title: Coagulation factor VIII levels are associated with long-term survival - interactions with gender in a large hospital-based cohort.
abstract: BACKGROUND
  Elevated coagulation factor VIII activity has been associated with increased risk for both venous and arterial thrombosis. The current study evaluated the influence of Factor VIII levels and interactions with gender on all cause mortality in a large Austrian cohort.
  
  
  METHODS
  During 1991 and 2003, 11203 individuals, first ever request for laboratory analyses of FVIII: C, age > or =18 years, were included in this study. The median observation period was 5 years covering a total of 46000 person-years. The death rate was 17.1%.
  
  
  RESULTS
  Compared to individuals within the reference category (FVIII: C <94%) hazard ratios gradually increased from 1.4 (95% CI: 1.1-1.8) in the 152-170% category (5th decile) to finally 4.4 (95% CI: 3.5-5.5) in the >313% category (highest decile, all p < 0.05). The association between FVIII: C levels and mortality remained essentially unchanged when considering non-cancer mortality, all cause vascular mortality or mortality due to ischemic heart disease. Compared to males females with elevated FVIII: C had a worse outcome resulting in higher hazard ratios reaching 6.8 (95% CI: 4.6-9.9) within the highest decile compared to males (HR: 3.4 (95% CI: 2.6-4.5)).
  
  
  CONCLUSIONS
  In our large patient cohort we might be able to demonstrate for the first time that FVIII: C plasma activity is strongly associated with all cause mortality. Additionally, FVIII: C appears to interact with gender. Especially in women FVIII: C might help identifying high-risk cohorts, which might benefit from individualized prevention strategies.
authors.affiliation: Department of Traumatology, Medical University of Vienna, Vienna, Austria.
authors.forename: Florian M
authors.initials: FM
authors.lastname: Kovar
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Marsik
authors.forename: Christian
authors.initials: C
authors.lastname: Joukhadar
authors.forename: Thomas
authors.initials: T
authors.lastname: Perkmann
authors.forename: Helmuth
authors.initials: H
authors.lastname: Haslacher
authors.forename: Thomas
authors.initials: T
authors.lastname: Schickbauer
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kyrle
authors.forename: Oswald F
authors.initials: OF
authors.lastname: Wagner
authors.forename: Georg
authors.initials: G
authors.lastname: Endler
mesh_terms: D000328:Adult; D000367:Age Factors; D001317:Austria; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005169:Factor VIII / Q000378:metabolism*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008136:Longevity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000401:mortality*; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors; D013223:Statistics as Topic; D015996:Survival Rate; D013927:Thrombosis / Q000097:blood* / Q000401:mortality*
chemical_list: D015415:Biomarkers; D005169:Factor VIII