Assessments of Birth Outcome of Twin Delivery and Associated Factors among Newborns in Dessie Referral Hospital, Dessie, Ethiopia, 2019

Background. There was a fast improvement of twin’s birth outcomes in the past decade, but it was average in developing countries. Stillbirth, preterm birth, low birth weight, and birth asphyxia are the major contributors to poor twin birth outcomes. This study was crucial to address the gaps and clarify the outcome of twin delivery. Objectives. To assess the birth outcome of twin delivery and associated factors among newborns who were delivered in Dessie Referral Hospital, Ethiopia, 2019. Methods. Institutional-based retrospective cross-sectional study was employed among 385 maternal records from Nov 10/2013 to Dec 10/2019. Data were selected by using a random sampling technique. Frequencies, proportion, and summary statics were used to describe the study population. The data were entered into Epi Info and exported in the SPSS version 20 for analysis. All variables with p value < 0.20 in bivariable logistic regression analysis were considered for multivariable logistic regression analysis; adjusted odds ratio with 95% confidence interval was used to measure the association variable with p value < 0.05 which was statistically significant. Results. This finding showed that the prevalence of twin birth outcome accounts 23.4% (95 % CI, 19.2–27.5). Low birth weight 9.1%, stillbirth 4.2%, Apgar score < 7 9.1%, and neonatal death 1 % were accounted. Hypertension disorder (95% CI, 6.01(2.43–14.87)), rural residence (95% CI 2.46(1.39–4.37)), PROM (95% CI 6.39(2.52–16.16)), and no ANC follow-up (95% CI, 13.47(2.49–72.85)) were significantly associated with adverse twin birth. Conclusions and Recommendations. Magnitude of twins’ adverse birth outcome was 23.4%. Hypertension disorder, rural residence, PROM, and no ANC follow-up were significant variables for twins’ adverse birth outcome. Therefore, all healthcare providers should give sustainable educations and instructions about the importance of sticking with the recommended ANC follow-up.

Download Full-text

Adverse Birth Out Comes and Associated Factors among Delivered Mothers in Dessie Referral Hospital, North East Ethiopia

Nursing and Health Care ◽

10.33805/2573-3877.121 ◽

2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Niguss Cherie ◽

Amare Mebratu

Keyword(s):

Logistic Regression ◽

Antenatal Care ◽

Birth Outcomes ◽

Birth Outcome ◽

Hemoglobin Level ◽

Referral Hospital ◽

Adverse Birth Outcome ◽

Adverse Birth Outcomes ◽

Significance Level ◽

Dessie Referral Hospital

Introduction: Though there are studies on the various forms of adverse birth outcomes particularly in developing countries, there is limited information on determinant maternal and fetal factors of adverse birth outcomes at Dessie referral hospital including north east Ethiopia. Objective: To assess adverse birth outcomes and associated factors among delivered mothers in Dessie referral hospital, Dessie, Ethiopia. Methods: Institutional based cross sectional study design was conducted in Dessie referral hospital from February 30-March 30, 2017. Random sampling technique was used and 462 sample size was deployed. The collected data was checked; coded and entered to Epi info 7.3 and exported to SPSS version 20 for further analysis. Bivariate logistic regression model used to determine the independent association of dependent and independent variables on the bases of COR; 95 percent of confidence level and significance level of 0.25 Those variables which had significance level of less than 0.25 transferred to multivariable logistic regression. Multivariable logistic regression also used to control the possible effects of confounder variables on the basis of AOR; 95 percent of confidence level and significance level of 0.05. Result: A total of 462 delivered mothers participated in this study which yields 100% response rate. The study finding showed that the proportion of adverse birth outcome among the study participants was 32.5%. Out of 462 births 8.2% were still birth, 16.7% were low birth weight, 15.2% preterm and 8.4% were with visible birth defects. Mothers who didn’t attend antenatal care were 4 times more likely to have adverse birth outcome when compared to those who attended antenatal care follow up, [AOR=4.01, 95% CI(2.8,8.3 )]. Similarly, mothers with hemoglobin level less than 11 mg/dl were encountered adverse birth outcomes 3 times more when compared to those with hemoglobin level greater or equal to 11 mg/dl [AOR=3.04, 95% CI(1.62, 5.71)]. The presence of any form of pregnancy complication to current pregnancy were 3 times more likely to result in adverse birth outcomes as compared to no complication [AOR=2.9, 95% CI (1.64, 5.15)]. Conclusion and Recommendation: proportion of adverse birth outcome among the study participants was high. Lack of antenatal care, hemoglobin level, and pregnancy complications, middle upper arm circumference, were predictors of adverse birth outcomes. Increasing antenatal care uptake, prevention and treatment of chronic medical illness, and anemia and improvements in quality of maternal health services require strict attention.

