher m-APACHE II scores in only one of three cohorts (odds ratio for cohort 1 [OR1] = 1.15, 95% confidence interval [CI] = 0.99 to 1.34; OR2 = 1.04, 95% CI = 0.94 to 1.16; OR3 = 1.18, 95% CI = 1.02 to 1.38) and was greater at higher scores within the pooled cohort (OR4 = 1.11, 95% CI = 1.04 to 1.19). In contrast, tree-based models overcame power constraints and identified m-APACHE-II thresholds for mortality in two of three cohorts (P = 0.02, 0.1, and 0.008) and the pooled cohort (P = 0.001). Predictive performance at each threshold was highly variable among cohorts. The selection of any one predictive threshold value resulted in fixed sensitivity and specificity. Tree-based models increased power and identified threshold values from continuous predictor variables; however, sample size and data distributions influenced the identified thresholds. The provision of predictive matrices or graphical displays of predicted probabilities within infectious disease studies can improve the

  1. Predicting growth and mortality of bivalve larvae using gene expression and supervised machine learning.

    PubMed

    Bassim, Sleiman; Chapman, Robert W; Tanguy, Arnaud; Moraga, Dario; Tremblay, Rejean

    2015-12-01

    It is commonly known that the nature of the diet has diverse consequences on larval performance and longevity, however it is still unclear which genes have critical impacts on bivalve development and which pathways are of particular importance in their vulnerability or resistance. First we show that a diet deficient in essential fatty acid (EFA) produces higher larval mortality rates, a reduced shell growth, and lower postlarval performance, all of which are positively correlated with a decline in arachidonic and eicosapentaenoic acids levels, two EFAs known as eicosanoid precursors. Eicosanoids affect the cell inflammatory reactions and are synthesized from long-chain EFAs. Second, we show for the first time that a deficiency in eicosanoid precursors is associated with a network of 29 genes. Their differential regulation can lead to slower growth and higher mortality of Mytilus edulis larvae. Some of these genes are specific to bivalves and others are implicated at the same time in lipid metabolism and defense. Several genes are expressed only during pre-metamorphosis where they are essential for muscle or neurone development and biomineralization, but only in stress-induced larvae. Finally, we discuss how our networks of differentially expressed genes might dynamically alter the development of marine bivalves, especially under dietary influence. PMID:26282335

  2. Circulating desmosine levels do not predict emphysema progression but are associated with cardiovascular risk and mortality in COPD.

    PubMed

    Rabinovich, Roberto A; Miller, Bruce E; Wrobel, Karolina; Ranjit, Kareshma; Williams, Michelle C; Drost, Ellen; Edwards, Lisa D; Lomas, David A; Rennard, Stephen I; Agustí, Alvar; Tal-Singer, Ruth; Vestbo, Jørgen; Wouters, Emiel F M; John, Michelle; van Beek, Edwin J R; Murchison, John T; Bolton, Charlotte E; MacNee, William; Huang, Jeffrey T J

    2016-05-01

    Elastin degradation is a key feature of emphysema and may have a role in the pathogenesis of atherosclerosis associated with chronic obstructive pulmonary disease (COPD). Circulating desmosine is a specific biomarker of elastin degradation. We investigated the association between plasma desmosine (pDES) and emphysema severity/progression, coronary artery calcium score (CACS) and mortality.pDES was measured in 1177 COPD patients and 110 healthy control subjects from two independent cohorts. Emphysema was assessed on chest computed tomography scans. Aortic arterial stiffness was measured as the aortic-femoral pulse wave velocity.pDES was elevated in patients with cardiovascular disease (p<0.005) and correlated with age (rho=0.39, p<0.0005), CACS (rho=0.19, p<0.0005) modified Medical Research Council dyspnoea score (rho=0.15, p<0.0005), 6-min walking distance (rho=-0.17, p<0.0005) and body mass index, airflow obstruction, dyspnoea, exercise capacity index (rho=0.10, p<0.01), but not with emphysema, emphysema progression or forced expiratory volume in 1 s decline. pDES predicted all-cause mortality independently of several confounding factors (p<0.005). In an independent cohort of 186 patients with COPD and 110 control subjects, pDES levels were higher in COPD patients with cardiovascular disease and correlated with arterial stiffness (p<0.05).In COPD, excess elastin degradation relates to cardiovascular comorbidities, atherosclerosis, arterial stiffness, systemic inflammation and mortality, but not to emphysema or emphysema progression. pDES is a good biomarker of cardiovascular risk and mortality in COPD. PMID:27009168

  3. Use of bovine pregnancy-associated glycoproteins to predict late embryonic mortality in postpartum Nelore beef cows.

    PubMed

    Pohler, K G; Peres, R F G; Green, J A; Graff, H; Martins, T; Vasconcelos, J L M; Smith, M F

    2016-06-01

    The primary objective was to determine if circulating concentration of bovine pregnancy-associated glycoproteins (bPAGs) on Day 30 after artificial insemination (AI) may serve as a marker of late embryonic mortality in Bos indicus (Nelore) beef cows. In experiment 1, postpartum Nelore beef cows (n = 56) were artificially inseminated at a fixed time (Day 0) after synchronization of ovulation. Serum samples were collected on Days 0, 21, 24, 27, and 30 after AI. The first significant increase (P < 0.0001) in serum bPAGs after insemination occurred on Day 24 of gestation. In experiment 2, ovulation was synchronized in postpartum Nelore beef cows (n = 1460) and AI was received at a fixed time. Pregnancy diagnosis and blood sample collection were carried out on Days 28 to 30 after insemination. Cows that maintained a pregnancy from Days 28 to 100 of gestation (n = 714) had significantly (P < 0.0001) higher circulating concentrations of bPAGs on Day 28 compared with cows that did not maintain a pregnancy (embryonic mortality [EM]) until Day 100 (n = 89). When Day 28 bPAG concentration was included in a logistic regression model to predict pregnancy maintenance until Day 100 of gestation, there was an increase (P < 0.0001) in the probability of maintaining pregnancy as maternal concentrations of bPAGs increased. A receiver operating characteristic curve was generated to determine bPAG concentrations on Day 28 that should predict embryonic survival or mortality with an accuracy of 95% or more. On the basis of the positive and negative predicative value analysis, at Day 28 of gestation a circulating concentration of bPAGs greater than 7.9 ng/mL was 95% accurate in predicting embryonic maintenance (to Day 100); a concentration of bPAGs less than 0.72 ng/mL was 95% accurate in predicting EM by Day 100. In experiment 3, the preceding model was tested in a separate set of Nelore beef cows to validate whether bPAGs would serve as an accurate measure of late

  4. Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study

    PubMed Central

    Gerdin, Martin; Roy, Nobhojit; Khajanchi, Monty; Kumar, Vineet; Dharap, Satish; Felländer-Tsai, Li; Petzold, Max; Bhoi, Sanjeev; Saha, Makhan Lal; von Schreeb, Johan

    2014-01-01

    Background In India alone, more than one million people die yearly due to trauma. Identification of patients at risk of early mortality is crucial to guide clinical management and explain prognosis. Prediction models can support clinical judgement, but existing models have methodological limitations. The aim of this study was to derive a vital sign based prediction model for early mortality among adult trauma patients admitted to three public university hospitals in urban India. Methods We conducted a prospective cohort study of adult trauma patients admitted to three urban university hospitals in India between October 2013 and January 2014. The outcome measure was mortality within 24 hours. We used logistic regression with restricted cubic splines to derive our model. We assessed model performance in terms of discrimination, calibration, and optimism. Results A total of 1629 patients were included. Median age was 35, 80% were males. Mortality between admission and 24 hours was 6%. Our final model included systolic blood pressure, heart rate, and Glasgow coma scale. Our model displayed good discrimination, with an area under the receiver operating characteristics curve (AUROCC) of 0.85. Predicted mortality corresponded well with observed mortality, indicating good calibration. Conclusion This study showed that routinely recorded systolic blood pressure, heart rate, and Glasgow coma scale predicted early hospital mortality in trauma patients admitted to three public university hospitals in urban India. Our model needs to be externally validated before it can be applied in the clinical setting. PMID:25180494

  5. PREDICTIVE MODELING OF LIGHT-INDUCED MORTALITY OF ENTEROCOCCI FAECALIS IN RECREATIONAL WATERS

    EPA Science Inventory

    One approach to predictive modeling of biological contamination of recreational waters involves the application of process-based approaches that consider microbial sources, hydrodynamic transport, and microbial fate. This presentation focuses on one important fate process, light-...

  6. High faecal glucocorticoid levels predict mortality in ring-tailed lemurs (Lemur catta)

    PubMed Central

    Ethan Pride, R

    2005-01-01

    Glucocorticoid levels are commonly used as measures of stress in wild animal populations, but their relevance to individual fitness in a wild population has not been demonstrated. In this study I followed 93 ring-tailed lemurs (Lemur catta) at Berenty Reserve in Madagascar, collecting 1089 faecal samples from individually recognized animals, and recording their survival over a 2 year period. I evaluated faecal glucocorticoid levels as predictors of individual survival to the end of the study. Animals with high glucocorticoid levels had a significantly higher mortality rate. This result suggests that glucocorticoid measures can be useful predictors of individual survival probabilities in wild populations. The ‘stress landscape’ indicated by glucocorticoid patterns may approximate the fitness landscape to which animals adapt. PMID:17148128

  7. STARD-compliant article: The utility of red cell distribution width to predict mortality for septic patients visiting the emergency department.

