P6476Surgery does not appear to improve survival in patients with endocarditis and substance use disorder

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Abdollah ◽  
S B Brogly ◽  
D Payne ◽  
K Lajkosz ◽  
N S Coverdale ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Early Death ◽  
Population Based ◽  
Hospital Death ◽  
Term Survival ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Increased Risk ◽  
One Year

Abstract Background Cohort studies of surgery compared with medical treatment (MT) on endocarditis mortality are conflicting. We conducted a population-based study to estimate associations between treatment and mortality. Methods 1,381 patients with substance use disorder (SUD) and 5,053 without (NSUD) hospitalized for endocarditis were included. Treatment was modeled as a time-dependent variable: patients who underwent surgery after admission were classified as MT until surgery occurred and surgically treated thereafter. Patients without surgery were classified as MT. Adjusted hazard ratios (aHR) between treatment and death (in-hospital, 30 days, one, two, five years) by SUD status were estimated. Results Among SUD patients, there was a trend towards reduction in in-hospital death with surgery vs. MT (aHR 0.61 [95% CI: 0.35–1.04]), but no difference at 30 days (aHR 0.79 [95% CI: 0.42–1.48]). Mortality was higher in SUD patients who underwent surgery compared with MT at one (aHR 1.30 [95% CI: 0.95–1.76]), two (aHR 1.27 [95% CI: 0.97–1.65]), and five years (aHR 1.37 [95% CI: 1.09–1.72]). In NSUD patients, in-hospital mortality (aHR 0.93 [95% CI 0.76–1.16]) did not differ, but 30 day mortality (aHR 1.36 [95% CI 1.04–1.77]) was higher with surgery versus MT, and lower at one (aHR 0.87 [95% CI: 0.73–1.03]), two (aHR 0.75 [95% CI: 0.64–0.88]), and five years (aHR 0.70 [95% CI: 0.61–0.81]). Kaplan-Meier Survival Curves of Patients Interpretation Surgery compared with MT conferred no long-term survival benefit in SUD patients. In NSUD patients, surgery was associated with an initial increased risk of early death followed by a lower risk after one year. Acknowledgement/Funding Grant from Department of Surgery, Queen's University

scholarly journals Gout Augments the Risk of Cardiovascular Disease in Patients With Psoriasis: A Population-Based Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhiyong Chen ◽  
Yiwen Xu ◽  
Miao Chen ◽  
Ran Cui ◽  
Yu-Hsun Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score Analysis ◽  
Population Based ◽  
Research Database ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Score Analysis ◽  
Increased Risk ◽  
Traditional Risk Factors ◽  
And Gender

ObjectivePatients with psoriasis (PsO) have a high frequency of concomitant gout and increased risk of cardiovascular diseases (CVD). We aimed to estimate the synergistic impact of gout on the risk of CVD in patients with PsO.MethodsA population-based cohort of patients registered in the National Health Insurance Research Database of Taiwan between 2000 and 2013 was stratified according to the presence of PsO and gout. Propensity score analysis was used to match age and gender at a ratio of 1:4. Cox proportional hazard models and subgroup analyses were used to estimate the hazard ratios (HRs) for CVD adjusted for traditional risk factors. The Kaplan–Meier method was used to plot the cumulative incidence curves.ResultsPatients with combined PsO and gout (n = 97), PsO alone (n = 388), gout alone (matched, n = 388) and matched controls (n = 388) were identified. Compared with the patients with PsO alone, the patients with combined PsO and gout had a significantly higher risk of CVD (relative risk 2.39, 95% CI 1.56 to 3.65). After adjustment for traditional risk factors, the risk of CVD was higher in patients with gout alone (HR 2.16, 95% CI 1.54 to 3.04) and in patients with combined PsO and gout (HR 2.72, 95% CI 1.73 to 4.28).ConclusionsGout augments the risk of CVD independently of traditional risk factors in patients with PsO.

