Abstract 2011: A Simple Nomogram to Predict the Probability of Successful Reperfusion with Pre-Hospital Thrombolysis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Vanina Bongard ◽  
Jacques Puel ◽  
Dominique Savary ◽  
Sandrine Charpentier ◽  
Loic Belle ◽  
...  
Keyword(s):  
Symptom Onset ◽  
A Priori ◽  
Multivariate Logistic Regression Analysis ◽  
Myocardial Reperfusion ◽  
Multivariate Logistic Regression ◽  
Real World Setting ◽  
Median Delay ◽  
St Elevation ◽  
Electrocardiogram Ecg ◽  
The Impact

In ST-elevation myocardial infarction (STEMI), coronary recanalisation is a prerequisite for deriving benefit from thrombolysis, but achieving myocardial reperfusion is also key to benefit. Data regarding the impact of thrombolysis on myocardial reperfusion are scarcer than for recanalisation, especially when pre-hospital thrombolysis is considered. To develop a nomogram for predicting myocardial reperfusion after pre-hospital thrombolysis. In 2004 – 05, 800 consecutive French patients with STEMI received pre-hospital thrombolysis within 6 hours of symptom onset (median delay of 110 minutes). The assessment of myocardial reperfusion was based on the measurement of ST resolution (STR) between a first electrocardiogram (ECG), recorded before thrombolysis, and a second one in the cath laboratory. Myocardial reperfusion was assessed when STR was 70%, at least, in the single lead with the greatest baseline ST-elevation. The sample comprised 18% of women and median age was 59. The median delay between the two ECGs was 110 minutes. The proportion of patients who achieved STR was 42%. The nomogram was based on the variables that were independently associated with STR in multivariate logistic regression analysis. For instance, a non-obese smoker patient, with a non-anterior STEMI and a maximum ST-elevation of 2 mm, for whom thrombolysis is possible within 1 hour of symptom onset, together with the administration of a thienopyridine, but no IV nitrates, has a probability of 0.87 to achieve STR. If thrombolysis is delayed after one hour, without thienopyridine administration, in case of anterior STEMI, the probability declines to 0.50. The probabilities of STR for the different situations covered by the nomogram range from 0.10 to 0.87. This nomogram, developed in a “real world” setting, is designed to predict a priori the probability of myocardial reperfusion following thrombolysis, based on simple clinical and electrocardiographic data.

scholarly journals Predictors of Mortality in Bloodstream Infections Caused by Pseudomonas aeruginosa and Impact of Antimicrobial Resistance and Bacterial Virulence

2019 ◽  
Vol 64 (2) ◽  
Author(s):  
Raúl Recio ◽  
Mikel Mancheño ◽  
Esther Viedma ◽  
Jennifer Villa ◽  
María Ángeles Orellana ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Resistance ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Multivariate Logistic Regression ◽  
Related Factors ◽  
Content Type ◽  
Crude Mortality ◽  
The Impact

ABSTRACT Whether multidrug resistance (MDR) is associated with mortality in patients with Pseudomonas aeruginosa bloodstream infections (BSI) remains controversial. Here, we explored the prognostic factors of P. aeruginosa BSI with emphasis on antimicrobial resistance and virulence. All P. aeruginosa BSI episodes in a 5-year period were retrospectively analyzed. The impact in early (5-day) and late (30-day) crude mortality of host, antibiotic treatment, and pathogen factors was assessed by multivariate logistic regression analysis. Of 243 episodes, 93 (38.3%) were caused by MDR-PA. Crude 5-day (20%) and 30-day (33%) mortality was more frequent in patients with MDR-PA (34.4% versus 11.3%, P < 0.001 and 52.7% versus 21.3%, P < 0.001, respectively). Early mortality was associated with neutropenia (adjusted odds ratio [aOR], 9.21; 95% confidence interval [CI], 3.40 to 24.9; P < 0.001), increased Pitt score (aOR, 2.42; 95% CI, 1.34 to 4.36; P = 0.003), respiratory source (aOR, 3.23; 95% CI,2.01 to 5.16; P < 0.001), inadequate empirical therapy (aOR, 4.57; 95% CI, 1.59 to 13.1; P = 0.005), shorter time to positivity of blood culture (aOR, 0.88; 95% CI, 0.80 to 0.97; P = 0.010), an exoU-positive genotype (aOR, 3.58; 95% CI, 1.31 to 9.79; P = 0.013), and the O11 serotype (aOR, 3.64; 95% CI, 1.20 to 11.1; P = 0.022). These risk factors were similarly identified for late mortality, along with an MDR phenotype (aOR, 2.18; 95% CI, 1.04 to 4.58; P = 0.040). Moreover, the O11 serotype (15.2%, 37/243) was common among MDR (78.4%, 29/37) and exoU-positive (89.2%, 33/37) strains. Besides relevant clinical variables and inadequate empirical therapy, pathogen-related factors such as an MDR phenotype, an exoU-positive genotype, and the O11 serotype adversely affect the outcome of P. aeruginosa BSI.