    PubMed

    Chen, Chun-Kuei; Lin, Shen-Che; Wu, Chin-Chieh; Chen, Li-Min; Tzeng, I-Shiang; Chen, Kuan-Fu

    2016-06-01

    Sepsis is a common condition in the emergency department that is associated with high mortality. Red blood cell distribution width (RDW) has been used as a simple prognosis predictor for patients with community-acquired pneumonia, gram-negative bacteremia, and severe sepsis or septic shock. To evaluate the performance of RDW to predict in-hospital mortality among septic patients, we conducted a hospital-based retrospective cohort study in an emergency department of a tertiary teaching hospital. RDW was compared with other commonly used clinical prediction scores (Systemic Inflammatory Response Syndrome (SIRS), Mortality in Emergency Department Sepsis (MEDS) and the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB65)). Of 6973 consecutive adult patients with a clinical diagnosis of sepsis and 2 sets of blood culture ordered by physicians, 477 (6.8%) died. The mortality group had higher RDW levels than the survival group (15.7% vs 13.8%). After dividing RDW into quartiles, the patients in the highest RDW quartile (RDW >15.6%; mortality, 16.7%) had more than twice the risk of in-hospital mortality compared with patients in the second highest quartile (RDW >14% and <15.6%; mortality, 7.3%), whereas the mortality rate in the lowest RDW quartile (<13.1%) was only 1.6%. The area under the receiver operating characteristic curve of RDW to predict mortality was 0.75 (95% confidence interval, 0.72-0.77), which is significantly higher than the areas under the curve of clinical prediction rules (SIRS, MEDS, and CURB65). After integrating RDW into these scores, all scores performed better in predicting mortality (0.73, 0.72, and 0.77, for SIRS, MEDS, and CURB65, respectively). RDW could be an independent predictor of mortality among septic patients. Clinicians could classify the septic patients into different risk groups according to RDW quartiles. For more accurate mortality prediction, RDW could be a potential parameter to be

  8. Low Serum Creatine Kinase Level Predicts Mortality in Patients with a Chronic Kidney Disease

    PubMed Central

    Metzger, Marie; Chassé, Jean-François; Haymann, Jean-Philippe; Boffa, Jean-Jacques; Flamant, Martin; Vrtovsnik, François; Houillier, Pascal; Stengel, Bénédicte

    2016-01-01

    Background Serum creatine kinase (sCK) reflects CK activity from striated skeletal muscle. Muscle wasting is a risk factor for mortality in patients with chronic kidney disease (CKD). The aim of this study is to evaluate whether sCK is a predictor of mortality and end-stage renal disease (ESRD) in a CKD population. Methods We included 1801 non-dialysis-dependent CKD patients from the NephroTest cohort. We used time-fixed and time-dependent cause-specific Cox models to estimate hazard ratios (HRs) for the risk of death and for the risk of ESRD associated with gender-specific sCK tertiles. Results Higher sCK level at baseline was associated with a lower age, a higher body mass index, and a higher level of 24 h urinary creatinine excretion, serum albumin and prealbumin (p<0.001). Men, patients of sub-Saharan ancestry, smokers and statin users also experienced a higher level of sCK. In a time-fixed Cox survival model (median follow-up 6.0 years), the lowest gender-specific sCK tertile was associated with a higher risk of death before and after adjustment for confounders (Crude model: hazard ratio (HR) 1.77 (95% CI: 1.34–2.32) compared to the highest tertile; fully-adjusted model: HR 1.37 (95% CI: 1.02–1.86)). Similar results were obtained with a time-dependent Cox model. The sCK level was not associated with the risk of ESRD. Conclusion A low level of sCK is associated with an increased risk of death in a CKD population. sCK levels might reflect muscle mass and nutritional status. PMID:27248151

  9. Mortality risk score prediction in an elderly population using machine learning.

    PubMed

    Rose, Sherri

    2013-03-01

    Standard practice for prediction often relies on parametric regression methods. Interesting new methods from the machine learning literature have been introduced in epidemiologic studies, such as random forest and neural networks. However, a priori, an investigator will not know which algorithm to select and may wish to try several. Here I apply the super learner, an ensembling machine learning approach that combines multiple algorithms into a single algorithm and returns a prediction function with the best cross-validated mean squared error. Super learning is a generalization of stacking methods. I used super learning in the Study of Physical Performance and Age-Related Changes in Sonomans (SPPARCS) to predict death among 2,066 residents of Sonoma, California, aged 54 years or more during the period 1993-1999. The super learner for predicting death (risk score) improved upon all single algorithms in the collection of algorithms, although its performance was similar to that of several algorithms. Super learner outperformed the worst algorithm (neural networks) by 44% with respect to estimated cross-validated mean squared error and had an R2 value of 0.201. The improvement of super learner over random forest with respect to R2 was approximately 2-fold. Alternatives for risk score prediction include the super learner, which can provide improved performance. PMID:23364879

  10. The Minimum Data Set 2.0: a functional assessment to predict mortality in nursing home residents.

    PubMed

    Abicht-Swensen, L M; Debner, L K

    1999-01-01

    Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents. The paper has been designed as a retrospective study of residents in 24 Minnesota nursing homes who were referred to a hospice program. The study included 199 patients from 30 to 107 years of age. Functional variables, as triggered by the Minimum Data Set, have a direct correlation to patient mortality within three months of the documented observation of the triggered variable, and are the main outcome measure. Of a total of 199 patients, 147 patients (74 percent) died within 15 days of a documented significant decline in the Minimum Data Set in areas of cognitive function, communication, activities of daily living, incontinence, and nutrition. Age, gender, diagnosis, and significant medical data received from the nursing home staff at the time of referral to hospice were applied to the Karnofsky Scale, the Modified ADL Scale, the Descriptive Scale, and the Minimum Data Set to determine if a resident assessment protocol (RAP) would be triggered by these data. The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents. A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive

  11. Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted

    PubMed Central

    Røe, Cecilie; Skandsen, Toril; Manskow, Unn; Ader, Tiina; Anke, Audny

    2015-01-01

    The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI. PMID:26688614

  12. Mortality and One-Year Functional Outcome in Elderly and Very Old Patients with Severe Traumatic Brain Injuries: Observed and Predicted.

    PubMed

    Røe, Cecilie; Skandsen, Toril; Manskow, Unn; Ader, Tiina; Anke, Audny

    2015-01-01

    The aim of the present study was to evaluate mortality and functional outcome in old and very old patients with severe traumatic brain injury (TBI) and compare to the predicted outcome according to the internet based CRASH (Corticosteroid Randomization After Significant Head injury) model based prediction, from the Medical Research Council (MRC). Methods. Prospective, national multicenter study including patients with severe TBI ≥ 65 years. Predicted mortality and outcome were calculated based on clinical information (CRASH basic) (age, GCS score, and pupil reactivity to light), as well as with additional CT findings (CRASH CT). Observed 14-day mortality and favorable/unfavorable outcome according to the Glasgow Outcome Scale at one year was compared to the predicted outcome according to the CRASH models. Results. 97 patients, mean age 75 (SD 7) years, 64% men, were included. Two patients were lost to follow-up; 48 died within 14 days. The predicted versus the observed odds ratio (OR) for mortality was 2.65. Unfavorable outcome (GOSE < 5) was observed at one year follow-up in 72% of patients. The CRASH models predicted unfavorable outcome in all patients. Conclusion. The CRASH model overestimated mortality and unfavorable outcome in old and very old Norwegian patients with severe TBI. PMID:26688614

  13. Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis

    PubMed Central

    Telles da Rosa, Luis Henrique; Garcia, Eduardo; Marroni, Cláudio Augusto

    2016-01-01

    Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below −70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above −70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis. PMID:27559536

  14. Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis.

    PubMed

    Faustini Pereira, José Leonardo; Galant, Lucas Homercher; Rossi, Danusa; Telles da Rosa, Luis Henrique; Garcia, Eduardo; de Mello Brandão, Ajácio Bandeira; Marroni, Cláudio Augusto

    2016-01-01

    Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below -70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above -70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis. PMID:27559536

  15. Evaluating the predictive performance of empirical estimators of natural mortality rate using information on over 200 fish species

    USGS Publications Warehouse

    Then, Amy Y.; Hoenig, John M; Hall, Norman G.; Hewitt, David A.

    2015-01-01

    Many methods have been developed in the last 70 years to predict the natural mortality rate, M, of a stock based on empirical evidence from comparative life history studies. These indirect or empirical methods are used in most stock assessments to (i) obtain estimates of M in the absence of direct information, (ii) check on the reasonableness of a direct estimate of M, (iii) examine the range of plausible M estimates for the stock under consideration, and (iv) define prior distributions for Bayesian analyses. The two most cited empirical methods have appeared in the literature over 2500 times to date. Despite the importance of these methods, there is no consensus in the literature on how well these methods work in terms of prediction error or how their performance may be ranked. We evaluate estimators based on various combinations of maximum age (tmax), growth parameters, and water temperature by seeing how well they reproduce >200 independent, direct estimates of M. We use tenfold cross-validation to estimate the prediction error of the estimators and to rank their performance. With updated and carefully reviewed data, we conclude that a tmax-based estimator performs the best among all estimators evaluated. The tmax-based estimators in turn perform better than the Alverson–Carney method based on tmax and the von Bertalanffy K coefficient, Pauly's method based on growth parameters and water temperature and methods based just on K. It is possible to combine two independent methods by computing a weighted mean but the improvement over the tmax-based methods is slight. Based on cross-validation prediction error, model residual patterns, model parsimony, and biological considerations, we recommend the use of a tmax-based estimator (M=4.899t−0.916max, prediction error = 0.32) when possible and a growth-based method (M=4.118K0.73L−0.33∞ , prediction error = 0.6) otherwise.

  16. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales

    PubMed Central

    McAllister, Katherine S.L.; Ludman, Peter F.; Hulme, William; de Belder, Mark A.; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A.; Sperrin, Matthew; Buchan, Iain E.