Short and long-term survival in metastatic pancreatic adenocarcinoma, 1993-2013.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 232-232 ◽  
Author(s):  
Talia Golan ◽  
Tal Sela ◽  
Ofer Margalit ◽  
Uri Amit ◽  
Naama Halpern ◽  
...  
Keyword(s):  
Marital Status ◽  
Tumor Location ◽  
Population Based ◽  
Phase Iii ◽  
Term Survival ◽  
Modest Improvement ◽  
Kaplan Meier ◽  
Phase Iii Trials ◽  
Study Population ◽  
One Year

232 Background: Over the previous two decades several new agents have been approved for the treatment of metastatic pancreatic cancer (mPDAC). Their efficacy was demonstrated amongst highly selected patients that participate in randomized phase III trials, hence it is not clear to what extent these advances are reflected within the broader mPDAC population. We performed a population-based survival analysis of newly diagnosed patients who presented with mPDAC. Methods: Survival statistics were extracted from the Survival, Epidemiology and End Results (SEER) Database for patients diagnosed with mPDAC between 1993-2013. Demographic variables collected included age, gender, race, and marital status. Tumor characteristics collected included location and grade. Survival was analyzed using the Kaplan-Meier method and proportional hazard models as appropriate. Exclusion criteria included diagnosis at autopsy, unknown histology and pancreatic neuroendocrine tumors. Results: The study population consisted of 57,263 patients diagnosed with mPDAC from 1993-2013, 52% male, median age 69 years (range 15-104). Prognosis correlated with age, gender, race, marital status, tumor location, grade and year of diagnosis. Median overall survival (OS) stayed stable at 2 months between 1993 and 2013. Improvements in OS were seen for all patients, but especially for younger patients ( < 50 years of age) and more recent year of diagnosis group (2009-2013). The percentage of patients who died within two months of initial diagnosis decreased between 1993 and 2013 (from 63.5% to 50.6%, p < 0.0001). The subgroup of patients achieving longer-term survival has increased, with 12-month survival improving from 4.9 % to 12.7% (p < 0.0001) between 1993 and 2013. Conclusions: There has been a continuous but modest improvement in OS of patients diagnosed with mPDAC between 1993 and 2013. The percentage of patients living beyond one year has significantly increased over time; however the percentage of patients dying within 2 months has only slightly decreased.

scholarly journals Cancer and the risk of COVID-19 diagnosis, hospitalisation, and death: a population-based multi-state cohort study including 4,618,377 adults in Catalonia, Spain

2021 ◽  
Author(s):  
Elena Roel ◽  
Andrea Pistillo ◽  
Martina Recalde ◽  
Sergio Fernandez-Bertolin ◽  
Maria Aragon ◽  
...  
Keyword(s):  
Cohort Study ◽  
Smoking Status ◽  
Population Based ◽  
High Risk Population ◽  
Cancer Type ◽  
Non Melanoma Skin Cancer ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
One Year

Objectives: To investigate the associations between cancer and risk of outpatient COVID-19 diagnosis, hospitalisation, and COVID-19-related death, overall and by years since cancer diagnosis (<1-year, 1-5-years, >5-years), sex, age, and cancer type. Design: Population-based cohort study Setting: Primary care electronic health records including ~80% of the population in Catalonia, Spain, linked to hospital and mortality records between 1 March and 6 May 2020. Participants: Individuals aged ≥18 years with at least one year of prior medical history available from the general population. Cancer was defined as any prior diagnosis of a primary invasive malignancy excluding non-melanoma skin cancer. Main outcome measures: Cause-specific hazard ratios (aHR) with 95% confidence intervals for each outcome. Estimates were adjusted by age, sex, deprivation, smoking status, and comorbidities. Results: We included 4,618,377 adults, of which 260,667 (5.6%) had a history of cancer. Patients with cancer were older and had more comorbidities than cancer-free patients. A total of 98,951 individuals (5.5% with cancer) were diagnosed and 6,355 (16.4% with cancer) were directly hospitalised (no prior diagnosis) with COVID-19. Of those diagnosed, 6,851 were subsequently hospitalised (10.7% with cancer) and 3,227 died without being hospitalised (18.5% with cancer). Among those hospitalised, 1,963 (22.5% with cancer) died. Cancer was associated with an increased risk of COVID-19 diagnosis (aHR: 1.08; 95% confidence interval [1.05-1.11]); direct COVID-19 hospitalisation (1.33 [1.24-1.43]); and death following a COVID-19 hospitalisation (1.12 [1.01-1.25]). These associations were stronger for patients recently diagnosed with cancer, aged <70 years, and with haematological cancers. Conclusions: Patients recently diagnosed with cancer, aged <70 years, or with haematological cancers are a high-risk population for COVID-19 diagnosis and severity. These patients should be prioritised in COVID-19 vaccination campaigns and continued non-pharmaceutical interventions.

