Dengue Infection Complicated by Hemophagocytic Lymphohistiocytosis: Experiences From 180 Patients With Severe Dengue

Abstract Background Globally, ~500 000 people with severe dengue (SD) require hospitalization yearly; ~12 500 (2.5%) die. Secondary hemophagocytic lymphohistiocytosis (sHLH) is a potentially fatal hyperinflammatory condition for which HLH-directed therapy (as etoposide and dexamethasone) can be life-saving. Prompted by the high mortality in SD and the increasing awareness that patients with SD may develop sHLH, our objectives were to (1) determine the frequency of dengue-HLH in SD, (2) describe clinical features of dengue-HLH, (3) assess mortality rate in SD and dengue-HLH, and (4) identify mortality-associated risk factors in SD. Methods A 5-year retrospective single-center study in all adult patients with SD admitted to a tertiary intensive care unit in Malaysia. Results Thirty-nine of 180 (22%) patients with SD died. Twenty-one of 180 (12%) had HLH defined as an HLH probability ≥70% according to histo score (HScore); 9 (43%) died. Similarly, 12 of 31 (39%) fulfilling ≥4 and 7 of 9 (78%) fulfilling ≥5 HLH-2004 diagnostic criteria died. Peak values of aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase, and creatinine correlated to fatality (odds ratios [ORs], 2.9, 3.4, 5.8, and 31.9; all P < .0001), as did peak ferritin (OR, 2.5; P = .0028), nadir platelets (OR, 1.9; P = .00068), hepatomegaly (OR, 2.9; P = .012), and increasing age (OR, 1.2; P = .0043). Multivariable logistic regression revealed peak AST (OR, 2.8; P = .0019), peak creatinine (OR, 7.3; P = .0065), and SOFA (Sequential Organ Failure Assessment) score (OR, 1.4; P = .0051) as independent risk factors of death. Conclusions Be observant of dengue-HLH due to its high mortality. A prospective study is suggested on prompt HLH-directed therapy in SD patients with hyperinflammation and evolving multiorgan failure at risk of developing dengue-HLH.

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Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02240-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhanchao Tan ◽

Hongzhi Hu ◽

Xiangtian Deng ◽

Jian Zhu ◽

Yanbin Zhu ◽

...

Keyword(s):

Risk Factors ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Medical Data ◽

Limited Information ◽

Related Factors ◽

Patella Fractures ◽

Independent Risk Factors ◽

Associated Risk Factors

Abstract Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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Su1314 A Prospective Study of Acute Pancreatitis Secondary to Eus Guided Biopsy Through the Pancreatic Parenchyma: Associated Risk Factors

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.760 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB331

Author(s):

Afonso L. Ribeiro ◽

Akash Goel

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Prospective Study ◽

Pancreatic Parenchyma ◽

Guided Biopsy ◽

Associated Risk Factors ◽

A Prospective Study

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Respiratory complications in the early post-operative period following elective craniotomies

Journal of Neuroanaesthesiology and Critical Care ◽

10.4103/2348-0548.154236 ◽

2015 ◽

Vol 02 (02) ◽

pp. 114-120

Author(s):

Sachidanand Bharati ◽

Mihir Pandia ◽

Girija Rath ◽

Parmod Bithal ◽

Hari Dash

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Ventilatory Support ◽

Categorical Variables ◽

Respiratory Complications ◽

Chi Square ◽

Post Operative Period ◽

Intraoperative Period ◽

Independent Risk Factors ◽

Associated Risk Factors

Abstract Background and Aims: Respiratory complications are of major concern after intracranial procedures. The objective of the study was to assess the incidence of respiratory complications in the initial 72 hours after elective craniotomies and to identify the associated risk factors. Materials and Methods: Patients undergoing elective craniotomies were studied prospectively. Information pertinent to history, physical examinations, investigation reports, perioperative events and outcome at discharge of the patients were recorded. Occurrence of any sign or symptom of respiratory system, need for reintubation/increased ventilatory support within 72 hours of surgery were considered as post-operative respiratory complication. Relationships of numerical variables and categorical variables with post-operative respiratory complications (PRCs) were assessed via T test and Chi-square (or Fisher’s exact). Multivariate analysis using multiple logistic regression was performed for finding independent risk factors for respiratory complications. Results: Out of 961 patients, 137 (14.3%) patients developed PRC within 72 hours of surgery. Ninety-nine (10.3%) patients developed purulent tracheobronchitis. The patients who had PRC had longer hospital stays and poor Glasgow Outcome Scale at hospital discharge. The variables found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and Glasgow Coma Scale (GCS) deterioration, hypokalemia and fever in the post-operative period. Conclusions: Respiratory complications within first 72 hours of elective craniotomies were common and were associated with prolonged hospital stay and poor neurological outcome. The variables which were found as independent risk factors were tachycardia, blood transfusion in the intraoperative period and GCS deterioration, hypokalemia and fever in the post-operative period.

