344. HIV and Diabetes in the Era of Antiretroviral Therapy

Abstract Background With advancements in ART, non-AIDS comorbidities are becoming more common among people living with HIV (PWH). In this analysis, we identified PWH followed at a single Ryan White HIV Clinic in Alabama and determined the overall prevalence of diabetes (DM). We then evaluated the cohort for risk factors associated with DM. Methods The records of all PWH who attended at least one routine care HIV primary provider visit from 2009 to 2018 at the UAB 1917 HIV Clinic in Birmingham, AL were abstracted. We defined DM as individuals having ≥1 of the following: (1) diagnosis of DM and receiving any diabetic medication, (2) Hgb A1c ≥ 6.5%, (3) any glucose >200 mg/dL. We evaluated the association of traditional, demographic, and HIV-specific risk factors with PWH with and without DM using Chi-square and Wilcoxon rank-sum testing. Univariate significance and amount of missing data were considered when constructing the multivariable logistic regression model to identify independent associations. Results Of the 5247 PWH assessed, 1178 were female (23%), 45 transgender persons (1%); 3235 (62%) black, 1834 (35%) white. At baseline, the median age was 37.5 years, median BMI 24.5 kg/m2, median CD4+ count 333 c/mm3. Overall, 1110 PWH developed DM (21%). By univariate analysis, numerous traditional, demographic and HIV-related risk factors were associated with diagnosis of DM (see Table 1). By multivariable analysis, the following factors were independently associated with DM: traditional (antihypertensive use, aspirin use, glucocorticoid use, statin use, comorbid CKD, comorbid liver disease), demographic (black race, female gender, older age), and HIV-related (nadir CD4) (P < 0.05 for all). Conclusion Over 20% of PWH had a diagnosis of DM. Both traditional and HIV-related factors were independently associated with DM. Notably, lower nadir CD4 and longer time to ART initiation were key HIV-related factors. Additionally, a majority of PWH with DM had multimorbidity (85%) and polypharmacy (90%). Despite the lower complexity of modern ART, the care of PWH remains challenging, partly because of cardiometabolic comorbidities, including DM. Effective diabetes prevention and treatment strategies for PWH should be prioritized. Disclosures All authors: No reported disclosures.

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Factors Predisposing to Post Dural Puncture Headache in Children

Journal of Child Neurology ◽

10.1177/08830738211007699 ◽

2021 ◽

pp. 088307382110076

Author(s):

Madhav Bandatmakur ◽

Carter Bench ◽

Ngum Ngwa ◽

Heba Osman ◽

Pooja Dave ◽

...

Keyword(s):

Risk Factors ◽

Statistical Significance ◽

Univariate Analysis ◽

Female Gender ◽

Pseudotumor Cerebri ◽

Multivariable Logistic Regression Analysis ◽

Postdural Puncture Headache ◽

Opening Pressure ◽

Related Factors ◽

Core Study

Background: Knowledge of the factors that predispose to postdural puncture headache in children may help reduce the occurrence of this complication. Materials and Methods: A retrospective cohort study of children who presented to the study institution between 2010 and 2018 was conducted. Children were divided into 2 groups: those who experienced postdural puncture headache and those who did not. The 2 groups were compared with respect to certain demographic, technical, and personnel-related factors. Only children who had opening pressure documented during the procedure were included in the core study group. Results: In univariate analysis, children aged ≥10 years, female gender, children with higher body mass index, standard blinded lumbar puncture procedure, use of sedation, higher opening pressure, and presence of pseudotumor cerebri increased the probability of postdural puncture headache. In multivariable logistic regression analysis, presence of pseudotumor cerebri was the only factor that attained statistical significance when the opening pressure was measured and documented. Conclusions: The risk factors for postdural puncture headache in a pediatric cohort varied from risk factors that are classically implicated in adults.