    2016-01-01

    Background The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. Methods and results The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. Conclusion We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. PMID:26942330

  17. Low serum carotenoid concentrations and carotenoid interactions predict mortality in US adults: The Third National Health and Nutrition Examination Survey (NHANES III)

    PubMed Central

    Shardell, Michelle D; Alley, Dawn E; Hicks, Gregory E; El-Kamary, Samer S; Miller, Ram R; Semba, Richard D; Ferrucci, Luigi

    2011-01-01

    Evidence regarding the health benefits of carotenoids is controversial. Effects of serum carotenoids and their interactions on mortality have not been examined in a representative sample of US adults. The objective was to examine whether serum carotenoid concentrations predict mortality among US adults. The study consisted of adults aged ≥20 years enrolled in the National Health and Nutrition Examination Survey (NHANES) III, 1988–1994, with measured serum carotenoids and mortality follow-up through 2006 (N=13,293). Outcomes were all-cause, cardiovascular disease (CVD), and cancer mortality. In adjusted Cox proportional hazards models, participants in the lowest total carotenoid quartile (<1.01µmol/L) had significantly higher all-cause mortality (mortality rate ratio=1.38; 95% confidence interval:1.15—1.65; P=0.005) than those in the highest total carotenoid quartile (>1.75µmol/L). For alpha-carotene, the highest quartile (>0.11µmol/L) had the lowest all-cause mortality rates (P<0.001). For lycopene, the middle two quartiles (0.29–0.58µmol/L) had the lowest all-cause mortality rates (P=0.047). Analyses with continuous carotenoids confirmed associations of serum total carotenoids, alpha-carotene, and lycopene with all-cause mortality (P<0.001). In a random survival forest analysis, very low lycopene was the carotenoid most strongly predictive of all-cause mortality, followed by very low total carotenoids. Alpha-carotene/beta-cryptoxanthin, alpha-carotene/lutein+zeaxanthin and lycopene/lutein+zeaxanthin interactions were significantly related to all-cause mortality (P<0.05). Low alpha-carotene was the only carotenoid associated with CVD mortality (P=0.002). No carotenoids were significantly associated with cancer mortality. Very low serum total carotenoid, alpha-carotene, and lycopene concentrations may be risk factors for mortality, but carotenoids show interaction effects on mortality. Interventions of balanced carotenoid combinations are needed for

  18. Does Cognitive Ability Predict Mortality in the Ninth Decade? The Lothian Birth Cohort 1921

    ERIC Educational Resources Information Center

    Murray, Catherine; Pattie, Alison; Starr, John M.; Deary, Ian J.

    2012-01-01

    To test whether cognitive ability predicts survival from age 79 to 89 years data were collected from 543 (230 male) participants who entered the study at a mean age of 79.1 years. Most had taken the Moray House Test of general intelligence (MHT) when aged 11 and 79 years from which, in addition to intelligence measures at these two time points,…

  19. Elevated Fibroblast Growth Factor 23 Concentration: Prediction of Mortality among Chronic Kidney Disease Patients

    PubMed Central

    Chathoth, Shahanas; Al-Mueilo, Samir; Cyrus, Cyril; Vatte, Chittibabu; Al-Nafaie, Awatif; Al-Ali, Rudaynah; Keating, Brendan J.; Al-Muhanna, Fahad; Al Ali, Amein

    2015-01-01

    Background The osteocyte-derived hormone, fibroblast growth factor 23 (FGF23), regulates the phosphorus metabolism and suppresses 1,25-dihydroxyvitamin D production, thereby mitigating hyperphosphatemia in patients with renal disorders. An elevated FGF23 level is suggested to be an early biomarker of altered phosphorus metabolism in the initial stages of chronic kidney disease (CKD) and acts as a strong predictor of mortality in dialysis patients. In the Saudi population, there is no report on the FGF23 level in CKD patients to date. This study aims to estimate the plasma FGF23 levels in the Saudi population and to correlate it with its clinical manifestations in order to ascertain its role in the pathogenesis of CKD patients. Methods The FGF23 level in the plasma samples was determined using ELISA in a diverse cohort of 89 cases with stage 3-5 CKD and 100 healthy subjects. The plasma FGF23 level was correlated with other biochemical parameters. Results The results revealed that the FGF23 level was markedly elevated among CKD patients compared to the control group, and a significant inverse correlation was observed between the FGF23 level and glomerular filtration rate. FGF23 elevation was approximately 40-fold among stage 5 patients compared to the control, while the elevation of phosphate, parathyroid hormone (PTH) and alkaline phosphatase was 2-, 3- and 8-fold in this stage, respectively. Conclusion Elevated FGF23 levels may have a strong correlation with the disease pathogenesis. In addition, FGF23 might be a future therapeutic target to intervene against the progression of CKD as well as to increase patient survivability. PMID:27194998

  20. Mortality Prediction after the First Year of Kidney Transplantation: An Observational Study on Two European Cohorts

    PubMed Central

    Lorent, Marine; Giral, Magali; Pascual, Manuel; Koller, Michael T.; Steiger, Jürg; Trébern-Launay, Katy; Legendre, Christophe; Kreis, Henri; Mourad, Georges; Garrigue, Valérie; Rostaing, Lionel; Kamar, Nassim; Kessler, Michèle; Ladrière, Marc; Morelon, Emmanuel; Buron, Fanny; Golshayan, Dela; Foucher, Yohann

    2016-01-01

    After the first year post transplantation, prognostic mortality scores in kidney transplant recipients can be useful for personalizing medical management. We developed a new prognostic score based on 5 parameters and computable at 1-year post transplantation. The outcome was the time between the first anniversary of the transplantation and the patient’s death with a functioning graft. Afterwards, we appraised the prognostic capacities of this score by estimating time-dependent Receiver Operating Characteristic (ROC) curves from two prospective and multicentric European cohorts: the DIVAT (Données Informatisées et VAlidées en Transplantation) cohort composed of patients transplanted between 2000 and 2012 in 6 French centers; and the STCS (Swiss Transplant Cohort Study) cohort composed of patients transplanted between 2008 and 2012 in 6 Swiss centers. We also compared the results with those of two existing scoring systems: one from Spain (Hernandez et al.) and one from the United States (the Recipient Risk Score, RRS, Baskin-Bey et al.). From the DIVAT validation cohort and for a prognostic time at 10 years, the new prognostic score (AUC = 0.78, 95%CI = [0.69, 0.85]) seemed to present significantly higher prognostic capacities than the scoring system proposed by Hernandez et al. (p = 0.04) and tended to perform better than the initial RRS (p = 0.10). By using the Swiss cohort, the RRS and the the new prognostic score had comparable prognostic capacities at 4 years (AUC = 0.77 and 0.76 respectively, p = 0.31). In addition to the current available scores related to the risk to return in dialysis, we recommend to further study the use of the score we propose or the RRS for a more efficient personalized follow-up of kidney transplant recipients. PMID:27152510

  1. [Predictive factors of mortality of the burnt persons: study on 221 adults hospitalized between 2004 and 2009].

    PubMed

    Elkafssaoui, S; Hami, H; Mrabet, M; Bouaiti, E; Tourabi, K; Quyou, A; Soulaymani, A; Ihrai, H

    2014-06-01

    The objective of the present study is the evaluation of the predictive factors of mortality to a troop of Moroccan grown-up serious burnt persons. Variables analyzed in the study are: the age, the sex, the localization of the burn, the degree of burn, indicates Total Body Surface Area (TBSA), indicate Unit of Standard Burn (UBS) and the indication of leases, sepsis and the medical histories (tobacco, diabetes). Factors associated significantly to a mortality raised at the burned patients were the female genital organ, the localization of the burn at the level of the head, the sepsis, one TBSA greater or equal to 20%, an UBS greater or equal to 200 and an indication of leases greater or equal to 75. Other factors such as the age, the degree of burn and the histories did not show a significant difference. An evaluation and a good knowledge of factors associated to a high risk of death allow an adequate coverage of this category of patients. PMID:22542367

  2. Host, pathogen, and environmental characteristics predict white-nose syndrome mortality in captive little brown myotis (Myotis lucifugus).

    PubMed

    Johnson, Joseph S; Reeder, DeeAnn M; McMichael, James W; Meierhofer, Melissa B; Stern, Daniel W F; Lumadue, Shayne S; Sigler, Lauren E; Winters, Harrison D; Vodzak, Megan E; Kurta, Allen; Kath, Joseph A; Field, Kenneth A

    2014-01-01

    An estimated 5.7 million or more bats died in North America between 2006 and 2012 due to infection with the fungus Pseudogymnoascus destructans (Pd) that causes white-nose syndrome (WNS) during hibernation. The behavioral and physiological changes associated with hibernation leave bats vulnerable to WNS, but the persistence of bats within the contaminated regions of North America suggests that survival might vary predictably among individuals or in relation to environmental conditions. To investigate variables influencing WNS mortality, we conducted a captive study of 147 little brown myotis (Myotis lucifugus) inoculated with 0, 500, 5000, 50,000, or 500,000 Pd conidia and hibernated for five months at either 4 or 10°C. We found that female bats were significantly more likely to survive hibernation, as were bats hibernated at 4°C, and bats with greater body condition at the start of hibernation. Although all bats inoculated with Pd exhibited shorter torpor bouts compared to controls, a characteristic of WNS, only bats inoculated with 500 conidia had significantly lower survival odds compared to controls. These data show that host and environmental characteristics are significant predictors of WNS mortality, and that exposure to up to 500 conidia is sufficient to cause a fatal infection. These results also illustrate a need to quantify dynamics of Pd exposure in free-ranging bats, as dynamics of WNS produced in captive studies inoculating bats with several hundred thousand conidia may differ from those in the wild. PMID:25409028

  3. Host, Pathogen, and Environmental Characteristics Predict White-Nose Syndrome Mortality in Captive Little Brown Myotis (Myotis lucifugus)

    PubMed Central

    Johnson, Joseph S.; Reeder, DeeAnn M.; McMichael, James W.; Meierhofer, Melissa B.; Stern, Daniel W. F.; Lumadue, Shayne S.; Sigler, Lauren E.; Winters, Harrison D.; Vodzak, Megan E.; Kurta, Allen; Kath, Joseph A.; Field, Kenneth A.

