scholarly journals Development and internal validation of a wasp severity score to assess severity and indicate blood purification in persons with Asian wasp stings

2021 ◽  
Author(s):  
Yong Liu ◽  
Hongmei Shu ◽  
Youlin Long ◽  
Xiaoqin Nie ◽  
Hongfu Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Severity Score ◽  
Medical Intervention ◽  
Blood Purification ◽  
Validation Dataset ◽  
Early Assessment ◽  
Training Set ◽  
Wasp Sting ◽  
Wasp Stings

Abstract Background In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. Methods The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp stings (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. Results The data of 1131 wasp sting patients from 2011–2019 were included in the training set. Logistic regression analysis showed that tea-colored urine (TCU), number of stings, and lactate dehydrogenase (LDH) and total bilirubin (TBIL) levels were risk factors for developing a SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve (AUC) of 0.918 (95% CI 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 hours after admission was significantly lower than that in those who did not receive PE treatment (14.3% vs. 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. Conclusions Patients with WSS scores ≥ 3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.

scholarly journals Prediction of Death After Multiple Wasp Stings with a Clinical Prognostic Model

2021 ◽  
Author(s):  
Maohe Wang ◽  
Mei Qin ◽  
Amanda Y Wang ◽  
Jia Wei Zhao ◽  
Fei Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Prognostic Model ◽  
Research Subjects ◽  
Predictive Tool ◽  
Wasp Sting ◽  
Risk Of Death ◽  
Severity Classification ◽  
Wasp Stings ◽  
Independent Risk Factors

Abstract Background: We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes.Methods: From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally.Results: The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001).Conclusions: PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

scholarly journals Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics

2020 ◽  
Author(s):  
Zhichao Feng ◽  
Qizhi Yu ◽  
Shanhu Yao ◽  
Lei Luo ◽  
Junhong Duan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Disease Progression ◽  
Severity Score ◽  
Clinical Characteristics ◽  
Lung Involvement ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Progressive Group ◽  
Novel Coronavirus

AbstractObjectiveTo determine the predictive value of CT and clinical characteristics for short-term disease progression in patients with 2019 novel coronavirus pneumonia (NCP).Materials and Methods224 patients with confirmed 2019 novel coronavirus (COVID-19) infection outside Wuhan who had chest CT examinations were retrospectively screened. Clinical data were obtained from electronic medical records. CT images were reviewed and scored for lesion distribution, lobe and segment involvement, ground-glass opacities, consolidation, and interstitial thickening. All included patients with moderate NCP were observed for at least 14 days from admission to determine whether they exacerbated to severe NCP (progressive group) or not (stable group). CT and clinical characteristics between the two groups were compared, and multivariate logistic regression and sensitivity analyses were performed to identify the risk factors for developing severe NCP.ResultsA total of 141 patients with moderate NCP were included, of which 15 (10.6%) patients developed severe NCP during hospitalization and assigned to the progressive group. Multivariate logistic regression analysis showed that higher neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] and 95% confidence interval [CI], 1.26 [1.04-1.53]; P = 0.018) and CT severity score (OR and 95% CI, 1.25 [1.08-1.46]; P = 0.004) on admission were independent predictors for progression to severe NCP, and sensitivity analysis confirmed the consistent results in nonimported patients but not in imported patients. However, no significant difference in lung involvement was found on CT between imported and nonimported patients (all P > 0.05). Patients who were admitted more than 4 days from symptom onset tended to have more severe lung involvement. Spearman correlation analysis showed the close association between CT severity score and inflammatory indexes (r = 0.17∼0.47, all P < 0.05).ConclusionCT severity score was associated with inflammatory levels and higher NLR and CT severity score on admission were independent risk factors for short-term progression in patients with NCP outside Wuhan. Furthermore, early admission and surveillance by CT should be recommended to improve clinical outcomes.

scholarly journals Development and Validation of a Model to Predict Acute Kidney Injury Following Wasp Stings: A Multicenter Cohort Study

2020 ◽  
Author(s):  
Xin Tang ◽  
Li Lin ◽  
ying Ying Yang ◽  
shuang Rong Huang ◽  
bei Bei Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Health Hazard ◽  
External Validation ◽  
Kidney Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Training Set ◽  
Wasp Stings ◽  
Validation Set