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Abstract TP165: Mortality After Large Artery Occlusion Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp165 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Rahul R Karamchandani ◽

Jeremy Rhoten ◽

Edwin Strong ◽

Brenda Chang ◽

Sam Singh ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Prediction Models ◽

Univariate Analysis ◽

Female Gender ◽

Artery Occlusion ◽

Large Artery ◽

Multivariable Logistic Regression Model ◽

Factors Associated ◽

Social Security Death Index

Introduction: Despite randomized trials demonstrating the benefit of endovascular therapy (EVT), large artery occlusion (LAO) acute ischemic stroke (AIS) remains associated with high mortality. Identifying factors associated with mortality for patients presenting with LAO AIS can assist in therapeutic decision-making and prognostication. Hypothesis: Among patients with LAO AIS, factors associated with 90-day mortality include older age, higher presenting NIHSS score, and lower final Thrombolysis in Cerebral Infarction (TICI) score. Methods: From November 2016 to April 2019, we conducted a retrospective analysis from a large healthcare system’s stroke network registry of patients presenting with ICA and/or MCA occlusions. Ninety-day mortality status from registry follow-up was corroborated with the Social Security Death Index. A multivariable logistic regression model was fitted to determine demographic and clinical characteristics associated with 90-day mortality. Results: Among 796 patients with 800 encounters, mean age was 68 years, 52% were women, mean presenting NIHSS was 14, and 97% presented within 24 hours of last known well time. Fifty-one percent were treated with EVT. Mortality rate for the entire cohort was 25%. In a univariate analysis, there were significant differences in age, gender, race, blood glucose, presenting NIHSS, hypertension, atrial fibrillation, CTP core volume, CTP delayed perfusion volume, EVT treatment, number of passes for EVT, final TICI score, and discharge mRS, between patients with and without 90-day mortality. In the multivariable model, increasing age (per 10 years, OR 1.54, 95% CI 1.20, 1.97) and higher discharge mRS (per 1 point, OR 4.47, 95% CI 3.05, 6.55) were associated with 90-day mortality. Female gender (OR 0.57, 95% CI 0.27, 1.18) and final TICI score of 2B or better (OR 0.42, 95% CI 0.18, 1.01) were protective against 90-day mortality. Conclusions: Increasing age and worse discharge functional outcome are associated with 90-day mortality after LAO AIS. Female gender and better revascularization after EVT are associated with lower mortality. Additional studies are required to refine mortality outcome prediction models for patients presenting with LAO AIS.

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Establishment of Predictive Model for Related Factors of Systemic Inflammatory Response Syndrome (SIRS) After Percutaneous Nephrolithotomy (PCNL)

10.21203/rs.3.rs-29106/v1 ◽

2020 ◽

Author(s):

Min Ju ◽

Jin Zheng ◽

li Ying Pan ◽

lin Lin Gao

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Percutaneous Nephrolithotomy ◽

Operative Time ◽

Univariate Analysis ◽

Infection Process ◽

Systemic Inflammatory Response ◽

Related Factors

Abstract Background:The percutaneous nephrolithotomy (PCNL) is a primary method of stone treatment, but the infection is a very common postoperative complication. The systemic inflammatory response syndrome (SIRS) is a stage of the infection process and a very important early clinical manifestation of sepsis, so identifying the risk factors associated with SIRS after PCNL plays an important role in ensuring patients’ safety and preventing sepsis. Methods:Between September 2016 and September 2017,there were total 352 patients who were diagnosed as renal stone and were treated with PCNL, andincluded in this study at last.Patients were divided into two groups according to whether SIRS occurred or not.The univariate analysis was performed on the related risk factors such as patients' age, gender, number of stone, diabetes et al. Then logistic regression was used for multivariate analysis and established a prediction model.Results:There are 352renal stone patients were treated with PCNL, and 106 patients (30.1%) suffered SIRS after operation.It was found that the operative time, preoperative fever and diabetes could be deemed as risk factors, and the Then logistic regression results indicated that diabetes (OR=2.049, 95%CI 1.008～4.166) and operative time (OR=1.011, 95%CI 1.003～1.019) entered the regression equation.Conclusion: Diabetes and operative time are independent risk factors for SIRS after PCNL, so the probability of SIRS after PCNL can be determined in accordance with these two indicators.

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Peripherally inserted central catheter-related complications in cancer patients: a prospective study of over 50,000 catheter days

The Journal of Vascular Access ◽

10.5301/jva.5000670 ◽

2017 ◽

Vol 18 (2) ◽

pp. 153-157 ◽

Cited By ~ 38

Author(s):

Junren Kang ◽

Wei Chen ◽

Wenyan Sun ◽

Ruibin Ge ◽

Hailong Li ◽

...

