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The relationship between increased short-term mortality rates after invasive pneumococcal disease (IPD) has been frequently studied. However, the relationship between IPD and long-term mortality rates is unknown. IPD patients in Alberta, Canada, had clinical data collected that were linked to administrative databases. We used Cox proportional hazards modeling, and the primary outcome was time to all-cause deaths. First IPD events were identified in 4,522 patients, who had a median follow-up of 3.2 years (interquartile range 0.8‒9.1 years). Overall all-cause mortality rates were consistently higher among cases than controls at 30 days (adjusted hazard ratio [aHR] 3.75, 95% CI 3.29–4.28), 30‒90 days (aHR 1.56, 95% CI 1.27‒1.93), and >90 days (aHR 1.43, 95% CI 1.33–1.54). IPD increases risk for short, intermediate, and long-term mortality rates regardless of age, sex, or concurrent conditions. These findings can help clinicians focus on postdischarge patient plans to limit long-term effects after acute IPD infection.

Rate-pressure product (RPP) calculated by multiplying heart rate by systolic blood pressure, is a convenient indicator closely associated with cardiac work or myocardial oxygen consumption. It has been reported to relate strongly to important indices of cardiovascular risk in patients with myocardial ischemia. However, its relationship with short- and long-term mortality in patients with acute coronary syndrome (ACS) undergoing primary PCI/immediate invasive strategy has not been defined. This study analyzed 1301 consecutive ACS patients who had undergone primary PCI, between January 2018 and September 2021. Patients with systolic BP < 90 mmHg were excluded to avoid the confounding effect of cardiogenic shock. RPP values were collected on admission and were divided into four groups: RPP ≤ 7.4, 7.4 ≤ 8.8, 8.8 <8.8 < RPP8, and RPP > 10.8. Clinical endpoints were in-hospital cardiac and long-term all-cause mortality. The predictive performance was assessed by C-statistic, multivariate analysis and survival analysis. Multivariate analysis showed that these in the highest vs lowest category of RPP (>10.8 vs ≤7.4) had OR of 4.33 (95% CI=1.10 -17.01; P = 0.036) in in-hospital cardiac mortality and 3.15 (95% CI=1.24 -8.00; P = 0.016) in long-term all-cause mortality. In C-statistic analyses, RPP was a strong predictor in ACS, STEMI or UA/NSTEMI group for in-hospital cardiac mortality (AUC = 0.746, 95% CI = 0.722-0.770, p < 0.001) and long-term all-cause mortality (AUC = 0.701, 95% CI = 0.675-0.725, p < 0.001). The Kaplan-Meier event rate for long-term survival of RPP > 10.8 was significantly lower than that of RPP ≤ 10.8. RPP showed a positive association with in-hospital cardiac or long-term all-cause mortality in ACS patients undergoing primary PCI/immediate invasive strategy, and RPP > 10.8 can be as an independent predictor.

Aims We aimed to explore associations between Red cell distribution width (RDW), RDW to albumin ratio (RAR), and long‐term all‐cause and cardiovascular disease (CVD) mortality in adults with diabetes and DN. Methods This study included adults aged ≥40 years with DN from the National Health and Nutrition Examination Survey from 1999 to 2004, followed through 2019. Cox proportional hazards models were used to assess associations between RDW, RAR, and all‐cause and CVD mortality. Predictive accuracy was determined using area under the curve (AUC) by receiver operating characteristic analyses. Results Data of a total of 624 participants with DN were analyzed. Each unit increase in RDW significantly increased all‐cause mortality by 12% (adjusted hazard ratio (aHR) = 1.12, 95% CI: 1.05–1.20) and CVD mortality by 15% (aHR = 1.15, 95% CI: 1.02–1.31), while each unit increase in RAR increased all‐cause mortality by 73% (aHR = 1.73) and CVD mortality by 93% (aHR = 1.93). In the highest versus lowest quartiles, RDW (aHR = 1.89) and RAR (aHR = 2.91) were associated with higher all‐cause mortality risk, and even higher risk for CVD mortality (RDW: aHR = 2.86; RAR: aHR = 4.84). The AUC for 5‐year predictions was RDW 0.825 and RAR 0.846 for all‐cause mortality, and RDW 0.811 and RAR 0.814 for CVD mortality. Conclusions RDW and RAR are strong predictors of long‐term mortality in individuals with DN. RAR demonstrates stronger associations and higher predictive accuracy than RDW, particularly in predicting CVD mortality. The study aimed to explore the relationship between RDW, RAR, and long‐term mortality in adults with diabetes and diabetic neuropathy (DN) using NHANES data from 1999 to 2004. Higher RDW and RAR were significantly associated with increased risks of all‐cause and cardiovascular mortality in individuals with diabetes and DN. RAR showed stronger predictive accuracy for mortality compared to RDW, especially for cardiovascular mortality. RDW and RAR are valuable prognostic markers for long‐term mortality in diabetic patients with neuropathy, suggesting a potential role in risk stratification and patient management.

