Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers

2019 ◽  
Vol 48 (3) ◽  
pp. 276-282 ◽  
Author(s):  
Maowan Wen ◽  
Zheng Li ◽  
Jun Li ◽  
Wen Zhou ◽  
Yu Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Flow ◽  
Survival Analysis ◽  
Arteriovenous Fistula ◽  
Cox Regression ◽  
Autoimmune Disorder ◽  
Major Barrier ◽  
Cox Regression Analysis ◽  
Medical Centers ◽  
Significant Difference

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). However, primary AVF dysfunction represents a major barrier to the long-term success of HD therapy. This study aims to analyze the variables that influence the incidence of first AVF failure in HD patients. Methods: From January 2012 to October 2016, a total of 100 HD subjects from 43 medical centers were enrolled for a retrospective survival analysis of AVF dysfunction. To diminish the potential influence of surgeon experiences, the same operation group in Second Xiangya Hospital performed all studied AVF placements. This study focuses on a Chinese population of idiopathic glomerular disease to avoid the secondary influence of other systemic diseases, including diabetes, hypertension, and autoimmune disorder. AVF dysfunction was defined as lower blood flow during dialysis (≤200 mL/min) or insufficiency of HD treatment caused by reduced blood flow. Results: Among all enrolled subjects, the incidence of AVF dysfunction due to impatency was 27% (n = 27) with a cumulative survival of 84.0, 73.1, and 71.6% in 6, 12, and 24 months of post-placement. AVF survival ­analysis revealed a higher incidence of AVF failure in females (p= 0.025) and elderly (p = 0.031) patients. Importantly, AVF dysfunction markedly increased in subjects with higher levels of platelets (PLTs; p = 0.024), severe anemia (p = 0.014), and extended temporary catheter retention (p = 0.020). Further multivariate Cox regression analysis confirmed these variables as independent risk factors for first AVF dysfunction. Meanwhile, no significant difference could be observed according to the levels of body mass index, serum albumin, serum calcium, serum phosphorus, prothrombin time, and activated partial thromboplastin time. Lastly, anti-coagulant treatments seemed to barely influence the outcomes of AVF survival in this study. Conclusion: These findings suggest that primary AVF dysfunction in HD patients is associated with gender, ageing, PLT counting number, hemoglobin level, and retention time of temporary catheter.

scholarly journals Constructing the Logical Regression Model to Predict the Target of Jianpi Jiedu Decoction in the Treatment of Hepatocellular Carcinoma

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Rongjie Zhang ◽  
Yan Chen ◽  
Ge Zhou ◽  
Baoguo Sun ◽  
Yue Li ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Analysis ◽  
Regression Model ◽  
Target Genes ◽  
Cox Regression ◽  
Risk Group ◽  
Cox Regression Analysis ◽  
Expression Levels ◽  
Prognostic Analysis ◽  
Significant Difference

Objectives. The purpose of this study was to identify the molecular mechanism and prognosis-related genes of Jianpi Jiedu decoction in the treatment of hepatocellular carcinoma. Methods. The gene expression data of hepatocellular carcinoma samples and normal tissue samples were downloaded from TCGA database, and the potential targets of drug composition of Jianpi Jiedu decoction were obtained from TCMSP database. The genes were screened out in order to obtain the expression of these target genes in patients with hepatocellular carcinoma. The differential expression of target genes was analyzed by R software, and the genes related to prognosis were screened by univariate Cox regression analysis. Then, the LASSO model was constructed for risk assessment and survival analysis between different risk groups. At the same time, independent prognostic analysis, GSEA analysis, and prognostic analysis of single gene in patients with hepatocellular carcinoma were performed. Results. 174 compounds of traditional Chinese medicine were screened by TCMSP database, corresponding to 122 potential targets. 39 upregulated genes and 9 downregulated genes were screened out. A total of 20 candidate prognostic related genes were screened out by univariate Cox analysis, of which 12 prognostic genes were involved in the construction of the LASSO regression model. There was a significant difference in survival time between the high-risk group and low-risk group ( p < 0.05 ). Among the genes related to prognosis, the expression levels of CCNB1, NQO1, NUF2, and CHEK1 were high in tumor tissues ( p < 0.05 ). Survival analysis showed that the high expression levels of these four genes were significantly correlated with poor prognosis of HCC ( p < 0.05 ). GSEA analysis showed that the main KEGG enrichment pathways were lysine degradation, folate carbon pool, citrate cycle, and transcription factors. Conclusions. In the study, we found that therapy target genes of Jianpi Jiedu decoction were mainly involved in metabolism and apoptosis in hepatocellular carcinoma, and there was a close relationship between the prognosis of hepatocellular carcinoma and the genes of CCNB1, NQO1, NUF2, and CHEK1.

