Risk of an Adverse Event in Individuals Who Aspirate: A Review of Current Literature on Host Defenses and Individual Differences

2021 ◽  
pp. 1-15
Author(s):  
Phyllis M. Palmer ◽  
Aaron H. Padilla
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Case Studies ◽  
Distress Syndrome ◽  
Adverse Outcome ◽  
Oropharyngeal Dysphagia ◽  
Central Theme ◽  
Host Defenses ◽  
Increase Risk ◽  
Key Variables

Purpose The presence of oropharyngeal dysphagia increases the likelihood of prandial aspiration, and aspiration increases the likelihood of a dysphagia-related pulmonary sequelae such as aspiration pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, and even death. Although these outcomes are unfortunate, it is important to point out that these consequences are not solely determined by the presence of aspiration. The purpose of this tutorial is to provide current information on pulmonary defenses and the variables that increase risk of an adverse outcome in individuals who aspirate. Method This tutorial reviews the basics of lung defenses and summarizes the literature to make the case that the host is a central theme in dysphagia management. Case studies are employed to highlight the key variables. Results Based on a literature review, a series of questions are proposed for consideration in dysphagia management. These questions, which take the focus away from the presence of aspiration and toward the associated risks within an individual, are then applied to two case studies. Conclusions A guiding framework is proposed to encourage clinicians to assess more than the presence of aspiration and consider the individual's ability to cope with the aspirated material. In the presence of aspiration, clinicians are urged to focus on the risk factors that can lead to a negative consequence, identify which factors are modifiable, and determine when a level of risk is acceptable.

scholarly journals Risk Factors Associated to Adverse Outcome in Preterm (PT) Babies with Respiratory Distress Syndrome (RDS) at the Hospital Infantil de Mexico

1999 ◽  
Vol 45 (4, Part 2 of 2) ◽  
pp. 258A-258A
Author(s):  
Monica Villa-Guillen ◽  
Rosa E Olivares-Canto ◽  
Dina Villanueva-Garcia ◽  
Enrique Udaeta-Mora ◽  
Carlos Avila-Figueroa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Adverse Outcome ◽  
Factors Associated

scholarly journals Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Paraskevi Stylianou-Riga ◽  
Theodora Boutsikou ◽  
Panayiotis Kouis ◽  
Paraskevi Kinni ◽  
Marina Krokou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Caesarean Section ◽  
Distress Syndrome ◽  
Elective Caesarean Section ◽  
Case Control ◽  
Male Gender ◽  
Term Neonates ◽  
Systemic Hypotension ◽  
Neonatal Respiratory Distress

Abstract Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

scholarly journals Numerical estimates of risk factors contingent on credit ratings

2021 ◽  
Author(s):  
T. Gärtner ◽  
S. Kaniovski ◽  
Y. Kaniovski
Keyword(s):  
Risk Factors ◽  
Financial Risk ◽  
Credit Rating ◽  
Likelihood Function ◽  
Adverse Outcome ◽  
Credit Ratings ◽  
Industry Sector ◽  
Random Events ◽  
Historical Transition ◽  
Industry Sectors

AbstractAssuming a favorable or an adverse outcome for every combination of a credit class and an industry sector, a binary string, termed as a macroeconomic scenario, is considered. Given historical transition counts and a model for dependence among credit-rating migrations, a probability is assigned to each of the scenarios by maximizing a likelihood function. Applications of this distribution in financial risk analysis are suggested. Two classifications are considered: 7 non-default credit classes with 6 industry sectors and 2 non-default credit classes with 12 industry sectors. We propose a heuristic algorithm for solving the corresponding maximization problems of combinatorial complexity. Probabilities and correlations characterizing riskiness of random events involving several industry sectors and credit classes are reported.

scholarly journals Patients with SLE have higher risk of cardiovascular events and mortality in comparison with controls with the same levels of traditional risk factors and intima-media measures, which is related to accumulated disease damage and antiphospholipid syndrome: a case–control study over 10 years

2021 ◽  
Vol 8 (1) ◽  
pp. e000454
Author(s):  
Sofia Ajeganova ◽  
Ingiäld Hafström ◽  
Johan Frostegård
Keyword(s):  
Risk Factors ◽  
Antiphospholipid Syndrome ◽  
Carotid Plaque ◽  
Adverse Outcome ◽  
Density Lipoprotein ◽  
Index Score ◽  
Baseline Body Mass Index ◽  
Systemic Lupus ◽  
Increased Risk ◽  
History Of

