scholarly journals Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035809
Author(s):  
Bert Vaes ◽  
Paulien Indestege ◽  
Tinne Serneels ◽  
Eralda Hegendörfer ◽  
Petra G van Peet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Predictive Value ◽  
Prospective Cohort ◽  
Risk Models ◽  
Very Old ◽  
Old Adults ◽  
History Of ◽  
Traditional Risk Factors

ObjectivesTo test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.DesignCross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study.SettingGeneral practice, Belgium and The Netherlands.ParticipantsThe BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.Outcome measuresThe model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.ResultsTraditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI −0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).ConclusionsThis study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.

scholarly journals Obesity Risk Factors among 25-65 Years Old Adults in Bogor City, Indonesia: A Prospective Cohort Study

2018 ◽  
Vol 13 (2) ◽  
pp. 55-62
Author(s):  
Sudikno Sudikno ◽  
Hidayat Syarief ◽  
Cesilia Meti Dwiriani ◽  
Hadi Riyadi ◽  
Julianti Pradono
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Obesity Risk ◽  
Old Adults ◽  
Obesity Risk Factors

scholarly journals Nomogram-Based Prediction of the Risk of Macrosomia: A Prospective Cohort Study in a Chinese Population

2021 ◽  
Author(s):  
Jing Du ◽  
Sanbao Chai ◽  
Xin Zhao ◽  
Jianbin Sun ◽  
Ning Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Operating Characteristic ◽  
Multivariate Logistic Regression Analysis ◽  
Maternal Factors ◽  
Multivariate Logistic Regression ◽  
History Of

Abstract Objective: This study aimed to establish a nomogram for predicting the risk of macrosomia in early pregnancy.Methods: We performed a prospective cohort study involving 1,549 pregnant women. According to the birth weight of newborn, the subjects were divided into two groups: macrosomia group and non-macrosomia group. Multivariate logistic regression was used to analyze the risk factors for macrosomia.Results: The prevalence of macrosomia was 6.13% (95/1549) in our hospital. Multivariate logistic regression analysis showed the risk factors of macrosomia were prepregnancy overweight (OR: 2.126, 95% CI: 1.181-3.826)/obesity (OR: 3.536, 95% CI: 1.555-8.036), multiparity (OR:1.877, 95% CI: 1.160-3.039), the history of macrosomia (OR: 36.971, 95% CI: 19.903-68.674), the history of GDM/DM (OR: 2.285, 95% CI: 1.314-3.976), the higher levels of HbA1c (OR: 1.763, 95% CI: 1.004-3.097) and TC (OR: 1.360, 95% CI: 1.004-1.842). A nomogram was developed for predicting macrosomia based on maternal factors related to the risk of macrosomia in early pregnancy. The area under the receiver operating characteristic (ROC) curve of the nomogram was 0.807 (95% CI: 0.755–0.859), the sensitivity and specificity of the model were 0.716 and 0.777, respectively.Conclusion: The nomogram model provides an accurate mothed for clinicians to early predict macrosomia.

scholarly journals Risk Factors for Delirium Are Different in the Very Old: A Comparative One-Year Prospective Cohort Study of 5,831 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Justus Marquetand ◽  
Leonie Bode ◽  
Simon Fuchs ◽  
Florian Hildenbrand ◽  
Jutta Ernst ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Care Systems ◽  
Predisposing Factors ◽  
Precipitating Factors ◽  
Very Old ◽  
Number Of Patients ◽  
Care Systems

Background: In an ever-aging society, health care systems will be confronted with an increasing number of patients over 80 years (“the very old”). Currently, knowledge about and recommendations for delirium management are often based on studies in patients aged 60 to 65 years. It is not clear whether these findings apply to patients ≥80 years.Aim: Comparison of younger and older patients with delirium, especially regarding risk factors.Methods: In this prospective cohort study, within 1-year, 5,831 patients (18–80 years: n = 4,730; ≥80: n = 1,101) with delirium were enrolled. The diagnosis of delirium was based on the Delirium Observation screening scale (DOS), Intensive Care Delirium Screening Checklist (ICDSC) and a DSM (Diagnostic and Statistical Manual)-5 construct of nursing instrument. Sociodemographic trajectories, as well as the relevant predisposing and precipitating factors for delirium, were assessed via a multiple regression analysis.Results: The very old were more commonly admitted as emergencies (OR 1.42), had a greater mortality risk (OR 1.56) and displayed fewer precipitating risk factors for the development of a delirium, although the number of diagnoses were not different (p = 0.325). Predisposing factors were sufficient almost alone for the development of delirium in patients ≥ 80 years of age; in 18–80 years of age, additional precipitating factors had to occur to make a delirium possible.Conclusion: When relevant predisposing factors for delirium are apparent, patients over 80 years of age require comparatively few or no precipitating factors to develop delirium. This finding should be taken into account at hospitalization and may allow better treatment of delirium in the future.