Objectives Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. Methods We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre‐operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C‐reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. Results The 30‐day, 1‐year, 2‐year, and 4‐year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut‐off values of admission NLR, MLR and CAR for 1‐year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080–1.864, p = 0.012) were found to be only independent risk factors with 4‐year all‐cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1‐year (HR = 1.700, 95% CI: 1.173–2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107–1.936, p = 0.008), and 4‐year (HR = 1.341, 95% CI: 1.057–1.700, p = 0.016) all‐cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all‐cause mortality. Conclusion Admission CAR and NLR may be useful indicators for predicting the long‐term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings. Hip fractures in elderly patients are associated with a high mortality rate. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. This was a retrospective study of 1085 elderly hip fracture patients. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C‐reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by ROC curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. The 30‐day, 1‐year, 2‐year, and 4‐year mortality were 1.6%, 11.5%, 21.4% and 48.9%. After adjusting the covariates, preoperative CAR ≥ 1.36 was associated with 1 year mortality, preoperative NLR ≥ 7.28 and CAR ≥ 1.36 were found to be associated with 4 year mortality. Age, CCI score, and low hemoglobin at admission were also risk factors for postoperative mortality. Admission NLR and CAR may be useful indicators for predicting the long‐term mortality of elderly patients undergoing hip fracture surgery.

Background: Numerous previous studies have shown that renal insufficiency (RI) in patients with acute coronary syndrome is associated with poor cardiovascular outcomes. These studies do not well address the impact of RI on the long-term outcome of patients with acute ST-elevation myocardial infarction (STEMI) in China. The aim of this study was to investigate the association of admission RI and inhospital and long-term mortality of patients with acute STEMI. Methods: This was a multicenter, observational, prospective-cohort study. 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI, between January 1,2006 and December 31,2006. Estimation of glomerular filtration rate (eGFR) was calculated using the modified abbreviated modification of diet in renal disease equation-based on the Chinese chronic kidney disease patients. The patients were categorized according to eGFR, as normal renal dysfunction (eGFR > 90 mlmin -1 1.73 m -2 ), mild RI (60 mlmin -1 1.73 m -2 < eGFR < 90 mlmin -1 1.73 m -2 ) and moderate or severe RI (eGFR < 60 mlmin -1 1.73 m -2 ). The association between RI and inhospital and 6-year mortality of was evaluated. Results: Seven hundred and eighteen patients with STEMI were evaluated. There were 551 men and 167 women with a mean age of 61.0 +- 13.0 years. Two hundred and eighty patients (39.0%) had RI, in which 61 patients (8.5%) reached the level of moderate or severe RI. Patients with RI were more often female, elderly, hypertensive, and more patients had heart failure and stroke with higher killip class. Patients with RI were less likely to present with chest pain. The inhospital mortality (1.4% vs. 5.9% vs. 22.9%, P < 0.001), 6-year all-cause mortality (9.5% vs. 19.8 vs. 45.2%, P < 0.001) and 6-year cardiac mortality (2.9% vs. 12.2% vs. 23.8%, P < 0.001) were markedly increased in patients with RI. After adjusting for other confounding factors, classification of admission renal function was an independent predictor of inhospital mortality (Odd ratio, 1.966; 95% confidence interval [CI], 1.002-3.070, P = 0.019), 6-year all-cause mortality (relative risk [RR] = 1.501, 95% CI: 1.018-4.373, P = 0.039) and 6-year cardiac mortality (RR = 1.663, 95% CI: 1.122-4.617, P = 0.042). Conclusions: RI is very common in STEMI patients. RI evaluated by eGFR is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

