5-Item Modified Frailty Index Predicts Outcomes After Below-Knee Amputation in the Vascular Quality Initiative Amputation Registry

2020 ◽  
Vol 86 (10) ◽  
pp. 1225-1229
Author(s):  
James C. Andersen ◽  
Joshua A. Gabel ◽  
Kristyn A. Mannoia ◽  
Sharon C. Kiang ◽  
Sheela T. Patel ◽  
...  
Keyword(s):  
Frailty Index ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Frailty Status ◽  
Knee Amputation ◽  
Point Increase ◽  
Increased Risk ◽  
History Of ◽  
Modified Frailty Index

Patient frailty indices are increasingly being utilized to anticipate post-operative complications. This study explores whether a 5-factor modified frailty index (mFI-5) is associated with outcomes following below-knee amputation (BKA). All BKAs in the vascular quality initiative (VQI) amputation registry from 2012-2017 were reviewed. Preoperative frailty status was determined with the mFI-5 which assigns one point each for history of diabetes, chronic obstructive pulmonary disease or active pneumonia, congestive heart failure, hypertension, and nonindependent functional status. Outcomes included 30-day mortality, unplanned return to odds ratio (OR), post-op myocardial infarction (MI), post-op SSI, all-cause complication, revision to higher level amputation, disposition status, and prosthetic use. 2040 BKAs were performed. Logistic regression showed an increasing mFI-5 score that was associated with higher risk of combined complications (OR 1.22, confidence interval [CI] 1.07-1.38, P < .05), 30-day mortality (OR 1.60, CI 1.19-2.16, P < .05), post-op MI (OR 1.79, CI 1.30-2.45, P < .05), and failure of long-term prosthetic use (OR 1.17, CI 1.03-1.32, P < .05). In the VQI, every one-point increase in mFI-5 is associated with an increased risk of 22% for combined complications, 60% for 30-day mortality, nearly 80% for post-op MI, and 17% for failure of prosthetic use in BKA patients. The mFI-5 frailty index should be incorporated into preoperative planning and risk stratification.

scholarly journals Clinical Characteristics and Risk Factors for Myocardial Injury and Arrhythmia in COVID-19 patients

2020 ◽  
Author(s):  
Hong Gang Ren ◽  
Xingyi Guo ◽  
Lei Tu ◽  
Qinyong Hu ◽  
Kevin Blighe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Characteristics ◽  
Myocardial Injury ◽  
Heart Diseases ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
History Of ◽  
Cross Sectional Design

ABSTRACTBackgroundPatients with COVID-19 can develop myocardial injury and arrhythmia during the course of their illness. However, the underlying risk factors for the development of cardiovascular related manifestations are unclear.MethodsUsing a register-based multi-center cross-sectional design, we analyzed 80 patients with myocardial injury and 401 controls, as well as 71 patients with arrhythmia and 409 controls, all admitted with COVID-19. Putative risk factors for myocardial injury and arrhythmia were evaluated with logistic regression with adjustment for potential confounders.ResultsCOVID-19 patients with myocardial injury had fatigue (66.2%) and dyspnea (63.7%), while those with arrhythmia had dyspnea (71.8%). Patients with myocardial injury and arrhythmia had a significant mortality of 92.5% and 94.4%, respectively. A history of chronic obstructive pulmonary disease (COPD) or heart diseases was associated with an increased risk of myocardial injury (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.01-3.71; OR = 7.43, 95% CI: 3.99-13.83) and arrhythmia (OR = 1.94, 95% CI: 1.00-3.75; OR = 13.16, 95% CI: 6.75-25.68). In addition, we found that gamma glutamyltranspeptidase (GGT) >50U/L (OR = 2.14, 95% CI: 1.37-3.32; OR = 1.85, 95% CI: 1.19-2.85), serum creatinine >111μmol/L (OR = 8.96, 95% CI: 4.4-18.23; OR = 3.71, 95% CI: 2.01-6.85), serum sodium <136 mmol/L (OR = 4.68, 95% CI: 2.46-8.91; OR = 2.06; 95% CI: 1.06-4.00) were all associated with increased risk of myocardial injury and arrhythmia, respectively.ConclusionOur reported clinical characteristics and identified risk factors are important for clinical study of COVID-19 patients developing myocardial injury and arrhythmia.

