@Article{info:doi/10.2196/17487,
author="Jhang, Jing-Yi
and Tzeng, I-Shiang
and Chou, Hsin-Hua
and Jang, Shih-Jung
and Hsieh, Chien-An
and Ko, Yu-Lin
and Huang, Hsuan-Li",
title="Association Rule Mining and Prognostic Stratification of 2-Year Longevity in Octogenarians Undergoing Endovascular Therapy for Lower Extremity Arterial Disease: Observational Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="1",
volume="22",
number="12",
pages="e17487",
keywords="endovascular therapy; lower extremity arterial disease; octogenarians; longevity; association rules; older people; prognosis; risk; medical informatics; clinical informatics",
abstract="Background: Two-year longevity is a crucial consideration in revascularization strategies for patients with symptomatic lower extremity arterial disease (LEAD). However, factors associated with 2-year longevity and risk stratification in octogenarians or nonagenarians have been underreported. Objective: This paper aims to investigate the associated variables and stratify the 2-year prognosis in older patients with LEAD. Methods: We performed logistic regression and association rule mining based on the Apriori algorithm to discover independent variables and validate their associations with 2-year longevity. Malnutrition, inflammation, and stroke factors were identified. C statistics and Kaplan-Meier analysis were used to assess the impact of different numbers of malnutrition, inflammation, and stroke factors on 2-year longevity. Results: We recruited a total of 232 octogenarians or nonagenarians (mean age 85 years, SD 4.2 years) treated with endovascular therapy. During the study period, 81 patients died, and 27 of those (33{\%}) died from a cardiac origin within 2 years. Association rules analysis showed the interrelationships between 2-year longevity and the neutrophil-lymphocyte ratio (NLR) and nutritional status as determined by the Controlling Nutritional Status (CONUT) score or Geriatric Nutritional Risk Index (GNRI). The cut-off values of NLR, GNRI, and CONUT were ≥3.89, ≤90.3, and >3, respectively. The C statistics for the predictive power for 2-year longevity were similar between the CONUT score and the GNRI-based models (0.773 vs 0.760; P=.57). The Kaplan-Meier analysis showed that 2-year longevity was worse as the number of malnutrition, inflammation, and stroke factors increased from 0 to 3 in both the GNRI-based model (92{\%} vs 68{\%} vs 46{\%} vs 12{\%}, respectively; P<.001) and the CONUT score model (87{\%} vs 75{\%} vs 49{\%} vs 10{\%}, respectively; P<.001). The hazard ratio between those with 3 factors and those without was 18.2 (95{\%} CI 7.0-47.2; P<.001) in the GNRI and 13.6 (95{\%} CI 5.9-31.5; P<.001) in the CONUT score model. Conclusions: This study demonstrated the association and crucial role of malnutrition, inflammation, and stroke factors in assessing 2-year longevity in older patients with LEAD. Using this simple risk score might assist clinicians in selecting the appropriate treatment. ",
issn="1438-8871",
doi="10.2196/17487",
url="https://www.jmir.org/2020/12/e17487",
url="https://doi.org/10.2196/17487",
url="http://www.ncbi.nlm.nih.gov/pubmed/33177036"
}