P6535Atrial fibrillation and its impact in hospitalised cancer patients

Abstract Background Atrial fibrillation (AF) is associated with increased morbidity and mortality. However, its impact on outcomes of cancer patients is largely unknown. We sought to determine the prevalence and effect of AF on in-hospital outcomes of patients admitted with AF in the United States. Methods We obtained and analyzed data from Nationwide Inpatient Sample (NIS 2002- 2014). The study population included all adults (>18 years old) with the discharge diagnosis of cancer and the associated secondary diagnosis of AF. The associations of AF with in-hospital complications, procedures, discharge outcomes, and mortality, were analyzed after adjusting for potential confounders using logistic regression analyses. Results During the study period, 12,410,290 patients were admitted with cancer; of which, 1,013,735 (8.2%) had AF. Patients with AF were likely to be male (51.1% vs 42.7%), white (86.3% vs 73.6%), and had significantly higher rates comorbidities including hypertension (59.6% vs 44.6%), diabetes (20.9% vs 15.8%), heart failure (23.8% vs 4.5%), and stroke (1.3% vs 0.7%). Similarly, in-hospital complications (including infections, venous thromboembolism, gastrointestinal bleeding, myocardial infarction) and hospital procedures (including cardiac catheterization, intubation, blood transfusion, percutaneous coronary intervention) were found at a significantly higher rate in cancer patients with AF compared to without AF (p-value for all <0.0001). After adjusting for all confounding factors, cancer patients in the AF group had higher odds of in-hospital death (odds ratio, 1.26; 95% confidence interval, 1.23–1.28; P<0.0001). The presence of AF conferred on average three days of extra inpatient stay in patients with cancer. Mortality in the cancer patients admitted with a concomitant diagnosis of AF has gradually increased from 7.2% to 9.7% over the 13-year study period. Table 1. Multivariate model showing Atrial fibrillation as an independent risk factor of inpatient mortality in cancer patients Unadjusted univariate model Multivariate model adjusted for age, sex, race and potential confounders* Odds ratio (95% confidence interval P-value Odds ratio (95% confidence interval P-value Discharged alive Reference Reference In-hospital mortality 2.08 (2.07, 2.10) <0.0001 1.26 (1.23, 1.28) <0.0001 *Confounders adjusted for include all clinical comorbidities and in-hospital complications and procedures. Conclusions In patients with cancer, AF confers significant in-hospital burden by increasing the hospital stay by 3 days. AF is also associated with significantly higher rates of in-hospital procedures and complications in cancer patients and is an independent risk factor of in-hospital mortality. Acknowledgement/Funding None

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P1571Atrial fibrillation is an independent predictor of mortality in hospitalized cancer patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0331 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A H Malik ◽

S Shetty ◽

S Malik

Keyword(s):

Atrial Fibrillation ◽

Colon Cancer ◽

Risk Factor ◽

Hospital Mortality ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Independent Risk Factor ◽

Attributable Mortality ◽

Patients With Cancer ◽

Hospitalised Patients

Abstract Background Atrial fibrillation (AF) is prevalent in patients with cancer. We performed a study to evaluate the outcomes associated with hospitalised cancer patients with AF. Methods The Nationwide Inpatient Sample was used to identify patients with a cancer diagnosis, who were found to have atrial fibrillation from the years 2002–2014. Descriptive statistics for mortality were calculated using univariate and multivariate model for each cancer, and we identified the type of cancer associated with the highest inpatient mortality. We also calculated the percentage of hospital mortality attributable to AF. Results 12,410,290 (nationwide estimate) patients with a cancer diagnosis were identified, and 8.2% of them had AF. In a multivariate adjusted model for various relevant comorbidities, age, gender and race, AF was also found to be an independent risk factor for higher in-hospital mortality in cancer patients, odds ratio (OR) 1.25 (95% CI 1.23, 1.28, p<0.0001). Colon cancer was found to be associated with the worst outcomes and the highest mortality. In cancer patients, the incident percentage of hospital mortality attributed to AF was 46.7%, population attributable mortality risk of was 7.17%, and number needed to harm was 21 (p<0.0001). Conclusion AF conferred significant morbidity and was found to be an independent risk factor for increased mortality in hospitalised patients with cancer. Colon cancer was found to have the strongest association of worst outcomes in hospitalized patients with AF. Acknowledgement/Funding None

