scholarly journals Clinical Features and Risk Factors for Mortality in Hospitalized Older Adults with Pneumonia

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nobuhiko Fukuda ◽  
Nobuaki Kobayashi ◽  
Makoto Masuda ◽  
Aya Wakabayashi ◽  
Nobuko Kusano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Clinical Features ◽  
Odds Ratio ◽  
Pneumococcal Vaccination ◽  
Small Sample ◽  
City Hospital

Background. Pneumonia is a common disease among the aging population in Japan. Hence, it is important to elucidate the risks related to pneumonia mortality. Since Streptococcus pneumoniae is the most commonly observed pathogen, pneumococcal vaccination is recommended to older adults. Therefore, this study aimed to clarify the clinical features of pneumonia, including the status of pneumococcal vaccination, in hospitalized older adult patients in Japan. Methods. This single-centered retrospective study was conducted by reviewing the medical records of all patients with acute pneumonia at Fujisawa City Hospital in Japan from April 2018 to March 2019. Patients were divided into two groups based on their history of pneumococcal vaccination. The primary endpoint was in-hospital mortality, while the secondary endpoint was risk factors associated with mortality. Results. We included 93 patients with pneumonia in this retrospective study. Although the mortality rate was higher in the vaccinated group (15.8%) than in the unvaccinated group (9.1%), vaccination status was not identified as a significant risk factor for mortality after multivariable logistic regression (odds ratio: 2.71; 95% confidence interval: 0.667–11.02; p = 0.16 ). In addition, the A-DROP score was identified as an independent risk factor (odds ratio: 2.64; 95% confidence interval: 1.22–5.72; p = 0.008 ). Conclusions. Our study suggested that the A-DROP score is a risk factor of mortality for pneumonia in older adults. In addition, pneumococcal vaccination history was related to increased mortality; however, the influence of the vaccination remains unclear because of the small sample size.

scholarly journals Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery

2017 ◽  
Vol 64 (2) ◽  
pp. 104-105 ◽  
Author(s):  
Masanori Tsukamoto ◽  
Miwa Kobayashi ◽  
Takeshi Yokoyama
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Pressure Ulcers ◽  
Oral Surgery ◽  
Male Gender ◽  
Quality Review ◽  
Nasal Tube

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680–170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034–1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

Relationship Between Insomnia, Depression, and Mortality: A 12-Year Follow-Up of Older Adults in the Community

2000 ◽  
Vol 12 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Lena Mallon ◽  
Jan-Erik Broman ◽  
Jerker Hetta
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Natural History ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Mortality Data ◽  
Total Death ◽  
History Of

The purpose of the study was to investigate the natural history of insomnia and its association with depression and mortality. In 1983, 1,870 randomly selected subjects aged 45–65 years answered a questionnaire on sleep and health. Of the 1,604 survivors in 1995, 1,244 (77.6%) answered a new questionnaire with almost identical questions. Mortality data were collected for the 266 subjects that had died during the follow-up period. Chronic insomnia was reported by 36.0% of women and 25.4% of men (χ2 = 9.7; p < .01). About 75% of subjects with insomnia at baseline continued to have insomnia at follow-up. Insomnia in women predicted subsequent depression (odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.1–7.2) but was not related to mortality. In men, insomnia predicted mortality (OR = 1.7; 95% CI 1.2–2.3), but after adjustment for an array of possible risk factors, this association was no longer significant. Men with depression at baseline had an adjusted total death rate that was 1.9 times higher than in the nondepressed men (95% CI: 1.2–3.0).

The Effect of Seromuscular-Dermal and All Layer-Dermal Suturing on the Rate of Early Stomal Mucocutaneous Separation: A Retrospective Study

2021 ◽  
Vol 67 (3) ◽  
pp. 21-28
Author(s):  
Yusuke Ohara ◽  
Tsuyoshi Enomoto ◽  
Yohei Owada ◽  
Daichi Kitaguchi ◽  
Katsuji Hisakura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Study ◽  
Odds Ratio ◽  
Suture Technique ◽  
Short Term ◽  
Steroid Use ◽  
Surgical History ◽  
History Of ◽  
Independent Risk Factors

BACKGROUND: Stomal mucocutaneous separation (SMS) is a serious and common short-term and long-term complication of ostomy surgery, but optimal methods to help prevent it have not been established. The authors hypothesized that seromuscular-dermal (SM-D) suturing may be better than all layer-dermal (AL-D) suturing to help prevent SMS. METHODS: This retrospective study evaluated the short-term SMS rate of patients who underwent colostomy or ileostomy surgery between 2015 and 2019. Patient demographics, medical and surgical history variables, as well as SMS outcomes were abstracted. Postoperative SMS severity was categorized by extent as follows: grade A (mild), grade B (moderate), and grade C (severe). RESULTS: In total, 105 patients (AL-D group, 45 patients; SM-D group, 60 patients) were enrolled in the study. SMS occurred in 24 patients (23%). The overall SMS rate was 18% (n = 11) in the SM-D group and 29% (n = 13) in the AL-D group (P = .202). The occurrence of severe (grade C) or moderate and severe SMS (grades B + C) in the SM-D compared with the AL-D group was significantly different (2% vs 16% [P = .011] and 10% vs 24% [P = .047], respectively). A history of steroid use was a risk factor for moderate and severe SMS (P = .016, odds ratio 5.694). Stomal height ≤1 cm was a a risk factor for all cases of SMS (P = .037, odds ratio 2.650). AL-D suture technique and a history of steroid use were independent risk factors for severe and moderate plus severe SMS (P = .021, odds ratio 12.844 and P = .027, odds ratio 4.808, respectively). CONCLUSION: In this study, use of the AL-D suturing technique and a history of steroid use were independent risk factors for the short-term development of moderate or severe SMS. Patients whose stoma was secured using the SM-D technique had a significantly lower rate of moderate or severe SMS.

