Economic Impact of Poststroke Delirium and Associated Risk Factors: Findings From a Prospective Cohort Study

Stroke ◽  
2021 ◽  
Author(s):  
Carl Moritz Zipser ◽  
Jeremy Werner Deuel ◽  
Jeremia Philipp Oskar Held ◽  
Jutta Ernst ◽  
Maria Schubert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Quantile Regression ◽  
Correlation Coefficient ◽  
Odds Ratio ◽  
Strong Predictor ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Severe Stroke ◽  
Factors Associated

Background and Purpose: Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). Methods: This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. Results: The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P <0.001), 52% male (115/221) versus 62% non-PSD (214/346) and hospitalized longer (mean 11.5 versus 9.3 days; P <0.001). Dementia was the most relevant predisposing factor for PSD (odds ratio, 16.02 [2.83–90.69], P =0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16–20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15–159.79], P <0.001). PSD was a strong predictor for 3-month mortality (odds ratio, 15.11 [3.33–68.53], P <0.001). Nursing and total costs were nearly twice as high in PSD ( P <0.001). There was a positive correlation between total costs and admission National Institutes of Health Stroke Scale (correlation coefficient, 0.491; P <0.001) and length of stay (correlation coefficient, 0.787; P <0.001) in all patients. Quantile regression revealed rising nursing and total costs associated with PSD, higher National Institutes of Health Stroke Scale, and longer hospital stay (all P <0.05). Conclusions: PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.

scholarly journals Risk Factors for Stroke Associated Pneumonia

2019 ◽  
Vol 7 (24) ◽  
pp. 4416-4419
Author(s):  
Do Quyet ◽  
Nguyen Minh Hien ◽  
Mai Xuan Khan ◽  
Dai Dinh Pham ◽  
Do Duc Thuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
High Risk ◽  
Odds Ratio ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Swallowing Disorder ◽  
Stroke Patients ◽  
Frequent Complication

BACKGROUND: Stroke patients are at high risk for stroke-associated pneumonia (SAP). If patients suffer from pneumonia their prognosis will worsen. AIM: To identify factors that increases the risk of SAP in stroke patients. METHODS: A group of 508 patients hospitalized within 5 days after the onset of stroke were enrolled prospectively. RESULTS: The incidence of SAP was 13.4%. Some major risk factors for SAP are: mechanical ventilation (MV) had odds ratio (OR) 16.4 (p <0.01); the National Institutes of Health Stroke Scale (NIHSS) > 15 OR 9.1 (p <0.01); the Gugging Swallowing Screen (GUSS) 0-14 OR 11.7 (p <0.01). CONCLUSION: SAP is a frequent complication. We identified some risk factors of SAP, especially stroke severity (NIHSS > 15), swallowing disorder (GUSS < 15) and mechanical ventilation.

scholarly journals Risk factors associated with severe hospital burden of COVID-19 disease in Regione Lombardia: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne M. Presanis ◽  
Kevin Kunzmann ◽  
Francesca M. Grosso ◽  
Christopher H. Jackson ◽  
Alice Corbella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Odds Ratio ◽  
Care Home ◽  
Population Characteristics ◽  
Factors Associated ◽  
Icu Admission ◽  
Lengths Of Stay ◽  
Increased Risk ◽  
Using Data

Abstract Background Understanding the risk factors associated with hospital burden of COVID-19 is crucial for healthcare planning for any future waves of infection. Methods An observational cohort study is performed, using data on all PCR-confirmed cases of COVID-19 in Regione Lombardia, Italy, during the first wave of infection from February-June 2020. A multi-state modelling approach is used to simultaneously estimate risks of progression through hospital to final outcomes of either death or discharge, by pathway (via critical care or not) and the times to final events (lengths of stay). Logistic and time-to-event regressions are used to quantify the association of patient and population characteristics with the risks of hospital outcomes and lengths of stay respectively. Results Risks of severe outcomes such as ICU admission and mortality have decreased with month of admission (for example, the odds ratio of ICU admission in June vs March is 0.247 [0.120–0.508]) and increased with age (odds ratio of ICU admission in 45–65 vs 65 + age group is 0.286 [0.201–0.406]). Care home residents aged 65 + are associated with increased risk of hospital mortality and decreased risk of ICU admission. Being a healthcare worker appears to have a protective association with mortality risk (odds ratio of ICU mortality is 0.254 [0.143–0.453] relative to non-healthcare workers) and length of stay. Lengths of stay decrease with month of admission for survivors, but do not appear to vary with month for non-survivors. Conclusions Improvements in clinical knowledge, treatment, patient and hospital management and public health surveillance, together with the waning of the first wave after the first lockdown, are hypothesised to have contributed to the reduced risks and lengths of stay over time.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049089
Author(s):  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Eduardo Marques Macário ◽  
Giovanny Vinícius A França
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Factors Associated ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

