16-Year Survival of the Canadian Collaborative Cohort of Related Dementias

AbstractBackground Survival estimates are integral to care for patients diagnosed with dementia. Few Canadian studies have carried out long-term follow-up of well-described cohorts, analyzing survival related to multiple risk factors. Methods Survival analysis of an inception cohort enrolled at a British Columbia (BC) tertiary dementia referral clinic between 1997 and 1999 was undertaken. Vital status was completed for 168 patients diagnosed with dementia. An evaluation of the effects of demographics, vascular risk factors, cognitive and functional ratings, apolipoprotein 4-status, and cholinesterase use on survival was performed using a log-rank test and time-dependent Cox regression. Survival of this dementia cohort was compared with the age-matched life expectancy of persons in BC. Results In all, 158/168 (94.0%) subjects died over 16.6 years, with a median survival of 7.08 years. Risk factors associated with shorter survival in dementia groups included age of onset ≥80 (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.05-2.32); greater functional disability (Disability Assessment for Dementia<55% [HR 1.47, 95% CI 1.04-2.08]); and cumulative medical illness severity (Cumulative Illness Rating Scale≥7 [HR 1.51, 95% CI 1.08-2.12)]. Compared with the BC population, years of potential life lost for dementia subjects aged <65 was 15.36 years, and for dementia subjects aged ≥80 it was 1.82 years. Conclusions Survival in dementia subjects is shorter than population life expectancies for each age strata, with greatest impact on younger patients. For people diagnosed with dementia, age ≥80 years, cumulative medical illness severity, and functional disabilities are the most significant survival predictors and can be used to guide prognosis.

Download Full-text

Long-term follow-up results of medial opening wedge high tibia osteotomy with a pre-countered non-locking steel plate

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03927-8 ◽

2021 ◽

Author(s):

Simo S. A. Miettinen ◽

Hannu J. A. Miettinen ◽

Jussi Jalkanen ◽

Antti Joukainen ◽

Heikki Kröger

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Mechanical Axis ◽

Steel Plate ◽

Cox Regression ◽

Opening Wedge ◽

Cumulative Survival ◽

Long Term Follow Up

Abstract Introduction This retrospective study investigated the long-term follow-up results of medial opening wedge high tibial osteotomy (MOWHTO) with a pre-countered non-locking steel plate implant (Puddu plate = PP) used for medial knee osteoarthrosis (OA) treatment. Materials and methods Consecutive 70 MOWHTOs (66 patients) were performed between 01.01.2004 and 31.12.2008 with the mean follow-up time of 11.4 (SD 4.5; range 1.2–16.1) years. The Kaplan–Meier survival analysis was used to evaluate the cumulative survival of the implant in terms of age (< 50 years old and ≥ 50 years old) and gender. Adverse events were studied and Cox regression analysis was used to evaluate risk factors [age, gender, body mass index (BMI), preoperative mechanical axis, severity of OA, use of bone grafting or substitution and undercorrection of mechanical axis from varus to valgus] for revisions. Results The estimates for the cumulative survival with no need for TKA after MOWHTO were 86% at 5 years, 67% at 10 years and 58% at 16.1 years (SE 0.6, CI 95% 11.1–13.5). A total of 33/70 (47%) adverse events occurred and 38/70 (54%) knees required some revision surgery during the follow-up. Cox regression did not show any statistically significant risk factors for revision. Conclusions The PP has feasible MOWHTO results with a cumulative survival of 67% at 10 years with no need for conversion to TKA. Many adverse events occurred and revision rate due to any reason was high. Age or gender did not have statistically significant differences in terms of survival.

Download Full-text

Camptocormia in patients with multiple system atrophy at different disease durations: frequency and related factors

BMC Neurology ◽

10.1186/s12883-021-02210-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ling Yu Zhang ◽

Bei Cao ◽

Qian-Qian Wei ◽

Ru Wei Ou ◽

Bi Zhao ◽

...