Risk of Surgery and Anesthesia for Ischemic Stroke

2000 ◽  
Vol 92 (2) ◽  
pp. 425-425 ◽  
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&lt;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.

Antibody profiles for the diagnosis of antiphospholipid syndrome

2005 ◽  
Vol 93 (06) ◽  
pp. 1147-1152 ◽  
Author(s):  
Alessandra Biasiolo ◽  
Cinzia Pegoraro ◽  
Umberto Cucchini ◽  
Franco Noventa ◽  
Sabino Iliceto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Confidence Interval ◽  
Antiphospholipid Syndrome ◽  
Odds Ratio ◽  
Obstetric Complications ◽  
Antibody Detection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Antiphospholipid Antibody ◽  
Arterial Thromboembolism

SummaryAmong the so called‘antiphospholipid antibodies’, the presence of Lupus Anticoagulant (LA) is associated with thrombosis-related events and defines the antiphospholipid syndrome. The role of anti-cardiolipin (aCL) antibodies and anti-human β2-glycoprotein I (aβ2GPI) antibodies is less striking. Since the problem of standardization for these tests is far from resolved, we evaluated whether the combination of results (antiphospholipid laboratory profiles) could help to better classify these patients. Over a 6-year period, 618 consecutive subjects (55% of whom had previous documented thrombosis-related events) were referred to our clinic for Antiphospholipid antibody detection. LA was detected according to internationally accepted recommendations. ACL and aβ2GPI antibodies were detected by Enzyme-Linked-Immunosorbent Assay (ELISA). Patients’ records were reviewed for the presence of previous thromboembolic events or obstetric complications according to Sapporo’s clinical criteria for the diagnosis of antiphospholipid syndrome (APS) and each patient underwent a physical examination. When individual tests were considered in a multivariate analysis which took into account age, gender, the presence of SLE or other autoimmune diseases and established risk factors for venous and arterial thromboembolism, LA (Odds Ratio 4.4, Confidence Interval 1.5–13.3) and aβ2GPI antibodies (Odds Ratio 2.9, Confidence Interval 1.1–7.5) but not aCL antibodies (Odds Ratio 1.2, Confidence Interval 0.5–2.7) were found to be independent risk factors for thrombosis-related events. When antiphospholipid antibody profiles instead of individual test positivity were analyzed in the above mentioned model, triple positivity resulted a strong independent risk factor (Odds Ratio 33.3, Confidence Interval 7.0–157.6), retaining its significance when the association with venous or arterial thromboembolism was considered. Double positivity with negative LA was close to significance for thrombosis-related events (Odds Ratio 2.2, Confidence Interval1.0–5.2, p=0.056) and highly significant risk factor for obstetric complications (Odds Ratio 10.8, Confidence Interval 2.9–40.8). Other combinations did not reach statistical significance. The mean level of IgG aβ2GPI antibodies was statistically higher in triple positive profile and might account for positive LA. As compared to a single test, the analysis of a complete antiphospholipid antibody profile can better determine patients at risk.

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

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.

scholarly journals Longer Diagnosis-surgery Duration Is Associated With an Increased Risk of Early Postoperative Complications for Crohn's Disease: A Retrospective Study

2021 ◽  
Author(s):  
Xuanyi Chen ◽  
Siqi Zhang ◽  
Fanru Shen ◽  
Yuan Shi ◽  
Sailiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Crohn’S Disease ◽  
Retrospective Study ◽  
Crohn's Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Early Postoperative Complications ◽  
Increased Risk ◽  
Surgery Duration