scholarly journals Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3710
Author(s):  
Sylvie Muhimpundu ◽  
Rebecca Baqiyyah N. Conway ◽  
Shaneda Warren Andersen ◽  
Loren Lipworth ◽  
Mark D. Steinwandel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Cohort Study ◽  
African Americans ◽  
Racial Differences ◽  
Prospective Cohort ◽  
White Americans ◽  
Low Socioeconomic ◽  
Factors Associated ◽  
Southeastern Us

The purpose of this study was to examine differences in risk factors associated with hepatocellular carcinoma (HCC) among White and African Americans from low socioeconomic backgrounds in the Southern Community Cohort Study (SCCS). The SCCS is a prospective cohort study with participants from the southeastern US. HCC incidence rates were calculated. Multivariable Cox regression was used to calculate HCC-adjusted hazard ratios (aHR) associated with known baseline HCC risk factors for White and African Americans, separately. There were 294 incident HCC. The incidence rate ratio for HCC was higher (IRR = 1.4, 95%CI: 1.1–1.9) in African Americans compared to White Americans. White Americans saw a stronger association between self-reported hepatitis C virus (aHR = 19.24, 95%CI: 10.58–35.00) and diabetes (aHR = 3.55, 95%CI: 1.96–6.43) for the development of HCC compared to African Americans (aHR = 7.73, 95%CI: 5.71–10.47 and aHR = 1.48, 95%CI: 1.06–2.06, respectively) even though the prevalence of these risk factors was similar between races. Smoking (aHR = 2.91, 95%CI: 1.87–4.52) and heavy alcohol consumption (aHR = 1.59, 95%CI: 1.19–2.11) were significantly associated with HCC risk among African Americans only. In this large prospective cohort, we observed racial differences in HCC incidence and risk factors associated with HCC among White and African Americans.

scholarly journals Prevalence and factors associated with memory disturbance and dementia after acute ischemic stroke

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Jesada Surawan ◽  
Teabpaluck Sirithanawutichai ◽  
Suchat Areemit ◽  
Somsak Tiamkao ◽  
Suprawita Saensak
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Factors Associated ◽  
Laboratory Test Results ◽  
Khon Kaen ◽  
Memory Disturbance ◽  
State Examination ◽  
With Memory

Prevalence and risk factors associated with memory disturbance and dementia were determined in acute ischemic stroke (AIS) patients in hospitals before discharge, three and six months after stroke. A prospective cohort study was conducted during January-December 2017 with 401 AIS patients admitted to Srinagarind Hospital, Khon Kaen Hospital and Chum Phae Hospital, Khon Kaen, Thailand. The demographics and clinical characteristics, previous illness and past medical history, and laboratory test results of the patients were collected from the medical records, while depression screening, NIH stroke scale (NIHSS) scoring and mini mental state examination (MMSE) were performed using particular medical record forms. The prevalence of memory disturbance and dementia was 56.6, 41.6 and 38.2% before discharge, three and six months after stroke, respectively. Based on logistic regression analysis, age, education and stroke severity were the risk factors associated with the studied disorders before discharge and three months after stroke. Meanwhile, age and education were the risk factors for six months after stroke. Our findings suggested that the prevalence of memory disturbance and dementia remained high at all study periods.

Risk factors associated with pseudoaldosteronism in patients with chronic hepatitis: A retrospective cohort study

2018 ◽  
Vol 124 (5) ◽  
pp. 607-614 ◽  
Author(s):  
Akihiro Komatsu ◽  
Tetsuhiro Yoshino ◽  
Takeshi Suzuki ◽  
Tomonori Nakamura ◽  
Takanori Kanai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Hepatitis ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hepatitis A ◽  
Factors Associated
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