scholarly journals Usefulness of Anticoagulant Therapy in the Prevention of Embolic Complications in Patients with Acute Infective Endocarditis

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Seung-Jae Lee ◽  
Sam-Sae Oh ◽  
Dal-Soo Lim ◽  
Suk-Keun Hong ◽  
Rak-Kyeong Choi ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Anticoagulant Therapy ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Death ◽  
Multivariate Logistic Regression ◽  
Cerebrovascular Events ◽  
Significant Difference ◽  
Time Of Admission ◽  
The Impact

Background. The use of anticoagulant therapy (ACT) in patients with acute infective endocarditis (IE) remains a controversial issue. Our study attempts to estimate the impact of ACT on the occurrence of embolic complications and the usefulness of ACT in the prevention of embolism in IE patients.Methods. The present authors analyzed 150 patients with left-sided IE. Embolisms including cerebrovascular events (CVE) and the use of ACT were checked at the time of admission and during hospitalization.Results. 57 patients (38.0%) experienced an embolic event. There was no significant difference in the incidence of CVE and in-hospital mortality between patients with and without warfarin use at admission, although warfarin-naïve patients were significantly more likely to have large (>1 cm) and mobile vegetation. In addition, there was no significant difference in the incidence of postadmission embolism and in-hospital death between patients with and without in-hospital ACT. On multivariate logistic regression analysis, ACT at admission was not significantly associated with a lower risk of embolism in patients with IE.Conclusions. The role of ACT in the prevention of embolism was limited in IE patients undergoing antibiotic therapy, although it seems to reduce the embolic potential of septic vegetation before treatment.

scholarly journals The burden of premature ventricular contractions predicts adverse fetal and neonatal outcomes among pregnant women without structural heart disease

2020 ◽  
Author(s):  
Jing Lin ◽  
Yanxia Qian ◽  
Xin Wu ◽  
Qiushi Chen ◽  
Qiang Ding ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Pregnant Women ◽  
Multivariate Logistic Regression Analysis ◽  
Structural Heart Disease ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Multivariate Logistic Regression ◽  
Premature Ventricular Contractions ◽  
The Impact

Abstract Objective: To investigate the outcomes of fetuses or neonates of pregnant women with premature ventricular contractions (PVCs). Study design: 6, 148 pregnant women were prospectively enrolled in the study. Of these women, 103 with a PVC burden >0.5% were divided into two groups based on the presence or absence of adverse fetal or neonatal events. The adverse outcomes were compared between the groups to assess the impact of PVCs on pregnancy. Results: A total of 17 adverse events (12 cases) occurred among 103 pregnant women with PVCs, which was significantly higher than that among women without PVCs (11.65% vs. 2.93%, p<0.01). The median PVC burden among pregnant women with PVCs was 2.84% (1.02% to 6.1%). Furthermore, compared with that of the women without adverse events, the median PVC burden of women with adverse fetal or neonatal outcomes was significantly higher (9.02% vs. 2.30%, p<0.01). Multivariate logistic regression analysis demonstrated that PVC burden was associated with adverse fetal or neonatal outcomes among pregnant women with PVCs (OR: 1.34, 95% CI (1.11-1.61), p<0.01). Conclusions: Frequent PVCs have adverse effects on pregnancy, and the PVC burden might be an important factor associated with adverse fetal and neonatal outcomes among pregnant women with PVCs. Our cohort study indicated that the higher the PVC burden is, the higher the likelihood of adverse events would be.

