One-year all-cause mortality for 338 patients admitted with epistaxis in a large tertiary ENT centre

AbstractObjectiveEpistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital.MethodThis study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period.ResultsThe one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046).ConclusionThere are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.

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Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

10.21203/rs.3.rs-20316/v1 ◽

2020 ◽

Author(s):

Marte Sofie Wang-Hansen ◽

Hege Kersten ◽

Torgeir Bruun Wyller

Keyword(s):

Risk Factors ◽

Body Mass ◽

Rating Scale ◽

Handgrip Strength ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Care Plans ◽

All Cause Mortality ◽

One Year

Abstract Background Due to expansion of longevity, the proportion of elderly people with multimorbidity is increasing. Our aim was to identify risk factors for all-cause mortality in elderly multimorbid medical in-patients one year after acute hospitalization. Information regarding risk factors is important to support targeted care plans after discharge. Methods Prospective cohort study of patients acutely admitted to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, received home care services before hospitalization, were aged 75+, and suffered from two or more chronic conditions. Inclusion period was 1. April – 31. October 2012. Candidate variables were number of daily prescribed drugs, Cumulative Illness Rating Scale for Geriatrics score, delirium, body mass index (BMI), handgrip strength, Barthel Activities of Daily Living Index score, and the laboratory analyses haemoglobin (Hgb), sodium (Na) and estimated glomerular filtration rate (eGFR). Results We included 227 patients; mean age 86 years, 59% women, 71% lived alone. During the year after hospitalization, 39% died. In the adjusted cox proportional hazards regression analysis, significant and independent risk factors were BMI (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.88-0.98 per kg/m 2 ), Hgb (HR 0.87, 95% CI 0.76-0.98 per g/100 mL), Na (HR 0.94, 95% CI 0.90-0.99 per mmol/L) and eGFR < 60 mL/min/1.73 m 2 (HR 1.82, 95% CI 1.07-3.08). Conclusions In this cohort of multimorbid elderly internal medicine patients, low body mass, hyponatremia, impaired renal function and anaemia were identified as independent and significant risk factors for one-year mortality.

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Risk factors for one-year all-cause mortality in elderly multimorbid medical in-patients.

10.21203/rs.3.rs-20316/v2 ◽

2020 ◽

Author(s):

Marte Sofie Wang-Hansen ◽

Hege Kersten ◽

Torgeir Bruun Wyller

Keyword(s):

Risk Factors ◽

Body Mass ◽

Rating Scale ◽

Handgrip Strength ◽

Significant Risk ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Care Plans ◽

All Cause Mortality ◽

One Year

Abstract Background: Due to expansion of longevity, the proportion of elderly people with multimorbidity is increasing. Our aim was to identify risk factors for all-cause mortality in elderly multimorbid medical in-patients one year after acute hospitalization. Information regarding risk factors is important to support targeted care plans after discharge. Methods: Prospective cohort study of patients acutely admitted to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, received home care services before hospitalization, were aged 75+, and suffered from two or more chronic conditions. Inclusion period was 1. April – 31. October 2012. Candidate variables were number of daily prescribed drugs, Cumulative Illness Rating Scale for Geriatrics score, delirium, body mass index (BMI), handgrip strength, Barthel Activities of Daily Living Index score, and the laboratory analyses haemoglobin (Hgb), sodium (Na) and estimated glomerular filtration rate (eGFR). Results: We included 227 patients; mean age 86 years, 59% women, 71% lived alone. During the year after hospitalization, 39% died. In the adjusted cox proportional hazards regression analysis, significant and independent risk factors were BMI (hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.88-0.98 per kg/m2), Hgb (HR 0.87, 95% CI 0.76-0.98 per g/100 mL), Na (HR 0.94, 95% CI 0.90-0.99 per mmol/L) and eGFR < 60 mL/min/1.73 m2 (HR 1.82, 95% CI 1.07-3.08).Conclusions: In this cohort of multimorbid elderly internal medicine patients, low body mass, hyponatremia, impaired renal function and anaemia were identified as independent and significant risk factors for one-year mortality.

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Risk Factors and Microbiological Control of Soils, Surfaces and Medical-technical Equipment at the Abomey-Calavi / So-Ava University Hospital Center, Benin

International Journal of Pathogen Research ◽

10.9734/ijpr/2019/v3i130086 ◽

2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Akim Socohou ◽

Haziz Sina ◽

Cyriaque C. Degbey ◽

Helène Ahouandjinou ◽

Houssenatou Gounou-Kora ◽

...

