scholarly journals Epilepsy and mortality: a retrospective cohort analysis with a nested case–control study identifying causes and risk factors from primary care and linkage-derived data

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052841
Author(s):  
Gabriella Wojewodka ◽  
Martin C Gulliford ◽  
Mark Ashworth ◽  
Mark P Richardson ◽  
Leone Ridsdale
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
General Population ◽  
Cause Of Death ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Case Control ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectivesPeople with epilepsy (PWE) have a higher mortality rate than the general population. Epilepsy-related deaths have increased despite all-cause mortality decreasing in the general population pre-COVID-19. We hypothesised that clinical and lifestyle factors may identify people more at risk.DesignWe used a retrospective cohort study to explore cause of death and a nested case–control study to identify risk factors.SettingWe explored factors associated with mortality using primary care population data from 1 April 2004 to 31 March 2014. Data were obtained from the Clinical Practice Research Datalink which compiles anonymised patient data from primary care in the UK. Cause of death data was supplemented from the Office of National Statistics when available.ParticipantsThe analysis included 70 431 PWE, with 11 241 registered deaths.ResultsThe number of deaths within the database increased by 69% between the first and last year of the study. Epilepsy was considered as a contributing cause in approximately 45% of deaths of PWE under 35. Factors associated with increased risk of death included attendance at emergency departments and/or emergency admissions (OR 3.48, 95% CI 3.19 to 3.80), antiepileptic drug (AED) polytherapy (2 AEDs: OR 1.60, 95% CI 1.51 to 1.71; 3 AEDs: OR 2.06, 95% CI 1.86 to 2.29; 4+AEDs: OR 2.62, 95% CI 2.23 to 3.08), status epilepticus (OR 2.78, 95% CI 1.64 to 4.71), depression (OR 1.67, 95% CI 1.57 to 1.76) and injuries (OR 1.54, 95% CI 1.43 to 1.67). No seizures in the prior year (OR 0.52, 95% CI 0.41 to 0.65).ConclusionOur results add to existing evidence that deaths in epilepsy are increasing. Future studies could focus on identifying PWE at high risk and addressing them with clinical interventions or better self-management. Identifying specific risk factors for younger people should be a priority as epilepsy may be a factor in close to half of deaths of PWE under 35 years of age.

scholarly journals Risk factors for progression of juvenile-onset non-radiographic axial spondyloarthritis to juvenile-onset ankylosing spondylitis: a nested case–control study

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001867
Author(s):  
Hao-Guang Li ◽  
Dan-Min Wang ◽  
Feng-Cai Shen ◽  
Shu-Xin Huang ◽  
Zhi-Duo Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Axial Spondyloarthritis ◽  
Disease Onset ◽  
Case Control ◽  
Buttock Pain ◽  
Juvenile Onset ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

ObjectiveTo evaluate the clinical characteristics of juvenile-onset non-radiographic axial spondyloarthritis (nr-axSpA) and to investigate risk factors associated with progression to juvenile-onset ankylosing spondylitis (JoAS).MethodsA nested case–control study was conducted using the retrospectively collected data of 106 patients with juvenile-onset nr-axSpA (age at disease onset, <16 years) in the Clinical characteristic and Outcome in Chinese Axial Spondyloarthritis study cohort. Baseline demographic and clinical characteristics and prognosis were reviewed. Logistic regression analyses were performed to investigate risk factors associated with progression to JoAS.ResultsOverall, 58.5% of patients with juvenile-onset nr-axSpA presented with peripheral symptoms at disease onset. In 82.1% of these patients, axial with peripheral involvement occurred during the disease course. The rate of disease onset at >12 years and disease duration of ≤10 years were significantly higher in those with progression to JoAS than in those without progression to JoAS (83.0% vs 52.8%, p=0.001; 92.5% vs 56.6%, p<0.001, respectively). Multivariable logistic regression analysis revealed that inflammatory back pain (IBP) (OR 13.359 (95% CI 2.549 to 70.013)), buttock pain (OR 10.171 (95% CI 2.197 to 47.085)), enthesitis (OR 7.113 (95% CI 1.670 to 30.305)), elevated baseline C reactive protein (CRP) levels (OR 7.295 (95% CI 1.984 to 26.820)) and sacroiliac joint-MRI (SIJ-MRI) positivity (OR 53.821 (95% CI 9.705 to 298.475)) were significantly associated with progression to JoAS.ConclusionPeripheral involvement was prevalent in juvenile-onset nr-axSpA. IBP, buttock pain, enthesitis, elevated baseline CRP levels and SIJ-MRI positivity in patients with the disease are associated with higher risk of progression to JoAS.

Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study

2020 ◽  
Vol 49 (6) ◽  
pp. 677-684
Author(s):  
Javier Enrique Cely ◽  
Elkin José Mendoza ◽  
John Jaime Sprockel ◽  
Luis Carlos Perez ◽  
Janeth Marcela Mateus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression Model ◽  
Case Control Study ◽  
Kidney Injury ◽  
Case Control ◽  
Factors Associated ◽  
Potential Risk Factors ◽  
Nephrotoxic Drugs ◽  
Nested Case Control ◽  
Control Study

<b><i>Introduction:</i></b> Research about the risk factors associated with community-acquired acute kidney injury (CA-AKI) in acute medical diseases is scarce. Data extrapolation from surgical to medical illnesses is questionable. <b><i>Objectives:</i></b> To evaluate potential risk factors and hospital outcomes associated with a CA-AKI in medical illnesses. <b><i>Methods:</i></b> We performed an unmatched nested case-control study from a previous prospective cohort study. We included adult patients with acute illnesses treated with internal medicine. Cases were defined as patients with a CA-AKI diagnosis upon hospital admission, and controls included patients from the same cohort who did not develop AKI during the first 5 days of hospitalisation. A logistic regression model was used to assess the association between potential risk factors and ­CA-AKI. <b><i>Results:</i></b> A total of 868 patients were included in the study (223 cases and 645 controls). The median age was 65 years (interquartile range 50–78). In a logistic regression model, the risk factors associated with CA-AKI included chronic kidney disease (CKD; OR 6.27; 95% CI 2.95–13.3, <i>p</i> &#x3c; 0.001), ≥65 years old (OR 1.72; 95% CI 1.16–2.57, <i>p</i> = 0.007), acute bacterial infection (OR 1.95; 95% CI 1.36–2.80, <i>p</i> &#x3c; 0.001), hypovolaemia (OR 1.88; 95% CI 1.32–2.69, <i>p</i> &#x3c; 0.001), pre-hospital nephrotoxic drugs (OR 1.77; 95% CI 1.23–2.55, <i>p</i> = 0.002), anaemia (OR 1.49; 95% CI 1.03–2.14, <i>p</i> = 0.031) and systolic blood pressure (SBP) &#x3c;107 mm Hg (OR 2.25; 95% CI 1.38–3.67, <i>p</i> = 0.001). A significant interaction between CKD and age was found (<i>p</i> = 0.017) and included in the model (patients with CKD and ≥65 years old [OR 10.85; 95% CI 4.14–28.41, <i>p</i> &#x3c; 0.001]). The area under the receiver operating characteristic curve of the final model was 0.743. <b><i>Conclusions:</i></b> CKD is strongly associated with CA-AKI upon hospital admission in medical illnesses patients. Older age enhances the risk of CA-AKI in patients with CKD. Other risk factors include pre-hospital nephrotoxic drugs, acute bacterial infection, anaemia, low SBP and hypovolaemia.

scholarly journals Risk factors associated with adverse outcome in empyema thoracis children aged 1 month-12 years in a tertiary care centre: a nested case control study

2017 ◽  
Vol 4 (4) ◽  
pp. 1284
Author(s):  
Arunagirinathan V. ◽  
Stalin S. ◽  
Narayanan E.
Keyword(s):  
Risk Factors ◽  
Pleural Fluid ◽  
Case Control Study ◽  
Case Control ◽  
Empyema Thoracis ◽  
Gram Stain ◽  
X Ray ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