Keyword(s):

Multiple System Atrophy ◽

Disease Severity ◽

Disease Duration ◽

Rating Scale ◽

Cox Regression ◽

Age Of Onset ◽

Older Age ◽

Related Factors ◽

Cox Regression Analysis ◽

The Impact

Abstract Background Camptocormia is common in patients with multiple system atrophy (MSA). The current study was aimed at assessing the frequency of camptocormia and its related factors in MSA patients with different disease durations. Also, the impact of camptocormia on disability was evaluated. Methods A total of 716 patients were enrolled in the study. They were classified into three groups based on disease duration (≤ 3, 3–5, ≥ 5 years). Specific scales were used to evaluate the motor and non-motor symptoms. Disease severity was assessed using the Unified Multiple System Atrophy Rating Scale (UMSARS). The binary logistic regression model was used to explore the factors related to camptocormia. To analyze the impact of camptocormia on disability in patients with disease duration less than 5 years, propensity score matching (PSM) and stratified Cox regression analysis were used. Results In the current study, we found that the frequency of camptocormia was 8.9, 19.7 and 19.2% when the disease duration was ≤3, 3–5, ≥ 5 years, respectively. In the disease duration ≤3 years group, we found that MSA-parkinsonian subtype (MSA-P) (OR = 2.043, P = 0.043), higher total UMSARS score (OR = 1.063, P < 0.001), older age of onset (OR = 1.047, P = 0.042), and lower score on the frontal assessment battery (FAB) (OR = 0.899, P = 0.046) were associated with camptocormia. Only greater disease severity was associated with camptocormia in the group of patients with disease duration 3–5 years (OR = 1.494, P = 0.025) and in the group of patients with disease duration ≥5 years (OR = 1.076, P = 0.005). There was no significant impact of camptocormia on disability in patients with a disease duration of < 5 years (HR = 0.687, P = 0.463). Conclusion The frequency of camptocormia increased with prolonged disease duration. Disease severity was related to camptocormia at different stages of the disease. The MSA-P subtype, older age of onset, and lower FAB score were associated with camptocormia in the early stage of the disease.

Download Full-text

Liver Metastases in Newly Diagnosed Pancreatic Ductal Adenocarcinoma: A Population Based Analysis

10.21203/rs.2.20788/v1 ◽

2020 ◽

Author(s):

Guoyi Wu ◽

Xiaoben Pan ◽

Baohua Wang ◽

Xiaolei Zhu ◽

Jing Wu ◽

...

Keyword(s):

Risk Factors ◽

Liver Metastases ◽

Pancreatic Ductal Adenocarcinoma ◽

Tumor Size ◽

Cox Regression ◽

Population Based ◽

The Body ◽

Ductal Adenocarcinoma ◽

Rank Test ◽

Factors Associated

Abstract Background Estimates of the incidence and prognosis of developing liver metastases at the pancreatic ductal adenocarcinoma (PDAC) diagnosis are lacking.Methods In this study, we analyzed the association of liver metastases and the PDAC patients outcome. The risk factors associated with liver metastases in PDAC patients were analyzed using multivariable logistic regression analysis. The overall survival (OS) was estimated using Kaplan-Meier curves and log-rank test. Cox regression was performed to identify factors associated with OS.Results Patients with primary PDAC in the tail of the pancreas had a higher incidence of liver metastases (62.2%) than those with PDAC in the head (28.6%). Female gender, younger age, primary PDAC in the body or tail of the pancreas, and larger primary PDAC tumor size were positively associated with the occurrence of liver metastases. The median survival of patients with liver metastases was significantly shorter than that of patients without liver metastases. Older age, unmarried status, primary PDAC in the tail of the pancreas, and tumor size ≥4 cm were risk factors for OS in the liver metastases cohort.Conclusions Population-based estimates of the incidence and prognosis of PDAC with liver metastases may help decide whether diffusion-weighted magnetic resonance imaging should be performed in patients with primary PDAC in the tail or body of the pancreas. The location of primary PDAC should be considered during the diagnosis and treatment of primary PDAC.

Download Full-text

Risk Factors for Hepatocellular Carcinoma After Splenectomy in Liver Cirrhotic Patients

The American Surgeon ◽

10.1177/00031348211041562 ◽

2021 ◽

pp. 000313482110415

Author(s):

Naruhiko Honmyo ◽

Tsuyoshi Kobayashi ◽

Shintaro Kuroda ◽

Kentaro Ide ◽

Masahiro Ohira ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Portal Hypertension ◽