Keyword(s):

Risk Factors ◽

Microbiological Quality ◽

University Hospital ◽

Technical Equipment ◽

Structured Interviews ◽

Hospital Environments ◽

Microbiological Control ◽

Biochemical Analyses ◽

The One ◽

Staphylococcus Spp

Aims: The aim of our work was, on the one hand, to evaluate the risk factors for infectious contamination in hospital environments and, on the other hand, to carry out a microbiological control of surfaces at the Abomey-Calavi / So-Ava hospital in Benin. Methodology: The risk factors were evaluated using structured interviews based on the questionnaire. Fifty-five health care workers were surveyed and the questionnaire focused on: i) knowledge of care-associated infections and risk factors, ii) services most affected by care-associated infections and iii) origin of care-associated infections. For the microbial quality control of medical surfaces and materials, samples were collected by the dry swab method and the microbial isolation was carried out on Chapman and EMB agar plates. The biochemical analyses were carried out for the confirmations. Results: Out of 55 respondents, the 93% think that bacterial germs are often involved in care-associated infections. In addition, 80% of respondents believe that the healthcare environment may be the source of care-associated infections. Regarding the microbiological quality of the surfaces, out of 96 samples collected, 77% were contaminated with Staphylococcus spp and 30% with Enterobacteria. Concerning units’ contamination, the highest prevalence was observed in paediatrics with 92% of samples contaminated with Staphylococcus spp followed by the operating theatre (87%). Conclusion: It is clear from our work that hygiene managers must carry out preventive and corrective actions for the respect of the principles of hygiene. It would also be important to conduct regular microbiological monitoring of surfaces to identify any contamination.

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Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study

BMJ Open ◽

10.1136/bmjopen-2021-052582 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052582

Author(s):

Martin Holmbom ◽

Maria Andersson ◽

Sören Berg ◽

Dan Eklund ◽

Pernilla Sobczynski ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Bloodstream Infection ◽

Case Control Study ◽

Case Control ◽

Important Risk Factor ◽

Retrospective Case ◽

Prehospital Delay ◽

All Cause Mortality ◽

Control Study

ObjectivesThe aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.MethodsA retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.ResultsOf the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01.ConclusionPrehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.

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Was bei Tumorpatienten mit Atemwegsstenosen die Prognose bestimmt: Erst Rekanalisierung, im Anschluss andere Therapieoptionen nicht versäumen

Karger Kompass Pneumologie ◽

10.1159/000507662 ◽

2020 ◽

Vol 8 (3) ◽

pp. 148-149

Author(s):

Manfred Wagner

Keyword(s):

Prognostic Factors ◽

Performance Status ◽

Survival Rates ◽

Poor Performance ◽

University Hospital ◽

Poor Performance Status ◽

Poor Survival ◽

Interventional Bronchoscopy ◽

Cox Proportional Hazard Regression ◽

One Year

Background: Malignant central airway obstruction (MCAO) occurs in 20–30% of patients with primary pulmonary malignancy. Although bronchoscopic intervention is widely performed to treat MCAO, little data exist on the prognosis of interventional bronchoscopy. Therefore, we evaluated the clinical outcomes and prognostic factors of bronchoscopic interventions in patients with MCAO due to primary pulmonary malignancy. Methods: This retrospective study was conducted at a university hospital and included 224 patients who received interventional bronchoscopy from 2004 to 2017, excluding patients with salivary gland-type tumor. A multivariable Cox proportional hazard regression analysis was used to identify independent prognostic factors associated with survival after the first bronchoscopic intervention. Results: Among 224 patients, 191 (85.3%) were males, and the median age was 63 years. The most common histological type of malignancy was squamous cell carcinoma (71.0%). Technical success was achieved in 93.7% of patients. Acute complications and procedure-related death occurred in 15.6 and 1.3% of patients, respectively. The median survival time was 7.0 months, and survival rates at one year and two years were 39.7 and 28.3%, respectively. Poor survival was associated with underlying chronic pulmonary disease, poor performance status, extended lesion, extrinsic or mixed lesion, and MCAO due to disease progression and not receiving adjuvant treatment after bronchoscopic intervention. Conclusions: Interventional bronchoscopy could be a safe and effective procedure for patients who have MCAO due to primary pulmonary malignancy. In addition, we found several prognostic factors for poor survival after intervention, which will help clinicians determine the best candidates for bronchoscopic intervention.

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259Higher risk of myocardial infarction in the first year following 5-fluorouracil treatment

European Heart Journal ◽

10.1093/eurheartj/ehz747.0075 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J W D Shanmuganathan ◽

K H K Kragholm ◽

B T Tayal ◽

L P Poulsen ◽

T C E G El-Galaly ◽

...

