Prediction of long-term survival and coagulation factor VIII levels: interactions with gender in a large hospital-based cohort

Introduction

Elevated coagulation factor VIII activity (FVIII:C) 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

A total of 11,203 individuals were included in this study. The median observation period was 5 years, covering a total of 46,000 person-years. The death rate was 17.1%.

Results

Compared with individuals within the reference category (FVIII:C <94%) hazard ratios gradually increased from 1.4 (95% CI = 1.1 to 1.8) in the 152 to 170% category (fifth decile) to finally 4.4 (95% CI = 3.5 to 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 noncancer mortality, all-cause vascular mortality or mortality due to ischemic heart disease. Compared with males, females with elevated FVIII:C had a worse outcome resulting in higher hazard ratios reaching 6.8 (95% CI = 4.6 to 9.9) within the highest decile compared with males (hazard ratio = 3.4, 95% CI = 2.6 to 4.5).

Conclusion

In our large patient cohort we are firstly able to demonstrate 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 that might benefit from individualized prevention strategies.