Download Full-text

Re-infection with SARS-CoV-2 in Patients Undergoing Serial Laboratory Testing

Clinical Infectious Diseases ◽

10.1093/cid/ciab345 ◽

2021 ◽

Author(s):

Adnan I Qureshi ◽

William I Baskett ◽

Wei Huang ◽

Iryna Lobanova ◽

S Hasan Naqvi ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Laboratory Testing ◽

Primary Infection ◽

Associated Factors ◽

Kidney Injury ◽

Healthcare Facilities ◽

The Mean

Abstract Background A better understanding of re-infection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become one of the healthcare priorities in the current pandemic. We determined the rate of re-infection, associated factors and mortality during follow up in a cohort of patients with SARS-CoV-2 infection. Methods We analyzed 9,119 patients with SARS-CoV-2 infection who received serial tests in total of 62 healthcare facilities in United States between December 1, 2019 to November 13, 2020. Re-infection was defined by two positive tests separated by interval of greater than 90 days two after resolution of first infection was confirmed by two or more consecutive negative tests. We performed logistic regression analysis to identify demographic and clinical characteristics associated with re-infection. Results Re-infection was identified in 0.7% (n=63, 95% confidence interval [CI] 0.5%-0.9%) during follow up of 9,119 patients with SARS-CoV-2 infection. The mean period (±standard deviation [SD]) between two positive tests was 116 ± 21 days. A logistic regression analysis identified that asthma (odds ratio [OR] 1.9, 95% CI 1.1-3.2) and nicotine dependence/tobacco use (OR 2.7, 95% CI 1.6-4.5) were associated with re-infection. There was a significantly lower rate of pneumonia, heart failure, and acute kidney injury observed with re-infection compared with primary infection among the 63 patients with re-infection There were two deaths (3.2%) associated with re-infection. Conclusions We identified a low rate of re-infection confirmed by laboratory tests in a large cohort of patients with SARS-CoV-2 infection. Although re-infection appeared to be milder than primary infection, there was associated mortality.

Download Full-text

P1450UREMIC PRURITUS IN MAINTENANCE HEMODIALYSIS PATIENTS: ASSOCIATED FACTORS AND OUTCOME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1450 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Albana Gjyzari (Velaj) ◽

Alma Idrizi ◽

Alketa Koroshi ◽

Margarita Gjata ◽

Merita Rroji (Molla) ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Sleep Disturbance ◽

