scholarly journals Risk Factors for Aspiration Pneumonia After Receiving Liquid-Thickening Recommendations

2021 ◽  
pp. 019459982110491
Author(s):  
Hiroaki Masuda ◽  
Rumi Ueha ◽  
Taku Sato ◽  
Takao Goto ◽  
Misaki Koyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aspiration Pneumonia ◽  
Performance Status ◽  
Significant Risk ◽  
Poor Performance ◽  
Clinical Risk Factors ◽  
Poor Performance Status ◽  
Clinical Risk ◽  
History Of ◽  
Laryngeal Sensation

Objective We examined the influence of liquid thickness levels on the frequency of liquid penetration-aspiration in patients with dysphagia and evaluated the clinical risk factors for penetration-aspiration and aspiration pneumonia development. Study Design A case series. Setting Single-institution academic center. Methods We reviewed medical charts from 2018 to 2019. First, we evaluated whether liquid thickness levels influence the frequency of liquid penetration-aspiration in patients with dysphagia. Penetration-aspiration occurrence in a videofluoroscopic swallowing study was defined as Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association between liquid thickness level and penetration-aspiration was analyzed, and clinical risk factors were identified. Moreover, clinical risk factors for aspiration pneumonia development within 6 months were investigated. Results Of 483 patients, 159 showed penetration-aspiration. The thickening of liquids significantly decreased the incidence of penetration-aspiration ( P < .001). Clinical risk factors for penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99), impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR, 2.90). Twenty-three patients developed aspiration pneumonia while undertaking advised dietary changes, including liquid thickening. Significant risk factors for aspiration pneumonia development were poor performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of aspiration pneumonia (OR, 7.00). Conclusion Thickening of liquids can reduce the incidence of penetration-aspiration. Vocal fold paralysis, impaired laryngeal sensation, and history of aspiration pneumonia are significant risk factors of penetration-aspiration. Poor performance status, PAS score ≥3, and history of aspiration pneumonia are significantly associated with aspiration pneumonia development following recommendations on thickening liquids. Level of Evidence 3.

Death In Complete Remission Among Patients with Acute Myeloid Leukemia: A Preventable Problem?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2710-2710
Author(s):  
Gloria Mattiuzzi ◽  
Hagop Kantarjian ◽  
Farhad Ravandi ◽  
Guillermo Garcia-Manero ◽  
Gautam Borthakur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
High Risk ◽  
Causes Of Death ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Newly Diagnosed ◽  
History Of ◽  
Prior Malignancy

Abstract Abstract 2710 Background: Significant advances in the treatment of patients with acute myelogenous leukemia (AML) and high risk myelodysplastic syndrome (HR-MDS) have improved their outcome. Mortality among patients with newly diagnosed AML and HR-MDS is mainly attributed to persistent disease (i.e., failure to achieve or loss of complete remission [CR]), infectious and other complications during induction chemotherapy. However, a small but significant proportion of patients die in CR. The aim of this study was to investigate the cause of death in AML and HR-MDS patients in CR and to analyze the associated risk factors. Methods: Retrospective review of medical records of patients with newly diagnosed AML, APL and HR-MDS who received induction chemotherapy at the Department of Leukemia at MD Anderson from January 2000 to December 2009. Results: During the study period, 2156 patients were treated. One thousand one hundred fifty patients achieved CR for an overall CR rate of 53%. Among them, 114 patients (10%) died in CR. The median time from achievement of CR to death was 5.3 months (range, 0.2 – 79). There was a decline in the rate of death in CR over the 10 years of analysis reported (p=0.010). [Table 1] Information about the causes of death in 35 patients (31%) was not available. The most frequent causes of death in the remaining 79 patients were infections (27%); SCT-related complications (19%); relapse of prior malignancy (8%); hemorrhage (4%); multi-organ failure (4%); and others (9%). Among patients who died in CR, 105 (92%) had AML and 9 high-risk MDS, 60% were female, and the median age was 64 years (range 21–86). Forty-two patients (37%) had history of a prior malignancy, 22% had received previous chemotherapy (for other malignancies), and 20% prior radiotherapy. Sixty-eight percent received high-dose cytarabine-containing regimen for induction therapy, 92% achieved CR after one cycle of chemotherapy, with a median of 33 days (range 21–152) to achievement of CR. Nineteen percent underwent stem cell transplantation while in CR. In comparison to patients who did not die in CR, patients who died in remission were significantly older at the time of diagnosis [64 vs. 57 years, p <.001]; were more likely to have history of prior malignancy, chemotherapy or radiotherapy [37% vs.21%, p<0.001; 22% vs.11%, p<0.001; 20% vs. 9%, p<0.001, respectively]; had worse performance status at the time of diagnosis [26% vs. 14%, p = 0.004]; and were more likely to have undergone stem cell transplantation (SCT) while in CR [19% vs. 8%, p<0.001]. Sixty-three percent of the patients who died in CR were 60 years or older. Among patients age 60 years or older, the probability of death in CR was 14% compared to 7% for patients younger than 60 (p<0.001). Multivariate logistic regression analysis confirmed that older age (p<0.000), prior malignancy (p<0.001), poor performance status (p<0.001) and SCT while in CR (p<0.000) were independently associated with the probability of dying in CR. Risk factors for dying from infections included only older age (p<0.003) and poor performance status (p, 0.05). Conclusion: Death in CR affects a significant number of patients with AML, with older patients with poor performance status having the highest probability of dying in CR, particularly from infections. Special attention should be put to these patients to minimize their risk of death in CR to improve their long term outcome. Disclosures: No relevant conflicts of interest to declare.