Abstract 11046: Chronic Obstructive Pulmonary Disease and Sudden Cardiac Death in Hypertensive Patients: The LIFE Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Peter M Okin ◽  
Sverre E Kjeldsen ◽  
Richard B Devereux
Keyword(s):  
Blood Pressure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Heart Rate ◽  
Cardiac Death ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Hypertensive Patients ◽  
Copd Patients ◽  
Increased Risk ◽  
History Of

Background: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of cardiovascular (CV) disease and CV mortality. A recent large, population-based study suggested that COPD is associated with an increased risk of sudden cardiac death (SCD). However, whether COPD predicts SCD in hypertensive patients during aggressive blood pressure (BP) lowering has not been examined. Methods: Risk of SCD was examined in relation to a history of COPD in 9193 hypertensive patients with ECG left ventricular hypertrophy (LVH) who were randomly assigned to losartan- or atenolol-based treatment. A history of COPD was present in 385 patients (4.2%). SCD, a prespecified secondary endpoint in LIFE, was defined as death that was sudden and unexpected, including observed arrhythmic deaths and those not attributable to myocardial infarction (MI), intractable heart failure (HF) or other identifiable cause, occurring within 24 hours of symptom onset or when the subject was last seen alive if unwitnessed SCD. Results: During mean follow-up of 4.8±0.9 years, 178 patients (2.4%) had SCD, with a higher incidence rate per 1000 person-years in those with COPD: 9.0; 95% CI, 6.1-11.9 vs 3.8; 95% CI, 3.4-4.2; p=0.001. In a univariate Cox model, COPD was associated with a > 2-fold increased risk of SCD (HR 2.36, 95% CI 1.42-3.95, p=0.001). In a multivariable Cox regression model that adjusted for other predictors of SCD in this population (randomized treatment, age, gender, race, history of atrial fibrillation, stroke or transient ischemic attack, baseline serum creatinine and glucose entered as standard covariates and incident MI, incident HF and in-treatment diastolic pressure, heart rate, QRS duration, HDL cholesterol, and use of hydrochlorothiazide or a statin entered as time-varying covariates), COPD remained associated with a nearly 2-fold increased risk of SCD (HR, 1.82; 95% CI, 1.04-3.18, p=0.035). Conclusions: COPD is associated with an increased risk of SCD in hypertensive patients. The higher SCD risk in COPD patients persists after adjusting for the higher prevalence of risk factors in COPD patients, in-treatment blood pressure, incident MI and HF, and the established predictive value of in-treatment ECG LVH and heart rate for SCD in this population.

Risk Factors for the Development of an Incisional Hernia after Sigmoid Resection for Diverticulitis: An Analysis of 33 Patient, Operative and Disease-associated Factors

2015 ◽  
Vol 81 (5) ◽  
pp. 492-497 ◽  
Author(s):  
Tara M. Connelly ◽  
Rafel Tappouni ◽  
Paul Mathew ◽  
Javier Salgado ◽  
Evangelos Messaris
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Incisional Hernia ◽  
Multivariate Regression Analysis ◽  
Sigmoid Resection ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
History Of