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Risk of Surgery and Anesthesia for Ischemic Stroke

Anesthesiology ◽

10.1097/00000542-200002000-00024 ◽

2000 ◽

Vol 92 (2) ◽

pp. 425-425 ◽

Cited By ~ 46

Author(s):

Gilbert Y. Wong ◽

David O. Warner ◽

Darrell R. Schroeder ◽

Kenneth P. Offord ◽

Mark A. Warner ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

High Risk ◽

Confidence Interval ◽

Odds Ratio ◽

Independent Risk Factor ◽

Index Date ◽

Stroke Index ◽

Increased Risk

Background The goal of this study was to determine if the combination of surgery and anesthesia is an independent risk factor for the development of incident (first-time) ischemic stroke. Methods All residents of Rochester, MN, with incident ischemic stroke from 1960 through 1984 (1,455 cases and 1,455 age- and gender-matched controls) were used to identify risk factors associated with ischemic stroke. Cases and controls undergoing surgery involving general anesthesia or central neuroaxis blockade before their stroke/index date of diagnosis were identified. A conditional logistic regression model was used to estimate the odds ratio of surgery and anesthesia for ischemic stroke while adjusting for other known risk factors. Results There were 59 cases and 17 controls having surgery within 30 days before their stroke/index date. After adjusting for previously identified risk factors, surgery within 30 days before the stroke/index date (perioperative period) was found to be an independent risk factor for stroke (P<0.001; odds ratio, 3.9; 95% confidence interval, 2.1-7.4). In an analysis that excluded matched pairs where the case and/or control underwent surgery considered "high risk" for stroke (cardiac, neurologic, or vascular procedures), "non-high-risk surgery" was also found to be an independent risk factor for perioperative stroke (P = 0.002; odds ratio, 2.9; 95% confidence interval, 1.5-5.7). Conclusion Our results suggest that there is an increased risk of ischemic stroke in the 30 days after surgery and anesthesia. This risk remains elevated even after excluding surgeries (cardiac, neurologic, and vascular surgeries) considered to be high risk for ischemic stroke.

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New-onset atrial fibrillation in critically ill patients with coronavirus disease 2019 (COVID-19)

10.22541/au.161625416.61272781/v1 ◽

2021 ◽

Author(s):

BİŞAR ERGÜN ◽

BEGUM ERGAN ◽

Melih Kaan SÖZMEN ◽

Mehmet Nuri YAKAR ◽

Murat KÜÇÜK ◽

...

Keyword(s):

Atrial Fibrillation ◽

Intensive Care Unit ◽

Risk Factor ◽

Intensive Care ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Independent Risk Factor ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Objectives: To determine the incidence, risk factors, and outcomes of new-onset atrial fibrillation (NOAF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). Methods: We conducted a retrospective study on patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19. NOAF was defined as atrial fibrillation that was detected after diagnosis of COVID-19 without a prior history. The primary outcome of the study was the effect of NOAF on mortality in critically ill COVID-19 patients. Results: We enrolled 248 eligible patients. NOAF incidence was 14.9% (n=37), and 78% of patients (n=29) were men in NOAF positive group. Median age of the NOAF group was 79.0 (interquartile range, 71.5-84.0). Hospital mortality was higher in the NOAF group (87% vs 67%, respectively, p=0.019). However, in multivariate analysis, NOAF was not an independent risk factor for hospital mortality (OR 1.42, 95% CI 0.40–5.09, p=0.582) Conclusions: The incidence of NOAF was 14.9% in critically ill COVID-19 patients. Hospital mortality was higher in the NOAF group. However, NOAF was not an independent risk factor for hospital mortality in patients with COVID-19. Keywords: Atrial fibrillation, critical care, intensive care unit, COVID-19, mortality, hospital mortality

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Comparison between Neutrophil Lymphocyte Ratio and Derived Neutrophil Lymphocyte Ratio as the Risk Factor of COVID-19