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Multivariable Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Multivariable Logistic Regression Analysis ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Multicenter Cohort Study ◽

Related Factors

Purpose To evaluate incidence and risk factors of peripherally inserted central catheter (PICC)-related complications in cancer patients. Methods A prospective, multicenter, cohort study of cancer patients with PICC insertion was performed from February 1, 2013 to April 24, 2014. All patients were monitored in clinic until PICCs were removed. The primary endpoint was PICC removal due to complications. Patient-, catheter- and insertion-related factors were analyzed in univariable and multivariable logistic regression analysis to identify significant independent risk factors for PICC-related complications. Results There were 477 cancer patients included, for a total of 50,841 catheter-days. Eighty-one patients (17.0%) developed PICC-related complications, with an incidence of 1.59 per 1000 catheter days. Thirty-six (7.5%) PICCs were removed because of complications. The most common complications were skin allergy (4.6%), catheter occlusion (3.4%) and accidental withdrawal (2.3%). Nine (1.9%) patients developed symptomatic upper extremity deep venous thrombosis (UEDVT) and central line associated bloodstream infection (CLABSI) was shown in six (1.3%) PICCs with an infection rate 0.12 per 1000 catheter days. In multivariable analysis, body mass index (BMI) >25 (odds ratio, 2.09; 95% confidence interval, 1.26-3.47, p = 0.004) was shown to be a significant risk factor for PICC complications. Conclusions Cancer patients with BMI greater than 25 were more likely to have PICC complications.

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Risk factors of S. aureus intramammary infection in pre partum dairy heifers under grazing conditions and molecular characterization of isolates from heifers and cows

Journal of Dairy Research ◽

10.1017/s0022029919001018 ◽

2020 ◽

Vol 87 (1) ◽

pp. 82-88

Author(s):

Cecilia M. Camussone ◽

Ana I. Molineri ◽

Marcelo L. Signorini ◽

Verónica E. Neder ◽

Carlos A. Vitulich ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Management Practices ◽

Molecular Level ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Cow Milk ◽

Intramammary Infection ◽

Dairy Heifers ◽

Lactating Cows

AbstractThe aims of the research reported here were to identify potential risk factors associated with the presence of Staphylococcus aureus intramammary infection (IMI) in pre partum dairy heifers on 17 dairy farms from three provinces of Argentina and to characterize, at molecular level, isolates from those heifers and lactating cows from two selected herds. A total of 1474 heifers and 4878 lactating cows were studied. The prevalence of Staphylococcus aureus IMI in the heifers, heifers at quarter level and lactating cow mammary quarters was 14.41, 4.82, and 14.65%, respectively. Univariate analysis showed the key variables associated with S. aureus IMI presence in the heifers were: S. aureus IMI prevalence in cows of the lactating herd, the time calves stayed with their dam after birth, the calf rearing system, the place of rearing (own farm or other dairy farm) and fly control on the farm. None of the variables included in the multivariable analysis was associated with the presence of S. aureus IMI in the pre partum heifers, probably due to low variability among management practices used by the farms for rearing the heifer calves. At the molecular level, S. aureus isolates were grouped into three main PFGE clusters and several genotypes within the clusters. Isolates from mammary secretion of pre partum heifers and milk of lactating cows comprised different PFGE clusters in both herds, although two exceptions occurred. The absence of gene fnbpB, which codifies for a virulence factor protein involved in cell invasion by S. aureus, was significantly more frequent in pre partum heifer secretion isolates than in isolates from lactating cow milk. These results suggest that, under these management conditions, isolates from mammary secretions of pre partum heifers do not originate from the milk of lactating cows, but rather other sources to which the heifer is exposed.