Abstract BackgroundAcute kidney injury (AKI) following wasp stings is a serious and common health hazard, however the early prediction remains challenging. The study aimed to establish a model to predict AKI following wasp stings and validate it.MethodsIn the multicenter prospective cohort study, 508 patients with wasp stings from Jul 2015 to Dec 2019 were randomly divided into the training set (n = 381) and validation set (n = 127) for internal and external validation. A model that based on the multivariable logistic regression analysis was utilized to predict the probability of AKI following wasp stings by a predictive formula and a nomogram. The performances of the model were assessed by using the area under the curve (AUC) and accuracy (ACC) of the receiver operating characteristic curve. The calibration curves were utilized for estimating the consistency between the actual observed outcome and the nomogram predicted AKI probability. Decision curve analysis (DCA) demonstrated the net benefit associated with the use of the nomogram-derived probability for the prediction of AKI following wasp stings.Results Number of stings, hemoglobin (HB) < 110 g/dl, total bilirubin (TBI) > 34 mg/dl, alanine transaminase (ALT) > 40 U/L and activated partial thromboplastin time (APTT) > 47 s were demonstrated as the independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.912, ACC = 0.869 and AUC = 0.936, ACC = 0.898 in the training set and validation set respectively). The predictive formula and nomogram of the model could be utilized to predict the AKI following wasp stings, which having sufficient accuracies, good predictive capabilities and good net benefits.ConclusionIn conclusion, we proved that number of stings, HB < 110 g/dl, TBI > 34 mg/dl, ALT > 40 U/L and APTT > 47 s were independence risk factors for AKI following wasp stings. The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of the AKI following wasp stings.

scholarly journals Prediction of death after multiple wasp stings with a clinical prognostic model

2021 ◽  
Author(s):  
Maohe Wang ◽  
Mei Qin ◽  
Amanda Y Wang ◽  
Jia Wei Zhao ◽  
Fei Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Prognostic Model ◽  
Research Subjects ◽  
Predictive Tool ◽  
Wasp Sting ◽  
Risk Of Death ◽  
Severity Classification ◽  
Wasp Stings ◽  
Independent Risk Factors

Abstract Background We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes. Methods From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally. Results The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001). Conclusions PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

scholarly journals Factors Defining the Development of Severe Illness in Patients with COVID-19: A Single-Center, Retrospective, Observational Study

2020 ◽  
Author(s):  
Xiong Yibai ◽  
Tian Yaxin ◽  
Liu Bin ◽  
Ruan Lianguo ◽  
Lu Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Lactate Dehydrogenase ◽  
Critical Illness ◽  
Observational Study ◽  
Risk Score ◽  
Severe Illness ◽  
Single Center ◽  
Training Set ◽  
Validation Set

Abstract Objective Early triage of patients with coronavirus disease 2019 (COVID-19) is pivotal in managing the disease. However, data on the risk factors for the development of severe disease remains scant. Here, we report a clinical risk score system for severe illness and highlight possible protective factors, which might inform proper treatment strategies.Methods We conducted a retrospective, single-center, observational study at the JinYinTan Hospital from January 24,2020 to March 31, 2020. We evaluated the demographic, clinical, and laboratory data and performed a 3-fold cross-validation to split the data into training set and validation set. We then screened the prognostic factors for severe illness using the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression, and finally conducted a risk score to estimate the probability of critical illness in the training set. Data from the validation set were used to validate the score. Furthermore, the clinical factors of those patients who recovered were compared with those who did not recover from the rapidly worsened illness. We then employed logistic regression tools to delineate the possible protective factors.Results A total of 302 patients were included. From 47 potential risk factors, 6 variables were measured as the risk score: sex(female) (OR, 0.372; 95%CI, 0.211-0.655), Chest Computed Tomography abnormality (OR, 1.90; 95%CI, 1.36-2.66), neutrophil value (OR, 1.33; 95%CI, 1.18-1.50), neutrophil to lymphocyte ratio (OR, 1.23; 95%CI, 1.14-1.34), lactate dehydrogenase (OR, 1.01; 95%CI, 1.006-1.012), albumin (OR, 0.77; 95%CI, 0.71-0.84). The mean AUC of development cohort was 0.82 (95% CI, 0.81-0.92) and the AUC of validation cohort was 0.894 (95% CI, 0.78-0.95). Our comparison data from patients who rapidly worsened but recovered with those who did not showed that 4 variables were predictive factors: Prealbumin (OR, 1.028; 95%CI, 1.010-1.057), percentage of lymphocytes (OR, 1.213; 95%CI, 1.062-1.385), lactate dehydrogenase (OR, 0.984; 95%CI, 0.973-0.996), Prothrombin ativity (OR, 1.065; 95%CI, 1.018-1.115).Conclusion and Relevance In this study, we developed a predictive risk score and highlight 4 factors that might predict recovery from suddenly worsened illness. This report may help define the potential of developing critical illness and recovery prospects in patients with rapidly worsened condition.