Keyword(s):

Myocardial Infarction ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Calcium Blockers ◽

All Cause Mortality ◽

One Year ◽

The One ◽

Population Controls ◽

Age And Sex

Abstract Abstract Background 5-fluorouracil (5-FU) is the third most commonly used chemotherapeutic agent in the treatment of solid malignancies across the world. The most common manifestation of cardiotoxicity associated with 5-FU is chest pain, presenting as atypical chest pain, angina on exertion or rest and acute coronary syndromes including myocardial infarction and in worse case even death. Nevertheless, a widespread appreciation of 5-FU related cardiotoxicity including myocardial infarction is poorly understood. Purpose This study aims to examine risk of myocardial infarction in patients treated with 5-FU compared to age- and sex-matched population controls. Methods and results Methods: Individuals treated with 5-FU between 2004 and 2014 in the Danish National Patient Register were identified and risk set matching was used to find background population controls matched on age and sex in a 1:5 ratio. Furthermore, two years follow-up time were added with total 13 years. Neither 5-FU patients nor controls had prior ischemic disease. Aalen-Johansen and Kaplan-Meier estimates were used to report the cumulative incidence of myocardial infarction and all-cause mortality, respectively. A multivariable Shared Frailty Cox regression analysis (adjusted for patient age, sex, hypertension, hypercholesterolemia, diabetes, chronic obstructive pulmonary disease, chronic kidney disease, heart failure and atrial fibrillation as well as selected anti-anginal medications including nitrates, beta- and calcium-blockers) was used to determine the association between 5-FU treatment and the one-year risk of myocardial infarction. Results A total of 9,012 5-FU patients and 45,060 controls formed the study population. Differences in comorbid conditions (diabetes, chronic obstructive pulmonary disease, chronic kidney disease, heart failure and atrial fibrillation) and selected anti-anginal medications (nitrates, beta- and calcium-blockers) were non-significant (all P>0.05). The one-year cumulative incidence of myocardial infarction is significantly higher for 5-FU patients at 0.8% versus 0.6% among population controls (Figure 1A), with a competing risk of death of 25.1% versus 1.2%. The risk diminishes beyond one year and becomes lower for 5-FU patients with time (Figure 1A), along with an increasing all-cause mortality (Figure 1B). The unadjusted and adjusted hazard ratio for the one-year risk of myocardial infarction were 1.38 [95% CI 1.07–1.78] and 1.54 [95% CI 1.19–1.99]. Conclusions Although the one-year risk of myocardial infarction is higher among 5-FU patients compared with population controls, the absolute risk is small and becomes insignificant beyond one year of follow-up.

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P2754Streptococcal infective endocarditis: distribution of species and their prognosis

European Heart Journal ◽

10.1093/eurheartj/ehz748.1071 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Chamat ◽

A Dahl ◽

C Hassager ◽

M Arpi ◽

L Oestergaard ◽

...

Keyword(s):

Infective Endocarditis ◽

Electronic Device ◽

Species Level ◽

University Hospital ◽

Heart Valve Disease ◽

Significant Difference ◽

Streptococcal Species ◽

Species Groups ◽

One Year ◽

The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

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Incidence of and Risk Factors for Missing Events Due to Wandering in Community-dwelling Older People with Dementia and Mild Cognitive Impairment

10.21203/rs.3.rs-673163/v1 ◽

2021 ◽

Author(s):