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v27i3.1706 ◽

2021 ◽

Vol 27 (3) ◽

pp. 260

Author(s):

Dwi Aryani ◽

Dea Noviana Pramatik

Keyword(s):

Infectious Disease ◽

Risk Factors ◽

Risk Factor ◽

Confidence Interval ◽

Odds Ratio ◽

P Value ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Study Population ◽

Common Sign

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Respiratory disorders were the most common sign and symptom of COVID-19. Inflammation on SARS-CoV-2 infection is presumed to play a role in the pathogenesis of COVID-19. The Neutrophil Lymphocyte Ratio (NLR) is one of many biomarkers that has been widely used to assess the risk factors of COVID-19. The derived Neutrophil Lymphocyte Ratio (d-NLR) is a simple, inexpensive, and widely available inflammation biomarker. However, its usage for COVID-19 remains to be further studied. This study aimed to determine the NLR and d-NLR ratio as a risk factor of COVID-19. This study was a retrospective study with a study population of 84 subjects, consisting of 33 patients with positive COVID-19 and 51 patients with negative COVID-19. The result showed that the odds ratio of NLR to COVID-19 was 2.665 with the p-value of 0.047 and confidence interval of 95% 0.998-7.038 at cut-off ≥ 3.1. The odd ratio of d-NLR to COVID-19 was 2.808 with the p-value of 0.026 and confidence interval of 95% 1.129-7.038 at cut-off ≥ 2.0. In conclusion, despite a higher odd ratio of d-NLR compared to NLR, both NLR and d-NLR can be used as a biomarker for the risk factor of COVID-19.

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Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury

The American Surgeon ◽

10.1177/000313482008600106 ◽

2020 ◽

Vol 86 (1) ◽

pp. 8-14

Author(s):

Sahil Gambhir ◽

Areg Grigorian ◽

Divya Ramakrishnan ◽

Catherine M. Kuza ◽

Brian Sheehan ◽

...

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Risk Factor ◽

Brain Injury ◽

Confidence Interval ◽

Odds Ratio ◽

Independent Risk Factor ◽

Factors Associated ◽

Severe Tbi ◽

Life Sustaining Treatment

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.

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Skin Punctures in Preterm Infants in the First 2 Weeks of Life

American Journal of Perinatology ◽

10.1055/s-0038-1654711 ◽

2018 ◽

Vol 35 (13) ◽

pp. 1326-1330 ◽

Cited By ~ 1

Author(s):

Daryl Butler ◽

Orla Sheehan ◽

Vicki Livingstone ◽

Eugene Dempsey ◽

Daragh Finn

Keyword(s):

Intensive Care Unit ◽

Multivariate Analysis ◽

Risk Factor ◽

Preterm Infants ◽

Odds Ratio ◽

Neonatal Intensive Care ◽

Independent Risk Factor ◽

Sepsis Group ◽

P Value ◽

Prospective Audit

Objective The objective of this study was to investigate frequency and trends of skin punctures in preterm infants. Study Design A prospective audit of preterm infants less than 35 weeks admitted over a 6-month period to a tertiary neonatal intensive care unit. Each skin puncture performed in the first 2 weeks of life was documented in a specifically designed audit sheet. Results Ninety-nine preterm infants were enrolled. Infants born at < 32 weeks' gestation had significantly more skin punctures than infants > 32 weeks (median skin punctures 26.5 vs. 17, p-value < 0.05). The highest frequency of skin punctures occurred during the first week of life for infants > 28 weeks' gestation (medians 17.5 in 28–31 + 6 weeks' gestation, and 15 in > 32 weeks), and during the second week of life for those born at < 28 weeks (median 17.5). Infants with sepsis had more skin punctures (p-value < 0.001), but this was not significant on multivariate analysis. Median skin punctures in the second week of life were statistically higher in the sepsis group on multivariate analysis (odds ratio: 1.07, 95% confidence interval: 1.00–1.14, p = 0.041). Conclusion Frequency of skin punctures is influenced by gestational age and postnatal age. Skin punctures were not an independent risk factor for sepsis.