Background: Empyema thoracis (ET) is serious complication of pneumonia in children, treatment outcome depends upon many risk factors. Empyema thoracis is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, ET remains associated with high morbidity worldwide. This study was undertaken to identify risk factors associated with poor outcome and to describe etiological agents.Methods: This nested case control study was conducted at Institute of Child Health and Hospital for Children, Egmore, and Chennai from January 2011 to October 2012 in age group from 1 month to 12 years attending with clinical/radiological evidence of empyema. Cases children with complications and controls without complications. Basic investigations, ultrasonogram chest, pleural fluid gram stain/ culture and blood culture done. Antibiotics started empirically and changed based on culture and sensitivity. Intercostal drainage (ICD) was inserted with an underwater seal.  Demographic data and other variables analysed were haemoglobin, persistent positive CRP, serum albumin level, pleural fluid gram stain, culture and sensitivity, imaging like ultra-sonogram, CECT, X-ray chest after ICD insertion.Results: Of 90 empyema cases, 26 recovered without complication, 56 recovered with complication, 8 died. Logistic regression uses to find association between variables and complications. Risk factors significantly associated with complications were persistent positive CRP, pleural fluid gram stain, imaging ultra-sonogram chest showing loculations, CECT scan showing pleural thickening and X-ray chest after ICD insertion.Conclusions: Independent risk factors associated with complications were X-ray chest after ICD insertion showing non-resolution, ultrasonogram revealing loculations and septations. Early diagnosis, appropriate antibiotics and timely intervention helps in reduction of empyema and complications.

scholarly journals Predictive indicators of severe COVID-19 independent of comorbidities and advanced age: a nested case−control study

2020 ◽  
Vol 148 ◽  
Author(s):  
Xinjie Li ◽  
Tuohutaerbieke Marmar ◽  
Qiang Xu ◽  
Jing Tu ◽  
Yue Yin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Kidney Injury ◽  
Case Control ◽  
Advanced Age ◽  
Control Group ◽  
Case Group ◽  
Factors Associated ◽  
Nested Case Control ◽  
Control Study

Abstract To determine what exacerbate severity of the COVID-19 among patients without comorbidities and advanced age and investigate potential clinical indicators for early surveillance, we adopted a nested case−control study, design in which severe cases (case group, n = 67) and moderate cases (control group, n = 67) of patients diagnosed with COVID-19 without comorbidities, with ages ranging from 18 to 50 years who admitted to Wuhan Tongji Hospital were matched based on age, sex and BMI. Demographic and clinical characteristics, and risk factors associated with severe symptoms were analysed. Percutaneous oxygen saturation (SpO2), lymphocyte counts, C-reactive protein (CRP) and IL-10 were found closely associated with severe COVID-19. The adjusted multivariable logistic regression analyses revealed that the independent risk factors associated with severe COVID-19 were CRP (OR 2.037, 95% CI 1.078–3.847, P = 0.028), SpO2 (OR 1.639, 95% CI 0.943–2.850, P = 0.080) and lymphocyte (OR 1.530, 95% CI 0.850–2.723, P = 0.148), whereas the changes exhibited by indicators influenced incidence of disease severity. Males exhibited higher levels of indicators associated with inflammation, myocardial injury and kidney injury than the females. This study reveals that increased CRP levels and decreased SpO2 and lymphocyte counts could serve as potential indicators of severe COVID-19, independent of comorbidities, advanced age and sex. Males could at higher risk of developing severe symptoms of COVID-19 than females.

scholarly journals A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension

Cephalalgia ◽  
2021 ◽  
pp. 033310242110241
Author(s):  
Anna Sundholm ◽  
Sarah Burkill ◽  
Elisabet Waldenlind ◽  
Shahram Bahmanyar ◽  
A Ingela M Nilsson Remahl
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Factors Associated ◽  
Control Study

Objective To study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls. Methods Using Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000–2016 were compared with randomly selected matched controls, five from the general population and five with obesity. Results We identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000–2005 to 0.95 in 2012–2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1–42.0)), arterial hypertension (odds ratio =17.5 (10.5–29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3–44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development. Conclusions The incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.

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