Background: Abnormal glucose metabolism is present in most patients with coronary artery disease (CAD). Inflammation is considered to be a common risk factor for CAD and diabetes. Fibrinogen-to-albumin ratio (FAR), a novel inflammation biomarker, has been proposed as a predictor for cardiovascular disease. However, the relationship between the level of FAR and long-term mortality including all-cause, cardiovascular and cancer mortality, remains unknown in CAD patients, especially those with prediabetes. Methods: We enrolled 66,761 CAD patients from 2007 to 2020 from a multi-center registry cohort study. The primary outcomes were the all-cause, cardiovascular and cancer mortality. FAR was calculated using the following formula: Fibrinogen (g/L)/Albumin (g/L). Patients were divided into three groups by FAR tertile (low FAR (FAR-L), median FAR (FAR-M), high FAR (FAR-H)), and further categorized into 9 groups according to FAR and glucose metabolism status (normal glucose regulation (NGR), prediabetes mellitus (PreDM), diabetes mellitus (DM)). Cox regression models and competing risk models were used to examine the relationships between FAR and clinical outcomes. Results: 66,761 patients (63.1 ± 11.0 years, 75.3% male) were enrolled. During the follow-up, 10,534 patients died, including 4991 cardiovascular deaths and 1092 cancer deaths. After adjusting for confounders, higher FAR was associated with increased risk of all-cause and cause-specific mortality in CAD patients with NGR, PreDM and DM. The risk of all-cause and cardiovascular mortality was highest in FAR-H with DM (HR (95% CI) = 1.71 (1.58–1.86), 2.11 (1.86–2.38), respectively; p < 0.001). FAR-H with PreDM was significantly associated with the highest risk of cancer mortality (HR (95% CI) = 2.27 (1.70–3.02), p < 0.001). Adding FAR to the original model significantly improved the prediction of long-term mortality. Conclusions: Increased FAR was significantly associated with higher risk of all-cause and cause-specific mortality in CAD patients with NGR, PreDM and DM. Abnormal glucose metabolism augments the relationship between FAR and mortality. Clinical Trial Registration: ClinicalTrials.gov NCT05050877.

Aims Left ventricular ejection fraction (LVEF) ≤ 40% is a well‐established risk factor for mortality after acute coronary syndromes (ACS). However, the long‐term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41–49%) after ACS remains less clear. Methods and results This was a retrospective study enrolling patients admitted with ACS included in a single‐centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mildly reduced (LVEF 41–49%), and reduced (LVEF ≤ 40%). The endpoint of interest was all‐cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36–1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05–1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96–1.57; P = 0.095). Conclusions In patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long‐term mortality compared with patients with normal EF. These data emphasize the importance of anti‐remodelling therapies for ACS patients who have LVEF in the mildly reduced range.

Introduction Long‐term mortality among TB survivors appears to be higher than control populations without TB in many settings. However, data are limited among persons with HIV (PWH). We assessed the association between cured TB and long‐term mortality among persons with PWH in Haiti. Methods A prospective cohort of PWH from the CIPRA HT‐001 trial was followed from study enrolment (August 2005 to July 2008) to study closure (December 2018) to compare mortality between participants with and without TB. The index date for the survival analysis was defined as 240 days after TB diagnosis or randomization date. Time to death was described using Kaplan–Meier curves, and log‐rank tests were used to compare time to death between the TB and no‐TB cohorts. The association between TB and long‐term mortality was estimated with multivariable Cox models. Results Of the 816 participants in the CIPRA HT‐001 trial, 77 were excluded for a history of TB prior to study enrolment and 31 were excluded due to death or attrition prior to the index date, leaving 574 in the no‐TB and 134 in the TB cohort. Twenty‐four (17.9%) participants in the TB and 48 (8.4%) in the no‐TB cohort died during follow‐up. Five and 10‐year mortality rates were 14.2% and 17.9% respectively, in the TB cohort, and 6.1% and 8.4% in the no‐TB cohort. In Kaplan–Meier analysis, participants in the TB cohort had a significantly shorter time to death (log‐rank p < 0.001). In multivariable analysis, TB treatment was the only predictor of mortality (HR: 2.78; 95% CI: 1.61, 4.79). Sensitivity analyses, which included only baseline TB cases, an index date of two years after TB diagnosis, and study enrolment and case‐control matching yielded results that were consistent with primary analyses. Conclusions PWH who are successfully treated for TB have higher long‐term mortality than those who are never diagnosed with TB, even after accounting for acute TB‐related mortality. A better understanding of the underlying mechanisms associated with TB sequelae is critically needed to guide specific interventions. Until then, more aggressive measures for health promotion and disease prevention are essential to improve long‐term survival for PWH after TB treatment.

