Factors associated with morbidity and mortality, measured through ?Days Alive and Out of Hospital?(DAOH) in patients with AL and ATTR amyloidosis

POSADAS-MARTÍNEZ, MARÍA LOURDES; EPSTEIN, TEO; SAEZ, MARÍA SOLEDAD; AGUIRRE, MARÍA ADELA; VAENA, MARIANA; CARRETERO, MARCELINA; POLLAN, JAVIER; OSORNO, MARÍA SOL; BRULC, ERIKA; SORROCHE, PATRICIA BEATRIZ; NUCIFORA, ELSA MERCEDES

HEIDELBERG

Simposio; XVIIIth International Symposium on Amyloidosis; 2022

INTERNATIONAL SOCIETY OF AMYLOIDOSIS

Contribution ID : 118Track / Type : ISA 2022 Abstract SubmissionFormat : Undecided (Oral or Poster Presentation)Title : Factors associated with morbidity and mortality, measured through ?Days Alive and Out of Hospital?(DAOH) in patients with AL and ATTR amyloidosis.Author(s) : Posadas Martínez, María Lourdes; Osorno, María Sol; Vaena, Mariana; Epstein, Teo; Brulc, Erika Bárbara; Carretero, Marcelina; Sáez, María Soledad; Sorroche, Patricia Beatriz; Pollan, Javier; Aguirre, María Adela; Nucifora, Elsa MercedesBackground: Cardiac involvement and age are known prognostic factors for overall survival in systemic amyloidosis. However, the impact of these on morbidity is less well known. Days alive and out of hospital (DAOH) is a novel patient-centered outcome that assesses the burden of disease, through the measurement of morbidity and mortality.Objectives: To evaluate factors associated with morbidity and mortality assessed through DAOH.Materials & Methods: Prospective cohort of consecutive patients diagnosed as AL or ATTRwt from the Institutional Registry of Amyloidosis (RIA) belonging to the Health Maintenance Organizations of the Italian Hospital of Buenos Aires between 01/01/2010 and 31 /08/2021. Patients with follow-up in another institution or less than 365 days were excluded. Quantitative variables were described with their median and interquartile range, and categorical variables with absolute and relative frequencies. We calculated DAOH at 1 year, subtracting days hospitalized and days dead from the potential follow-up time. Only patients with a follow-up equal to or greater than the potential follow-up time were included. The factors associated with DAOH were evaluated with a multiple linear regression model.Results & Discussion: 149 patients were eligible, of whom 53 were excluded and 96 were included (Figure 1). The median age was 76 years and 34% were women. The most frequently affected organ was the heart (78%) and renal (31%). Seventy-five percent of patients had at least one episode of hospitalization during follow-up at one year, with a median number of hospitalizations of 2 (IR 0.5-3).The median of DAOH at 1 year was 360 (IR 327-365). The median of DAOH was 346 (IR 274-365) and 365 days (IR 353-365) for AL and ATTRwt, respectively. Multivariate regression analysis showed that ATTRwt was associated with higher DAOH compared to AL (Coef. beta 126 CI95% 74 to 177) whilst cardiac involvement and age were associated with lower DAOH (Coef. beta -74 CI95% -126 to -23) and (Coef. beta -2, CI5% -4 to -0.08), respectively. In the present study we found that the morbidity and mortality associated with amyloidosis can be affected by different factors. Age and the presence of cardiac involvement at the time of diagnosis were associated with less DAOH at one year and therefore higher morbidity and mortality. These results coincide with studies that evaluate cardiac involvement as a prognostic factor using traditional methods [1,2]. On the other hand, when comparing patients with AL amyloidosis and ATTRwt, it was observed that the ATTRwt was associated with lower morbidity and mortality and higher DAOH at one year, similar to the results observed by the Rubin et al [3].The present study uses DAOH as a new measure of morbidity and mortality and, unlike "time to event" studies, it takes into account not only the first hospitalization, but all of them, in number and duration, and prioritizes the time to death. At the moment, there are no other published studies that have evaluated factors associated with morbidity and mortality using DAOH.Summary & Discussion: Days alive and out of hospital is a measure of patient-centered outcomes that describes patients? journey with disease. This is the first paper that demonstrates DAOH can be affected by subtype of amyloidosis, age and cardiac involvement, which strengthens the use of this measure in disease follow-up.Keywords: Immunoglobulin light chains; transthyretin amyloidosis; patient-centered outcome; prognosis; morbidity; mortality