scholarly journals COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

2021 ◽  
Author(s):  
Alvin J. X. Lee ◽  
Karin Purshouse
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Poor Performance ◽  
Cancer Registries ◽  
Adverse Outcomes ◽  
Smoking History ◽  
Poor Performance Status ◽  
International Studies ◽  
Patients With Cancer ◽  
Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

scholarly journals Major clinical risk factors for seizures in febrile children aged 6 to 60 months.

2020 ◽  
Vol 27 (05) ◽  
pp. 891-894
Author(s):  
Shahid Ishaq ◽  
Ejaz Mazari ◽  
Fazal ur Rehman
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Febrile Seizures ◽  
Study Groups ◽  
Clinical Risk Factors ◽  
P Value ◽  
Chi Square ◽  
Clinical Risk ◽  
Significant Difference ◽  
History Of

Objectives: Febrile seizures (FS) are the most common type of seizures and typically transpire in children with ages from 6 to 60 months. This study was planned to find out major clinical risk factors for seizures in febrile children who were aged 6 to 60 months. A total of 100 febrile children aged 6 to 60. Study Design: Analytical Study. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health, Multan. Period: From 1st April 2018 to 31st December 2018. Material & Methods: Group A had 40 children with febrile seizures while group B had 60 febrile children but without seizures. Demographic features along with family history of (H/O) epilepsy as well as family history of febrile seizure, types of seizure and infection diseases were noted and analyzed using SPSS version 20. Odds ratio was calculated for various risk factors. Chi square test was applied and P value < 0.05 was considered as significant. Results: Out of a total of 100 children, there were 54 (54.0%) male and 46 (46.0%) female. There was no statistical difference in terms of gender between the two groups (p value = 0.566). Overall, mean age of the children was 26.02 months with standard deviation of 13.4 months. There were 28 (70.0%) children who reported with simple seizures while complex seizures were found in 12 (30.0%) cases. Statistically significant difference (p value = 0.001) was seen in terms of types of infections between the two study groups. When risk of seizures for various risk factors was calculated, family H/O FS, family H/O epilepsy, and upper RTI were as 14, 7 and 3 times respectively and turned out to be the major risk factors for seizures in febrile children. Conclusions: Family H/O FS, family H/O epilepsy and upper RTIs are the major risk factors related with seizures in febrile children. Measures to prevent these risk factors can decrease the burden of FS in our population.

scholarly journals Examining the Relationship between Biopsychosocial History and Clinical Profiles Following Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 765-765
Author(s):  
K Emami ◽  
A M Sufrinko ◽  
M W Collins ◽  
A P Kontos ◽  
E A Rossi
Keyword(s):  
Risk Factors ◽  
Motion Sickness ◽  
Clinical Profile ◽  
Clinical Risk Factors ◽  
Post Injury ◽  
Chi Square ◽  
Clinical Risk ◽  
History Of ◽  
Concussion History ◽  
Clinical Profiles

