Risk factors for the incidence and severity of peristomal skin disorders defined using two scoring systems

Abstract Purpose: While nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no prior studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. Therefore, the purpose of this study was to assess the impact of preoperative nutritional status on stoma development, and determine risk factors for postoperative PSDs and their increased severity. Methods: A retrospective analysis was performed in 116 consecutive patients with rectal cancer who underwent radical surgery with stoma creation, including ileostomy and colostomy. Results: PSDs were diagnosed in 32 patients (27.6%); 10 (8.7%) cases were defined as severe based on the ABCD-stoma score. A multivariate analysis indicated that the laparoscopic approach (odds ratio [OR], 3.221; 95% confidence interval [CI], 1.001–10.362; P = 0.050) and ileostomy (OR, 3.394; 95% CI, 1.349–8.535; P = 0.009) were both independent risk factors for PSD. In a separate multivariate analysis for severe PSD, the only independent risk factor was the CONUT score (OR, 11.298; 95% CI, 1.382–92.373; P = 0.024). Conclusion: Severe PSDs are associated with preoperative nutritional disorders, as determined via the CONUT score. Furthermore, PSDs may potentially increase in severity, regardless of stoma type.

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The presurgical controlling nutritional status (CONUT) score is independently associated with severe peristomal skin disorders: a single-center retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-98369-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takuya Shiraishi ◽

Hiroomi Ogawa ◽

Chika Katayama ◽

Katsuya Osone ◽

Takuhisa Okada ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Nutritional Status ◽

Multivariable Logistic Regression Analysis ◽

Skin Disorders ◽

Nutritional Interventions ◽

Multivariable Logistic Regression ◽

Peristomal Skin ◽

The Impact ◽

Conut Score

AbstractWhile nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no previous studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. The purpose of this study was to assess the impact of preoperative nutritional status on stoma health, and determine risk factors for postoperative PSDs, including severe PSDs. A retrospective analysis was performed of 116 consecutive patients with rectal cancer who underwent radical surgery with ileostomy or colostomy creation. PSDs were diagnosed in 32 patients (27.6%); including 10 cases (8.7%) that were defined as severe based on the ABCD-stoma score. Multivariable logistic regression showed that smoking (odds ratio [OR] 3.451, 95% confidence interval [CI] 1.240–9.607, p = 0.018) and ileostomy (OR 3.287, 95% CI 1.278–8.458, p = 0.014) were independent risk factors for PSDs. A separate multivariable logistic regression analysis of risk factors for severe PSDs, found that the only independent risk factor was the CONUT score (OR 10.040, 95% CI 1.191–84.651, p = 0.034). Severe PSDs are associated with preoperative nutritional disorders, as determined by the CONUT score. Furthermore, nutritional disorders may increase the severity of PSDs, regardless of the stoma type.

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Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era

10.21203/rs.2.12458/v3 ◽

2020 ◽

Author(s):

Takuya Shiraishi ◽

Yuji Nishizawa ◽

Koji Ikeda ◽

Yuichiro Tsukada ◽

Takeshi Sasaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Parastomal Hernia ◽

Loop Ileostomy ◽

Laparoscopic Approach ◽

Rectus Abdominis ◽

Rectus Abdominis Muscle ◽

Skin Disorders ◽

Hernia Formation ◽

Peristomal Skin

Abstract Background: Laparoscopic approach is now a widespread technique used worldwide, but there are few recent studies on risk factors for parastomal hernia. Therefore, this study was performed to analyze the incidence of parastomal hernia in laparoscopic and open surgery in which a loop stoma was created and was intended to be temporary, and to determine risk factors for parastomal hernia formation. Associations between parastomal hernia and other stoma-related complications were also analyzed. Methods: A retrospective analysis of patient and surgical characteristics was performed in 153 consecutive patients who underwent a temporary diverting loop ileostomy or colostomy after surgery related to malignant diseases at our hospital from January to December 2016. Results: Parastomal hernia developed in 77 cases (50.3%), including 39 (25.5%) diagnosed by physical examination and 38 (24.8%) detected by CT alone. On multivariate analysis, a stoma not passing through the middle of the rectus abdominis muscle was the only independent risk factor for parastomal hernia formation (p=0.005) during the median follow-up of 245.0 days. When we analyzed the factors that were associated with a stoma not passing through the middle of the rectus abdominis muscle, the only independent factor associated with this misplacement of the stoma was a laparoscopic approach (p=0.012). An analysis of stoma-related complications showed that peristomal skin disorders were significantly associated with parastomal hernia (p=0.049). Conclusions: This study showed that a stoma that is not formed through the middle of the rectus abdominis muscle is a risk factor for parastomal hernia formation, and that a laparoscopic approach is associated with this risk factor. Moreover, a parastomal hernia is significantly associated with peristomal skin disorders.