scholarly journals Development and Validation of a Nomogram Based on Noninvasive Liver Reserve and Fibrosis (PALBI and FIB-4) Model to Predict Posthepatectomy Liver Failure Grade B-C in Patients with Hepatocellular Carcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Wenhui Zhong ◽  
Feng Zhang ◽  
Kaijun Huang ◽  
Yiping Zou ◽  
Yubin Liu
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Logistic Regression ◽  
Liver Failure ◽  
Roc Curves ◽  
Postoperative Liver Failure ◽  
Multivariate Logistic Regression ◽  
Training Set ◽  
Independent Risk Factors ◽  
Validation Set

Hepatectomy is currently one of the most effective treatments for hepatocellular carcinoma (HCC). However, postoperative liver failure (PHLF) is a serious complication and the leading cause of mortality in patients with HCC after hepatectomy. This study attempted to develop a novel nomogram based on noninvasive liver reserve and fibrosis models, platelet-albumin-bilirubin grade (PALBI) and fibrosis-4 index (FIB-4), able to predict PHLF grade B-C. This was a single-centre retrospective study of 574 patients with HCC undergoing hepatectomy between 2014 and 2018. The independent risk factors of PHLF were screened using univariate and multivariate logistic regression analyses. Multivariate logistic regression was performed using the training set, and the nomogram was developed and visualised. The utility of the model was evaluated in a validation set using the receiver operating characteristic (ROC) curve. A total of 574 HCC patients were included (383 in the training set and 191 for the validation set) and included PHLF grade B-C complications of 14.8, 15.4, and 13.6%, respectively. Overall, cirrhosis ( P < 0.026 , OR = 2.296, 95% confidence interval (CI) 1.1.02–4.786), major hepatectomy ( P = 0.031 , OR = 2.211, 95% CI 1.077–4.542), ascites ( P = 0.014 , OR = 3.588, 95% 1.299–9.913), intraoperative blood loss ( P < 0.001 , OR = 4.683, 95% CI 2.281–9.616), PALBI score >−2.53 (, OR = 3.609, 95% CI 1.486–8.764), and FIB-4 score ≥1.45 ( P < 0.001 , OR = 5.267, 95% CI 2.077–13.351) were identified as independent risk factors associated with PHLF grade B-C in the training set. The areas under the ROC curves for the nomogram model in predicting PHLF grade B-C were significant for both the training and validation sets (0.832 vs 0.803). The proposed nomogram predicted PHLF grade B-C among patients with HCC with a better prognostic accuracy than other currently available fibrosis and noninvasive liver reserve models.

scholarly journals Respiratory Severity Score and Its Association with Adverse Outcomes in Extremely Low Birth Weight Infants Undergoing Invasive Mechanical Ventilation

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mesut Dursun ◽  
Umut Zubarioglu
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Severity Score ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Roc Curves ◽  
Extremely Low Birth Weight ◽  
Multivariate Logistic Regression