Biochemical Parameters ◽

Associated Factors ◽

Hemodialysis Patients ◽

Male Gender ◽

Maintenance Hemodialysis ◽

Independent Factor

Abstract Background and Aims Uremic pruritus (UP) is a frequent problem in hemodialysis patients. Despite the strong impact in the quality of life, its pathogenesis is not completely understood. Multiple factors are found associated with UP in several studies. The aim of this study was to evaluate the frequency and severity of pruritus in maintenance hemodialysis (MHD) patients, associated factors and outcome. Method This observational study was performed between January 2016 and December 2019. A total of 85 adult (age >18 years) MHD patients were included in this study. Data were collected using a questionnaire. The severity of pruritus was scored according to the localization and the disturbance in usual work and sleep during the previous month. Mild: Episodic and localized pruritus without disturbance in usual work and sleep; Moderate: Generalized and continuous pruritus without sleep disturbance; Severe: Generalized and continuous pruritus with sleep disturbance. Some relevant demographic, clinical and laboratory parameters were evaluated. During follow up 2 patients underwent transplantation and 3 patients lost follow up. Mortality was the recorded outcome. We investigated whether demographic, clinical, biochemical parameters and outcome were correlated to UP. Results Pruritus was present in 61 % of the hemodialysis patients. Pruritic patients were older: median years 57.5(48.5-66.5) vs. 52(45-59) non pruritic; p=0.046 and male patients were significantly more affected (76.9% male vs. 23.1% female; p=0.015). Pruritic patients had shorter time on HD (mean years 5.2±3.4 vs. 7.8±4.2 non pruritic; p=0.003). The intensity of itching was mild, moderate and severe, in 35.3%, 20% and 5.9% of patients, respectively and severe pruritic patients had a significantly shorter time on HD (3.3±1.7 years; p=0.17). Xerosis was present in 84.6% of pruritic patients vs. 66.7% of non-pruritic; p=0.053. We didn’t find association with marital status, level of education, employment, presence of neuropathy, history of atopy, Diabetes Mellitus (DM). Urea redaction ratio (URR) was significantly lower in our pruritic patients: median 67(63-71) vs. 72(66-74) non-pruritic; p=049. Among biochemical parameters phosphorus (mg/dl) was significantly higher between pruritic patients: median 5.6(5.0-6.6) vs. 5.0(3.9-6.0) non-pruritic; p=0.051. Univariate logistic regression analysis showed significant factors associated with UP: male gender OR=3.1, 95% CI: 1.2-8.0, p=0.017; time on HD OR=0.8, 95% CI: 0.73-0.95, p=0.006; phosphorus level OR=1.4, 95% CI: 1.0-2.0, p=0.034. Multivariate logistic regression analysis adjusted for confounders (age, DM) identified as independent factor associated with UP: male gender OR=3.9, 95% CI: 1.3-11.7, p=0.017 During 4 years follow up 29 (36.3%) patients died. Cox Regression analysis showed moderate pruritus as independent factor for mortality (64.7% dead vs. 35.3% survived within moderate pruritic patients) OR=3.2, 95% CI: 1.4-9.0, p=0.027 (fig. 1). Conclusion UP was a frequent complication in the first years of MHD patients and associated with a worse outcome. A multidimensional approach should be adapted for pruritic MHD patients. Data regarding the possible risk factors of male pruritic MHD patients must be followed closely.

Download Full-text

Adverse birth outcome and associated factors among diabetic pregnant women in Ethiopia: Systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0241811 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241811

Author(s):

Demeke Mesfin Belay ◽

Wubet Alebachew Bayih ◽

Abebaw Yeshambel Alemu ◽

Aklilu Endalamaw Sinshaw ◽

Demewoz Kefale Mekonen ◽

...

Keyword(s):