ObjectiveSLE is a strong risk factor for premature cardiovascular (CV) disease and mortality. We investigated which factors could explain poor prognosis in SLE compared with controls.MethodsPatients with SLE and population controls without history of clinical CV events who performed carotid ultrasound examination were recruited for this study. The outcome was incident CV event and death. Event-free survival rates were compared using Kaplan-Meier curves. Relative HR (95% CI) was used to estimate risk of outcome.ResultsPatients (n=99, 87% female), aged 47 (13) years and with a disease duration of 12 (9) years, had mild disease at inclusion, Systemic Lupus Erythematosus Diseases Activity Index score of 3 (1–6) and Systemic Lupus International Collaborating Clinics (SLICC) Damage Index score of 0 (0–1). The controls (n=109, 91% female) were 49 (12) years old. Baseline carotid intima-media thickness (cIMT) did not differ between the groups, but plaques were more prevalent in patients (p=0.068). During 10.1 (9.8-10.2) years, 12 patients and 4 controls reached the outcome (p=0.022). Compared with the controls, the risk of the adverse outcome in patients increased threefold to fourfold taking into account age, gender, history of smoking and diabetes, family history of CV, baseline body mass index, waist circumference, C reactive protein, total cholesterol, high-density lipoprotein, low-density lipoprotein, dyslipidaemia, cIMT and presence of carotid plaque. In patients, higher SLICC score and SLE-antiphospholipid syndrome (SLE-APS) were associated with increased risk of the adverse outcome, with respective HRs of 1.66 (95% CI 1.20 to 2.28) and 9.08 (95% CI 2.71 to 30.5), as was cIMT with an HR of 1.006 (95% CI 1.002 to 1.01). The combination of SLICC and SLE-APS with cIMT significantly improved prediction of the adverse outcome (p<0.001).ConclusionIn patients with mild SLE of more than 10 years duration, there is a threefold to fourfold increased risk of CV events and death compared with persons who do not have SLE with similar pattern of traditional CV risk factors, cIMT and presence of carotid plaque. SLICC, SLE-APS and subclinical atherosclerosis may indicate a group at risk of worse outcome in SLE.

Neonatal outcome in pregnant patients with antiphospholipid syndrome

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Katarina Jeremic ◽  
Aleksandar Stefanovic ◽  
Jelena Dotlic ◽  
Jelena Stojnic ◽  
Sasa Kadija ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Distress Syndrome ◽  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Distress Syndrome ◽  
Adverse Pregnancy Outcome ◽  
Perinatal Asphyxia ◽  
Premature Delivery ◽  
Control Group ◽  
Adverse Pregnancy

AbstractThe study aim was to evaluate pregnancy outcomes in patients with antiphospholipid syndrome (APS) and to determine which clinical parameters present risk factors for adverse pregnancy outcomes in these patients.The study included 55 patients with APS treated at the Clinic for Ob/Gyn, Clinical Center of Serbia, from 2006 to 2012. The control group consisted of 55 healthy pregnant women. Data regarding previous pregnancies and conception method were registered. Immunological and laboratory tests were performed. Pregnancy outcomes, including miscarriage, intrauterine fetal death, hypertensive disorders, diabetes mellitus, phlebothrombosis, fetal growth restriction, premature delivery, delivery method, perinatal asphyxia, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis were followed.The premature delivery rate in APS patients was 31.8%, and pregnancy loss was 18.2%. Significantly more patients with APS had thrombocytopenia, pregnancy losses, intrauterine growth restriction, and perinatal asphyxia compared with the control group. More miscarriages, preterm delivery, lower birth weight, preeclampsia, and IgM anticardiolipin antibody levels significantly correlated with adverse pregnancy outcomes. Although rare, respiratory distress syndrome can also worsen neonatal health status. According to ROC analysis, previous miscarriages correctly explained 66.3% of adverse pregnancy outcome cases. We generated four equations of adverse pregnancy outcome risk factors.The most important prognostic factor for pregnancy outcome in APS patients is the number of previous miscarriages. Using appropriate current therapeutic protocol can enable live birth of a healthy newborn in most cases.

Prognostic factors for development of acute respiratory distress syndrome following traumatic injury – a systematic review and meta-analysis

2021 ◽  
pp. 2100857
Author(s):  
Alexandre Tran ◽  
Shannon M. Fernando ◽  
Laurent J. Brochard ◽  
Eddy Fan ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Prognostic Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Traumatic Injury ◽  
Clinical Risk Factors ◽  
Factors Associated ◽  
Post Traumatic

PurposeTo summarise the prognostic associations between various clinical risk factors and the development of the acute respiratory distress syndrome (ARDS) following traumatic injury.MethodsWe conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with the development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or the Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS tool and certainty of findings using GRADE methodology.ResultsWe included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with the development of post-traumatic ARDS (adjusted odds ratio [aOR] 1.19 for each additional liter of crystalloid administered within first 6 h after injury, 95% CI 1.15 to 1.24, high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic white race, blunt mechanism of injury, presence of head injury, pulmonary contusion, or rib fracture; and increasing chest injury severity.ConclusionWe identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform the development of a risk-stratification tools.

Major Depression and Generalised Anxiety Disorder

1996 ◽  
Vol 168 (S30) ◽  
pp. 68-75 ◽  
Author(s):  
Kenneth S. Kendler
Keyword(s):  
Risk Factors ◽  
Anxiety Disorder ◽  
Major Depression ◽  
Environmental Risk ◽  
Genetic Factors ◽  
Environmental Risk Factors ◽  
Generalised Anxiety Disorder ◽  
Increase Risk ◽  
Twin Models ◽  
One Year

In both clinical and epidemiological samples, major depression (MD) and generalised anxiety disorder (GAD) display substantial comorbidity. In a prior analysis of lifetime MD and GAD in female twins, the same genetic factors were shown to influence the liability to MD and to GAD. A follow-up interview in the same twin cohort examined one-year prevalence for MD and GAD (diagnosed using a one-month minimum duration of illness). Bivariate twin models were fitted using the program Mx. High levels of comorbidity were observed between MD and GAD. The best-fitting twin models, when GAD was diagnosed with or without a diagnostic hierarchy, found a genetic correlation of unity between the two disorders. The correlation in environmental risk factors was +0.70 when GAD was diagnosed non-hierarchically, but zero when hierarchical diagnoses were used. Our findings provide further support for the hypothesis that in women, MD and GAD are the result of the same genetic factors. Environmental risk factors that predispose to ‘pure’ GAD episodes may be relatively distinct from those that increase risk for MD.

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