scholarly journals Does Hemoperfusion Increase Survival in Acute Paraquat Poisoning? A Retrospective Multicenter Study

Toxics ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 84
Author(s):  
Ying-Tse Yeh ◽  
Chun-Kuei Chen ◽  
Chih-Chuan Lin ◽  
Chia-Ming Chang ◽  
Kai-Ping Lan ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Cox Regression ◽  
Severity Index ◽  
Cox Regression Analysis ◽  
Medical Centers ◽  
Paraquat Poisoning ◽  
Significant Difference ◽  
Retrospective Multicenter Study

The efficacy of hemoperfusion (HP) in patients with acute paraquat poisoning (PQ) remains controversial. We conducted a multi-center retrospective study to include acute PQ-poisoned patients admitted to two tertiary medical centers between 2005 and 2015. We used the Severity Index of Paraquat Poisoning (SIPP) to stratify the severity of PQ-poisoned patients. The indication to start HP was a positive result for the semiquantitative urine PQ test and presentation to the hospital was within 24 h. Early HP was defined as the first session of HP performed within five hours of PQ ingestion. A total of 213 patients (100 HP group, 113 non-HP group) were eligible for the study. The overall 60-day mortality of poisoned patients was 75.6% (161/213). Multivariate Cox regression analysis showed no statistically significant difference in 60-day survival between HP and non-HP groups (95% confidence interval (CI): 0.84–1.63, p = 0.363). Further subgroup analysis in the HP group showed early HP (95% CI: 0.54–1.69, p = 0.880), and multiple secessions of HP (95% CI: 0.56–1.07, p = 0.124) were not significantly related to better survival. Among acute PQ-poisoned patients, this study found that HP was not associated with increased 60-day survival. Furthermore, neither early HP nor multiple secessions of HP were associated with survival.

scholarly journals Head and neck cutaneous melanoma: 5-year survival analysis in a Serbian university center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Aleksandar Višnjić ◽  
Predrag Kovačević ◽  
Asen Veličkov ◽  
Mariola Stojanović ◽  
Stefan Mladenović
Keyword(s):  
Survival Analysis ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Cox Regression ◽  
Total Sample ◽  
Advanced Stage ◽  
Cross Sectional ◽  
Cox Regression Analysis ◽  
Significant Difference

Abstract Background Head and neck melanoma (HNM) is specific from the anatomical and etiopathogenetic aspects. In addition to morphopathological parameters, rich vascularization and lymphatic drainage of the head and neck affect the occurrence of lymphogenic and hematogenous metastases, as well as the metastases on both sides of the neck. Methods A retrospective cross-sectional study included cutaneous melanoma patients who underwent surgery at a clinical center over a 10-year period. The clinical follow-up was at least 60 months. The Kaplan-Meier method was used for the survival analysis. The predictor effect of certain independent variables on a given dichotomous dependent variable (survival) was measured by the Cox regression analysis. Results The analysis of demographic and clinical characteristics of 116 patients with HNM revealed that there was no statistically significant difference in age and gender in the total sample. Thirty-three (28.45%) patients were already in stage III or IV of the disease at the first examination, which affected the overall survival rate. The overall 5-year survival was 30.2%. No statistically significant difference in 5-year survival was found in relation to age and location. The period without melanoma progression decreased progressively in the advanced stage. Forty-nine patients (42%) underwent surgery for lymphogenic metastases in the parotid region and/or neck during the follow-up. Conclusions Patients with HNM included in this study frequently presented an advanced stage of the disease at the first examination, which is reflected in a low rate of 5-year survival. Early diagnosis and adequate primary treatment can ensure longer survival.

scholarly journals Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

2021 ◽  
Author(s):  
Hui Wang ◽  
Tun Wang ◽  
Hao He ◽  
Xin Li ◽  
Yuan Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Aortic Pseudoaneurysm ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
The Mean

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.