Pregnant Women ◽

Birth Outcomes ◽

Associated Factors ◽

Birth Outcome ◽

Meta Analysis ◽

Adverse Birth Outcome ◽

Adverse Birth Outcomes ◽

Pooled Prevalence ◽

History Of

Background The magnitude of adverse birth outcome among diabetic pregnant women is high in low-and-middle income countries, like Ethiopia. Precise epidemiological evidence is necessary to plan, evaluate and improve effective preventive measures. This systematic review and meta-analysis is the first to estimate the pooled prevalence of adverse birth outcome and associated factors among diabetic pregnant women in Ethiopia. Methods PubMed, Cochrane Library, Google Scholar, SCOPUS, Web of Science and PsycINFO, and article found in University online repository were accessed. Observational studies such as cross-sectional, case-control and prospective cohort reported using English language was involved. I2 statistic was used to check heterogeneity. Egger’s test and funnel plot were used to measure publication bias. Weighted inverse variance random effects model was also performed. Results Seven studies with 1,225 study participants were retrieved to estimate the pooled prevalence of adverse birth outcome and associated factors. The pooled prevalence of adverse birth outcome among diabetic pregnant women was 5.3% [95% CI; 1.61, 17.41]. Fasting blood glucose level above 100 mg/dl [Adjusted Odds ratio (AOR) = 10.51; 95% Confidence Interval (CI) = 5.90, 15.12], two hour post prandial glucose level above 120 mg/dl [AOR = 8.77; 95% CI = 4.51, 13.03], gestational age <37 completed week [AOR = 9.76; 95% CI = 5.29, 14.23], no ANC follow-up [AOR = 10.78; 95% CI = 6.12, 15.44], history of previous adverse outcomes [AOR = 3.47; 95% CI = 1.04, 5.90], maternal age < 30 years [AOR = 3.47; 95% CI = 1.04, 5.90], and illiteracy [AOR = 2.89; 95% CI = 0.81,4.97)] were associated factors of adverse birth outcome. Conclusions The pooled prevalence of adverse birth outcomes among diabetic pregnant women in Ethiopia was high. Child born from mothers who were illiterate, maternal age < 30 years, gestational age < 37 completed weeks, history of previous adverse birth outcomes and no ANC follow-up increased the risk of adverse birth outcome. Trial registration It is registered in PROSPERO data base: (PROSPERO 2020: CRD42020167734).

Download Full-text

Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

Otolaryngology ◽

10.1177/0194599821993383 ◽

2021 ◽

pp. 019459982199338

Author(s):

Flora Yan ◽

Dylan A. Levy ◽

Chun-Che Wen ◽

Cathy L. Melvin ◽

Marvella E. Ford ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Sleep Disordered Breathing ◽

Healthy Children ◽

Loss To Follow Up ◽

Cox Regression Analysis ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

Download Full-text

The prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy

Current HIV Research ◽

10.2174/1570162x19666211202100308 ◽

2021 ◽

Vol 19 ◽

Author(s):

Safiye Nur Ozcan ◽

Dilek Yıldız Sevgi ◽

Ahsen Oncul ◽

Alper Gunduz ◽

Ozgun Pehlivan ◽

...

Keyword(s):

Bone Mineral Density ◽

Logistic Regression ◽

Regression Analysis ◽

Viral Load ◽

Bone Mineral ◽

Associated Factors ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Mineral Density ◽

Hiv Diagnosis

Background: Reduced bone mineral density (BMD) is a frequent comorbidity observed in people living with HIV (PLHIV). Objective: The aim of the study is to determine the prevalence and associated factors of reduced bone mineral density (BMD) among men with suppressed viral load taking antiretroviral therapy. Method: The study was conducted as a cross-sectional study design between January to April 2019. 211 patients were included in the study. Z-score at either body site between -1.0 and -2.0 or -2 or less were defined as osteopenia or osteoporosis, respectively. Multivariate logistic regression analysis was used to evaluate the factors affecting the development of reduced BMD. Results: The mean age of the patients involved in the study was 34.8 ± 7.6. Osteoporosis was detected in 21.4% and osteopenia in 44.5% of the patients. There was a significant relationship between HIV diagnosis time, ART usage duration, tenofovir disoproxil fumarate (TDF) use, TDF use in the past, total TDF usage time and decreased BMD. Multivariate logistic regression analysis showed that the likelihood of reduced bone marrow density was 67% lower among those with regular milk or dairy product intake compared to those without (OR=0.330; 95% CI = 0.12-0.92, p=0.033 ) Conclusion: There is a high prevalence of reduced BMD among PLHIV aged under 50 which is mainly confounded by HIV diagnosis time, ART usage duration and TDF usage. Although virological control has been achieved, these patients should be followed up, considering that they may have decreased BMD.