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Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era

10.21203/rs.2.12458/v4 ◽

2020 ◽

Author(s):

Takuya Shiraishi ◽

Yuji Nishizawa ◽

Koji Ikeda ◽

Yuichiro Tsukada ◽

Takeshi Sasaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Parastomal Hernia ◽

Loop Ileostomy ◽

Laparoscopic Approach ◽

Rectus Abdominis ◽

Rectus Abdominis Muscle ◽

Skin Disorders ◽

Hernia Formation ◽

Peristomal Skin

Abstract Background: Laparoscopic approach is now a widespread technique used worldwide, but there are few recent studies on risk factors for parastomal hernia. Therefore, this study was performed to analyze the incidence of parastomal hernia in laparoscopic and open surgery in which a loop stoma was created and was intended to be temporary, and to determine risk factors for parastomal hernia formation. Associations between parastomal hernia and other stoma-related complications were also analyzed.Methods: A retrospective analysis of patient and surgical characteristics was performed in 153 consecutive patients who underwent a temporary diverting loop ileostomy or colostomy after surgery related to malignant diseases at our hospital from January to December 2016.Results: Parastomal hernia developed in 77 cases (50.3%), including 39 (25.5%) diagnosed by physical examination and 38 (24.8%) detected by CT alone. On multivariate analysis, a stoma not passing through the middle of the rectus abdominis muscle was the only independent risk factor for parastomal hernia formation (p=0.005) during the median follow-up of 245.0 days. When we analyzed the factors that were associated with a stoma not passing through the middle of the rectus abdominis muscle, the only independent factor associated with this misplacement of the stoma was a laparoscopic approach (p=0.012). An analysis of stoma-related complications showed that peristomal skin disorders were significantly associated with parastomal hernia (p=0.049).Conclusions: This study showed that a stoma that is not formed through the middle of the rectus abdominis muscle is a risk factor for parastomal hernia formation, and that a laparoscopic approach is associated with this risk factor. Moreover, parastomal hernia is significantly associated with peristomal skin disorders.

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Development of a Sex-Specific Risk Scoring System for Predicting Cognitive Normal to Mild Cognitive Impairment (SRSS-CNMCI)

10.21203/rs.3.rs-517520/v1 ◽

2021 ◽

Author(s):

Wen Luo ◽

Hao Wen ◽

Shuqi Ge ◽

Chunzhi Tang ◽

Xiufeng Liu ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

High Risk ◽

Scoring System ◽

External Validation ◽

Scoring Systems ◽

Cutoff Point ◽

Risk Scoring ◽

Risk Scoring System

Abstract Objective: We aim to develop a sex-specific risk scoring system for predicting cognitive normal (CN) to mild cognitive impairment (MCI), abbreviated SRSS-CNMCI, to provide a reliable tool for the prevention of MCI.Methods: Participants aged 61-90 years old with a baseline diagnosis of CN and an endpoint diagnosis of MCI were screened from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database with at least one follow-up. Multivariable Cox proportional hazards models were used to identify risk factors associated with conversion from CN to MCI and to build risk scoring systems for male and female groups. Receiver operating characteristic (ROC) curve analysis was applied to determine the risk probability cutoff point corresponding to the optimal prediction effect. We ran an external validation of the discrimination and calibration based on the Harvard Aging Brain Study (HABS) database.Results: A total of 471 participants, including 240 women (51%) and 231 men (49%), aged 61 to 90 years, were included in the study cohort for subsequent primary analysis. The final multivariable models and the risk scoring systems for females and males included age, APOE ε4, Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). The scoring systems for females and males revealed C statistics of 0.902 (95% CI 0.840-0.963) and 0.911 (95% CI 0.863-0.959), respectively, as measures of discrimination. The cutoff point of high and low risk was 33% in females, and more than 33% was considered high risk, while more than 9% was considered high risk for males. The external validation effect of the scoring systems was good: C statistic 0.950 for the females and C statistic 0.965 for the males. Conclusions: Our parsimonious model accurately predicts conversion from CN to MCI with four risk factors and can be used as a predictive tool for the prevention of MCI.

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An Application of Metabolic Syndrome Severity Scores in the Lifestyle Risk Assessment of Taiwanese Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103348 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3348 ◽

Cited By ~ 1

Author(s):

Chih-Ming Lin

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Severity Score ◽

Density Lipoprotein ◽

Scoring Systems ◽

Lifestyle Habits ◽

Gender And Age ◽

Severity Scores ◽

Potential Risk Factors ◽

Lifestyle Risk

A metabolic syndrome (MS) diagnosis was made when the criteria for three or more of five MS components were met. Due to some limitations in the traditional MS criteria, however, different health care societies have sought to develop applicable MS scoring systems instead. Continuous MS scores can be of meaningful value in the prevention, diagnosis, and treatment of MS at different life stages. Relatedly, this study used a database for 27,748 subjects aged 20 to 64 years who received health checks at a health screening institution in Taiwan from 2010 to 2015 to a similar end. Five components of MS (waist circumference, fasting plasma glucose, blood pressure, fasting triglycerides, and high-density lipoprotein) were used to formulate an MS severity score in different gender and age stratums, which was then used to evaluate the risks of various lifestyle habits. Those estimates were then compared with the results for traditional MS diagnosis. The MS severity scores for some behaviors relating to smoking, drinking, physical activity, and sweetened beverage consumption were found to have changed from 0.03 to 0.2; however, a logistic regression analysis with dichotomous diagnosis did not indicate significant links between these behaviors and MS. The models established by the MS severity scores can identify the risk factors for MS in a more sensitive manner than the traditional MS diagnosis can, especially with respect to specific lifestyle habits. MS severity score can serve as an indicator to explore the potential risk factors for subclinical conditions in the early stages of MS.