We aimed to compare differences in risk and timing of recurrent ischemic events among patients with stable ischemic heart disease (SIHD), non–ST-segment elevation acute coronary syndrome (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We performed an individual data pooled analysis of 5 randomized controlled all-comer trials including a total of 8,859 patients and investigated the risk and timing of recurrent ischemic events among patients with SIHD (n = 3,543), NSTE-ACS (n = 3,364), and STEMI (n = 1,952) throughout 2 years of follow-up. At 2 years, all-cause mortality was higher among patients with STEMI (6.4%) and NSTE-ACS (6.1%) compared with those with SIHD (4.2%) (STEMI vs SIHD: hazard ratio [HR] 1.40, 95% CI 1.09-1.78, P = .007; NSTE-ACS vs SIHD: 1.40, 95% CI 1.13-1.73, P = .002). In a landmark analysis, the risk of mortality among patients with STEMI compared with those with SIHD was confined to the first 30 days after PCI (HR 6.19, 95% CI 3.15-12.16, P < .001) but was similar between 30 days and 2 years (HR 1.00, 95% CI 0.76-1.33, P = .974) (Pinteraction < .001). Conversely, patients with NSTE-ACS had a higher risk of mortality compared with those with SIHD both within the first 30 days (HR 2.19, 95% CI 1.08-4.47, P = .031) and beyond (HR 1.34, 95% CI 1.07-1.67, P = .012) (Pinteraction < .001). A similar pattern in the differential timing of events was observed for cardiac death. Beyond 30 days, the risk of myocardial infarction was comparable in patients with STEMI and SIHD, whereas the risk in patients with NSTE-ACS was increased (HR 1.65, 95% CI 1.23-2.21, P = .001). Whereas patients with NSTE-ACS are at increased risk for death at any time after PCI, the mortality of STEMI patients is higher during the first 30 days after PCI but not thereafter compared with patients with SIHD.

Hip fractures are common in patients of advanced age and are associated with excess mortality. Rapid and accurate prediction of the prognosis using information that can be easily obtained before surgery would be advantageous to clinical management. We performed a population‐based retrospective cohort study using an 8.5‐year Japanese claims database (April 2012–September 2020) to develop and validate a predictive model for long‐term mortality after hip fracture. The study included 43,529 patients (34,499 [79.3%] women) aged ≥65 years with first‐onset hip fracture. During the observation period, 43% of the patients died. Cox regression analysis identified the following prognostic predictors: sex, age, fracture site, nursing care certification, and several comorbidities (any malignancy, renal disease, congestive heart failure, chronic pulmonary disease, liver disease, metastatic solid tumor, and deficiency anemia). We then developed a scoring system called the Shizuoka Hip Fracture Prognostic Score (SHiPS); this system was established by scoring based on each hazard ratio and classifying the degree of mortality risk into four categories based on decision tree analysis. The area under the receiver operating characteristic (ROC) curve (AUC) (95% confidence interval [CI]) of 1‐year, 3‐year, and 5‐year mortality based on the SHiPS was 0.718 (95% CI, 0.706–0.729), 0.736 (95% CI, 0.728–0.745), and 0.758 (95% CI, 0.747–0.769), respectively, indicating good predictive performance of the SHiPS for as long as 5 years after fracture onset. Even when the SHiPS was individually applied to patients with or without surgery after fracture, the prediction performance by the AUC was >0.7. These results indicate that the SHiPS can predict long‐term mortality using preoperative information regardless of whether surgery is performed after hip fracture. A retrospective cohort study was used to identify variables predicting mortality in those suffering first hip fracture, with sex, fracture site, nursing care certification, and diseases including malignancy and heart failure being identified. These variables were used to construct a points‐based scoring system called Shizuoka Hip Fracture Prognostic Score (SHiPS), which successfully predicted mortality up to 5 years after fracture. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.