Abstract P079: Prediction of All-Cause Mortality in Diabetic Patients
Authors: Augusto Filippo Di Castelnuovo, Simona Costanzo, Marialaura Bonaccio, Amalia de Curtis, Mariarosaria Persichillo, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello
Journal: Circulation (2019)

Introduction: Diabetics people have an increased risk of developing health problems, including macro-vascular complications, and have more than double risk of death for any causes. Early identification of high-risk diabetic patients is therefore important so that appropriate interventions can be provided to help reduce the risk of premature mortality. Hypothesis: The purpose of this study was to investigate factors associated with all-cause mortality in diabetic patients and create a mortality risk calculator to aid in treatment decisions. Methods: Longitudinal analysis on 2,286 patients with type 2 diabetes individuated in the general population of the Moli-sani study, a population-based cohort study that recruited 24,325 men and women aged≥35 yr of Southern Italy, 2005-2010. Diabetes was defined as use of antidiabetic treatment or fasting blood glucose ≥126 mg/dl at baseline. The cohort was followed up until December 31 st 2015. Overall mortality was assessed by the Italian mortality registry (ReNCaM registry) and validated by Italian death certificates. Association of risk factors with mortality was assessed by multivariable Cox-regression survival analysis. A global score for mortality was obtained summing up scores (σ) obtained as rescaled beta coefficients of the Cox regression for each conditions. Results: Over a median follow-up of 7.8 years (17,652 person-years), 318 all-cause deaths were ascertained. Starting from a large panel of potential risk factors, we settled a final multivariable model including conditions independently associated with all-cause mortality, specifically: age (σ=0, 2 or 7 for age&lt;55 yr, 55-70 yr or ≥70 yr, respectively), sex (σ=0 or 2 for women or men), diabetic drugs in use (σ=0, 1 or 2 for none, yes but not insulin, insulin, respectively), history of cardiovascular disease (σ=0 or 2 for no or yes), cigarette smoking (σ=0, 2 or 3 for no, former or current), C-reactive protein (CRP) (σ=0, 1 or 3 for CRP≤1 mg/L, 1-2.99 mg/L or 3-10 mg/L), estimated glomerular filtration rate (eGFR, ml/min/1.73m 2 ) (σ=0, 1 or 3 for eGFR≥90, 60-90 or &lt;60) and adhesion to Mediterranean Diet (σ=0, -1 or -2 for low (0-3 points), intermediate or high adhesion (≥6 points)). C-statistic for the final model was 0.74. Diabetic patients stratified according to global score clearly were discriminated as mortality risk; specifically hazard ratio and predicted risk of death at 10 years were 1.0 (referent) and 4.5%, 2.80 (95%CI: 2.00 to 3.93) and 12.1% and 8.47 (6.14 to 11.68) and 32.2% for values of the global score 0 to 5 (prevalence 15.7%), 8 to10 (19.9%) and 14 to 24 (16.8%), respectively (P for difference in Kaplan-Meier curves &lt;0.0001). Conclusions: A global score of risk for all-cause mortality in diabetic patients has been developed, easy to use in clinical practice which include classical CVD risk factors and indicators of nephropathy, low grade inflammation and adherence to Mediterranean Diet.