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Periodontal Disease Is an Independent Predictor of Intracardiac Calcification

BioMed Research International ◽

10.1155/2013/854340 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Gregg S. Pressman ◽

Atif Qasim ◽

Nitin Verma ◽

Masami Miyamae ◽

Kumiko Arishiro ◽

...

Keyword(s):

Risk Factors ◽

Periodontal Disease ◽

Subclinical Atherosclerosis ◽

Scoring Systems ◽

Cross Sectional Study ◽

Inflammatory Condition ◽

Cross Sectional ◽

Calcification Score ◽

Chronic Inflammatory Condition ◽

Traditional Risk Factors

Background. Periodontitis is the most common chronic inflammatory condition worldwide and is associated with incident coronary disease.Hypothesis. We hypothesized that periodontal disease would also be associated with cardiac calcification, a condition which shares many risk factors with atherosclerosis and is considered a marker of subclinical atherosclerosis.Methods. Cross-sectional study at two sites (USA and Japan) involving subjects with both clinical echocardiograms and detailed dental examinations. Semiquantitative scoring systems were used to assess severity of periodontal disease and echocardiographic calcification.Results. Fifty-six of 73 subjects (77%) had cardiac calcifications, and 51% had moderate to severe periodontal disease (score > 2). In unadjusted analysis, a significant relationship between periodontal score and cardiac calcification (Spearman rho = 0.4,P=0.001) was noted, with increases in mean calcification score seen across increasing levels of periodontal disease. On multivariate logistic regression, adjusted for age, gender, race, glomerular filtration rate, and traditional risk factors, this association remained significant (P=0.024). There was no significant interaction by study site, race, or gender.Conclusions. In a multiracial population, we found a significant association between the degree of periodontal disease, a chronic inflammatory condition, and cardiac calcification. Further, higher periodontal scores were associated with greater degrees of calcification.

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Preoperative cardiac risk management

Acta chirurgica iugoslavica ◽

10.2298/aci1102009v ◽

2011 ◽

Vol 58 (2) ◽

pp. 9-18

Author(s):

Radosav Vidakovic ◽

Don Poldermans ◽

Aleksandar Neskovic

Keyword(s):

Risk Factors ◽

Myocardial Revascularization ◽

Scoring Systems ◽

Cardiac Risk ◽

Noncardiac Surgery ◽

Cardiac Complications ◽

Cardiac Events ◽

Perioperative Morbidity ◽

True Incidence ◽

Non Invasive

Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: 1) identified risk factors, and 2) the type of the surgical procedure. On that basis, different scoring systems have been developed in order to accurately assess the perioperative cardiac risk and to improve the patient management. Importantly, patients with estimated high risk should be tested preoperatively by non-invasive cardiac imaging modalities. According to test results, they can proceed directly to planed surgery with the use of cardioprotective drugs (?-blockers, statins, aspirin), or to myocardial revascularization prior to non-cardiac surgery. In this review, we discuss the role of clinical cardiac risk factors, laboratory measurements, additional non-invasive cardiac testing, and consequent strategies in perioperative management of patients undergoing noncardiac surgery.

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Pneumonia in patients with stroke: risk factors, identification of at-risk patients, and methods of prevention

Aktualności Neurologiczne ◽

10.15557/an.2020.0012 ◽

2020 ◽

Vol 20 (2) ◽

pp. 88-96

Author(s):

Michał Turlakiewicz ◽

◽

Anna Piekarska ◽

Keyword(s):

Risk Factors ◽

Acute Phase ◽

Stroke Risk ◽

Early Stage ◽

Scoring Systems ◽

Stroke Risk Factors ◽

Risk Of Death ◽

Risk Patients ◽

Clinically Significant ◽

Expert Recommendations

Stroke-associated pneumonia (SAP) is the most common complication of the early stage of ischaemic stroke. The prevalence of SAP is difficult to determine precisely, but it is estimated to affect 2–22% of patients in the acute phase of stroke. Strokeassociated pneumonia is a clinically significant problem, as it markedly increases the risk of death compared to the population of acute stroke patients without pneumonia. In addition, SAP is associated with poorer final functional status, greater dependence on other people’s help after hospital discharge, extended hospital stay, and higher treatment costs. The paper presents the risk factors for stroke-related pneumonia, including the two best documented: dysphagia and stroke-induced immunodepression syndrome (SIDS). An attempt is made to identify patients in the acute phase of stroke who should be evaluated for the risk of developing pneumonia, and tools useful in the identification of such patients (A2DS2, ISAN scoring systems) are discussed. Also, based on expert recommendations, measures to minimise the risk of stroke-related pneumonia are proposed, and the recommended therapeutic regimen is described.

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