Background: Respiratory severity score (RSS) is a simple, non-invasive respiratory failure assessment tool that its appropriateness for lung disease severity is well-established. Objectives: This study aimed to investigate the potential value of early-life RSS values in predicting mortality or severe bronchopulmonary dysplasia (BPD) in infants with extremely low birth weight (ELBW) undergoing invasive mechanical ventilation. Methods: Following a retrospective approach, the current multi-center study intended to estimate the RSS and RSS/kg values in the first three days of life and time-weighted means of these values in ELBW babies who received invasive mechanical ventilation. Participants were categorized into two groups of survival without severe BPD and those with severe BPD or death. All RSS values and other risk factors were compared between groups. A multivariate logistic regression analysis was used to identify factors affecting severe BPD or death. The sensitivity and specificity of RSS values in predicting severe BPD or death were estimated using receiver operating characteristic (ROC) curves. Results: A total of 101 infants met the inclusion criteria. All RSS and RSS/kg values in the first three days of life were found to be significantly higher in the severe BPD or death group. The maximum area under the curve (AUC) in the ROC curves created for the respiratory severity score values was determined as RSS/kg mean with a cut-off value of 3.62 (85.3%), (P = 0.001). According to the multivariate logistic regression analysis, which included risk factors that may affect the development of severe BPD or mortality, both the mean RSS/kg score and the duration of invasive mechanical ventilation maintained statistically significant. [RSS/kg mean; OR = 2.28 (1.37 – 3.78), P = 0.001], [invasive MV duration; OR = 1.08 (95% CI, 1.03 – 1.14), P = 0.003]. Conclusions: This study demonstrated that high RSS/kg mean values in the early periods of life are valuable in predicting severe BPD or death in ELBW babies undergoing invasive mechanical ventilation. Furthermore, mean RSS had more predictive power than single RSS determinations, and incorporating body weight was associated with improved sensitivity of the score.

scholarly journals Gross Hematuria in Patients with Wasp Sting: A Retrospective Study

2020 ◽  
Author(s):  
wei wang ◽  
Maohe Wang ◽  
Prince singh ◽  
Yong Tang ◽  
Xiang Zhong ◽  
...  
Keyword(s):  
Severity Score ◽  
Clinical Symptoms ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Early Assessment ◽  
Gross Hematuria ◽  
Wasp Sting ◽  
Incidence And Mortality ◽  
Severity Scores ◽  
Poisoning Severity Score

Abstract Background: Wasp sting is common in the world, and gross hematuria after wasp sting has been reported in Asia to occur before AKI. Gross hematuria is often used by clinicians as a sign indicated for intensive care and blood purification treatment. However, there is no study on the clinical characteristics and prognosis of wasp sting patients complicated with gross hematuria. Methods: The demographic characteristics and clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score was used as the criterion for severity classification. According to the presence of gross hematuria, the patients were divided into gross hematuria group and non-gross hematuria group. Multivariate logistic regression analysis was performed to explore the risk factors for gross hematuria.Results: Of the 363 wasp sting patients, 219 were male and 144 were female, mean age was 55.9±16.3 years. 51 (14%) had gross hematuria, 39(10.7%) had Acute Kidney Injury(AKI), 105 (28.9%) had rhabdomyolysis, 61(16.8%) had hemolysis, 56 (15.4%) had Multiple Organ Dysfunction Syndrome (MODS), 13 (3.6%) had Acute Respiratory Distress Syndrome (ARDS), 45(12.4%) went on to receive renal replacement therapy, and 14 (3.9%) died. Patients with gross hematuria group had significantly higher poisoning severity scores when admitted to the hospital than those without gross hematuria group (2.2±0.5 vs. 1.1±0.3, P<0.001).Conclusion: Gross hematuria is one of the early clinical symptoms of severe wasp sting patients. AKI incidence and mortality of patients with gross hematuria are significantly increased. Prompt treatment should be taken for wasp sting patients complicated with gross hematuria. The poisoning severity score can be used for early assessment of the severity of wasp sting patients.

scholarly journals CD8+ T cells predicted the conversion of common covid-19 to severe

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Li Liu ◽  
Zhiyong Chen ◽  
Yingrong Du ◽  
Jianpeng Gao ◽  
Junyi Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Cells ◽  
Logistic Regression ◽  
Prediction Model ◽  
Roc Curve ◽  
Multiple Logistic Regression Analysis ◽  
Laboratory Data ◽  
Training Set ◽  
Area Under Roc Curve ◽  
Validation Set