Cardiotoxicity and related risk factors in long-term trastuzumab (T) administration for metastatic breast cancer (MBC): A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11616-e11616
Author(s):  
Barbara Pistilli ◽  
Andrea Marcellusi ◽  
Michele Valeri ◽  
Umberto Torresi ◽  
Dania Nacciarriti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Significant Risk ◽  
Concomitant Chemotherapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
History Of

e11616 Background: Continuing T beyond progression has become a common strategy in the treatment of human epidermal growth receptor 2- overexpressing (HER2) MBC. However, T administered for several years with concomitant chemotherapy elicits concern about cardiac safety especially in patients (pts) with risk factors. Methods: Cardiac events (CEs) and survival of HER2 MBC pts treated with T +/- chemotherapy at our institution from Dec 2003 to Jun 2012 were evaluated. CEs were graded by NCI-CTCAE v 3.0. Risk factors assessed for cardiotoxicity were: age, body mass index, antihypertensive therapy, history of cardiac disease, diabetes, hypothyroidism, smoking, prior radiotherapy on the chest wall, prior cumulative dose of anthracycline(A), interval between last A dose and first T dose, baseline LVEF, continued/interrupted T exposure, concomitant chemotherapy. Chi-square test was used to compare distribution of CEs over different times of T exposure (p≤ 0.05). Univariate and multivariate Cox regression analysis were used to assess the effect of risk predictors. Results: Sixty-two pts assessable. Median age 52 years (range, 29 to 76), median cumulative time receiving T 29.5 months (range, 3 to 99 months); 40 pts (64.5%) received T without interruption and 19 pts (30.6%) were treated for more than 36 months. CEs occurred in 11 out of all pts (17.7%): grade 1 in 3 pts (4.8%), grade 2 in 5 (8.1%) and grade 3 in 3 (4.8%). The rate of CEs showed no statistically significant difference in pts receiving T for up to 36 months and over: 7/43 (16.3%) and 4/19 (21%), respectively, (p =0.724). In univariate Cox regression analysis significant risk factors were: history of cardiac disease (HR 6,814, 95% CI: 1,384-33,542) and smoking (HR 5,228, 95% CI: 1,403-19,491). In multivariate analysis smoking was the only independent predictor (HR 5,886, 95% CI: 1,479-23,247). Median survival from MBC diagnosis was 50 months (range, 6 to 101 months). Conclusions: Despite the limited sample size, our analysis suggests that cardiotoxicity does not hamper a long-term use of T, since the rate of CEs did not increase in pts treated over 36 months. Moreover, smoking appears to be a predictive factor of T cardiotoxicity.

scholarly journals Independent Risk Factor Analysis for Major Cardiovascular Adverse Events in Patients with Mild Coronary Stenosis

2019 ◽  
Author(s):  
Wei Luo ◽  
Ru Zhao ◽  
YanQiu Song ◽  
Hui Zhao ◽  
WeiJun Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Coronary Stenosis ◽  
Cox Regression ◽  
Risk Group ◽  
Adverse Cardiovascular Event ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
Hs Crp