    2014-01-01

    An estimated 5.7 million or more bats died in North America between 2006 and 2012 due to infection with the fungus Pseudogymnoascus destructans (Pd) that causes white-nose syndrome (WNS) during hibernation. The behavioral and physiological changes associated with hibernation leave bats vulnerable to WNS, but the persistence of bats within the contaminated regions of North America suggests that survival might vary predictably among individuals or in relation to environmental conditions. To investigate variables influencing WNS mortality, we conducted a captive study of 147 little brown myotis (Myotis lucifugus) inoculated with 0, 500, 5 000, 50 000, or 500 000 Pd conidia and hibernated for five months at either 4 or 10°C. We found that female bats were significantly more likely to survive hibernation, as were bats hibernated at 4°C, and bats with greater body condition at the start of hibernation. Although all bats inoculated with Pd exhibited shorter torpor bouts compared to controls, a characteristic of WNS, only bats inoculated with 500 conidia had significantly lower survival odds compared to controls. These data show that host and environmental characteristics are significant predictors of WNS mortality, and that exposure to up to 500 conidia is sufficient to cause a fatal infection. These results also illustrate a need to quantify dynamics of Pd exposure in free-ranging bats, as dynamics of WNS produced in captive studies inoculating bats with several hundred thousand conidia may differ from those in the wild. PMID:25409028

  4. [Regulation of osteoclastogenesis by osteocytes through growth differentiation factor-15].

    PubMed

    Hinoi, Eiichi

    2014-01-01

    Osteocytes are the most abundant cells in bone. However, little attention has been paid to their role in bone remodeling. In this study, osteoclast differentiation was significantly enhanced by conditioned media derived from cultures of osteocytic MLO-Y4 cells that were cultured under hypoxic conditions. Using microarray analysis, we identified growth differentiation factor-15 (GDF15) as a pivotal factor secreted from osteocytes under hypoxia. Indeed, treatment with recombinant GDF15 markedly increased osteoclast differentiation in vitro. Further to investigate the importance of GDF15 in vivo, we used a hypoxic murine model that involved ligation of the right femoral artery. The volume of cancellous bone in the proximal tibia of the ligated limb was significantly reduced, together with a significant increase in osteoclast-related parameters. Addition of anti-GDF15 antibody prevented bone loss and osteoclastic activation in the tibiae of mice that had undergone femoral artery ligation. These results suggest that GDF15, which is secreted from osteocytes under hypoxia during bone remodeling, may be a positive regulator of osteoclastic differentiation. The in vivo usefulness of the anti-GDF15 antibody might provide insights for the development of novel therapeutics for bone disorders related to hypoxia or ischemic insults. PMID:25452236

  5. Kruppel-like factor 15 is critical for vascular inflammation

    PubMed Central

    Lu, Yuan; Zhang, Lisheng; Liao, Xudong; Sangwung, Panjamaporn; Prosdocimo, Domenick A.; Zhou, Guangjin; Votruba, Alexander R.; Brian, Leigh; Han, Yuh Jung; Gao, Huiyun; Wang, Yunmei; Shimizu, Koichi; Weinert-Stein, Kaitlyn; Khrestian, Maria; Simon, Daniel I.; Freedman, Neil J.; Jain, Mukesh K.

    2013-01-01

    Activation of cells intrinsic to the vessel wall is central to the initiation and progression of vascular inflammation. As the dominant cellular constituent of the vessel wall, vascular smooth muscle cells (VSMCs) and their functions are critical determinants of vascular disease. While factors that regulate VSMC proliferation and migration have been identified, the endogenous regulators of VSMC proinflammatory activation remain incompletely defined. The Kruppel-like family of transcription factors (KLFs) are important regulators of inflammation. In this study, we identified Kruppel-like factor 15 (KLF15) as an essential regulator of VSMC proinflammatory activation. KLF15 levels were markedly reduced in human atherosclerotic tissues. Mice with systemic and smooth muscle–specific deficiency of KLF15 exhibited an aggressive inflammatory vasculopathy in two distinct models of vascular disease: orthotopic carotid artery transplantation and diet-induced atherosclerosis. We demonstrated that KLF15 alters the acetylation status and activity of the proinflammatory factor NF-κB through direct interaction with the histone acetyltransferase p300. These studies identify a previously unrecognized KLF15-dependent pathway that regulates VSMC proinflammatory activation. PMID:23999430

  6. The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing

    PubMed Central

    2010-01-01

    Background Self-rated health (SRH) measures with different wording and reference points are often used as equivalent health indicators in public health surveys estimating health outcomes such as healthy life expectancies and mortality for older adults. Whilst the robust relationship between SRH and mortality is well established, it is not known how comparable different SRH items are in their relationship to mortality over time. We used a dynamic evaluation model to investigate the sensitivity of time-varying SRH measures with different reference points to predict mortality in older adults over time. Methods We used seven waves of data from the Australian Longitudinal Study of Ageing (1992 to 2004; N = 1733, 52.6% males). Cox regression analysis was used to evaluate the relationship between three time-varying SRH measures (global, age-comparative and self-comparative reference point) with mortality in older adults (65+ years). Results After accounting for other mortality risk factors, poor global SRH ratings increased mortality risk by 2.83 times compared to excellent ratings. In contrast, the mortality relationship with age-comparative and self-comparative SRH was moderated by age, revealing that these comparative SRH measures did not independently predict mortality for adults over 75 years of age in adjusted models. Conclusions We found that a global measure of SRH not referenced to age or self is the best predictor of mortality, and is the most reliable measure of self-perceived health for longitudinal research and population health estimates of healthy life expectancy in older adults. Findings emphasize that the SRH measures are not equivalent measures of health status. PMID:20403203

  7. Activin A Predicts Left Ventricular Remodeling and Mortality in Patients with ST-Elevation Myocardial Infarction

    PubMed Central

    Lin, Jeng-Feng; Hsu, Shun-Yi; Teng, Ming-Sheng; Wu, Semon; Hsieh, Chien-An; Jang, Shih-Jung; Liu, Chih-Jen; Huang, Hsuan-Li; Ko, Yu-Lin

    2016-01-01

    Background Activin A levels increase in a variety of heart diseases including ST-elevation myocardial infarction (STEMI). The aim of this study is to investigate whether the level of activin A can be beneficial in predicting left ventricular remodeling, heart failure, and death in patients with ST-elevation myocardial infarction (STEMI). Methods We enrolled 278 patients with STEMI who had their activin A levels measured on day 2 of hospitalization. Echocardiographic studies were performed at baseline and were repeated 6 months later. Thereafter, the clinical events of these patients were followed for a maximum of 3 years, including all-cause death and readmission for heart failure. Results During hospitalization, higher activin A level was associated with higher triglyceride level, lower left ventricular ejection fraction (LVEF), and lower left ventricular end diastolic ventricular volume index (LVEDVI) in multivariable linear regression model. During follow-up, patients with activin A levels > 129 pg/ml had significantly lower LVEF, and higher LVEDVI at 6 months. Kaplan-Meier survival curves showed that activin A level > 129 pg/ml was a predictor of all-cause death (p = 0.022), but not a predictor of heart failure (p = 0.767). Conclusions Activin A level > 129 pg/ml predicts worse left ventricular remodeling and all-cause death in STEMI. PMID:27471355

  8. Spontaneous intracerebral hemorrhage: Clinical and computed tomography findings in predicting in-hospital mortality in Central Africans

    PubMed Central

    Tshikwela, Michel Lelo; Longo-Mbenza, Benjamin

    2012-01-01

    Background and Purpose: Intracerebral hemorrhage (ICH) constitutes now 52% of all strokes. Despite of its deadly pattern, locally there is no clinical grading scale for ICH-related mortality prediction. The first objective of this study was to develop a risk stratification scale (Kinshasa ICH score) by assessing the strength of independent predictors and their association with in-hospital 30-day mortality. The second objective of the study was to create a specific local and African model for ICH prognosis. Materials and Methods: Age, sex, hypertension, type 2 diabetes mellitus (T2DM), smoking, alcohol intake, and neuroimaging data from CT scan (ICH volume, Midline shift) of patients admitted with primary ICH and follow-upped in 33 hospitals of Kinshasa, DR Congo, from 2005 to 2008, were analyzed using logistic regression models. Results: A total of 185 adults and known hypertensive patients (140 men and 45 women) were examined. 30-day mortality rate was 35% (n=65). ICH volume>25 mL (OR=8 95% CI: 3.1-20.2; P<0.0001), presence of coma (OR=6.8 95% CI 2.6-17.4; P<0.0001) and left hemispheric site of ICH (OR 2.6 95% CI: 1.1-6; P=0.027) were identified as significant and independent predictors of 30-day mortality. Midline shift > 7 mm, a consequence of ICH volume, was also a significant predictor of mortality. The Kinshasa ICH score was the sum of individual points assigned as follows: Presence of coma coded 2 (2 × 2 = 4), absence of coma coded 1 (1 × 2 = 2), ICH volume>25 mL coded 2 (2 × 2=4), ICH volume of ≤25 mL coded 1(1 × 2=2), left hemispheric site of ICH coded 2 (2 × 1=2), and right hemispheric site of hemorrhage coded 1(1 × 1 = 1). All patients with Kinshasa ICH score ≤7 survived and the patients with a score >7 died. In considering sex influence (Model 3), points were allowed as follows: Presence of coma (2 × 3 = 6), absence of coma (1 × 3 = 3), men (2 × 2 = 4), women (1 × 2 = 2), midline shift ≤7 mm (1 × 3 = 3), and midline shift >7 mm (2 × 3