scholarly journals Association of nasal septal deviation with the incidence of anxiety, depression, and migraine: A national population-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259468
Author(s):  
Ki-Il Lee ◽  
Seung Min In ◽  
Jong-Yeup Kim ◽  
Jee-Young Hong ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Population Based ◽  
Septal Deviation ◽  
Rank Test ◽  
Control Group ◽  
Nasal Septal Deviation ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Increased Risk ◽  
General Populations ◽  
Anxiety Depression

Background & aims Nasal obstruction caused by nasal septal deviation is very bothersome and, therefore, can affect the patient’s emotional state. However, little is known about the effect of nasal septal deviation (NSD) on the neuropsychiatric aspects of patients. Therefore, this study aims to verify the higher incidence of anxiety, depression, and migraine in patients diagnosed with NSD compared to general populations using big data. Methods This retrospective cohort study collected subjects from the Korean National Health Insurance Service (NHIS) database. Adjustments were made to minimize the confounding of variables for age, sex, residence type, income levels, hypertension, diabetes, dyslipidemia, rhinitis, and chronic rhinosinusitis between the two groups. The primary endpoint of this study was newly diagnosed anxiety, depression, and migraine between January 2009 and December 2018. Kaplan-Meier survival curves, logarithmic rank test, and Cox proportional regression test were used for statistical analysis. Results Among a total of 135,769 subjects in the NHIS database, 48,495 patients with NSD (NSD group) and 54,475 control subjects (control group) were selected. Patients with NSD had an increased risk of anxiety, depression, and migraine compared to the control group. In the NSD group, the adjusted hazard ratios (HR) were 1.236 (95% CI, 1.198–1.276) for anxiety, 1.289 (95% CI, 1.238–1.343) for depression, and 1.251 (95% CI, 1.214–1.290) for migraine. Conclusion NSD is associated with a higher incidence of anxiety, depression, and migraine. Therefore, it is suggested that physicians carefully consider psychoneurological distress and employ therapeutic strategies to minimize these conditions.

scholarly journals Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

2018 ◽  
Vol 212 (4) ◽  
pp. 227-233 ◽  
Author(s):  
Antti Mustonen ◽  
Solja Niemelä ◽  
Tanja Nordström ◽  
Graham K. Murray ◽  
Pirjo Mäki ◽  
...  
Keyword(s):  
Substance Use ◽  
General Population ◽  
Birth Cohort ◽  
Psychotic Disorders ◽  
Temporal Order ◽  
Population Based ◽  
Cannabis Use ◽  
Prodromal Symptoms ◽  
Increased Risk ◽  
Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

Increased risk for stroke in burn patients: A population-based one-year follow-up study

Burns ◽  
2014 ◽  
Vol 40 (1) ◽  
pp. 54-60 ◽  
Author(s):  
Shiu-Dong Chung ◽  
Chin-Shyan Chen ◽  
Herng-Ching Lin ◽  
Jiunn-Horng Kang
Keyword(s):  
Population Based ◽  
Burn Patients ◽  
Follow Up Study ◽  
Increased Risk ◽  
One Year

scholarly journals Sleep problems increase the risk of musculoskeletal pain in boys but not girls: a prospective cohort study

2020 ◽  
Vol 179 (11) ◽  
pp. 1711-1719
Author(s):  
Alessandro Andreucci ◽  
Paul Campbell ◽  
Lisa K Mundy ◽  
Susan M Sawyer ◽  
Silja Kosola ◽  
...  
Keyword(s):  
Cohort Study ◽  
Musculoskeletal Pain ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Sleep Problems ◽  
Large Population ◽  
Population Based ◽  
School Aged Children ◽  
Increased Risk ◽  
One Year