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Effect of metabolic syndrome components on the risk of malignancy in patients with gallbladder lesions

10.1101/2020.06.06.20123992 ◽

2020 ◽

Author(s):

Zheng Deng ◽

Yan Xuan ◽

Xinxing Li ◽

William J Crawford ◽

Zhiqing Yuan ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

Confidence Interval ◽

Odds Ratio ◽

Independent Risk Factor ◽

Adjusted Odds Ratio ◽

Fold Increase ◽

Multivariate Logistic Regression ◽

Risk Of Malignancy ◽

Metabolic Syndrome Components

AbstractBackground and AimsThe malignant potential of gallbladder lesions is debated, and there is limited guidance on surveillance. Predicting their risk of malignancy could help clinicians manage and potentially improve prognosis. We evaluated the independent and joint effects of metabolic syndrome components on the risk of malignancy among patients with gallbladder lesions.MethodsUsing a multicenter database, consecutive patients with pathologically confirmed gallbladder lesions between 2012 and 2019 were identified. Univariate and multivariate logistic regression analyses were used to evaluate the effects of metabolic syndrome components (diabetes, hypertension, dyslipidemia, obesity) as additive or combined indicators for the risk of malignancy. Unadjusted and adjusted odds ratios were calculated.ResultsOf the 625 patients, 567 patients were identified with benign gallbladder lesions and 58 patients with gallbladder cancer (GBC). Among all metabolic syndrome components, the proportion of GBC patients with dyslipidemia (63.8%) was significantly greater than benign gallbladder polyps (42.2%, P = 0.002). In multivariate logistic regression analysis, dyslipidemia was associated with a 2.67-fold increase in the risk of GBC (95% confidence interval 1.17-6.09). Dyslipidemia is an independent risk factor for malignancy (adjusted odds ratio 2.164, 95% confidence interval 1.165-4.021), regardless of whether the other risk factors and metabolic syndrome components are combined. Dyslipidemia (adjusted odds ratio 2.164, 95% confidence interval 1.165-4.021) and decreased high-density lipoprotein (HDL, adjusted odds ratio 3.035, 95% confidence interval 1.645-5.600) were closely associated with increased risk of malignancy.ConclusionsDyslipidemia is associated with a 2.67-fold increase in the risk of malignancy, regardless of the presence of other metabolic syndrome components. Dyslipidemia is an independent risk factor for malignancy in patients with gallbladder lesions.

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The Long-Term Efficacy and Safety of Carotid Artery Stenting among the Elderly: A Single-Center Study in China

Behavioural Neurology ◽

10.1155/2018/4707104 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Lan Wen ◽

Suxia Wang ◽

Lei Liu ◽

Lin Chen ◽

Jia Geng ◽

...

Keyword(s):

Risk Factor ◽

Carotid Artery ◽

Confidence Interval ◽

Elderly Patients ◽

Carotid Artery Stenting ◽

Odds Ratio ◽

Independent Risk Factor ◽

Stroke Recurrence ◽

Disability Score

Compared to carotid endarterectomy, carotid artery stenting (CAS) is reportedly associated with higher perioperative risks in elderly patients. To verify the long-term safety and efficacy of CAS with embolic protection in elderly patients, we retrospectively reviewed the medical records of patients with carotid stenosis treated between January 2003 and March 2010 at the Department of Neurology of a large university hospital in China. We included patients with symptomatic, moderate, or severe carotid stenosis of atherosclerotic etiology (other etiologies were excluded), with a disability score ≤ 3 on the modified Rankin Scale, and who received CAS instead of carotid endarterectomy. The clinical endpoints studied were stroke recurrence and all-cause death. The 84 patients included in this study (median follow-up, 8.08 years) were stratified according to age at surgery (<70 vs. ≥70 years), and no significant between-group difference was found regarding baseline characteristics. Of the 14 patients (16.67%) who experienced a defined clinical endpoint, 4 (7.14%) were aged <70 years and 10 (35.71%) were aged ≥70 years (P=0.002). Overall mortality was 14.29% (12/84), with 3 (5.36%) and 9 (32.14%) deaths among patients aged <70 and ≥ 70 years, respectively (P=0.002). Heart disease and cancer accounted for most deaths. The two groups did not differ regarding stroke recurrence, disability score, or rate of in-stent restenosis (blockage ≥ 50%), but patients aged ≥70 years had a higher risk of mortality (odds ratio, 8.3684; 95% confidence interval, 2.048–34.202; P=0.003), and age was an independent risk factor for death (odds ratio, 20.054; 95% confidence interval, 3.094–129.987, P=0.002). Among elderly patients in Southwest China, CAS can effectively prevent stroke recurrence without increasing the risk of stroke-related death, but the risk of all-cause death is higher, with age as an independent risk factor. Careful patient selection is of key importance in the treatment of symptomatic carotid artery stenosis.