Cox Regression ◽

Univariate Analysis ◽

Hemoglobin Level ◽

Rank Test ◽

Predictive Index ◽

Preoperative Hemoglobin ◽

Preoperative Hemoglobin Level

Background Splenectomy is sometimes indicated for portal hypertension caused by cirrhosis, which is a risk for hepatic carcinogenesis. This study aimed to identify risk factors for hepatocellular carcinoma (HCC) development after splenectomy. Methods This retrospective study included 65 patients who underwent splenectomy for portal hypertension between 2009 and 2017. Cox regression analyses were performed to identify factors related to HCC development after splenectomy. The predictive index for HCC development was constructed from the results of multivariate analysis, and 3 risk-dependent groups were defined. Discrimination among the groups was estimated using Kaplan-Meier curves and the log-rank test. Results Post-splenectomy, 36.9% of patients developed HCC. In the univariate analysis, the etiology of cirrhosis (hepatitis C virus antibody, P = .005, and hepatitis B surface antigen, P = .008, referring to non-B and non-C patients, respectively), presence of HCC history ( P < .001), and preoperative hemoglobin level ( P = .007) were related to HCC development, and the presence of HCC history ( P = .002) and preoperative hemoglobin level ( P = .022) were independent risk factors. The predictive index classified three groups at risk; the hazards in each group were significantly different (low vs middle risk, P = .035, and middle vs high risk, P = .011). Discussion The etiology of cirrhosis, presence of HCC history, and hemoglobin level were associated with HCC development after splenectomy. The predictive model may aid in HCC surveillance after splenectomy for patients with portal hypertension.

Download Full-text

PD-L1+NEUT, Foxp3+Treg, and NLR as New Prognostic Marker with Low Survival Benefits Value in Hepatocellular Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/15330338211045820 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110458

Author(s):

Lin Zhou ◽

Jing Wang ◽

Shao-cheng Lyu ◽

Li-chao Pan ◽

Xian-jie Shi ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Peripheral Blood ◽

Cox Regression ◽

Disease Free Survival ◽

Rank Test ◽

Cancer Tissue ◽

Cox Regression Analysis ◽

Poorly Differentiated ◽

Independent Risk Factors

Background: This presented study was aimed to evaluate the diagnostic and prognostic value of PD-L1+Neutrophils (PD-L1+NEUT) and neutrophil to lymphocyte ratio (NLR) based on our previous experience of Foxp3+Treg in transplantation. Methods: the NLR cutoff value of 1.79 was used to include 136 cases from the 204 patients with hepatocellular carcinoma (HCC) confirmed by clinical pathology, which were divided into highly-moderately and poorly differentiated HCC groups. The expressions of PD-L1+NEUT and Foxp3+Treg in peripheral blood and cancer tissue were detected with flow cytometry, meanwhile, PD-L1 and Foxp3 expressed in carcinoma and para-carcinoma tissues were marked by immunohistochemistry. Survival rates, including overall survival and disease-free survival, were calculated by the Kaplan–Meier curve and evaluated with the log-rank test. Finally, Cox risk regression model was used to analyze the independent risk factors for prognostic survival. Results: The level of PD-L1+NEUT, Foxp3+Treg, and NLR in peripheral blood of patients with poorly differentiated HCC were significantly increased (all P < .001). Both PD-L1+NEUT and NLR were positively correlated with Foxp3+Treg ( r = 0.479, P = .0017; r = 0.58, P < .0001). The level of PD-L1+NEUT and Foxp3+Treg as well as PD-L1 and Foxp3 in cancer tissue and patients with poorly differentiated HCC were obviously increased (all P < .01), respectively. Cox regression analysis indicated that PD-L1+NEUT, NLR, and Foxp3+Treg were independent risk factors for the prognosis ( P = .000, .000, .006) with a RR and 95%CI of 2.704-(2.155-3.393), 3.139-(2.361-4.173), 1.409-(1.105-1.798), respectively. Conclusion: PD-L1+NEUT, NLR, and Foxp3+Treg are independent risk factors for prognosis which maybe new marker of lower survival benefits.

Download Full-text

Logistic Regression Analysis of the Factors Involved in the Failure of Osseointegration and Survival of Dental Implants with an Internal Connection and Machined Collar: A 6-Year Retrospective Cohort Study

BioMed Research International ◽

10.1155/2021/9684511 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Aritza Brizuela-Velasco ◽

Ángel Álvarez-Arenal ◽

Esteban Pérez-Pevida ◽

Iker Bellanco-De La Pinta ◽

Héctor De Llanos-Lanchares ◽

...