  9. Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea

    PubMed Central

    Park, Cheol-Kyu; Oh, Hyoung-Joo; Choi, Ha-Young; Shin, Hong-Joon; Lim, Jung Hwan; Oh, In-Jae; Kim, Yu-Il; Lim, Sung-Chul; Kim, Young-Chul; Kwon, Yong-Soo

    2016-01-01

    Background Identification and understanding of the pathogens responsible for pleural infection is critical for appropriate antibiotic treatment. This study sought to determine the microbiological characteristics of pleural infection and to identify potential predictive factors associated with mortality. Methods In this retrospective study, we analyzed patient data from 421 cases of parapneumonic effusion. A total of 184 microorganisms were isolated from 164 patients, using two culture systems: a standard method and a method using pairs of aerobic and anaerobic blood culture bottles. Results The most frequently isolated microorganisms were streptococci (31.5%), followed by staphylococci (23.4%), gram-negative bacteria (18.5%) and anaerobes (10.3%). Streptococci were the main microorganisms found in standard culture (41.9%) and community-acquired infections (52.2%), and were susceptible to all antimicrobial agents in drug sensitivity testing. Staphylococci were the most frequently isolated pathogens in blood cultures (30.8%) and hospital-acquired infections (38.3%), and were primarily multidrug-resistant (61.8%). In multivariate analysis, the following were significant predictive factors for 30-day mortality among the total population: CURB-65 ≥ 2 (aOR 5.549, 95% CI 2.296–13.407, p<0.001), structural lung disease (aOR 2.708, 95% CI 1.346–5.379, p = 0.004), PSI risk class IV-V (aOR 4.714, 95% CI 1.530–14.524, p = 0.007), no use of intrapleural fibrinolytics (aOR 3.062, 95% CI 1.102–8.511, p = 0.014), hospital-acquired infection (aOR 2.205, 95% CI 1.165–4.172, p = 0.015), age (aOR 0.964, 95% CI 0.935–0.994, p = 0.018), and SOFA score ≥2 (aOR 2.361, 95% CI 1.134–4.916, p = 0.022). Conclusion In this study, common pathogens causing pleural infection were comparable to previous studies, and consisted of streptococci, staphylococci, and anaerobes. CURB-65 ≥2, structural lung disease, PSI risk class IV-V, no use of intrapleural fibrinolytics, hospital

  10. Hepcidin-25 in Diabetic Chronic Kidney Disease Is Predictive for Mortality and Progression to End Stage Renal Disease

    PubMed Central

    Wagner, Martin; Ashby, Damien R.; Kurtz, Caroline; Alam, Ahsan; Busbridge, Mark; Raff, Ulrike; Zimmermann, Josef; Heuschmann, Peter U.; Wanner, Christoph; Schramm, Lothar

    2015-01-01

    Background Anemia is common and is associated with impaired clinical outcomes in diabetic chronic kidney disease (CKD). It may be explained by reduced erythropoietin (EPO) synthesis, but recent data suggest that EPO-resistance and diminished iron availability due to inflammation contribute significantly. In this cohort study, we evaluated the impact of hepcidin-25—the key hormone of iron-metabolism—on clinical outcomes in diabetic patients with CKD along with endogenous EPO levels. Methods 249 diabetic patients with CKD of any stage, excluding end-stage renal disease (ESRD), were enrolled (2003–2005), if they were not on EPO-stimulating agent and iron therapy. Hepcidin-25 levels were measured by radioimmunoassay. The association of hepcidin-25 at baseline with clinical variables was investigated using linear regression models. All-cause mortality and a composite endpoint of CKD progression (ESRD or doubling of serum creatinine) were analyzed by Cox proportional hazards models. Results Patients (age 67 yrs, 53% male, GFR 51 ml/min, hemoglobin 131 g/L, EPO 13.5 U/L, hepcidin-25 62.0 ng/ml) were followed for a median time of 4.2 yrs. Forty-nine patients died (19.7%) and forty (16.1%) patients reached the composite endpoint. Elevated hepcidin levels were independently associated with higher ferritin-levels, lower EPO-levels and impaired kidney function (all p<0.05). Hepcidin was related to mortality, along with its interaction with EPO, older age, greater proteinuria and elevated CRP (all p<0.05). Hepcidin was also predictive for progression of CKD, aside from baseline GFR, proteinuria, low albumin- and hemoglobin-levels and a history of CVD (all p<0.05). Conclusions We found hepcidin-25 to be associated with EPO and impaired kidney function in diabetic CKD. Elevated hepcidin-25 and EPO-levels were independent predictors of mortality, while hepcidin-25 was also predictive for progression of CKD. Both hepcidin-25 and EPO may represent important prognostic factors

  11. Predicting the mortality from asbestos-related diseases based on the amount of asbestos used and the effects of slate buildings in Korea.

    PubMed

    Kim, Su-Young; Kim, Young-Chan; Kim, Yongku; Hong, Won-Hwa

    2016-01-15

    Asbestos has been used since ancient times, owing to its heat-resistant, rot-proof, and insulating qualities, and its usage rapidly increased after the industrial revolution. In Korea, all slates were previously manufactured in a mixture of about 90% cement and 10% chrysotile (white asbestos). This study used a Generalized Poisson regression (GPR) model after creating databases of the mortality from asbestos-related diseases and of the amount of asbestos used in Korea as a means to predict the future mortality of asbestos-related diseases and mesothelioma in Korea. Moreover, to predict the future mortality according to the effects of slate buildings, a comparative analysis based on the result of the GPR model was conducted after creating databases of the amount of asbestos used in Korea and of the amount of asbestos used in making slates. We predicted the mortality from asbestos-related diseases by year, from 2014 to 2036, according to the amount of asbestos used. As a result, it was predicted that a total of 1942 people (maximum, 3476) will die by 2036. Moreover, based on the comparative analysis according to the influence index, it was predicted that a maximum of 555 people will die from asbestos-related diseases by 2031 as a result of the effects of asbestos-containing slate buildings, and the mortality was predicted to peak in 2021, with 53 cases. Although mesothelioma and pulmonary asbestosis were considered as asbestos-related diseases, these are not the only two diseases caused by asbestos. However the results of this study are highly important and relevant, as, for the first time in Korea, the future mortality from asbestos-related diseases was predicted. These findings are expected to contribute greatly to the Korean government's policies related to the compensation for asbestos victims. PMID:26513124

  12. Child-Pugh versus MELD score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis

    PubMed Central

    Peng, Ying; Qi, Xingshun; Dai, Junna; Li, Hongyu; Guo, Xiaozhong

    2015-01-01

    A retrospective study was conducted to compare the performance of Child-Pugh and Model for End-Stage Liver Diseases (MELD) scores for predicting the in-hospital mortality of acute upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis. A total of 145 patients with a diagnosis of liver cirrhosis and acute UGIB between July 2013 and June 2014 were retrospectively analyzed (male/female: 94/51; mean age: 56.77±11.33 years; Child-Pugh class A/B/C: 46/64/35; mean Child-Pugh score: 7.88±2.17; mean MELD score: 7.86±7.22). The in-hospital mortality was 8% (11/145). Areas under receiving-operator characteristics curve (AUROC) for predicting the in-hospital mortality were compared between MELD and Child-Pugh scores. AUROCs for predicting the in-hospital mortality for Child-Pugh and MELD scores were 0.796 (95% confidence interval [CI]: 0.721-0.858) and 0.810 (95% CI: 0.736-0.870), respectively. The discriminative ability was not significant different between the two scoring systems (P=0.7241). In conclusion, Child-Pugh and MELD scores were similar for predicting the in-hospital mortality of acute UGIB in cirrhotic patients. PMID:25785053

  13. Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?

    PubMed Central

    Oh, Hyung Jung; Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2015-01-01

    Abstract Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients. PMID:26554763

  14. Predicting mortality in patients with acute heart failure: Role of risk scores

    PubMed Central

    Passantino, Andrea; Monitillo, Francesco; Iacoviello, Massimo; Scrutinio, Domenico

    2015-01-01

    Acute heart failure is a leading cause of hospitalization and death, and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation, avoiding the overtreatment of low-risk subjects or the early, inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic, clinical, hemodynamic and laboratory variables. Data sets are derived from public registries, clinical trials, and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points, with C-indices generally higher than 0.70, but their applicability in real-world populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables (age, blood pressure, sodium concentration, renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers. PMID:26730296

  15. Pretransplant pulmonary function tests predict risk of mortality following fractionated total body irradiation and allogeneic peripheral blood stem cell transplant

    SciTech Connect

    Singh, Anurag K. . E-mail: singan@mail.nih.gov; Karimpour, Shervin E.; Savani, Bipin N.; Guion, Peter M.S.; Hope, Andrew J.; Mansueti, John R.; Ning, Holly; Altemus, Rosemary M. Ph.D.; Wu, Colin O.; Barrett, A. John

    2006-10-01

    Purpose: To determine the value of pulmonary function tests (PFTs) done before peripheral blood stem cell transplant (PBSCT) in predicting mortality after total body irradiation (TBI) performed with or without dose reduction to the lung. Methods and Materials: From 1997 to 2004, 146 consecutive patients with hematologic malignancies received fractionated TBI before PBSCT. With regimen A (n = 85), patients were treated without lung dose reduction to 13.6 gray (Gy). In regimen B (n = 35), total body dose was decreased to 12 Gy (1.5 Gy twice per day for 4 days) and lung dose was limited to 9 Gy by use of lung shielding. In regimen C (n = 26), lung dose was reduced to 6 Gy. All patients received PFTs before treatment, 90 days after treatment, and annually. Results: Median follow-up was 44 months (range, 12-90 months). Sixty-one patients had combined ventilation/diffusion capacity deficits defined as both a forced expiratory volume in the first second (FEV{sub 1}) and a diffusion capacity of carbon dioxide (DLCO) <100% predicted. In this group, there was a 20% improvement in one-year overall survival with lung dose reduction (70 vs. 50%, log-rank test p = 0.042). Conclusion: Among those with combined ventilation/diffusion capacity deficits, lung dose reduction during TBI significantly improved survival.