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A prospective study of postnatal depressive symptoms and associated risk factors in first-time fathers

Journal of Affective Disorders ◽

10.1016/j.jad.2019.02.033 ◽

2019 ◽

Vol 249 ◽

pp. 371-377 ◽

Cited By ~ 14

Author(s):

Deborah Da Costa ◽

Coraline Danieli ◽

Michal Abrahamowicz ◽

Kaberi Dasgupta ◽

Maida Sewitch ◽

...

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

Prospective Study ◽

Postnatal Depressive Symptoms ◽

Associated Risk Factors ◽

A Prospective Study ◽

First Time

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Longterm Survival and Associated Risk Factors in Patients with Adult-onset Idiopathic Inflammatory Myopathies and Amyopathic Dermatomyositis: Experience in a Single Institute in Japan

The Journal of Rheumatology ◽

10.3899/jrheum.101002 ◽

2011 ◽

Vol 38 (8) ◽

pp. 1636-1643 ◽

Cited By ~ 70

Author(s):

YOSHIOKI YAMASAKI ◽

HIDEHIRO YAMADA ◽

MICHIKO OHKUBO ◽

MASAOMI YAMASAKI ◽

KOHEI AZUMA ◽

...

Keyword(s):

Risk Factors ◽

Therapeutic Strategy ◽

Causes Of Death ◽

Idiopathic Inflammatory Myopathies ◽

Adult Onset ◽

Inflammatory Myopathies ◽

Skin Ulcers ◽

Independent Risk Factors ◽

Longterm Survival ◽

Associated Risk Factors

Objective.To analyze clinical characteristics, survival, causes of death, and risk factors associated with mortality in patients with adult-onset idiopathic inflammatory myopathies (IIM) in Japan.Methods.We retrospectively investigated 197 patients diagnosed with adult-onset IIM at our hospital from 1984 to 2009 according to Bohan and Peter criteria for polymyositis (PM)/dermatomyositis (DM) and modified Sontheimer’s criteria for clinically amyopathic DM (ADM).Results.Survival in the whole group at 1, 5, and 10 years was 85%, 75%, and 67%, respectively. Mortality in cancer-associated myositis was the worst (25% at 5 yrs), followed by clinically ADM (61% at 5 yrs) and primary DM (77% at 5 yrs). Primary DM had significantly low survival compared to primary PM (91% at 5 yrs; p = 0.0427). Among the 53 patients who died were 6 patients with ADM (11%) and 20 patients with primary DM (38%). Interstitial lung disease (ILD) was the main cause of death in clinically ADM (71%) and primary DM (60%), most of which occurred within the first few months. Fewer patients died in primary PM (9%) and overlap myositis (13%). Independent risk factors for death were older age (HR 1.031; 95% CI 1.009–1.053) and skin ulcers (HR 3.018; 95% CI 1.340–6.796) in the whole group and ILD with mild serum creatine kinase levels (< 500 IU/l; HR 3.537; 95% CI 1.260–9.928) in primary DM.Conclusion.Survival of clinically ADM and primary DM was low, mainly due to fatal ILD, compared to primary PM. Establishing therapeutic strategy for ILD may improve the survival in our patient population.

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Mesh Exposure and Associated Risk Factors in Women Undergoing Transvaginal Prolapse Repair with Mesh

Obstetrics and Gynecology International ◽

10.1155/2013/926313 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Elizabeth A. Frankman ◽

Marianna Alperin ◽

Gary Sutkin ◽

Leslie Meyn ◽

Halina M. Zyczynski

Keyword(s):

Risk Factors ◽

Retrospective Chart Review ◽

Vaginal Wall ◽

Anterior Vaginal Wall ◽

Repair System ◽

Mesh Exposure ◽

Prolapse Repair ◽

Increased Risk ◽

Independent Risk Factors ◽

Associated Risk Factors

Objective. To determine frequency, rate, and risk factors associated with mesh exposure in women undergoing transvaginal prolapse repair with polypropylene mesh.Methods. Retrospective chart review was performed for all women who underwent Prolift Pelvic Floor Repair System (Gynecare, Somerville, NJ) between September 2005 and September 2008. Multivariable logistic regression was performed to identify risk factors for mesh exposure.Results. 201 women underwent Prolift. Mesh exposure occurred in 12% (24/201). Median time to mesh exposure was 62 days (range: 10–372). When mesh was placed in the anterior compartment, the frequency of mesh exposure was higher than that when mesh was placed in the posterior compartment (8.7% versus 2.9%,P=0.04). Independent risk factors for mesh exposure were diabetes (AOR = 7.7, 95% CI 1.6–37.6;P=0.01) and surgeon (AOR = 7.3, 95% CI 1.9–28.6;P=0.004).Conclusion. Women with diabetes have a 7-fold increased risk for mesh exposure after transvaginal prolapse repair using Prolift. The variable rate of mesh exposure amongst surgeons may be related to technique. The anterior vaginal wall may be at higher risk of mesh exposure as compared to the posterior vaginal wall.