Abstract Background: Independent risk factors for major adverse cardiovascular event (MACE) in patients with mild coronary stenosis are uncertain. This study aims to predict high-risk plaques detected by coronary computed tomographic angiography (CCTA) associated with indicative biomarkers.Methods: Totally 381 patients with mild coronary stenosis were included and MACE incidences were recorded through a 24-month follow-up. Totally 91 high-risk plaques are detected by CCTA, dividing into three plaque groups: high-risk group (HR), intermediate-risk group (IR) and low-risk group (LR). Specific blood biomarker measurements of hs-CRP, MMP-9, and MPO were taken simultaneously.Results: The mean age, levels of hs-CRP and MPO in HR and IR group were significantly higher than LR group. A considerably higher level of MMP-9 showed in HR group compared to LR group. The incidence rates of MACE were remarkably higher in HR group than LR group and IR group. Kaplan—Meier survival analysis demonstrated that the cumulative event—free survival rate of HR was significantly higher than that in LR and IR group and there were no significant difference between LR and IR group. The univariate COX regression analysis indicated that the age of patients, hs-CRP, MPO, and high-risk plaque scores≥2 were independent risk factors for MACE. Conclusion: Age, levels of hs-CRP and MPO, and high-risk plaque features informed by CCTA independently predicted MACE in patients with mild coronary stenosis. These results may improve the risk stratification in patients with mild coronary stenosis and suggest strategies for the individualized prevention programs.

Evaluation of the risk factors on time to phlebitis- and nonphlebitis-related failure when peripheral venous catheters were replaced as clinically indicated

2020 ◽  
pp. 112972982092455
Author(s):  
H Selcuk Ozger ◽  
Merve Yasar ◽  
Rahşan Başyurt ◽  
Figen Bucak ◽  
Murat Dizbay
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Survival Rates ◽  
Venous Catheter ◽  
Logrank Test ◽  
Significance Level ◽  
Cox Regression Analysis ◽  
Catheter Survival ◽  
Peripheral Venous Catheter ◽  
Significant Difference

Background: This study aimed to determine the frequency of peripheral venous catheter–related complications and the risk factors that have an impact on the time of peripheral venous catheter failure when they were replaced as clinically indicated. Methods: This was a prospective observational study. The demographic and clinical characteristics of the patients, as well as the catheter specifications, were recorded. All the catheters were followed-up at 12-h intervals for the development of complications. Two different peripheral venous catheters were used in the study. The catheter dwell times were estimated using Kaplan–Meier analysis. The logrank test was utilized to investigate the catheter dwell times by univariate analyses. Variables with a significance level of less than 0.20 were taken into Cox regression analysis. Results: Our results revealed that phlebitis and nonphlebitis complications occurred more frequently within the first 96 h. No significant difference was observed in the occurrence time of phlebitis, nonphlebitis, and composite failures. The use of a locally manufactured catheter, unsuccessful first attempt, poor skin integrity, after-hours’ insertion, the use of sterile gauze dressing were all associated with shorter catheter survival rates. Conclusion: We observed no difference on the time to phlebitis or nonphlebitis symptoms with clinically indicated replacement of peripheral venous catheters. We found a significant difference in survival rates between locally manufactured and imported peripheral venous catheters. Our identified risk factors should be taken into account to reduce peripheral venous catheter–related complications and to increase dwell time.

scholarly journals Smoking and alcohol abuse – predictive factors in oropharyngeal squamous cell carcinoma: A retrospective study

2019 ◽  
Vol 68 ◽  
pp. 02013
Author(s):  
Andrejs Lifsics ◽  
Elza Rate ◽  
Juris Tars ◽  
Modra Murovska ◽  
Valerija Groma
Keyword(s):  
Risk Factors ◽  
Survival Analysis ◽  
Alcohol Abuse ◽  
Cox Regression ◽  
Neck Region ◽  
Early Death ◽  
Malignant Neoplasms ◽  
Head And Neck Region ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Oropharynx is one of the most common localizations for malignant neoplasms in the head and neck region. HPV-positive OPSCCs are the most common subtypes in Western countries with tobacco and alcohol use, remaining the major risk factors for cancer development in this region. The study aims to address the significance of smoking and alcohol abuse in OPSCC cases and perform a survival analysis of the patients with OPSCC treated over a 10-year period in a single hospital in Latvia, correlating these data with patients' hazardous habits (smoking and alcohol abuse). Out of 247 patients, the majority were smokers (75.95%, n = 180), approximately one third were habitual drinkers (35.19%, n = 82) or were exposed to both aforementioned major risk factors (31.47%, n = 73). Kaplan-Meier survival analysis showed significantly better survival for the patients without the aforementioned hazardous habits. Cox regression analysis proved a higher early death rate when both factors (smoking and alcohol abuse) were present. It seems that smoking has a higher predictive value than alcohol abuse.

