INCREASED PHYSIOLOGICAL VARIABILITY PREDICTS DECLINING HEALTH AND CRITICAL TRANSITIONS IN HEMODIALYSIS PATIENTS

• Published in: Innovation in aging 2019-11, Vol.3 (Supplement_1), p.S789-S789
• Main Authors: Cohen, Alan A, Nakazato, Yuichi, Sugiyama, Tomoko, Leung, Diana L, Legault, Véronique, Côté, Anne-Marie
• Format: Article
• Language: English
• ISSN: 2399-5300; 2399-5300
• DOI: 10.1093/geroni/igz038.2905

Abstract Increased variability in levels of several individual biomarkers has been shown to predict adverse outcomes, particularly in hemodialysis patients, for whom time series data is often available. Here, we evaluate the feasibility of using multivariate approaches to quantify global physiological variability as a potential predictor of adverse outcomes. We used data on 588 deaths and 1196 hospitalisations across ~38,000 visits of 591 hemodialysis patients at a Quebec hospital, as well as data on frailty and mortality in 580 patients assessed 20+ times within a one-year period at a hospital in Saitama, Japan. We use two approaches: principal components analysis (PCA) of the coefficients of variation (CVs) of the individual biomarkers over the previous year, and Mahalanobis distance (MD) of the biomarker profile relative to the same profile at the previous time point. We show that both methods provide substantial prediction of both impending mortality and impending hospitalisation, with hazard ratios across the 95% quantile range of the indices varying between 1.5 and 3.5 (p