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Cancer Radiation Therapy May Be Associated With Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.610915 ◽

2021 ◽

Vol 8 ◽

Author(s):

Nachiket Apte ◽

Parinita Dherange ◽

Usman Mustafa ◽

Lina Ya'qoub ◽

Desiree Dawson ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Radiation Therapy ◽

Risk Factor ◽

Cancer Patients ◽

Independent Risk Factor ◽

Cancer Type ◽

Cancer Therapies ◽

Tumor Type ◽

Multivariable Logistic Regression

Background: The association of atrial fibrillation (AF) with cancer and cancer types is inconclusive. Similarly, data regarding the association of AF with different cancer therapies are controversial.Objectives: To study the association of AF with cancer subtypes and cancer therapies.Methods: We studied all patients aged 18–89 years who presented to the Feist Weiller Cancer Center, with or without a diagnosis of cancer, between January 2011 and February 2016. Electronic health records were systematically queried for baseline demographics and ICD-9 and ICD-10 codes for specific co-morbidities. Patients with a diagnosis of AF were tabulated based on cross-validation with the ECG database and/or by recorded history. We assessed the prevalence and risk of AF based on cancer diagnosis, specific cancer type, and cancer therapy.Results: A total of 14,600 patients were analyzed. Compared to non-cancer patients (n = 6,801), cancer patients (n = 7,799) had a significantly higher prevalence of AF (4.3 vs. 3.1%; p < 0.001). However, following correction for covariates in a multivariable logistic regression model, malignancy was not found to be an independent risk factor for AF (p = 0.32). While patients with solid tumors had a numerically higher prevalence of AF than those with hematological malignancies (4.3 vs. 4.1%), tumor type was not independently associated with AF (p = 0.13). AF prevalence was higher in patients receiving chemotherapy (4.1%), radiation therapy (5.1%), or both (6.9%) when compared to patients not receiving any therapy (3.6%, p = 0.01). On multivariable logistic regression, radiation therapy remained an independent risk factor for AF for the entire study population (p = 0.03) as well as for the cancer population (p < 0.01).Conclusions: Radiation therapy for cancer is an independent risk factor for AF. The known association between cancer and AF may be mediated, at least in part, by the effects of radiation therapy.

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Gender and Post–Dural Puncture Headache

Anesthesiology ◽

10.1097/00000542-200609000-00027 ◽

2006 ◽

Vol 105 (3) ◽

pp. 613-618 ◽

Cited By ~ 39

Author(s):

Christopher L. Wu ◽

Andrew J. Rowlingson ◽

Seth R. Cohen ◽

Robert K. Michaels ◽

Genevieve E. Courpas ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Confidence Interval ◽

Odds Ratio ◽

Independent Risk Factor ◽

Dural Puncture ◽

Meta Analysis ◽

Post Dural Puncture Headache ◽

Female Subjects

Gender is believed to be an independent risk factor for the development of post-dural puncture headache, but there are some of the inconsistencies in the available data. This systematic review examined a total of 18 trials (2,163 males, 1,917 females). The odds of developing a post-dural puncture headache were significantly lower for male than nonpregnant female subjects (odds ratio = 0.55; 95% confidence interval, 0.44-0.67). Although the authors found that nonpregnant female subjects seem to have a higher incidence of post-dural puncture headache than males, the etiology behind these findings is not clear from the current meta-analysis.

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