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Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz200 ◽

2019 ◽

Vol 112 (7) ◽

pp. 720-727 ◽

Cited By ~ 6

Author(s):

Lucas K Vitzthum ◽

Paul Riviere ◽

Paige Sheridan ◽

Vinit Nalawade ◽

Rishi Deka ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Cancer Survivors ◽

Critical Role ◽

Multivariable Analysis ◽

Area Under The Curve ◽

Opioid Abuse ◽

Opioid Use ◽

Multivariable Logistic Regression Model ◽

Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

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A Longitudinal Evaluation of Risk Factors and Interactions for the Development of Nonspecific Neck Pain in Office Workers in Two Cultures

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720820904231 ◽

2020 ◽

pp. 001872082090423

Author(s):

Deokhoon Jun ◽

Venerina Johnston ◽

Steven M. McPhail ◽

Shaun O’Leary

Keyword(s):

Risk Factors ◽

Neck Pain ◽

Job Strain ◽

Female Gender ◽

Coping Resources ◽

Office Workers ◽

Related Factors ◽

Sitting Posture ◽

Two Cultures ◽

Work Related

Objective To identify risk factors for the development of interfering neck pain in office workers including an examination of the interaction effects between potential risk factors. Background The 1-year incidence of neck pain in office workers is reported as the highest of all occupations. Identifying risk factors for the development of neck pain in office workers is therefore a priority to direct prevention strategies. Methods Participants included 214 office workers without neck pain from two cultures. A battery of measures evaluating potential individual and workplace risk factors were administered at baseline, and the incidence of interfering neck pain assessed monthly for 12 months. Survival analysis was used to identify relationships between risk factors and the development of interfering neck pain. Results One-year incidence was 1.93 (95% CI [1.41, 2.64]) per 100 person months. Factors increasing the risk of developing interfering neck pain were older age, female gender, increased sitting hours, higher job strain, and stress. A neutral thorax sitting posture, greater cervical range of motion and muscle endurance, and higher physical activity were associated with a decreased risk of neck pain. The effects of some risk factors on the development of neck pain were moderated by the workers’ coping resources. Conclusion Multiple risk factors and interactions may explain the development of neck pain in office workers. Therefore, plans for preventing the development of interfering neck pain in office workers should consider multiple individual and work-related factors with some factors being potentially more modifiable than others.

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Amino Acid-Based Metabolic Profile Provides Functional Assessment and Prognostic Value for Heart Failure Outpatients

Disease Markers ◽

10.1155/2019/8632726 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Chao-Hung Wang ◽

Mei-Ling Cheng ◽

Min-Hui Liu ◽

Tieh-Cheng Fu

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Amino Acid ◽

Functional Capacity ◽

Prognostic Value ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Metabolic Status ◽

Metabolic Equivalents ◽

Composite Events

Functional capacity is a crucial parameter correlated with outcomes. The currently used New York Heart Association functional classification (NYHA Fc) system has substantial limitations, leading to inaccurate classification. This study investigated whether amino acid-based assessment on metabolic status provides an objective way to assess functional capacity and prognosis in heart failure (HF) outpatients. Plasma concentrations of histidine, ornithine, and phenylalanine (HOP) were measured on 890 HF outpatients to assess metabolic status by calculating the HOP score. Cardiopulmonary exercise testing (CPET) was performed in 387 patients to measure metabolic equivalents (MET) in order to define the functional class based on MET (MET Fc). Patients were followed for composite events (death/HF-related rehospitalization) up to one year. We found only 47% concordance between the MET Fc and NYHA Fc. HOP scores worked better than NYHA Fc for discriminating patients with MET Fc II and III from those with MET Fc I, with the optimal cutoff value set at 8.8. HOP scores≥8.8 were associated with risk factors for composite events in different kinds of HF populations and were a powerful predictor of composite events in univariate analysis. In multivariable analysis, HOP scores≥8.8 remained a powerful event predictor, independent of other risk factors. Kaplan-Meier curves revealed that HOP scores of ≥8.8 stratified patients at higher risk of composite events in a variety of HF populations. In conclusion, amino acid-based assessment of metabolic status correlates with functional capacity in HF outpatients and provides prognostic value for a variety of HF populations.

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Prognostic factors for survival in patients with stage (stg) IV malignant melanoma (MM)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9072 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9072-9072

Author(s):

N. Seetharamu ◽

H. Hamilton ◽

T. Tu ◽

P. Christos ◽

I. Osman ◽

...