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Dental Implants ◽

Cox Regression ◽

Rank Test ◽

Cox Regression Analysis ◽

Internal Connection ◽

Study Results ◽

Logit Function ◽

Cox Analysis

Background. Although the long-term success rate of dental implants is currently close to 95%, it is necessary to provide more evidence on the factors related to the failure of osseointegration and survival. Purpose. To establish the risk factors associated with the failure of osseointegration and survival of dental implants with an internal connection and machined collar and to establish a predictive statistical model. Materials and Methods. An analytical, retrospective, and observational clinical study of a sample of 297 implants with a follow-up of up to 76 months. Independent variables related to the implant, patient, and surgical and rehabilitative procedures were identified. The dependent variables were failure of osseointegration and failure of implant survival after prosthetic loading. A survival analysis was carried out by applying the Kaplan-Meier model (significance for p < 0.05 ). The log-rank test and the Cox regression analysis were applied to the factors that presented differences. Finally, the regression logit function was used to determine whether it is possible to predict the risk of implant failure according to the analyzed variables with the data obtained in this study. Results. The percentages of osseointegration and survival were 97.6 and 97.2%, respectively. For osseointegration, there were significant differences according to gender ( p = 0.048 ), and the risk of nonosseointegration was 85% lower in women. Regarding survival, the Cox analysis converged on only two factors, which were smoking and treatment with anticoagulant drugs. The risk of loss was multiplied by 18.3 for patients smoking more than 10 cigarettes per day and by 28.2 for patients treated with anticoagulants. Conclusions. The indicated risk factors should be considered, but the analysis of the results is not sufficient to create a predictive model.

Download Full-text

Diabetic foot ulcers: Retrospective comparative analysis from Sicily between two eras

PLoS ONE ◽

10.1371/journal.pone.0259405 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0259405

Author(s):

Valentina Guarnotta ◽

Stefano Radellini ◽

Enrica Vigneri ◽

Achille Cernigliaro ◽

Felicia Pantò ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Foot ◽

Cox Regression ◽

Age Of Onset ◽

Age At Onset ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Risk Of Death

Aim The aim of this study was to analyze changes in the incidence, management and mortality of DFU in Sicilian Type 2 diabetic patients hospitalized between two eras, i.e. 2008–2013 and 2014–2019. Methods We compared the two eras, era1: 2008–13, era2: 2014–19. In era 1, n = 149, and in era 2, n = 181 patients were retrospectively enrolled. Results In the population hospitalized for DFU in 2008–2013, 59.1% of males and 40.9% of females died, whilst in 2014–2019 65.9% of males and 34.1% of females died. Moderate chronic kidney disease (CKD) was significantly higher in patients that had died than in ones that were alive (33% vs. 43%, p < 0.001), just as CKD was severe (14.5% vs. 4%, p < 0.001). Considering all together the risk factors associated with mortality, at Cox regression multivariate analysis only moderate-severe CKD (OR 1.61, 95% CI 1.07–2.42, p 0.021), age of onset greater than 69 years (OR 2.01, 95% CI 1.37–2.95, p <0.001) and eGFR less than 92 ml/min (OR 2.84, 95% CI 1.51–5.34, p 0.001) were independently associated with risk of death. Conclusions Patients with DFU have high mortality and reduced life expectancy. Age at onset of diabetic foot ulcer, eGFR values and CKD are the principal risk factors for mortality.

Download Full-text

P14.40 Incidence and risk factors identification for lung cancer brain metastasis

Neuro-Oncology ◽

10.1093/neuonc/noz126.275 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii76-iii76

Author(s):

H Fariña ◽

M Rodríguez-Salazar ◽

M Rodríguez-Yanes ◽

J Plata-Bello

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Brain Metastasis ◽

Cox Regression ◽

Small Cell Lung Carcinoma ◽

Malignant Neoplasm ◽

Small Cell ◽

Rank Test ◽

Cell Lung Carcinoma ◽

New Diagnosis

Abstract BACKGROUND Lung Cancer (LC) is the most frequent malignant neoplasm around the world and it is one of the most frequent brain metastasis origins. The aim of the present work is to measure the incidence of brain metastasis in new-diagnosed LC patients and to identify the risk factors associated with its development. MATERIAL AND METHODS A retrospective observational study has been performed. Patients with new diagnosis of LC between January 2015 and December 2016 in our Center were included. Demographic, clinical and molecular variables were studied. Statistical analysis included a uni- and multivariate COX regression, survival analysis (log-rank test) and non-parametric two-independent sample tests. RESULTS Three-hundred and thirty-nine patients were diagnosed with LC in our Center between 2015 and 2016 (99 female; mean age: 66.1 years, SD=10.89). The incidence of brain metastasis was 16.25 cases each year since the initial diagnosis (19.2% of all patients). The risk of brain metastasis was increased in the first year after the diagnosis of LC (83.07% of cases). Patients with metastasis were younger than non-metastatic patients (64.0 vs. 66.6 years of age; p=.041). Small-cell lung carcinoma was the most frequent histological subtype associated with the development of metastasis (HR=2.267; p=.011), followed by the adenocarcinoma (HR=1.131; p=.624) and epidermoid (HR=.546; p=.067). No molecular factor (EGFR, ALK or p63 expression) was identified as risk factor. The overall survival of brain-metastatic patients was significantly lower than non-metastatic patients (167.0 vs. 273.0 days; p=.0002). CONCLUSION Brain metastasis are diagnosed in almost 20% of LC patients with, at least, three-years follow-up. Small-cell carcinoma subtype and younger patients were associated with a higher risk of brain metastasis, which is associated with a bad prognosis.