Abstract Background: Early postoperative complications(ePOCs) frequently occur in Crohn’s patients after surgery. The risk factors of ePOCs for Crohn’s disease (CD), however, remain controversial. We aimed to assess the incidence and risk factors of ePOCs in CD patients after surgical resection.Methods: The retrospective study was conducted on 97 patients undergoing surgeries between January 2010 and September 2019 for Crohn’s disease in a tertiary hospital in China. Results: In total, 33 patients (34.0%) experienced ePOCs, including 11 intra-abdominal septic complications (11.3%) and 1 postoperative death (1.0%). Severe complications (Dindo–Clavien III–IV) were seen in 8 patients (8.2%). In multivariate analysis, diagnosis-surgery duration exceeding 6 months(odds-ratio [OR]=4.07; confidence interval [CI] 95%[1.10-15.09], P=0.036), serum platelet count <300*1000/mm3(odds-ratio [OR]=6.74; confidence interval [CI] 95%[1.58-28.71], P=0.01) and serum gamma-glutamyl transpeptidase(GGT) level >10U/L(odds-ratio [OR]=9.22; confidence interval [CI] 95%[1.23-68.99], P=0.031)were identified as independent risk factors for ePOCs. Preoperative exposure to anti-tumor necrosis factor (TNF) agents (P=1.00) were not associated with a higher risk of ePOCs. 34.0% of CD patients developed ePOCs after surgical resection.Conclusions: Diagnosis-surgery duration exceeding 6 months, serum platelet count <300*1000/mm3, and serum GGT level >10U/L were associated with an increased risk of ePOCs. Preoperative exposure to anti-TNF agents were not associated with a higher risk of ePOCs.

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

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.

scholarly journals Shorter Axial Length Is a Risk Factor for Proliferative Vitreoretinopathy Grade C in Eyes Unmodified by Surgical Invasion

2021 ◽  
Vol 10 (17) ◽  
pp. 3944
Author(s):  
Sakiko Minami ◽  
Atsuro Uchida ◽  
Norihiro Nagai ◽  
Hajime Shinoda ◽  
Toshihide Kurihara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retinal Detachment ◽  
Propensity Score ◽  
Confidence Interval ◽  
Axial Length ◽  
Proliferative Vitreoretinopathy ◽  
Odds Ratio ◽  
Rhegmatogenous Retinal Detachment ◽  
Surgical Failure

Purpose: To investigate the risk factors for the development of proliferative vitreoretinopathy grade C (PVR-C), independent of prior surgical invasion. Methods: Patients who underwent surgery for rhegmatogenous retinal detachment were prospectively registered with the Japan-Retinal Detachment Registry, organized by the Japanese Retina and Vitreous Society, between February 2016 and March 2017. Data obtained from general ophthalmic examinations performed before and at 1, 3, and 6 months after surgery were analyzed. Results: We included 2013 eyes of 2013 patients (men, 1326 (65.9%); mean age, 55.2 ± 15.2 years) from amongst 3446 registered patients. Preoperative PVR-C was observed in 3.6% of patients. Propensity score matching revealed that a shorter axial length (AL) was a risk factor for preoperative PVR-C (OR (Odds Ratio), 0.81; 95%CI (Confidence Interval), 0.69 to 0.96; p = 0.015), which was a risk factor for surgical failure (OR, 4.22; 95%CI, 1.12 to 15.93; p = 0.034); the association was particularly significant for eyes with an AL < 25.0 mm (p = 0.016), while it was insignificant for eyes with an AL ≥ 25.0 mm. Conclusions: A shorter AL was related to the development of PVR-C before surgical invasion. Our results will help elucidate the fundamental pathogenesis of PVR and caution clinicians to meticulously examine eyes with a shorter AL to detect retinal detachment before PVR development.

scholarly journals Plasma acylcarnitines and risk of lower-extremity functional impairment in older adults: a nested case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Félix Caballero ◽  
Ellen A. Struijk ◽  
Alberto Lana ◽  
Antonio Buño ◽  
Fernando Rodríguez-Artalejo ◽  
...  
Keyword(s):  
Older Adults ◽  
Confidence Interval ◽  
Lower Extremity ◽  
Functional Impairment ◽  
Odds Ratio ◽  
Case Control Study ◽  
Case Control ◽  
Community Dwelling ◽  
Control Study ◽  
Long Chain

AbstractElevated concentrations of acylcarnitines have been associated with higher risk of obesity, type 2 diabetes and cardiovascular disease. The aim of the present study was to assess the association between L-carnitine and acylcarnitine profiles, and 2-year risk of incident lower-extremity functional impairment (LEFI). This case–control study is nested in the Seniors-ENRICA cohort of community-dwelling older adults, which included 43 incident cases of LEFI and 86 age- and sex- matched controls. LEFI was assessed with the Short Physical Performance Battery. Plasma L-carnitine and 28 acylcarnitine species were measured. After adjusting for potential confounders, medium-chain acylcarnitines levels were associated with 2-year incidence of LEFI [odds ratio per 1-SD increase: 1.69; 95% confidence interval: 1.08, 2.64; p = 0.02]. Similar results were observed for long-chain acylcarnitines [odds ratio per 1-SD increase: 1.70; 95% confidence interval: 1.03, 2.80; p = 0.04]. Stratified analyses showed a stronger association between medium- and long-chain acylcarnitines and incidence of LEFI among those with body mass index and energy intake below the median value. In conclusion, higher plasma concentrations of medium- and long-chain acylcarnitines were associated with higher risk of LEFI. Given the role of these molecules on mitochondrial transport of fatty acids, our results suggest that bioenergetics dysbalance contributes to LEFI.

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