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Frequency of Peripheral Intravenous Catheter Related Phlebitis and Related Risk Factors: A Prospective Study

Journal of Medicine ◽

10.3329/jom.v20i1.38818 ◽

2019 ◽

Vol 20 (1) ◽

pp. 29-33

Author(s):

Umma Salma ◽

Mohammad Abdus Sattar Sarker ◽

Nahida Zafrin ◽

Kazi Shamin Ahamed

Keyword(s):

Risk Factors ◽

Prospective Study ◽

Clinical Practices ◽

Related Complication ◽

Related Risk ◽

Peripheral Intravenous Catheter ◽

Amoxicillin Clavulanic Acid ◽

Grade 3 ◽

Associated Risk Factors ◽

A Prospective Study

Background: Peripheral Intravenous Catheterization (PIVC) related complication is a common and significant problem in clinical practices. The aim of the study was to see the pattern of complication developed by PIVC and to find out the associated risk factors. Materials & methods: A prospective study was conducted amongst 300 patients and 420 PIVCs were observed. Results: 76 (18.09%) patients developed phlebitis and among the phlebitis patients 55.26% were grade 2 and 22.37% grade 3. Hypertonic fluid infusion and some antibiotics were found as risk factors for phlebitis. Amongst the antibiotics flucloxacilin (60%), amikacin (50%), amoxicillin + clavulanic acid were most common antibiotics responsible for development of phlebitis. Conclusions: Catheterization site and use of antibiotics and potassium chloride with associated co-morbidities are predisposing factors for phlebitis. Better insertion technique may be sought to lower the incidence of PIVC related complications. J MEDICINE JUL 2019; 20 (1) : 29-33

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Review of comorbidities and risk factors for the development of migraine complications (infarct and chronic migraine)

Cephalalgia ◽

10.1177/03331024090290s303 ◽

2009 ◽

Vol 29 (3_suppl) ◽

pp. 7-14 ◽

Cited By ~ 2

Author(s):

DW Dodick

Keyword(s):

Risk Factors ◽

Chronic Migraine ◽

Episodic Migraine ◽

Depression And Anxiety ◽

Vascular Events ◽

Disease Management Strategy ◽

Acute Medication ◽

Independent Risk Factors ◽

Associated Risk Factors

A number of comorbid disorders, behavioural traits and associated risk factors in patients with migraine are known to increase the risk of complications such as ischaemic vascular events and chronic migraine, a syndrome that is more disabling and resistant to treatment with acute and preventative medications than episodic migraine. Reduction of cardiovascular risk factors, smoking cessation and use of non-oestrogen-containing oral contraceptives in female patients are beneficial strategies to reduce the risk of ischaemic events in patients with migraine (especially those with aura). Attack frequency, acute medication overuse, obesity and coexisting depression and anxiety disorders are particularly strong but potentially modifiable independent risk factors for progression to chronic migraine. Identifying and managing comorbidities and associated risk factors for complications of migraine are likely to require an integrated disease management strategy involving several disciplines and allied health services. Such a disease-oriented model of care may potentially interrupt the cycle of progression and disability and improve quality of life for patients with migraine.

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Risk factors for secondary hemophagocytic lymphohistiocytosis in severe coronavirus disease 2019 adult patients

BMC Infectious Diseases ◽

10.1186/s12879-021-06094-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mei Meng ◽

Limin Chen ◽

Sheng Zhang ◽

Xuan Dong ◽

Wenzhe Li ◽

...

Keyword(s):

Risk Factors ◽

Organ Failure ◽

Hemophagocytic Lymphohistiocytosis ◽

Viral Infections ◽

Adult Patients ◽

Reactive Protein ◽

Failure Assessment ◽

Life Threatening ◽

Independent Risk Factors ◽

Secondary Hemophagocytic Lymphohistiocytosis

Abstract Background Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory event and a fatal complication of viral infections. Whether sHLH may also be observed in patients with a cytokine storm induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still uncertain. We aimed to determine the incidence of sHLH in severe COVID-19 patients and evaluate the underlying risk factors. Method Four hundred fifteen severe COVID-19 adult patients were retrospectively assessed for hemophagocytosis score (HScore). A subset of 7 patients were unable to be conclusively scored due to insufficient patient data. Results In 408 patients, 41 (10.04%) had an HScore ≥169 and were characterized as “suspected sHLH positive”. Compared with patients below a HScore threshold of 98, the suspected sHLH positive group had higher D-dimer, total bilirubin, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, serum creatinine, triglycerides, ferritin, interleukin-6, C-reactive protein, procalcitonin, lactate dehydrogenase, creatine kinase isoenzyme, troponin, Sequential Organ Failure Assessment (SOFA) score, while leukocyte, hemoglobin, platelets, lymphocyte, fibrinogen, pre-albumin, albumin levels were significantly lower (all P < 0.05). Multivariable logistic regression revealed that high ferritin (>1922.58 ng/mL), low platelets (<101 × 109/L) and high triglycerides (>2.28 mmol/L) were independent risk factors for suspected sHLH in COVID-19 patients. Importantly, COVID-19 patients that were suspected sHLH positive had significantly more multi-organ failure. Additionally, a high HScore (>98) was an independent predictor for mortality in COVID-19. Conclusions HScore should be measured as a prognostic biomarker in COVID-19 patients. In particular, it is important that HScore is assessed in patients with high ferritin, triglycerides and low platelets to improve the detection of suspected sHLH.

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