Incisional hernia (IH) is a relatively common sequelae of sigmoidectomy for diverticulitis. The aim of this study was to investigate factors that may predict IH in diverticulitis patients. Two hundred and one diverticulitis patients undergoing sigmoidectomy between January 2002 and December 2012 were identified (mean follow-up 5.15 ± 2.33 years). Patients with wound infections were excluded. Thirteen patient-associated, three diverticular disease-related, and 17 operative variables were evaluated in patients with and without IH. Volumetric fat was measured on pre-operative CTs. Fischer's exact, χ2, and Mann–Whitney tests and multivariate regression analysis were used for statistics. Thirty-four (17%) patients had an IH. On multivariate analysis, wound packing (OR 3.4, P = 0.017), postoperative nonwound infection (OR 7.4, P = 0.014), and previous hernia (OR 3.6, P = 0.005) were as independent predictors of IH. Fifteen of 34 (44%) patients who developed a hernia had a history of prior hernia. Of 33 potential risk factors analyzed, including smoking, chronic obstructive pulmonary disease, and obesity, the only patient factor present preoperatively associated with increased risk of a postsigmoidectomy hernia after multivariate analysis was a history of a previous hernia. Preoperative identification of patients with a history of hernia offers the opportunity to employ measures to decrease the likelihood of IH.

scholarly journals Preoperative pulmonary function in all comers for cardiac surgery predicts mortality

2019 ◽  
Vol 29 (2) ◽  
pp. 244-251
Author(s):  
Emilie C Risom ◽  
Katrine B Buggeskov ◽  
Ulla B Mogensen ◽  
Martin Sundskard ◽  
Jann Mortensen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Lung Function ◽  
Airflow Obstruction ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Clinical Trial Registration ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract OBJECTIVES Although reduced lung function and chronic obstructive pulmonary disease (COPD) is associated with higher risk of death following cardiac surgery, preoperative spirometry is not performed routinely. The aim of this study was to investigate the relationship between preoperative lung function and postoperative complications in all comers for cardiac surgery irrespective of smoking or COPD history. METHODS Preoperative spirometry was performed in elective adult cardiac surgery patients. Airflow obstruction was defined as the ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio below the lower limit of normal (LLN) and reduced forced ventilatory capacity defined as FEV1 <LLN. RESULTS A history of COPD was reported by 132 (19%) patients; however, only 74 (56%) had spirometry-verified airflow obstruction. Conversely, 64 (12%) of the 551 patients not reporting a history of COPD had spirometry-verified airflow obstruction. The probability of death was significantly higher in patients with airflow obstruction (8.8% vs 4.5%, P = 0.04) and in patients with a FEV1 <LLN (8.7% vs 3.7%, P = 0.007). In the multivariate analysis were age [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0–2.5; P = 0.04], prolonged cardiopulmonary bypass time (HR 1.2, 95% CI 1.02–1.3; P = 0.03), reduced kidney function (HR 2.5, 95% CI 1.2–5.6; P = 0.02) and FEV1 <LLN (HR 2.4, 95% CI 1.1–5.2; P = 0.03) all independently associated with an increased risk of death. CONCLUSIONS Preoperative spirometry reclassified 18% of the patients. A reduced FEV1 independently doubled the risk of death. Inclusion of preoperative spirometry in routine screening of cardiac surgical patients may improve risk prediction and identify high-risk patients. Clinical trial registration number NCT01614951 (ClinicalTrials.gov).

Risk Factors for Developing Postprocedural Microemboli following Carotid Interventions

2007 ◽  
Vol 14 (4) ◽  
pp. 561-567 ◽  
Author(s):  
Maureen M. Tedesco ◽  
Sheila M. Coogan ◽  
Ronald L. Dalman ◽  
Jason S. Haukoos ◽  
Barton Lane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Characteristics ◽  
Time Frame ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Mri Scans ◽  
History Of ◽  
Distal Protection