Download Full-text

Prevalence of postural deviations and associated factors in children and adolescents: a cross-sectional study

Fisioterapia em Movimento ◽

10.1590/1980-5918.029.004.ao14 ◽

2016 ◽

Vol 29 (4) ◽

pp. 777-786 ◽

Cited By ~ 4

Author(s):

Mariana Vieira Batistão ◽

Roberta de Fátima Carreira Moreira ◽

Helenice Jane Cote Gil Coury ◽

Luis Ernesto Bueno Salasar ◽

Tatiana de Oliveira Sato

Keyword(s):

Physical Activity ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Associated Factors ◽

Multiple Logistic Regression Analysis ◽

Extrinsic Factors ◽

Cross Sectional ◽

Postural Changes ◽

Intrinsic And Extrinsic Factors

Abstract Introduction: Postural deviations are frequent in childhood and may cause pain and functional impairment. Previously, only a few studies have examined the association between body posture and intrinsic and extrinsic factors. Objective: To assess the prevalence of postural changes in school children, and to determine, using multiple logistic regression analysis, whether factors such as age, gender, BMI, handedness and physical activity might explain these deviations. Methods: The posture of 288 students was assessed by observation. Subjects were aged between 6 and 15 years, 59.4% (n = 171) of which were female. The mean age was 10.6 (± 2.4) years. Mean body weight was 38.6 (± 12.7) kg and mean height was 1.5 (± 0.1) m. A digital scale, a tapeline, a plumb line and standardized forms were used to collect data. The data were analyzed descriptively using the chi-square test and logistic regression analysis (significance level of 5%). Results: We found the following deviations to be prevalent among schoolchildren: forward head posture, 53.5%, shoulder elevation, 74.3%, asymmetry of the iliac crests, 51.7%, valgus knees, 43.1%, thoracic hyperkyphosis, 30.2%, lumbar hyperlordosis, 37.2% and winged shoulder blades, 66.3%. The associated factors were age, gender, BMI and physical activity. Discussion: There was a high prevalence of postural deviations and the intrinsic and extrinsic factors partially explain the postural deviations. Conclusion: These findings contribute to the understanding of how and why these deviations develop, and to the implementation of preventive and rehabilitation programs, given that some of the associated factors are modifiable.

Download Full-text

Prevalence of Anemia and Its Associated Factors among Chronic Kidney Disease patients at University of Gondar Hospital, North West Ethiopia: a Hospital-based Cross Sectional Study

10.21203/rs.2.10112/v1 ◽

2019 ◽

Author(s):

Hailemariam Adera ◽

Workagegnehu Hailu ◽

Ayineshet Adane ◽

abilo tadesse

Keyword(s):

Chronic Kidney Disease ◽

Logistic Regression ◽

Kidney Disease ◽

Associated Factors ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Rural Residence ◽

Sectional Study ◽

Cross Sectional ◽

Prevalence Of Anemia

Abstract Background chronic kidney disease (CKD) is a global public health problem associated with progressive decline in kidney function and adverse cardiovascular outcome. Anemia in CKD has substantial adverse outcomes in CKD patients. There is paucity of published data on prevalence of anemia and its associated factors among CKD patients in Northwest Ethiopia. Objective This study aimed to determine the prevalence of anemia and its associated factors among CKD patients at University of Gondar hospital, Northwest Ethiopia. Methods A hospital-based cross-sectional study was conducted from May1, to September 30, 2018. Consecutive sampling was used to recruit 251 study subjects. Data regarding patient’s socio-demographics, clinical characteristics and laboratory parameters were collected from patients’ interview and medical records. Data was analyzed using SPSS version 20. Bi-variate and multi-variate logistic regression analyses were used to identify predictors of anemia in CKD patients. P<0.05 was used to declare association. Results The prevalence of anemia was high (64.5%), and tended to increase as eGFR declined. Hypertension (45%), chronic glomerulonephritis (24%) and diabetes (20%) were common causes of CKD. Multivariate logistic regression analysis revealed rural residence (AOR= 2.75, 95% CI: 1.34-5.65, p=0.006), BMI<18.5 kg/m2 (AOR=6.78, 95% CI: 1.32-34.73, p=0.022) and BMI of 18.5-24.9 kg/m2 (AOR=5.04, 95% CI: 1.26-20.10, p=0.022), and having hemodialysis history (AOR=3.59, 95% CI: 1.24-10.38, p=0.018) were predictors of anemia in CKD patients. Conclusion Prevalence of anemia in CKD patients was high (64.5%). Rural residence, non-obese body habitus and having hemodialysis history were found to be predictors of anemia in CKD patients. Periodic screening and intervention for anemia in CKD patients should be practiced to prevent its sequelae.