  16. Serum Cholinesterase Activities Distinguish between Stroke Patients and Controls and Predict 12-Month Mortality

    PubMed Central

    Ben Assayag, Einor; Shenhar-Tsarfaty, Shani; Ofek, Keren; Soreq, Lilach; Bova, Irena; Shopin, Ludmila; Berg, Ronan MG; Berliner, Shlomo; Shapira, Itzhak; Bornstein, Natan M; Soreq, Hermona

    2010-01-01

    To date there is no diagnostic biomarker for mild stroke, although elevation of inflammatory biomarkers has been reported at early stages. Previous studies implicated acetylcholinesterase (AChE) involvement in stroke, and circulating AChE activity reflects inflammatory response, since acetylcholine suppresses inflammation. Therefore, carriers of polymorphisms that modify cholinergic activity should be particularly susceptible to inflammatory damage. Our study sought diagnostic values of AChE and Cholinergic Status (CS, the total capacity for acetylcholine hydrolysis) in suspected stroke patients. For this purpose, serum cholinesterase activities, butyrylcholinesterase-K genotype and inflammatory biomarkers were determined in 264 ischemic stroke patients and matched controls during the acute phase. AChE activities were lower (P < 0.001), and butyrylcholinesterase activities were higher in patients than in controls (P = 0.004). When normalized to sampling time from stroke occurrence, both cholinergic parameters were correlated with multiple inflammatory biomarkers, including fibrinogen, interleukin-6 and C-reactive protein (r = 0.713, r = 0.607; r = 0.421, r = 0.341; r = 0.276, r = 0.255; respectively; all P values < 0.001). Furthermore, very low AChE activities predicted subsequent nonsurvival (P = 0.036). Also, carriers of the unstable butyrylcholinesterase-K variant were more abundant among patients than controls, and showed reduced activity (P < 0.001). Importantly, a cholinergic score combining the two cholinesterase activities discriminated between 94.3% matched pairs of patients and controls, compared with only 75% for inflammatory measures. Our findings present the power of circulation cholinesterase measurements as useful early diagnostic tools for the occurrence of stroke. Importantly, these were considerably more distinctive than the inflammatory biomarkers, albeit closely associated with them, which may open new venues for stroke diagnosis and treatment

  17. GRACE Score among Six Risk Scoring Systems (CADILLAC, PAMI, TIMI, Dynamic TIMI, Zwolle) Demonstrated the Best Predictive Value for Prediction of Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction

    PubMed Central

    Littnerova, Simona; Kala, Petr; Jarkovsky, Jiri; Kubkova, Lenka; Prymusova, Krystyna; Kubena, Petr; Tesak, Martin; Toman, Ondrej; Poloczek, Martin; Spinar, Jindrich; Dusek, Ladislav; Parenica, Jiri

    2015-01-01

    Aim To compare the prognostic accuracy of six scoring models for up to three-year mortality and rates of hospitalisation due to acute decompensated heart failure (ADHF) in STEMI patients. Methods and Results A total of 593 patients treated with primary PCI were evaluated. Prospective follow-up of patients was ≥3 years. Thirty-day, one-year, two-year, and three-year mortality rates were 4.0%, 7.3%, 8.9%, and 10.6%, respectively. Six risk scores—the TIMI score and derived dynamic TIMI, CADILLAC, PAMI, Zwolle, and GRACE—showed a high predictive accuracy for six- and 12-month mortality with area under the receiver operating characteristic curve (AUC) values of 0.73–0.85. The best predictive values for long-term mortality were obtained by GRACE. The next best-performing scores were CADILLAC, Zwolle, and Dynamic TIMI. All risk scores had a lower prediction accuracy for repeat hospitalisation due to ADHF, except Zwolle with the discriminatory capacity for hospitalisation up to two years (AUC, 0.80–0.83). Conclusions All tested models showed a high predictive value for the estimation of one-year mortality, but GRACE appears to be the most suitable for the prediction for a longer follow-up period. The tested models exhibited an ability to predict the risk of ADHF, especially the Zwolle model. PMID:25893501

  18. Predicting Prostate Cancer Mortality Among Men With Intermediate to High-Risk Disease and Multiple Unfavorable Risk Factors

    SciTech Connect

    Nguyen, Paul L. Chen Minghui; Catalona, William J.; Moul, Judd W.; Sun, Leon; D'Amico, Anthony V.

    2009-03-01

    Purpose: To determine whether the number of unfavorable risk factors could be used to predict the risk of prostate cancer-specific mortality (PCSM) among men with intermediate- to high-risk prostate cancer. Methods and Materials: We studied 1,063 men who underwent radical prostatectomy (n = 559), external beam radiotherapy (n = 288), or radiotherapy plus androgen suppression therapy (n = 116) for prostate cancer between 1965 and 2002. Fine and Gray's regression analysis was used to determine whether an increasing number of unfavorable risk factors (prostate-specific antigen level >10 ng/mL, Gleason score of {>=}7, clinical Stage T2b or greater, or pretreatment prostate-specific antigen velocity >2.0 ng/mL/y) was associated with the interval to PCSM and all-cause mortality. Results: Median follow-up was 5.6 years. Compared with those with one risk factor, the adjusted hazard ratio for PCSM was 2.3 (95% confidence interval 1.1-4.8; p = 0.03) for two risk factors, 5.4 (95% confidence interval 2.7-10.7; p < 0.0001) for three risk factors, and 13.6 (95% confidence interval 6.3-29.2; p < 0.0001) for all four risk factors. The 5-year cumulative incidence of PCSM was 2.4% for one factor, 2.4% for two factors, 7.0% for three factors, and 14.7% for all four factors. Prostate cancer deaths as a proportion of all deaths was 19% for one factor, 33% for two factors, 53% for three factors, and 80% for four factors. Conclusion: The number of unfavorable risk factors was significantly associated with PCSM. Prostate cancer was the major cause of death in men with at least three risk factors. Therefore, these men should be considered for clinical trials designed to assess whether survival is prolonged with the addition of novel agents to current standards of practice.

  19. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients.

    PubMed

    Yoon, Hye Eun; Kim, Sung Jun; Hwang, Hyeon Seok; Chung, Sungjin; Yang, Chul Woo; Shin, Seok Joon

    2015-01-01

    Red blood cell distribution width (RDW) is a robust marker of adverse clinical outcomes in various populations. However, the clinical significance of a progressive rise in RDW is undetermined in end-stage renal disease (ESRD) patients. The purpose of this study was to determine the prognostic importance of a change in RDW in ESRD patients. Three hundred twenty-six incident dialysis patients were retrospectively analyzed. Temporal changes in RDW during 12 months after dialysis initiation were assessed by calculating the coefficients by linear regression. Patients were divided into two groups: an RDW-decreased group who had negative coefficient values (n = 177) and an RDW-increased group who had positive values (n = 149). The associations between rising RDW and mortality and cardiovascular (CV) events were investigated. During a median follow-up of 2.7 years (range, 1.0-7.7 years), 75 deaths (24.0%) and 60 non-fatal CV events (18.4%) occurred. The event-free survival rate for the composite of end-points was lower in the RDW-increased group (P = 0.004). After categorizing patients according to baseline RDW, the event-free survival rate was lowest in patients with a baseline RDW >14.9% and increased RDW, and highest in patients with a baseline RDW ≤14.9% and decreased RDW (P = 0.02). In multivariate analysis, rising RDW was independently associated with the composite of end-points (hazard ratio = 1.75, P = 0.007), whereas the baseline RDW was not. This study shows that a progressive rise in RDW independently predicted mortality and CV events in ESRD patients. Rising RDW could be an additive predictor for adverse CV outcomes ESRD patients. PMID:25961836

  20. Stratified neutrophil-to-lymphocyte ratio accurately predict mortality risk in hepatocellular carcinoma patients following curative liver resection

    PubMed Central

    Huang, Gui-Qian; Zhu, Gui-Qi; Liu, Yan-Long; Wang, Li-Ren; Braddock, Martin; Zheng, Ming-Hua; Zhou, Meng-Tao

    2016-01-01

    Objectives Neutrophil lymphocyte ratio (NLR) has been shown to predict prognosis of cancers in several studies. This study was designed to evaluate the impact of stratified NLR in patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC). Methods A total of 1659 patients who underwent CLR for suspected HCC between 2007 and 2014 were reviewed. The preoperative NLR was categorized into quartiles based on the quantity of the study population and the distribution of NLR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses. Univariate and multivariate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease prognosis. Results Multivariable Cox proportional hazards models showed that the level of NLR (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P<0.001), portal vein thrombosis (HR = 4.329, 95%CI: 1.968-9.521, P<0.001), microvascular invasion (HR = 2.527, 95%CI: 1.726-3.700, P<0.001) and CTP score (HR = 1.675, 95%CI: 1.153-2.433, P = 0.007) were significant predictors of mortality. From the Kaplan-Meier analysis of overall survival (OS), each NLR quartile showed a progressively worse OS and apparent separation (log-rank P=0.008). The highest 5-year OS rate following CLR (60%) in HCC patients was observed in quartile 1. In contrast, the lowest 5-year OS rate (27%) was obtained in quartile 4. Conclusions Stratified NLR may predict significantly improved outcomes and strengthen the predictive power for patient responses to therapeutic intervention. PMID:26716411

  1. Predicted risks of second malignant neoplasm incidence and mortality due to secondary neutrons in a girl and boy receiving proton craniospinal irradiation

    NASA Astrophysics Data System (ADS)

    Taddei, Phillip J.; Mahajan, Anita; Mirkovic, Dragan; Zhang, Rui; Giebeler, Annelise; Kornguth, David; Harvey, Mark; Woo, Shiao; Newhauser, Wayne D.