seungwon Jeong ◽

Takao Suzuki ◽

Kiyoko Miura ◽

Takashi Sakurai

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Recurrence Rate ◽

Community Dwelling ◽

Disease Assessment ◽

People With Dementia ◽

One Year ◽

The One

Abstract BackgroundThe burden of missing incidents is not only on the person with dementia, but also on their family, neighbors, and community. The extent to which dementia-related wandering and missing incidents occur in the community has not been evaluated thoroughly in the published literature. Therefore, we evaluated the incidence of and risk factors for missing events due to wandering.MethodsWe conducted a non-randomized prospective one-year follow-up cohort study based on symptom registration with missing events due to wandering as the endpoint. In the first consultation, 374 patients with dementia or mild cognitive impairment (MCI) and their caregivers who visited the National Center for Geriatrics and Gerontology in Japan were included. The incidence and recurrence rate of missing events were calculated. Participants were divided into (those with) dementia and (those with) MCI. Patients' basic and medical information was documented at baseline and after one year of follow-up. Furthermore, analysis of variance and logistic regression analysis were performed to clarify the risk factors associated with the missing event.ResultsAmong the 236 patients with dementia enrolled, 65 (27·5%) had a previous missing event at baseline, and 28 had a missing event during the one-year follow-up period (recurrence rate of 43·1%). Of the 171 who did not have a previous missing event at baseline, 23 had a missing event during the one-year follow-up period (incidence rate of 13·5%). The scores of Mini-Mental State Examination (MMSE), Dementia Behavior Disturbance Scale (DBD), and Alzheimer's Disease Assessment Scale (ADAS) were statistically significant as the risk factors for the incidence of wandering leading to a missing event (p<0·05).ConclusionsPrevention of missing event due to wandering requires focused attention on changes in the MMSE, DBD, ADAS scores, and the development of a social environment to support family caregivers.

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Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.726282 ◽

2021 ◽

Vol 11 ◽

Author(s):

Fei Zhang ◽

Jinbiao Zhong ◽

Handong Ding ◽

Jiashan Pan ◽

Jing Yang ◽

...

Keyword(s):

Risk Factors ◽

Survival Rate ◽

Klebsiella Pneumoniae ◽

Postoperative Mortality ◽

Effective Prevention ◽

Carbapenem Resistant ◽

Kaplan Meier ◽

Total Prevalence ◽

One Year ◽

The One

BackgroundInfections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections.MethodsWe conducted a retrospective study of all patients who received KT in our hospital between January 2017 and December 2019. We evaluated the demographic, clinical, infection characteristics and the one-year postoperative outcomes.ResultsAmong the 419 patients who received KT between January 2017 and December 2019, 150 patients had at least one infection within 90 days after KT. The total prevalence of early infections was 36.1% (150/415), the prevalence of early CRKP infections was 10.4% (43/415), and the one-year postoperative mortality was 15.3% (23/150) in patients with early infections. The risk factors independently related to one-year postoperative mortality were mechanical ventilation (MV) > 48 h (Odds ratio (OR)= 13.879, 95%Confidence interval (CI): 2.265~85.035; P=0.004) and CRKP infection (OR=6.751, 95% CI: 1.051~43.369; P =0.044). MV> 48 h was independently related to CRKP infection (OR=3.719, 95% CI: 1.024~13.504; P=0.046). Kaplan-Meier survival curves showed that the one-year survival rate of patients infected with CRKP in the early postoperative stage was significantly lower than that of uninfected patients.ConclusionsIn general, the prevalence of early infections after KT is high, and CRKP infection is closely correlated with poor prognosis. The effective prevention and treatment of CRKP infection is an important way to improve the one-year survival rate after KT.

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Reevaluation of risk factors for time to subsequent events after first stroke occurrence using a new weighted all-cause effect measure

10.21203/rs.2.19014/v1 ◽

2019 ◽

Author(s):

Ann-Kathrin Ozga ◽

Bernhard Rauch ◽

Frederick Palm ◽

Christian Urbanek ◽

Armin Grau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Atrial Fibrillation ◽

Recurrent Stroke ◽

Composite Endpoint ◽

Hazard Ratio ◽

Specific Effects ◽

Index Stroke ◽

One Year ◽

The One

Abstract Background : Risk factors for stroke include atrial fibrillation, hypertension, diabetes mellitus, smoking, and high cholesterol. However, the role of these factors on subsequent cardiovascular events or death is less clear due to therapeutic measures. We therefore aim to get insights into the persistence of known risk factors on subsequent stroke or death one year after the first stroke and to illustrate how the new weighted all-cause hazard ratio can ease the interpretation of competing time-to-event endpoints with different clinical relevance. Methods : This study evaluates the one year follow-up of 470 first ever stroke cases identified in the area of Ludwigshafen, Germany, with 23 deaths and 34 subsequent stroke events. The recently introduced weighted all-cause hazard ratio was used which allows a weighting of the competing endpoints in a composite endpoint. We extended this approach to allow adjustment for covariates. The investigated risk factors were atrial fibrillation, hypertension, diabetes mellitus, smoking, and hypercholesterolemia adjusting for age and sex. Results : None of these meanwhile treated risk factors of which some have been modified after first stroke remained to be associated with subsequent death or stroke. Cause-specific effects point sometimes into opposite directions. Conclusions : Using the new weighted hazard ratio, we can support that well established risk factors for the occurrence of an index stroke are no good predictors of further disease progress defined by death or recurrent stroke. It has been demonstrated that the new weighted hazard ratio provides interpretation advantages over the common all-cause hazard ratio.

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