Pathways impact on chemotherapy administration before death.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 86-86
Author(s):  
Marcus A. Neubauer ◽  
Jody S. Garey ◽  
Brian Turnwald ◽  
Josh Howell ◽  
Robyn K. Harrell ◽  
...  
Keyword(s):  
Pancreas Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Best Supportive Care ◽  
Inclusion Criteria ◽  
Multivariate Logistic Regression ◽  
Chemotherapy Administration ◽  
Level I ◽  
Line Of Therapy ◽  
The Impact ◽  
To Receive

86 Background: Continuing IV chemotherapy (chemo) in patients (pts) with advanced cancer near death does not extend survival or improve quality, but does increase costs. Pathways (PW) programs have compared treatment (tx) costs but have not evaluated the impact on chemo given near death. The primary goal is to evaluate IV chemo administered in the last 14 and 30 days of life in pts treated On vs. Off-PW. Methods: Eligibility: in US Oncology’s (USO) iKnowMed (iKM) EHR 7/1/09-6/30/12; diagnosis (dx) of breast, colon, NSCLC, SCLC or pancreas cancer; >/=3 visits to a USO clinic; assessed for Level I PW compliance in the last 12 mths of life; and a date of death. IV chemo received in the last year of life was assessed. Pts were defined On-PW if all tx was On-PW or if pts did not receive IV chemo 12 mths before death (best supportive care). Pts were Off-PW if any tx received was Off-PW. PW-status, age, sex, dx, and last line of therapy (LOT) received were assessed. Multivariate logistic regression analysis was used to assess if PW status predicted likelihood of chemo within 14 and 30 days of death. Results: 12,551 pts met inclusion criteria. PW status was independently associated with chemo 14 and 30 days before death. Pts treated Off-PW had 2-fold higher odds of receiving IV chemo within 14, 30 days of death vs. pts treated On-PW (OR: 2; 95% CI: 1.8-2.3, OR: 2.2, 95% CI: 2-2.4), see Table. Findings were similar for each dx. Tx for pts On-PW vs Off-PW showed lower mean last LOT overall (1 vs. 2) and by dx. Conclusions: Pts On-PW were less likely to receive IV chemo within 14 and 30 days of death and had fewer LOT. This suggests adherence to Level I PWs is associated with improved quality metrics. [Table: see text]

scholarly journals The Impact of tagSNPs in CXCL16 Gene on the Risk of Myocardial Infarction in a Chinese Han Population

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Shun Xu ◽  
Jie Cheng ◽  
Meng-yun Cai ◽  
Li-li Liang ◽  
Jin-ming Cen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Chinese Han ◽  
Han Population ◽  
Stratified Analysis ◽  
The Impact ◽  
Chinese Subjects ◽  
Apparent Association

CXCL16 has been demonstrated to be involved in the development of atherosclerosis and myocardial infarction (MI). Nonetheless, the role of the CXCL16 polymorphisms on MI pathogenesis is far to be elucidated. We herein genotyped four tagSNPs in CXCL16 gene (rs2304973, rs1050998, rs3744700, and rs8123) in 275 MI patients and 670 control subjects, aimed at probing into the impact of CXCL16 polymorphisms on individual susceptibility to MI. Multivariate logistic regression analysis showed that C allele (OR = 1.31, 95% CI = 1.03–1.66, and P=0.029) and CC genotype (OR = 1.84, 95% CI = 1.11–3.06, and P=0.018) of rs1050998 were associated with increased MI risk; and C allele (OR = 0.77, 95% CI = 0.60–0.98, and P=0.036) of rs8123 exhibited decreased MI risk, while the other two tagSNPs had no significant effect. Consistently, the haplotype rs2304973T-rs1050998C-rs3744700G-rs8123A containing the C allele of rs1050998 and A allele of rs8123 exhibited elevated MI risk (OR = 1.41, 95% CI = 1.02–1.96, and P=0.037). Further stratified analysis unveiled a more apparent association with MI risk among younger subjects (≤60 years old). Taken together, our results provided the first evidence that CXCL16 polymorphisms significantly impacted MI risk in Chinese subjects.

scholarly journals Door-to-balloon Time for ST-elevation MI in the Coronavirus Disease 2019 Era

2021 ◽  
Vol 15 ◽  
Author(s):  
Haytham Mously ◽  
Nischay Shah ◽  
Zachary Zuzek ◽  
Ibrahim Alshaghdali ◽  
Adham Karim ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Treatment Modality ◽  
Arrival Time ◽  
Coronary Intervention ◽  
Hospital Arrival ◽  
Improved Outcomes ◽  
St Elevation ◽  
Door To Balloon ◽  
The Impact