First-line (1L) immuno-oncology (IO) combination therapies in metastatic renal cell carcinoma (mRCC): Preliminary results from the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 584-584 ◽  
Author(s):  
Shaan Dudani ◽  
Jeffrey Graham ◽  
Connor Wells ◽  
Sumanta K. Pal ◽  
Nazli Dizman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Cox Regression ◽  
Combination Strategy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Baseline Characteristics

584 Background: In mRCC, ipilimumab and nivolumab (ipi-nivo) is a 1L treatment option. Recent data have also shown efficacy of 1L PD(L)1-VEGF (PV) inhibitor combinations. The efficacy of these two strategies has not been compared. Methods: Using the IMDC dataset, patients (pts) treated with any 1L PV combination were compared to those treated with ipi-nivo. Multivariable Cox regression analysis was performed to control for imbalances in IMDC risk factors. Results: 164 pts received 1L IO combination therapy: 104 treated with PV combinations and 60 with ipi-nivo. Baseline characteristics and IMDC risk factors were comparable between groups (Table). When comparing PV combinations vs ipi-nivo, 1L response rates (RR) were 30% vs 39% (p = 0.29), time to treatment failure (TTF) was 13.2 (95% CI 8.3-16.1) vs 8.5 months (95% CI 5.7-14.0, p = 0.31), and median overall survival (OS) was not reached (NR) (95% CI 19.7-NR) vs NR (95% CI 27.6-NR, p = 0.39). When adjusted for IMDC risk factors, the hazard ratio (HR) for TTF was 0.77 (95% CI 0.44-1.35, p = 0.36) and the HR for death was 0.94 (95% CI 0.33-2.71, p = 0.91). Similar results were seen when restricting the cohort to IMDC intermediate/poor risk pts only. In pts receiving subsequent VEGF TKI monotherapy, second-line (2L) RR (13% vs 45%, p = 0.07) and TTF (5.5 vs 5.4 months, p = 0.80) for PV combinations (n = 15) vs ipi-nivo (n = 20) were not significantly different. Conclusions: There does not appear to be a superior 1L IO combination strategy in mRCC, as PV combinations and ipi-nivo have comparable RR, TTF and OS. Although there is a trend towards differences in RR, there does not appear to be a significant difference in TTF for patients receiving 2L VEGF TKI therapy. [Table: see text]

Predictive Model for Live Birth at 12 Months After Starting In-Vitro Fertilization Treatment

MedPharmRes ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 5-20
Author(s):  
Vu Ho ◽  
Toan Pham ◽  
Tuong Ho ◽  
Lan Vuong
Keyword(s):  
In Vitro Fertilization ◽  
Live Birth ◽  
Cox Regression ◽  
Financial Burden ◽  
Oocyte Retrieval ◽  
Operating Characteristics ◽  
Vitro Fertilization ◽  
Cox Regression Analysis ◽  
Significant Difference

IVF carries a considerable physical, emotional and financial burden. Therefore, it would be useful to be able to predict the likelihood of success for each couple. The aim of this retrospective cohort study was to develop a prediction model to estimate the probability of a live birth at 12 months after one completed IVF cycle (all fresh and frozen embryo transfers from the same oocyte retrieval). We analyzed data collected from 2600 women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at a single center in Vietnam between April 2014 and December 2015. All patients received gonadotropin-releasing hormone (GnRH) antagonist stimulation, followed by fresh and/or frozen embryo transfer (FET) on Day 3. Using Cox regression analysis, five predictive factors were identified: female age, total dose of recombinant follicle stimulating hormone used, type of trigger, fresh or FET during the first transfer, and number of subsequent FET after the first transfer. The area under the receiver operating characteristics curve for the final model was 0.63 (95% confidence interval [CI] 0.60‒0.65) and 0.60 (95% CI 0.57‒0.63) for the validation cohort. There was no significant difference between the predicted and observed probabilities of live birth (Hosmer-Lemeshow test, p > 0.05). The model developed had similar discrimination to existing models and could be implemented in clinical practice.

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