Download Full-text

MO558ROLE OF ANEMIA ON PROGRESSION AND CLINICAL OUTCOMES OF CKD: A PATIENT-LEVEL, RETROSPECTIVE, COHORT ANALYSIS OF A CKD OUTPATIENTS POPULATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab085.0021 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Sara Fernandes ◽

Beatriz Donato ◽

Adriana Paixão Fernandes ◽

Luís Falcão ◽

Mário Raimundo ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Cohort Analysis ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

Ckd Progression ◽

Patient Level

Abstract Background and Aims Anemia is a well-know complication of Chronic Kidney Disease (CKD) and it seems to contribute for deterioration of kidney function. Experimental data suggest that anemia produces hypoxia of tubular cells which leads to tubulointerstitial damage resulting on CKD progression. Other mechanism described is that red blood cells have antioxidant properties that prevent the damage of tubulointerstitial cells and glomerulosclerosis from oxidative stress. There aren’t many observational studies that evaluated the association between anemia and progression of CKD. Therefore, our aim was to evaluate the association of anemia and CKD progression and its association outcomes in an outpatient ND-CKD population. Method We conduct a retrospective, patient-level, cohort analysis of all adult ND-CKD patients evaluated in an outpatient nephrology clinic over a 6 years period. The follow up time was at least 12 months. Anemia was defined according to the WHO definition (hemoglobin [hb] < 13.0 g/dL in men and 12.0 g/dL in women). Progression of CKD was defined by one of the following criteria: decline in eGFR (CKD-EPI) superior to 5 ml/min/1.73 m2/year; duplication of serum creatinine or the need renal replacement therapy. Demographics and clinical data were also accessed. Results Out of 3008 patients referred to the nephrology clinic, 49.9% had anemia (mean age 71.9±15.9 years; 50.4% male; 92% white; mean follow-up time of 2.3±1.2 years). The mean Hb was 11.8 ±1.9 g/dL. Important cardiovascular comorbidities in patients with anemia were arterial hypertension (86.7%), obesity (65.5%), Diabetes Mellitus (DM) (52%) and dyslipidemia (46%). In univariate analysis, mortality was associated with anemia (36.9 vs 13.0%, p<0.001), obesity (30.1 vs 21.8%, p<0.001) and DM (30.1 vs 21.1%, p<0.001). Of the patients with anemia, 738 met the criteria for CKD progression. In univariate analysis, CKD progression was associated with anemia (49.6 vs 43.9%, p=0.002), male gender (49.5 vs 43.6% p= 0.001); DM (49.6 vs 44.8 % p=0.009) and hypertension (47.9 vs 42.3% p=0.0018). In multivariate logistic regression analysis, anemia emerged was an independent predictor of CKD progression (OR 1.435, CI 95% 1.21-1.71, p<0,001). Comparing hb values intervals (hb ≤10g/dl; hb10-12 g/dL; hb ≥12 g/dL), in the multivariate logistic regression analysis, hb ≤10g/dl was not associated with CKD progression and hb value between 10-12 g/dL was associated (OR 1,486, CI 95% 1.23-1.80, p<0,001), when compared with the group with hb ≥12g/dL. In multivariate logistic regression analysis, the independent predictors of mortality were: older age (OR per 1 year increase: 1.048, 95% CI 95% 1.04-1.06, p<0.001); arterial hypertension (OR 0.699 CI 95% 0.51-0.96, p=0.0029); obesity (OR 0.741, CI 95% 0.60-0.91, p=0.004) and hb value (OR per 1 g/dL decrease: 1.301, CI 95% 1.23-1.38, p<0.001). Cardiovascular events were correlated with Hb levels between 10-12 g/dL (univariate analysis: OR 2.021, CI 95% 1.27-3.22, P=0.003), but not with the group with hb≤10 g/dL (univariate analysis: OR 1.837, CI 95% 0.96-3.51, P=0.066), having the group with hb ≥12g/dL was reference. Anemia was strongly associated with hospitalizations (multivariate logistic regression analysis: OR per 1 g/dL of Hb decrease: 1.256 CI 95% 1.12-1.32 p<0.001), and this strong association was also observed on the groups with hb hb≤10 g/dL (multivariate logistic regression analysis: OR 3.591 CI 95% 32.67-4.84 p<0.001) and between 10-12 g/dL (multivariate logistic regression analysis: OR 1.678 CI 95% 1.40-2.02, p<0.001) Conclusion Our study suggests that anemia, at first consultation, increases the risk for rapid CKD progression and global mortality. This study could guide us on the development of futures studies in order to prove if anemia correction can slow the progression of CKD.