    2010-12-01

    The purpose of this study was to compare the predicted risks of second malignant neoplasm (SMN) incidence and mortality from secondary neutrons for a 9-year-old girl and a 10-year-old boy who received proton craniospinal irradiation (CSI). SMN incidence and mortality from neutrons were predicted from equivalent doses to radiosensitive organs for cranial, spinal and intracranial boost fields. Therapeutic proton absorbed dose and equivalent dose from neutrons were calculated using Monte Carlo simulations. Risks of SMN incidence and mortality in most organs and tissues were predicted by applying risks models from the National Research Council of the National Academies to the equivalent dose from neutrons; for non-melanoma skin cancer, risk models from the International Commission on Radiological Protection were applied. The lifetime absolute risks of SMN incidence due to neutrons were 14.8% and 8.5%, for the girl and boy, respectively. The risks of a fatal SMN were 5.3% and 3.4% for the girl and boy, respectively. The girl had a greater risk for any SMN except colon and liver cancers, indicating that the girl's higher risks were not attributable solely to greater susceptibility to breast cancer. Lung cancer predominated the risk of SMN mortality for both patients. This study suggests that the risks of SMN incidence and mortality from neutrons may be greater for girls than for boys treated with proton CSI.

  2. Cerebrospinal fluid cytokine profiles predict risk of early mortality and immune reconstitution inflammatory syndrome in HIV-associated cryptococcal meningitis.

    PubMed

    Jarvis, Joseph N; Meintjes, Graeme; Bicanic, Tihana; Buffa, Viviana; Hogan, Louise; Mo, Stephanie; Tomlinson, Gillian; Kropf, Pascale; Noursadeghi, Mahdad; Harrison, Thomas S

    2015-04-01

    Understanding the host immune response during cryptococcal meningitis (CM) is of critical importance for the development of immunomodulatory therapies. We profiled the cerebrospinal fluid (CSF) immune-response in ninety patients with HIV-associated CM, and examined associations between immune phenotype and clinical outcome. CSF cytokine, chemokine, and macrophage activation marker concentrations were assayed at disease presentation, and associations between these parameters and microbiological and clinical outcomes were examined using principal component analysis (PCA). PCA demonstrated a co-correlated CSF cytokine and chemokine response consisting primarily of Th1, Th2, and Th17-type cytokines. The presence of this CSF cytokine response was associated with evidence of increased macrophage activation, more rapid clearance of Cryptococci from CSF, and survival at 2 weeks. The key components of this protective immune-response were interleukin (IL)-6 and interferon-γ, IL-4, IL-10 and IL-17 levels also made a modest positive contribution to the PC1 score. A second component of co-correlated chemokines was identified by PCA, consisting primarily of monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α). High CSF chemokine concentrations were associated with low peripheral CD4 cell counts and CSF lymphocyte counts and were predictive of immune reconstitution inflammatory syndrome (IRIS). In conclusion CSF cytokine and chemokine profiles predict risk of early mortality and IRIS in HIV-associated CM. We speculate that the presence of even minimal Cryptococcus-specific Th1-type CD4+ T-cell responses lead to increased recruitment of circulating lymphocytes and monocytes into the central nervous system (CNS), more effective activation of CNS macrophages and microglial cells, and faster organism clearance; while high CNS chemokine levels may predispose to over recruitment or inappropriate recruitment of immune cells to the CNS and IRIS

  3. Role of Right Ventricular Global Longitudinal Strain in Predicting Early and Long-Term Mortality in Cardiac Resynchronization Therapy Patients

    PubMed Central

    Nagy, Vivien Klaudia; Széplaki, Gábor; Apor, Astrid; Kutyifa, Valentina; Kovács, Attila; Kosztin, Annamária; Becker, Dávid; Boros, András Mihály; Gellér, László; Merkely, Béla

    2015-01-01

    Background Right ventricular (RV) dysfunction has been associated with poor prognosis in chronic heart failure (HF). However, less data is available about the role of RV dysfunction in patients with cardiac resynchronization therapy (CRT). We aimed to investigate if RV dysfunction would predict outcome in CRT. Design We enrolled prospectively ninety-three consecutive HF patients in this single center observational study. All patients underwent clinical evaluation and echocardiography before CRT and 6 months after implantation. We assessed RV geometry and function by using speckle tracking imaging and calculated strain parameters. We performed multivariable Cox regression models to test mortality at 6 months and at 24 months. Results RV dysfunction, characterized by decreased RVGLS (RV global longitudinal strain) [10.2 (7.0–12.8) vs. 19.5 (15.0–23.9) %, p<0.0001] and RVFWS (RV free wall strain) [15.6 (10.0–19.3) vs. 17.4 (10.5–22.2) %, p = 0.04], improved 6 months after CRT implantation. Increasing baseline RVGLS and RVFWS predicted survival independent of other parameters at 6 months [hazard ratio (HR) = 0.37 (0.15–0.90), p = 0.02 and HR = 0.42 (0.19–0.89), p = 0.02; per 1 standard deviation increase, respectively]. RVGLS proved to be a significant independent predictor of mortality at 24 months [HR = 0.53 (0.32–0.86), p = 0.01], and RVFWS showed a strong tendency [HR = 0.64 (0.40–1.00), p = 0.05]. The 24-month survival was significantly impaired in patients with RVGLS below 10.04% before CRT implantation [area under the curve = 0.72 (0.60–0.84), p = 0.002, log-rank p = 0.0008; HR = 5.23 (1.76–15.48), p = 0.003]. Conclusions Our findings indicate that baseline RV dysfunction is associated with poor short-term and long-term prognosis after CRT implantation. PMID:26700308

  4. The length of unemployment predicts mortality, differently in men and women, and by cause of death: a six year mortality follow-up of the Swedish 1992-1996 recession.

    PubMed

    Garcy, Anthony M; Vågerö, Denny

    2012-06-01

    This study examines the relationship between the total amount of accumulated unemployment during the deep Swedish recession of 1992-1996 and mortality in the following 6 years. Nearly 3.4 million Swedish men and women, born between 1931 and 1965 who were gainfully employed at the time of the 1990 census were included. Almost 23% of these individuals were unemployed at some point during the recession. We conduct a prospective cohort study utilizing Cox proportional hazard regression with a mortality follow-up from January 1997 to December 2002. We adjust for health status (1982-1991), baseline (1991) social, family, and employer characteristics of individuals before the recession. The findings suggest that long-term unemployment is related to elevated all-cause mortality for men and women. The excess mortality effects were small for women and attributable to a positive, linear increase in the hazard of alcohol disease-related mortality and external causes-of-death not classified as suicides or transport accidents. For men, the excess hazard of all-cause mortality was best represented by a cubic, non-linear shape. The predicted hazard increases rapidly with the shortest and longest accumulated levels of unemployment. However, the underlying pattern differed by cause-of-death. The cancer, circulatory, and alcohol disease-related analyses suggest that mortality peaks with mid-levels of accumulated unemployment and then declines with longer duration unemployment. For men, we observed a positive, linear increase in the hazard ratios associated with transport and suicide mortality, and a very steep non-linear increase in the excess hazard ratio associated with other external causes of death that were not classified as suicide or transport accidents. In conclusion, mortality risk increases with the duration of unemployment among men and women. This was best described by a cubic function for men and a linear function for women. Behind this pattern, different causes

  5. Fibroblast growth factor 15 deficiency impairs liver regeneration in mice

    PubMed Central

    Kong, Bo; Huang, Jiansheng; Zhu, Yan; Li, Guodong; Williams, Jessica; Shen, Steven; Aleksunes, Lauren M.; Richardson, Jason R.; Apte, Udayan; Rudnick, David A.

    2014-01-01

    Fibroblast growth factor (FGF) 15 (human homolog, FGF19) is an endocrine FGF highly expressed in the small intestine of mice. Emerging evidence suggests that FGF15 is critical for regulating hepatic functions; however, the role of FGF15 in liver regeneration is unclear. This study assessed whether liver regeneration is altered in FGF15 knockout (KO) mice following 2/3 partial hepatectomy (PHx). The results showed that FGF15 KO mice had marked mortality, with the survival rate influenced by genetic background. Compared with wild-type mice, the KO mice displayed extensive liver necrosis and marked elevation of serum bile acids and bilirubin. Furthermore, hepatocyte proliferation was reduced in the KO mice because of impaired cell cycle progression. After PHx, the KO mice had weaker activation of signaling pathways that are important for liver regeneration, including signal transducer and activator of transcription 3, nuclear factor-κB, and mitogen-activated protein kinase. Examination of the KO mice at early time points after PHx revealed a reduced and/or delayed induction of immediate-early response genes, including growth-control transcription factors that are critical for liver regeneration. In conclusion, the results suggest that FGF15 deficiency severely impairs liver regeneration in mice after PHx. The underlying mechanism is likely the result of disrupted bile acid homeostasis and impaired priming of hepatocyte proliferation. PMID:24699334

  6. Predicting Mortality in Patients With “Malignant” Middle Cerebral Artery Infarction Using Susceptibility-Weighted Magnetic Resonance Imaging