Keyword(s):

Proportional Hazards ◽

Univariate Analysis ◽

Primary Melanoma ◽

Stage Iv ◽

Female Gender ◽

Cox Proportional Hazards ◽

Independent Effect ◽

P Value ◽

Related Factors ◽

Ajcc Staging

9072 Background: Prognosis for survival in MM is not uniform with some pts being long-term survivors. Identifying this subset of pts may have implications on surveillance and treatment (tx). Unfortunately, prognostic data available for MM and the utility of AJCC staging in predicting survival is limited. We analyzed prospectively collected data from the NYUCI Interdisciplinary Melanoma Cooperative Group program (IMCG) to identify clinicopathological variables predictive of MM survival. Methods: We identified 185 pts enrolled in the IMCG with MM diagnosed and treated at NYUCI. Demographic, clinical, and tx-related factors were included in the analysis. Kaplan-Meier (KM) survival analysis was used to identify univariate predictors of post-stage IV survival and their independent effect was assessed in a multivariate Cox proportional hazards regression model. Results: Median age at diagnosis (dx) of metastatic MM was 64 years (22–92). Median overall survival: 13.8 months(m) (128 deaths and a median follow up of 18.6 m (4–141) for survivors). Factors identified on univariate analysis at p<0.20 were evaluated in the multivariate model ( table ). Co-morbidities, site and histology of primary melanoma, initial staging, prior loco-regional recurrences, and adjuvant tx of primary melanoma were not associated with MM survival. Univariate analysis also showed significant survival advantage (p value 0.0011) for patients with AJCC stages M1a and M1b (21.6 m and 17.2 m respectively) over those with AJCC stage M1c (9 m). Conclusions: This cohort study of MM identified female gender, nl serum LDH, nl albumin, and solitary organ involvement as independent survival predictors. Patients who received systemic therapy± local measures had survival benefit over those that had surgery and/or radiation alone suggesting a role for systemic treatment in MM. Patients with personal history of another malignancy (n=37) showed a trend towards improved survival. This novel observation needs to be validated and studied further. [Table: see text] No significant financial relationships to disclose.

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Venous thromboembolism (VTE) risk in patients with localized urinary tract tumors (UTT).

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.422 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 422-422 ◽

Cited By ~ 1

Author(s):

Jorge Ramos ◽

Yu-Ning Wong ◽

Simon J. Crabb ◽

Guenter Niegisch ◽

Joaquim Bellmunt ◽

...

Keyword(s):

Risk Factors ◽

Renal Dysfunction ◽

Univariate Analysis ◽

Multivariate Logistic Regression Model ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Related Factors ◽

Metastatic Setting ◽

Chi Squared ◽

Localized Disease

422 Background: VTE is common in cancer patients, but there is limited data in patients with UTT. We previously demonstrated that non-urothelial histology, cardiovascular disease (CVD) or CVD risk factors or renal dysfunction increased VTE risk in metastatic UTT. In this study, we assessed the frequency and risk factors for VTE in localized disease. Methods: Data was collected via an electronic data capture platform from 29 centers. Patients diagnosed with < cT2, > N1, or M1 disease at diagnosis were excluded. Patients without a date of diagnosis, last follow up, or VTE data were excluded. Cumulative, unadjusted VTE incidence was calculated from time of diagnosis, excluding VTEs diagnosed in the metastatic setting. Chi-squared analyses were used to assess differences in VTE rates for various patient, therapy, and tumor-related factors. Significant covariates were incorporated into a multivariate, logistic regression model. Results: 1131 patients were eligible for analysis. Perioperative chemotherapy was utilized in 46.9% (530/1131) of patients. 70.8% (801/1131) underwent definitive surgical intervention. There were 64 VTEs (cumulative incidence 5.7%). Treatment with chemotherapy (p = 0.609) or surgery (p = 0.886) did not increase VTE risk. In the univariate analysis, non-urothelial histology (p = 0.025), CVD or CVD risk factors (p = 0.004), renal dysfunction (p = 0.023), and radiation to the primary tumor (p = 0.048) were statistically significant factors. Multivariate analysis demonstrated that non-urothelial histology and CVD or CVD risk factors were associated with increased VTE risk (table). Conclusions: The VTE incidence of 5.7% in localized disease is lower than our previously reported rate in the metastatic setting (8.2%). Consistent with our findings in metastatic UTT, non-urothelial histology and CVD or CVD risk factors increase VTE risk in localized disease. Additional analyses to control for baseline demographics in patients treated with surgery and chemotherapy will be performed. [Table: see text]

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