In patients presenting with ST-elevation MI, prompt primary coronary intervention is the preferred treatment modality. Several studies have described improved outcomes in patients with door-to-balloon (D2B) and symptom onset-to-balloon (OTB) times of less than 2 hours, but the specific implications of the coronavirus disease 2019 (COVID-19) pandemic on D2B and OTB times are not well-known. This review aims to evaluate the impact of COVID-19 on D2B time and elucidate both the factors that delay D2B time and strategies to improve D2B time in the contemporary era. The search was directed to identify articles discussing the significance of D2B times before and during COVID-19, from the initialization of the database to December 1, 2020. The majority of studies found that onset-of-symptom to hospital arrival time increased in the COVID-19 era, whereas D2B time and mortality were unchanged in some studies and increased in others.

P4629Long-term outcomes in patients with ST-segment elevation myocardial infarction according to modalities of reperfusion therapy: data from china acute myocardial infarction (CAMI) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X J Gao ◽  
J G Yang ◽  
Y J Yang ◽  
C Wu ◽  
S B Qiao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Real World ◽  
Symptom Onset ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Real World Setting ◽  
St Segment ◽  
The Impact

Abstract Background Although primary percutaneous coronary intervention (pPCI) is the optimal reperfusion method for ST-segment elevation myocardial infarction (STEMI), it remains difficult to implement in many areas. Some STEMI patients have to accept fibrinolytic therapy and no reperfusion therapy instead. Purpose The aim of this study was to describe the impact of reperfusion therapy on the long-term outcomes of STEMI patients in China. Methods Using data from the China Acute Myocardial Infarction (CAMI) registry, we analyzed the 2-year outcomes of 18,075 STEMI patients symptom onset within 7 days from January 2013 to September 2014 according to the type of reperfusion therapy. The primary endpoint was a composite of major adverse cardiovascular event (MACE), defined as all-cause mortality, myocardial infarction or stroke. Results 7798 (43%) were treated with pPCI and 1798 (10%) underwent fibrinolysis; 8479 (47%) did not receive any reperfusion. The 2-year MACE was 9.6% following pPCI, 15.7% following fibrinolysis, and 21.5% for patients without reperfusion therapy (P<0.0001). Adjusted hazard ratios for 2-year MACE were 0.71 (95% confidence interval [CI] 0.65–0.78, P<0.0001) for pPCI versus no reperfusion and 0.92 (95% CI 0.82–1.03, P=0.16) for fibrinolysis versus no reperfusion. Compared with patients without reperfusion, fibrinolysis only showed benefit in patients presented within 3 hours of symptom onset (HR 0.70, 95% CI 0.57–0.85, P=0.0005), whereas pPCI was associated with significantly decreased 2-year MACE rate in patients presented within 3 hours (HR 0.53, 95% CI 0.44–0.64, P<0.0001), 3–6 hours (HR 0.60, 95% CI 0.51–0.71, P<0.0001) and >6 hours (HR 0.86, 95% CI 0.76–0.97, P=0.01) of symptom onset. Adjusted cumulative MACE rate Conclusions In a real-world setting, early reperfusion is the optimal strategy for STEMI. Fibrinolysis was not associated with better outcome in STEMI patients admitted >3 hours of symptom onset in Chinese real world setting. Acknowledgement/Funding Ministry of Science and Technology of China (Grant No. 2011BAI11B02)

scholarly journals The Correlation Between Clinical Features and Viral RNA Shedding in Outpatients With COVID-19

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Tingting Liao ◽  
Zhengrong Yin ◽  
Juanjuan Xu ◽  
Zhilei Lv ◽  
Sufei Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Features ◽  
Symptom Onset ◽  
Protective Factor ◽  
Multivariate Logistic Regression Analysis ◽  
Viral Rna ◽  
Severe Illness ◽  
Time Interval ◽  
Multivariate Logistic Regression ◽  
Virus Shedding