Prospective Cohort Study of the Incidence, Risk Factors and Long-Term Sequelae of Symptomatic Catheter-Related Thrombosis in Adults with Cancer.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2200-2200
Author(s):  
Agnes Y. Lee ◽  
Carolyn Webb ◽  
Qing Guo ◽  
Lorrie Costantini ◽  
Greg Butler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Dwell Time ◽  
History Of ◽  
The Mean ◽  
Catheter Related Thrombosis

Abstract Long-term indwelling central venous catheters (CVCs) are used for delivering chemotherapy, parenteral nutrition, antibiotics, and blood products, as well as for facilitating blood drawing, in many patients with malignancy. Although the important supportive role of CVCs is unquestioned, there is uncertainty regarding the prevention and treatment of catheter-related thrombosis (CRT) because there is a lack of prospective and contemporary data on the natural history of this complication. As a first step towards improving CRT management, we conducted a prospective cohort study to examine the incidence, clinical risk factors, and the long-term sequelae of symptomatic CRT in adults with cancer. Consecutive patients undergoing insertion of a CVC at a tertiary care center were enrolled and followed for the duration of their catheter-dwell time plus 4 weeks or a maximum of 52 weeks, whichever comes first. Scheduled assessments were done at weeks 1, 2, 4, 8, 12, 24, 36 and 52 weeks after insertion. Patients with symptomatic CRT were treated with anticoagulants and were followed for an additional 52 weeks from the date of CRT diagnosis. Baseline information and follow-up data regarding catheter patency, thromboprophylaxis, clinical symptoms, and thrombotic events was collected. Standardized regional guidelines for catheter care were followed and symptomatic CRT was diagnosed based on objective testing and satisfaction of prespecified criteria. Between March 2002 and July 2003, 444 patients underwent 500 catheter insertions. The mean patient age was 56 y (range 18–91 y) and 55% of patients were female. Catheters inserted included PICCs (65%), ports (18%), pheresis (11%), and Hickman catheters (6%). As of July 22, 2004, 442 patients had completed follow-up. The total catheter-dwell time was 59,959 d (median 88 d), while the total follow-up was 73,654 pt-d (median 151 d). Colorectal was the most common tumor type in 18% of patients and 41% of all patients at enrolment had metastatic solid tumor. Overall, there were 19 episodes of symptomatic CRT, representing an incidence of 4.3% (95% CI 2.6–6.6%) of patients or 0.3 CRTs per 1000 catheter-dwell days (95% CI 0.2–0.5 per 1000 d). The mean time to CRT was 53 d (range 6–162 d). Development of CRT was not associated with age, ECOG performance status, cancer treatment, catheter type, side of insertion, thromboprophylaxis, infection, or previous history of thrombosis. The only significant risk factor was ovarian cancer (P=0.02). In patients with symptomatic CRT, 89% (17/19) of CRTs were treated with anticoagulant therapy alone, 5.3% (1/19) had the catheter removed, and 5.3% (1/19) were treated with both; none had symptomatic pulmonary embolism or post-thrombotic syndrome during follow-up. In summary, the incidence of symptomatic CRT in adults with cancer is low and treatment with anticoagulant therapy alone was not associated with any serious long-term sequelae. Due to the small number of CRTs observed, larger studies are required to further evaluate risk factors and identify the optimal therapeutic approach for CRTs.

Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

2021 ◽  
Vol 135 (4) ◽  
pp. 711-723
Author(s):  
James S. Khan ◽  
Daniel I. Sessler ◽  
Matthew T. V. Chan ◽  
C. Y. Wang ◽  
Ignacio Garutti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Rating Scale ◽  
Noncardiac Surgery ◽  
Persistent Pain ◽  
Increased Risk ◽  
History Of ◽  
Incisional Pain

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The Natural Course and Risk Factors for Progression of Diabetic Retinopathy-KNDP Prospective Cohort Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1571-P
Author(s):  
HYUN UK MOON ◽  
JA YOUNG JEON ◽  
SOOJIN LEE ◽  
SEUNG JIN HAN ◽  
HAE JIN KIM ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Natural Course
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