    PubMed Central

    Chao, Shu-Ping; Chen, Chia-Yuen; Tsai, Fong Y.; Chan, Wing P.; Chen, Chin-I

    2016-01-01

    Abstract To evaluate malignant middle cerebral artery (MCA) infarction (defined as space-occupying edema in more than 50% to 75% of the MCA territory) on magnetic resonance imaging (MRI) with susceptibility-weighted imaging (SWI) sequence and assess the usefulness of SWI findings, diffusion-weighted imaging (DWI) findings, and apparent diffusion coefficient (ADC) as predictors of clinical outcome. Data from 16 patients with large MCA infarction previously admitted to our institution between December 2009 and October 2012 were retrospectively collected and analyzed. Within 7 days after stroke onset, 1 neurologist and 1 neuroradiologist estimated the area of infarction on DWI/ADC and extent of prominent vessel sign (PVS) on SWI images using the Stroke Program Early MR Score (SPEMRS). The PVS on SWI was defined as a local prominence of hypointense vessels with either increased vessel number or diameter in the target area, when compared with the number or diameter of the contralateral MCA territory vessels. Six patients died and 10 survived. Although the DWI/ADC-SPEMRS and clinical profiles were similar between the nonsurvivor and survivor groups, SWI-SPEMRS was significantly lower in the nonsurvivor group (P < 0.001). The area of deoxygenation on SWI in patients with malignant MCA infarction can predict mortality. Lower SWI-SPEMRS is a potentially better predictor of poor outcome than lower DWI-SPEMRS. A larger prospective study is needed to clarify the role of SWI as a therapeutic guide in malignant MCA. PMID:26937906

  7. Comparison of the Utility of Preoperative versus Postoperative B-type Natriuretic Peptide for Predicting Hospital Length of Stay and Mortality after Primary Coronary Artery Bypass Grafting

    PubMed Central

    Fox, Amanda A.; Muehlschlegel, Jochen D.; Body, Simon C.; Shernan, Stanton K.; Liu, Kuang-Yu; Perry, Tjorvi E.; Aranki, Sary F.; Cook, E. Francis; Marcantonio, Edward R.; Collard, Charles D.

    2016-01-01

    Background Preoperative B-type natriuretic peptide (BNP) is known to predict adverse outcomes after cardiac surgery. The value of postoperative BNP for predicting adverse outcomes is less well delineated. The authors hypothesized that peak postoperative plasma BNP (measured postoperative days 1–5) predicts hospital length of stay (HLOS) and mortality in patients undergoing primary coronary artery bypass grafting, even after adjusting for preoperative BNP and perioperative clinical risk factors. Methods This study is a prospective longitudinal study of 1,183 patients undergoing primary coronary artery bypass grafting surgery. Mortality was defined as all-cause death within 5 yr after surgery. Cox proportional hazards analyses were conducted to separately evaluate the associations between peak postoperative BNP and HLOS and mortality. Multivariable adjustments were made for patient demographics, preoperative BNP concentration, and clinical risk factors. BNP measurements were log10 transformed before analysis. Results One hundred fifteen deaths (9.7%) occurred in the cohort (mean follow-up = 4.3 yr, range = 2.38–5.0 yr). After multivariable adjustment for preoperative BNP and clinical covariates, peak postoperative BNP predicted HLOS (hazard ratio [HR] = 1.28, 95% CI = 1.002–1.64, P = 0.049) but not mortality (HR = 1.62, CI = 0.71–3.68, P = 0.25), whereas preoperative BNP independently predicted HLOS (HR = 1.09, CI = 1.01–1.18, P = 0.03) and approached being an independent predictor of mortality (HR = 1.36, CI = 0.96–1.94, P = 0.08). When preoperative and peak postoperative BNP were separately adjusted for within the clinical multivariable models, each independently predicted HLOS (preoperative BNP HR = 1.13, CI = 1.05–1.21, P = 0.0007; peak postoperative BNP HR = 1.44, CI = 1.15–1.81, P = 0.001) and mortality (preoperative BNP HR = 1.50, CI = 1.09–2.07, P = 0.01; peak postoperative BNP HR = 2.29, CI = 1.11–4.73, P = 0.02). Conclusions Preoperative

  8. Hyponatremia, hypochloremia, and hypoalbuminemia predict an increased risk of mortality during the first year of antiretroviral therapy among HIV-infected Zambian and Kenyan women.

    PubMed

    Dao, Christine N; Peters, Philip J; Kiarie, James N; Zulu, Isaac; Muiruri, Peter; Ong'ech, John; Mutsotso, Winfred; Potter, Dara; Njobvu, Lungowe; Stringer, Jeffrey S A; Borkowf, Craig B; Bolu, Omotayo; Weidle, Paul J

    2011-11-01

    Early mortality rates after initiating antiretroviral therapy (ART) are high in sub-Saharan Africa. We examined whether serum chemistries at ART initiation predicted mortality among HIV-infected women. From May 2005 to January 2007, we enrolled women initiating ART in a prospective cohort study in Zambia and Kenya. We used Cox proportional hazards models to identify risk factors associated with mortality. Among 661 HIV-infected women, 53 (8%) died during the first year of ART, and tuberculosis was the most common cause of death (32%). Women were more likely to die if they were both hyponatremic (sodium <135 mmol/liter) and hypochloremic (chloride <95 mmol/liter) (37% vs. 6%) or hypoalbuminemic (albumin <34 g/liter, 13% vs. 4%) when initiating ART. A body mass index <18 kg/m(2) [adjusted hazard ratio (aHR) 5.3, 95% confidence interval (CI) 2.6-10.6] and hyponatremia with hypochloremia (aHR 4.5, 95% CI 2.2-9.4) were associated with 1-year mortality after adjusting for country, CD4 cell count, WHO clinical stage, hemoglobin, and albumin. Among women with a CD4 cell count >50 cells/μl, hypoalbuminemia was also a significant predictor of mortality (aHR=3.7, 95% CI 1.4-9.8). Baseline hyponatremia with hypochloremia and hypoalbuminemia predicted mortality in the first year of initiating ART, and these abnormalities might reflect opportunistic infections (e.g., tuberculosis) or advanced HIV disease. Assessment of serum sodium, chloride, and albumin can identify HIV-infected patients at highest risk for mortality who may benefit from more intensive medical management during the first year of ART. PMID:21417949

  9. Elevated Circulating Osteoprotegerin and Renal Dysfunction Predict 15-Year Cardiovascular and All-Cause Mortality: A Prospective Study of Elderly Women

    PubMed Central

    Zhu, Kun; Lim, Ee M.; Bollerslev, Jens; Prince, Richard L.

    2015-01-01

    Background Data on the predictive role of estimated glomerular filtration rate (eGFR) and osteoprotegerin (OPG) for cardiovascular (CVD) and all-cause mortality risk have been presented by our group and others. We now present data on the interactions between OPG with stage I to III chronic kidney disease (CKD) for all-cause and CVD mortality. Methods and Results The setting was a 15-year study of 1,292 women over 70 years of age initially randomized to a 5-year controlled trial of 1.2 g of calcium daily. Serum OPG and creatinine levels with complete mortality records obtained from the Western Australian Data Linkage System were available. Interactions were detected between OPG levels and eGFR for both CVD and all-cause mortality (P < 0.05). Compared to participants with eGFR ≥60ml/min/1.73m2 and low OPG, participants with eGFR of <60ml/min/1.73m2 and elevated OPG had a 61% and 75% increased risk of all-cause and CVD mortality respectively (multivariate-adjusted HR, 1.61; 95% CI, 1.27-2.05; P < 0.001 and HR, 1.75; 95% CI, 1.22-2.55; P = 0.003). This relationship with mortality was independent of decline in renal function (P<0.05). Specific causes of death in individuals with elevated OPG and stage III CKD highlighted an excess of coronary heart disease, renal failure and chronic obstructive pulmonary disease deaths (P < 0.05). Conclusion The association between elevated OPG levels with CVD and all-cause mortality was more evident in elderly women with poorer renal function. Assessment of OPG in the context of renal function may be important in studies investigating its relationship with all-cause and CVD mortality. PMID:26222774

  10. Incident Subjective Cognitive Decline Does Not Predict Mortality in the Elderly – Results from the Longitudinal German Study on Ageing, Cognition, and Dementia (AgeCoDe)

    PubMed Central

    Roehr, Susanne; Luck, Tobias; Heser, Kathrin; Fuchs, Angela; Ernst, Annette; Wiese, Birgitt; Werle, Jochen; Bickel, Horst; Brettschneider, Christian; Koppara, Alexander; Pentzek, Michael; Lange, Carolin; Prokein, Jana; Weyerer, Siegfried; Mösch, Edelgard; König, Hans-Helmut; Maier, Wolfgang; Scherer, Martin

    2016-01-01

    Objective Subjective cognitive decline (SCD) might represent the first symptomatic representation of Alzheimer’s disease (AD), which is associated with increased mortality. Only few studies, however, have analyzed the association of SCD and mortality, and if so, based on prevalent cases. Thus, we investigated incident SCD in memory and mortality. Methods Data were derived from the German AgeCoDe study, a prospective longitudinal study on the epidemiology of mild cognitive impairment (MCI) and dementia in primary care patients over 75 years covering an observation period of 7.5 years. We used univariate and multivariate Cox regression analyses to examine the relationship of SCD and mortality. Further, we estimated survival times by the Kaplan Meier method and case-fatality rates with regard to SCD. Results Among 971 individuals without objective cognitive impairment, 233 (24.0%) incidentally expressed SCD at follow-up I. Incident SCD was not significantly associated with increased mortality in the univariate (HR = 1.0, 95% confidence interval = 0.8–1.3, p = .90) as well as in the multivariate analysis (HR = 0.9, 95% confidence interval = 0.7–1.2, p = .40). The same applied for SCD in relation to concerns. Mean survival time with SCD was 8.0 years (SD = 0.1) after onset. Conclusion Incident SCD in memory in individuals with unimpaired cognitive performance does not predict mortality. The main reason might be that SCD does not ultimately lead into future cognitive decline in any case. However, as prevalence studies suggest, subjectively perceived decline in non-memory cognitive domains might be associated with increased mortality. Future studies may address mortality in such other cognitive domains of SCD in incident cases. PMID:26766555