Abstract Background Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can shed virus, thereby causing human-to-human transmission, and the viral RNA shedding is commonly used as a proxy measure for infectivity. Methods We retrospectively reviewed confirmed cases of COVID-19 who attended the fever clinic of Wuhan Union Hospital from January 14 to February 24. In terms of the viral RNA shedding (median values) at first visit, patients were divided into a high–viral RNA shedding group and a low–viral RNA shedding group. Univariate and multivariate logistic regression analysis were performed to investigate the correlation between viral RNA shedding and clinical features. Results A total of 918 consecutive COVID-19 patients were enrolled, and severe patients made up 26.1%. After univariate and multivariate logistic regression, advanced age (odds ratio [OR], 1.02; 95% CI, 1.01–1.03; P = .001), having severe chronic diseases (OR, 1.44; 95% CI, 1.03–2.01; P = .04), and severe illness (OR, 1.60; 95% CI, 1.12–2.28; P = .01) were independent risk factors for high viral RNA shedding. Shorter time interval from symptom onset to viral detection was a protective factor for viral RNA shedding (OR, 0.97; 95% CI, 0.94–0.99; P = .01). Compared with mild patients, severe patients have higher virus shedding over a long period of time after symptom onset (P = .01). Conclusions Outpatients who were old, had severe illness, and had severe underlying diseases had high viral RNA shedding.

Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study

2008 ◽  
Vol 14 (9) ◽  
pp. 1225-1233 ◽  
Author(s):  
E Cocco ◽  
C Sardu ◽  
P Gallo ◽  
R Capra ◽  
MP Amato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cumulative Dose ◽  
Ad Hoc ◽  
Immunosuppressive Treatment ◽  
Multivariate Logistic Regression Analysis ◽  
Reproductive Capacity ◽  
Multivariate Logistic Regression ◽  
Childbearing Age ◽  
The Impact ◽  
Age At Exposure

Background Improved prognosis in women with multiple sclerosis (MS) undergoing immunosuppressive treatment with mitoxantrone (MITO) has led to an increased interest in the effect of such treatments on fertility. FErtility and Mitoxantrone In MS (FEMIMS) is a collaborative retrospective study aimed at evaluating the impact of MITO treatment on fertility in women with MS. Methods Occurrence of chemotherapy-induced amenorrhea (CIA) was evaluated in 189 women with MS treated with MITO before the age of 45. An “ad hoc” questionnaire, paying particular attention to onset of CIA either during or post-MITO treatment, was administered to each patient. The probability of CIA was calculated using a multivariate logistic regression analysis taking into account age at exposure, cumulative dose, and use of estroprogestinic (EP) drugs during treatment. Results Forty-eight (26%) patients presented CIA following MITO. The probability of CIA was increased by 2%/mg/m2 of cumulative dose and by 18% for each year of age, whereas it was reduced by administration of EP during treatment. Conclusions MITO treatment may affect reproductive capacity in women with MS. Patients of childbearing age should be properly counseled before MITO treatment and EP therapy should be administered to reduce the risk of CIA.

scholarly journals The Impact of Senile Cataract Maturity on Blood Oxidative Stress Markers and Glutathione-Dependent Antioxidants: Relations with Lens Variables

2012 ◽  
Vol 31 (3) ◽  
pp. 184-192 ◽  
Author(s):  
Dijana Mirić ◽  
Bojana Kisić ◽  
Lepša Žorić ◽  
Zana Dolićanin ◽  
Radoslav Mitić ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Multivariate Logistic Regression Analysis ◽  
Senile Cataract ◽  
Oxidative Stress Markers ◽  
Multivariate Logistic Regression ◽  
Glutathione S Transferase ◽  
Stress Markers ◽  
Systemic Oxidative Stress ◽  
Antioxidant Enzymes Activities ◽  
The Impact

The Impact of Senile Cataract Maturity on Blood Oxidative Stress Markers and Glutathione-Dependent Antioxidants: Relations with Lens VariablesOxidative stress is implicated in senile cataract (SC) genesis, although the impact of SC maturity on blood oxidative stress markers is unclear. Total hydroperoxides, malondialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR) and glutathione S-transferase (GST) were measured in the blood and lens samples of patients having either immature (n=31) or mature SC (n=50), and in 22 blood samples from noncataract controls. Compared to controls, SC patients had higher plasma MDA and serum GST, and decreased plasma GR and GSH levels. Plasma GPx as well as hydroperoxides differed from control values only in patients with mature SC. The multivariate logistic regression analysis showed that the fall of plasma GR activity (OR 5.14; CI 1.82-14.51;p=0.0020), as well as serum GST activity (OR 3.84; CI 1.36-10.83;p=0.0108) were independently associated with the maturity of SC. Lens hydroperoxides, MDA and GST, showed no correlation with correspondent blood values, in contrast to GPx (r=0.715; p<0.001) and GR (r=0.703; p<0.001). This study showed that the severity of SC is associated with increased systemic oxidative stress, which could be due to the fall of GSH-dependent antioxidant enzymes activities.

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