AbstractTo evaluate the predictive effect of T-lymphoid subsets on the conversion of common covid-19 to severe. The laboratory data were collected retrospectively from common covid-19 patients in the First People's Hospital of Zaoyang, Hubei Province, China and the Third People's Hospital of Kunming, Yunnan Province, China, between January 20, 2020 and March 15, 2020 and divided into training set and validation set. Univariate and multivariate logistic regression was performed to investigate the risk factors for the conversion of common covid-19 to severe in the training set, the prediction model was established and verified externally in the validation set. 60 (14.71%) of 408 patients with common covid-19 became severe in 6–10 days after diagnosis. Univariate and multiple logistic regression analysis revealed that lactate (P = 0.042, OR = 1097.983, 95% CI 1.303, 924,798.262) and CD8+ T cells (P = 0.010, OR = 0.903, 95% CI 0.835, 0.975) were independent risk factors for general type patients to turn to severe type. The area under ROC curve of lactate and CD8+ T cells was 0.754 (0.581, 0.928) and 0.842 (0.713, 0.970), respectively. The actual observation value was highly consistent with the prediction model value in curve fitting. The established prediction model was verified in 78 COVID-19 patients in the verification set, the area under the ROC curve was 0.906 (0.861, 0.981), and the calibration curve was consistent. CD8+ T cells, as an independent risk factor, could predict the transition from common covid-19 to severe.

Reoperation for device infection and erosion following deep brain stimulation implantable pulse generator placement

2020 ◽  
Vol 133 (2) ◽  
pp. 403-410 ◽  
Author(s):  
Travis J. Atchley ◽  
Nicholas M. B. Laskay ◽  
Brandon A. Sherrod ◽  
A. K. M. Fazlur Rahman ◽  
Harrison C. Walker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Pulse Generator ◽  
Rank Test ◽  
Implantable Pulse Generator ◽  
Device Infection ◽  
Deep Brain

OBJECTIVEInfection and erosion following implantable pulse generator (IPG) placement are associated with morbidity and cost for patients with deep brain stimulation (DBS) systems. Here, the authors provide a detailed characterization of infection and erosion events in a large cohort that underwent DBS surgery for movement disorders.METHODSThe authors retrospectively reviewed consecutive IPG placements and replacements in patients who had undergone DBS surgery for movement disorders at the University of Alabama at Birmingham between 2013 and 2016. IPG procedures occurring before 2013 in these patients were also captured. Descriptive statistics, survival analyses, and logistic regression were performed using generalized linear mixed effects models to examine risk factors for the primary outcomes of interest: infection within 1 year or erosion within 2 years of IPG placement.RESULTSIn the study period, 384 patients underwent a total of 995 IPG procedures (46.4% were initial placements) and had a median follow-up of 2.9 years. Reoperation for infection occurred after 27 procedures (2.7%) in 21 patients (5.5%). No difference in the infection rate was observed for initial placement versus replacement (p = 0.838). Reoperation for erosion occurred after 16 procedures (1.6%) in 15 patients (3.9%). Median time to reoperation for infection and erosion was 51 days (IQR 24–129 days) and 149 days (IQR 112–285 days), respectively. Four patients with infection (19.0%) developed a second infection requiring a same-side reoperation, two of whom developed a third infection. Intraoperative vancomycin powder was used in 158 cases (15.9%) and did not decrease the infection risk (infected: 3.2% with vancomycin vs 2.6% without, p = 0.922, log-rank test). On logistic regression, a previous infection increased the risk for infection (OR 35.0, 95% CI 7.9–156.2, p < 0.0001) and a lower patient BMI was a risk factor for erosion (BMI ≤ 24 kg/m2: OR 3.1, 95% CI 1.1–8.6, p = 0.03).CONCLUSIONSIPG-related infection and erosion following DBS surgery are uncommon but clinically significant events. Their respective timelines and risk factors suggest different etiologies and thus different potential corrective procedures.

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