Abstract Adults with sleep problems are at higher risk for onset of musculoskeletal pain, but the evidence is less clear for children. This prospective cohort study investigated whether children with sleep problems are at higher risk for onset of musculoskeletal pain and explored whether sex is a modifier of this association. In a prospective cohort study of Australian schoolchildren (n = 1239, mean age 9 years), the associations between sleep problems at baseline and new onset of both musculoskeletal pain and persistent musculoskeletal pain (pain lasting > 3 months) 1 year later were investigated using logistic regression. The potential modifying effect of sex was also assessed. One-year incidence proportion for musculoskeletal pain onset is 43% and 7% for persistent musculoskeletal pain. Sleep problems were associated with musculoskeletal pain onset and persistent musculoskeletal pain onset in boys, odds ratio 2.80 (95% CI 1.39, 5.62) and OR 3.70 (1.30, 10.54), respectively, but not girls OR 0.58 (0.28, 1.19) and OR 1.43 (0.41, 4.95), respectively. Conclusions: Rates of musculoskeletal pain are high in children. Boys with sleep problems are at greater risk of onset of musculoskeletal pain, but girls do not appear to have higher risk. Consideration of sleep health may help prevent persistent musculoskeletal pain in children. What is Known:• Sleep problems are associated with the onset of musculoskeletal pain in adults.• It is not clear if the association between sleep problems and the onset of musculoskeletal pain is present also in children and if sex plays a role in this association. What is New:• This is the first large population-based study that has prospectively investigated the relationship between sleep problems and onset of musculoskeletal pain in school-aged children.• Children, especially boys with sleep problems, were at increased risk for the development of persistent musculoskeletal pain.

scholarly journals 701. Blood Stream Infection And Risk Of Endocarditis Following Cardiac Valve Repair: A Population-Based Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Jack McHugh ◽  
Talha Khawaja ◽  
Larry M Baddour ◽  
Larry M Baddour ◽  
Juan Crestanello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Population Based ◽  
Cardiac Valve ◽  
Valve Repair ◽  
Population Based Study ◽  
Increased Risk ◽  
One Year

Abstract Background Bloodstream infections (BSIs) confer an increased risk of infective endocarditis (IE) in patients with a prosthetic cardiac valve. This relationship is less well established in patients undergoing valve repair. We conducted a retrospective population-based study to determine the incidence of BSIs following valve repair and identify risk factors associated with the development of IE. Methods The Rochester Epidemiology Project (REP) data linkage system was used to identify all persons who underwent valve repair in a 7-county region in Southeastern Minnesota between January 1, 2010 and December 31, 2018. Medical records were screened for the development of a BSI from time of procedure until May 15, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. IE at outset was defined as cases where IE was diagnosed at the time of initial positive blood culture. Results A total of 387 patients underwent valve repair surgery. A total of 31 (8%) patients subsequently developed a BSI, 4% within one year of surgery. Seventeen patients underwent mitral repair with annuloplasty, 9 underwent tricuspid annuloplasty, and 5 had concurrent repairs. Median time to the development of BSI was 338 days. Of the 31 patients with BSI, 4 (13%) had BSI with IE at outset. No patients developed IE subsequent to BSI, Enterococcus spp. was responsible for 3 cases of IE, and MSSA for 1. All cases occurred within one year of surgery. Given the low incidence, statistical analysis of associated risk factors for IE was not feasible. All patients with BSI and IE at outset, however, died by the end of the study period, versus 11/27 in the BSI only group. Conclusion Incidence of BSIs was higher in patients undergoing cardiac valve repair than in the general population. The incidence of IE with a BSI was 13%, which is lower than what has been previously published. It is notable that all cases of IE occurred within one year of surgery. Recognizing that endothelialization of device surfaces occurs, it is tempting to speculate that the risk of IE may be time dependent and may decline over time. Subsequent investigation of this theory is underway. Disclosures Larry M. Baddour, MD, Boston Scientific (Consultant)

scholarly journals Fate of mild-to-moderate bicuspid aortic valve disease untreated during ascending aorta replacement

2020 ◽  
Author(s):  
Alessandro Verzini ◽  
Marta Bargagna ◽  
Guido Ascione ◽  
Alessandra Sala ◽  
Davide Carino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Term Survival ◽  
Kaplan Meier ◽  
Aortic Root Surgery ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Ascending Aorta Replacement

Background: Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed. Methods: From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (± mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyze. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4±3.9 years, max 16.4). Kaplan Meier estimates were employed to analyze long-term survival. Cumulative incidence function for time to re-operation, recurrence of aortic regurgitation (AR)≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed. Results: There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4±2.5%, 95% CI [83.16-99.63]. At follow-up there were no cases of aortic root surgery whereas 3 patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6±2.5%, 95% CI [0.20-11.53]. At follow up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR>2+/4+ was 5.1±4.98% and of AS>moderate 6.9±3.8%. Conclusions: In our study mild to moderate regurgitation of a BAV did not significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.

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