Download Full-text

Risk factors for death in patients with non-infectious adverse events

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.2069.3001 ◽

2018 ◽

Vol 26 (0) ◽

Author(s):

Gilcilene Oliveira Gadelha ◽

Hémilly Caroline da Silva Paixão ◽

Patricia Rezende do Prado ◽

Renata Andréa Pietro Pereira Viana ◽

Thatiana Lameira Maciel Amaral

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Cox Regression ◽

Simplified Acute Physiology Score ◽

Variable Number ◽

Rank Test ◽

Protection Factor ◽

Saps 3 ◽

Risk Of Death ◽

Increased Risk

ABSTRACT Objetive: to identify risk factors for death in patients who have suffered non-infectious adverse events. Method: a retrospective cohort study with patients who had non-infectious Adverse Events (AE) in an Intensive Care Unit. The Kaplan Meier method was used to estimate the conditional probability of death (log-rank test 95%) and the risk factors associated with death through the Cox regression. Results: patients over 50 years old presented a risk 1.57 times higher for death; individuals affected by infection/sepsis presented almost 3 times the risk. Patients with a Simplified Acute Physiology Score III (SAPS3) greater than 60 points had four times higher risk for death, while those with a Charlson scale greater than 1 point had approximately two times higher risk. The variable number of adverse events was shown as a protection factor reducing the risk of death by up to 78%. Conclusion: patients who had suffered an adverse event and who were more than 50 years of age, with infection/sepsis, greater severity, i.e., SAPS 3>30 and Charlson>1, presented higher risk of death. However, the greater number of AEs did not contributed to the increased risk of death.

Download Full-text

ML-09 The REAL-WORLD of Elderly PCNSL Therapy in Tohoku and Niigata Area According to Retrospective Analysis: A Collaborative Investigation of the Tohoku Brain Tumor Study Group

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.072 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii17-ii17

Author(s):

Kenichiro Asano ◽

Yoji Yamashita ◽

Takahiro Ono ◽

Manabu Natsumeda ◽

Takaaki Beppu ◽

...

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

Real World ◽

Cox Regression ◽

Univariate Analysis ◽

Central Nervous System Lymphoma ◽

Rank Test ◽

Cox Regression Analysis ◽

The Real

Abstract Introduction: Recently, the number of cases of primary central nervous system lymphoma in elderly patients(EL-PCNSL) has been increasing. However, the treatment may be insufficient because of poor performance status and pre- and posttreatment complications. Therefore, we analyzed the risk factors for EL-PCNSL in the Tohoku and Niigata areas of Japan and clarified the REAL-WORLD of EL-PCNSL therapy. Materials & Methods: We investigated surgical and nonsurgical cases of patients aged 71 years or older from eight facilities during the last 8 years. We analyzed patient information, radiotherapy/chemotherapy or not, PFS, OS, RRs, second-line therapy, pre- and posttreatment complications, outcomes, and risk factors for poor prognosis. The log-rank test was used for univariate analysis, and Cox regression analysis was used for a multivariate analysis of risk factors. Results: Of the 142 cases registered, five differed from PCNSL pathologically, three receiving BSC were excluded, 31 were treated without biopsy, three were treated based on CSF-findings, and 100 were treated with biopsy. Total 134 cases were followed. The median age was 76 years, pretreatment KPS was 50%, and 118 cases(88%) had 217 pretreatment complications. The treatment contents consisted of various combinations depending on the attending physician. The retrospective overall PFS was 16 months and OS was 24 months. In the early treatment phase, out of 16 cases with dropout, four tumor and four complication deaths occurred. There were 77 deaths(58%), 39 internal tumor deaths(51%), and 33 complication deaths(43%). Poor prognostic risk factors were <60% posttreatment KPS, complications involving pretreatment cardiovascular and central nervous system disease, posttreatment pneumonia or severe infection, and absence of radiation or chemotherapy. Conclusions: Pretreatment KPS did not affect poor outcomes, but posttreatment KPS <60% and pre- and posttreatment complications did. Radiotherapy and chemotherapy are reportedly effective, but additional research to clarify the details of these modalities is needed.

Download Full-text