Download Full-text

Abstract WP202: Decompressive Hemicraniectomy After Malignant Middle Cerebral Artery Ischemic Stroke in a Developing Country is Associated With Poor Long Term Functional Outcome and High Mortality

Stroke ◽

10.1161/str.51.suppl_1.wp202 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Hellen C Homem ◽

Francisco J Montalverne ◽

Fernanda M Carvalho ◽

Francisco Ramos Junior ◽

Heitor F Ramos ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Middle Cerebral Artery ◽

Functional Outcome ◽

Stroke Care ◽

Rehabilitation Services ◽

Decompressive Hemicraniectomy ◽

Malignant Mca Infarction

Background: Decompressive hemicraniectomy (DH) is a level IA therapy for malignant middle cerebral artery (MCA) infarction. However, randomized trials were performed in high income countries with better access to post-stroke care and rehabilitation services. We aimed to assess long term functional outcome and the associated prognostic factors of patients undergoing DH in Brazil. Methods: From January 2013 and July 2018, all patients undergoing DH for malignant MCA infarction in a single comprehensive stroke center were retrospectively identified. Outcomes were the modified Rankin Scale (mRS) (dichotomized as ≤ 4 vs. > 4) and mortality at follow-up. The mRS at follow-up was collected prospectively by telephone using a validated structured interview. Logistic regression analysis was performed to assess independent predictors of outcome. Results: Eighty patients who underwent DH for malignant MCA infarction were identified. Age ranged from 16 to 78 years (median 48 years, IQR 42 - 54,7 years), 46 (57.6%) were males and median time from stroke onset to hemicraniectomy was 30.75 hours (IQR 17.8-46.0). Hospital discharge mRS ≤ 3 and ≤ 4 was observed in 5 (6.2%) and 74 (92,5%) patients respectively. Follow-up information was available for 65 (81.2%) patients. At follow-up (raging from 1.1 to 5.6 years), mRS ≤ 4 was observed in 23 (35.3%) patients. In binary logistic regression analysis, age (OR 1.09, 95% CI 1.02 - 1.17, p=0.01), and right MCA infarction (OR 16.70, 95% CI 1.8-152.30, p=0.01) were independently associated with a worse functional outcome at follow-up. Admission NIHSS (OR 1.0 ,95% CI 0.8-1.3, p=0.45), IV rt-PA (OR 0.5, 95% CI 0.08-3.00, p=0.46) or time of hemicraniectomy (OR 1.00, 95% CI 1.00 - 1.00, p=0.94) were not associated with functional outcome at follow-up. Mortality was 26% (N=21) at hospital discharge and 46% (N=30) at follow-up. Conclusion: The large effect size of DH for malignant MCA infarction is significantly diminished in the population of patients treated under the less than ideal conditions typically found in the public healthcare system of a developing country. Poor access to post-stroke care and rehabilitation services might be possible reasons for the results observed.

Download Full-text