Purpose: To determine risk factors predictive of microemboli found on diffusion-weighted magnetic resonance imaging (DW-MRI) following carotid angioplasty and stenting (CAS) with distal protection and carotid endarterectomy (CEA). Methods: A retrospective review was conducted of all carotid interventions at a single institution between 2004 and 2006. In that time frame, 64 carotid interventions (34 CAS, 30 CEA) were performed in 63 male patients (mean age 69.5 years, range 52 to 91) with DW-MRI scans available for review. Patient characteristics, including age, gender, smoking history, diabetes mellitus, hypertension, hyperlipidemia, obesity (body mass index >30), coronary artery disease (CAD), chronic obstructive pulmonary disease, peripheral vascular disease, and atrial fibrillation, were documented. For the CAS patients, anatomical and procedural characteristics, including fluoroscopy time, contrast volume, performance of an arch angiogram, and lesion anatomy, were recorded. Bivariate analyses were performed to determine which parameters were associated with the occurrence of acute postprocedural microemboli found on DW-MRI by 2 blinded neuroradiologists. Results: Twenty-four (71%) of the 34 CAS patients and 1 (3%) of the 30 CEA patients demonstrated new cerebral microemboli postoperatively. In the bivariate analyses of all patient, anatomical, and procedural characteristics, only a history of CAD was associated with an increased risk of microemboli; 20 (80%) of the 25 patients who had postprocedure microemboli had CAD compared to 18 (46%) of 39 patients without microemboli (p=0.007). Twenty (53%) of the 38 (59%) patients with CAD developed microemboli compared to 5 (19%) of the 26 patients without CAD (p=0.007). All other patient, procedural, and anatomical characteristics were not found to be independent risk factors predictive of postprocedure microemboli. Conclusion: CAS with distal protection carries a significantly greater risk for developing new microemboli compared to CEA. Of all the risk factors analyzed, only a history of CAD emerged as an independent risk factor for the development of microemboli following carotid intervention. This finding may influence the decision to perform CAS in patients deemed high risk solely due to the presence of CAD.

Use of β2-adrenoreceptor agonist and antagonist drugs and risk of Parkinson disease

Neurology ◽  
2019 ◽  
Vol 93 (2) ◽  
pp. e135-e142 ◽  
Author(s):  
Franziska Hopfner ◽  
Mette Wod ◽  
Günter U. Höglinger ◽  
Morten Blaabjerg ◽  
Thomas W. Rösler ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Inhaled Corticosteroids ◽  
Causal Link ◽  
Chronic Obstructive ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Nicotine Abuse ◽  
Increased Risk ◽  
Agonist And Antagonist

ObjectiveTo verify the previously reported association between long-term use of β2-adrenoreceptor (β2AR) agonist and antagonist with reduced and increased risk of Parkinson disease (PD), respectively.MethodsWe obtained odds ratios (ORs) associating time of β2AR agonist and antagonist use with PD risk in nationwide Danish health registries.ResultsWe included 2,790 patients with PD and 11,160 controls. Long-term β2AR agonist use was associated with reduced PD risk (OR 0.57, 95% confidence interval [CI] 0.40–0.82) in this cohort. Unexpectedly, short-term β2AR agonist use was equally associated (OR 0.64, 95% CI 0.42–0.98). Because β2AR agonists are prescribed mostly for chronic obstructive pulmonary disease (COPD), often caused by long-term nicotine abuse, we analyzed other markers of smoking. Diagnosis of COPD (OR 0.51, 95% CI 0.37–0.69) and use of inhaled corticosteroids (OR 0.78, 95% CI 0.59–1.02) or inhaled anticholinergics (OR 0.41, 95% CI 0.25–0.67) were also inversely associated with PD. Increased PD risk was not found for all β2AR antagonists but only for propranolol and metoprolol. Associations were markedly stronger for short-term than long-term use.ConclusionWe confirmed β2AR agonist use to be associated with reduced PD risk and β2AR antagonist use with increased PD risk. However, our data indicate the association of β2AR agonists to be indirectly mediated by smoking, which is repeatedly associated with reduced risk of PD. The association of β2AR antagonists indicates reverse causation, with PD symptoms triggering their prescription rather than β2AR antagonists causing PD. Thus, current epidemiologic data do not support a causal link between β2AR agonists and antagonists and PD risk.

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