Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia.

Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000-2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.

Incidence and treatment outcome of aplastic anemia in Taiwan-real-world data from single-institute experience and a nationwide population-based database.

Aplastic anemia (AA) is a rare disease characterized by pancytopenia and bone marrow failure. The incidence of AA tends to be higher in Asia than in the West, but real-world data about AA in Asia remain limited. We aimed to describe the basic data, treatment, and outcome of AA patients from our institute and evaluate the incidence of AA in Taiwan with a nationwide population-based cohort from National Health Insurance Research Database (NHIRD). We identified patients older than 2 years with AA in the Registry of Catastrophic Illness of NHIRD between 2001 and 2010 and excluded patients with any diagnosis suggestive of congenital or secondary bone marrow failure. With a total of 1270 patients, the overall incidence was 5.67 per million people per year, and there was a biphasic age distribution of incidence rate, highest in ≥ 70 years (19.83 per million people per year) and another peak at age 2-9 years (5.26 per million people per year). Overall, the 5-year survival was 60.0%. Hematopoietic stem cell transplantation (HSCT) and anti-thymocyte globulin-based immunosuppressive therapy (IST) were the major first-line treatments in patients younger than 40 years and were linked with good survival. In contrast, the majority of patients older than 60 years were treated with androgen, and the survival was poor. In multivariate analysis, "severe AA," "very severe AA," and "treatment other than HSCT, IST, or androgen" were independent risk factors for inferior survival. In conclusion, the incidence of AA in Taiwan is consistent with nearby Asian countries and is higher than in the West. Advanced age is associated with higher incidence and poorer outcome.

Long Term Survival of Pathological Thoracolumbar Fractures Treated with Vertebroplasty: Analysis Using a Nationwide Insurance Claim Database.

BACKGROUND: There are still debates on the long-term outcome of treating pathological thoracolumbar fractures, including osteoporosis and oncologic problems, using vertebroplasty. METHODS: We collected 8625 patients with pathological thoracolumbar fractures (ICD-9-CM codes 733.13 combined with 805.2 or 805.4) between the years of 2003 to 2013, from the two million random samples from the National Health Insurance Research Database in Taiwan. Survival analysis was conducted to estimate the mortality risks of different treatments, including vertebroplasty (n = 1389), conventional open surgery (n = 1219), or conservative treatment (n = 6017). A multivariable Cox proportional hazard model was constructed for adjustment of age, gender, comorbidities and complications. RESULTS: Crude incidence rate of patients with pathological thoracolumbar fractures in Taiwan gradually increased year by year. Compared with conservative treatment, conventional open surgery and vertebroplasty seemed to improve long-term survival with adjusted hazard ratios (aHR) of 0.80 (95% confidence interval (CI) 0.70-0.93), and 0.87 (95% CI 0.77-0.99), respectively. The survival advantage of vertebroplasty appeared more evident for those aged over 75. However, we were unable to rule out confounding by indication. CONCLUSION: Although conventional open surgery would usually be the best choice for the treatment of patients with pathological thoracolumbar fractures, database information from current real-world practice appears to support vertebroplasty as a viable choice for elderly people over 75 years of age.

Behind and Beyond the Masaoka Staging: A 25-Year Follow-up Study of Tumor Recurrence in Completely Resected Thymic Epithelial Tumors in a Single Institution.

We analyzed prognosticators for recurrence and post-recurrence survival in completely resected thymic epithelial tumors for the past 25 years in a single institution.Between June 1988 and December 2013, 238 patients undergoing intent-to-treat surgery for thymic epithelial tumors were reviewed. Sex, age, myasthenia gravis (MG), tumor histology, Masaoka staging, characteristic of locoregional invasion and recurrence, and the treatment for recurrence were collected. Comparison between groups was conducted using the Student t test and χ test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. The Cox proportional hazards model was used for univariate and multivariate analyses of prognostic factors.One hundred sixteen of 135 patients with completely resected thymoma and 35 of 56 patients with thymic carcinoma remained free of recurrence. In patients with completely resected thymoma, Masaoka staging, MG, tumor invasion into the lung, pericardium, and innominate vein or superior vena cava (SVC) invasion were associated with recurrence-free survival in univariate analysis (P = 0.004, 0.003, 0.001, 0.007, and 0.039, respectively). In multivariate analysis, MG was the positive independent prognosticator (P = 0.039). In patients with completely resected thymic carcinoma, Masaoka staging and innominate vein or SVC invasion were associated with recurrence-free survival in univariate analysis (P = 0.045 and 0.005, respectively), whereas innominate vein or SVC invasion was the negative independent prognosticator (P = 0.012). In patients with recurrent thymoma, those treated with surgery followed by chemotherapy had a significantly better post-recurrence survival than those undergoing chemoradiotherapy (P = 0.029) and those without treatment (P = 0.007). Patients with recurrent thymic carcinoma undergoing surgery followed by chemotherapy had a significantly better post-recurrence survival than those without treatment (P = 0.004), but not significantly better than those undergoing chemoradiotherapy (P = 0.252).In patients with completely resected thymoma, MG was the positive independent prognosticators of recurrence-free survival. Surgery should be attempted for recurrent disease for better post-recurrence survival. In patients with completely resected thymic carcinoma, innominate vein or SVC invasion was the negative independent prognosticator. Surgery for recurrence could be considered since it provided benefit for post-recurrence survival as chemoradiotherapy did.

Factors predicting recurrence and postrecurrence survival in completely resected thymic carcinoma.

BACKGROUND: There are few data on factors predicting recurrence of completely resected thymic carcinoma. This study analyzed prognosticators for recurrence and postrecurrence survival. METHODS: Eighty-two patients with surgically treated thymic carcinoma were reviewed between June 1988 and March 2013, and 54 who underwent complete resection were enrolled. Sex, age, myasthenia gravis, tumor histologic classification, Masaoka staging, characteristics of locoregional invasion and recurrence, and the treatment for recurrence were collected. Continuous variables between groups were compared using Student's t test, and categorical variables were compared using the χ2 test, Fisher's exact test, or Spearman rank correlation. Survival analysis was performed using the Kaplan-Meier and log-rank test. Statistical significance was set at a probability value of less than 0.05. RESULTS: A total of 54 patients underwent complete resection for thymic carcinoma, 21 of whom had recurrent diseases and 33 of whom remained disease-free. Patients without recurrent disease had a significantly better 5-year overall survival of 79% than 26% of those who had recurrent disease (p=0.000). Masaoka staging and tumor invasion of the superior vena cava were significantly associated with recurrence-free survival in the univariate analysis (p=0.047 and 0.019, respectively). In the multivariate analysis for survival, tumor invasion into the superior vena cava was the only prognostic variable for recurrence-free survival (p=0.047). Patients who underwent surgical intervention followed by chemotherapy for recurrent diseases had the best progression-free survival after recurrence (p=0.000). CONCLUSIONS: Superior vena cava invasion as well as Masaoka staging was significantly associated with recurrence-free survival in patients with completely resected thymic carcinoma. In patients with recurrent disease, surgical resection should be attempted for localized disease because it might provide some benefit for progression-free survival.