Abstract Purpose To determine if clinical risk factors (e.g., migraine history, motion sickness, concussion history) place an individual at risk for specific clinical profiles (e.g., posttraumatic migraine, vestibular) designated by a clinician following concussion. Methods Fifty (22M; 28F) symptomatic, concussed patients (17.02±3.14 years old) were evaluated within 21days post-injury. Demographics and medical history were obtained, including history of migraine, motion sickness, ADHD, learning disability (LD), oculomotor disorder, psychiatric diagnoses, and prior concussion. The presence of each clinical profile was determined by a clinician, based on synthesis of evaluation findings, including neurocognitive testing, symptom report, and vestibular/oculomotor screening results. Chi-square analyses were used to explore associations between risk factors and clinical profile post-injury. Results Chi-square analyses found that female sex was associated with increased odds (OR=5.25,95% CI[1.55, 17.77]) of vestibular clinical profile, X2(1, n=50)=7.55, p=.006. History of concussion was associated with increased odds (OR=7.10,95%CI[1.39,35.87]) of the PTM profile (X2[1, n=50]=6.56, p=.01) and increased odds (OR=9.85,95%CI[1.00,96.67]) of anxiety/mood profile (X2 1, n=50]=5.24, p=.022. Further, history of motion sickness was associated with increased odds OR=10.2,95%CI[1.2,86.69] of the PTM profile (X2[1, n=50]=6.11, p=.013). No other relationships were found. Conclusion Some clinical risk factors were associated with post-injury clinical profiles consistent with prior literature, while others were not. For example, females were more likely to have a vestibular profile. While motion sickness was associated with PTM, history of migraine was not. Concussion history, which has inconsistent findings for re-injury outcomes, was associated with increased likelihood of PTM and anxiety/mood profiles. Findings add to the literature supporting relationships among risk factors and clinical outcomes.

scholarly journals Biological versus Clinical Risk Factors in Acute Myeloid Leukemia: Is There a Winner?

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
M. Malagola ◽  
N. Polverelli ◽  
V. Cancelli ◽  
E. Morello ◽  
A. Turra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndrome ◽  
Myeloid Leukemia ◽  
Clinical Risk Factors ◽  
Decision Algorithm ◽  
Platelet Recovery ◽  
Clinical Risk ◽  
History Of ◽  
Acute Myeloid

We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.

scholarly journals Hematopoietic Growth Factors in the Management of Anemia and Febrile Neutropenia

Breast Care ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. 93-98
Author(s):  
Hartmut Link
Keyword(s):  
Risk Factors ◽  
Febrile Neutropenia ◽  
Performance Status ◽  
Dose Intensity ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Hematopoietic Growth Factors ◽  
Related Risk ◽  
Chemotherapy Protocol ◽  
The Individual

Chemotherapy-induced anemia (CIA) in cancer patients correlates with poor performance status and decreased quality of life. Currently recommended causal therapies are erythropoiesis-stimulating agents (epoetins), iron substitution, or a combination of both. Guidelines recommend considering red blood cell (RBC) transfusions for symptomatic anemia at a hemoglobin (Hb) level of <8 g/dl. Granulocyte colony-stimulating factor (G-CSF) is recommended if the risk of febrile neutropenia (FN) following from the chosen chemotherapy protocol is ≥20%. If a chemotherapy is planned that induces a moderate FN risk (10-20%), the individual overall FN risk should be assessed prior to each chemotherapy cycle, taking into account patient- or tumor-related risk factors. G-CSF is required when risk factors such as age ≥ 65 years, advanced disease or relevant comorbidity, or previous neutropenia complications are present. Neutropenia that required a shift in chemotherapy is also an indication for G-CSF prophylaxis in subsequent cycles, in order to maintain the planned dose intensity. The use of G-CSF improves patient survival and reduces the rate of neutropenia complications.

Phase II Study of Gemtuzumab Ozogamycin (GO) and Cytarabine (ARA-C) in Patients with High Risk MDS and AML..

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4723-4723
Author(s):  
Peter Kang ◽  
Karen Seiter ◽  
Delong Liu ◽  
Muhammad Arshad ◽  
Anila Qureshi ◽  
...  
Keyword(s):  
High Risk ◽  
Performance Status ◽  
Poor Performance ◽  
Complete Response ◽  
Lung Damage ◽  
Poor Performance Status ◽  
High Cumulative Dose ◽  
History Of ◽  
M 12 ◽  
To Receive

Abstract To evaluate the efficacy of GO + ara-c in high risk pts, we treated 22 pts with MDS (10) and AML (12) with cytarabine 100 mg/m2/d x 7 d and GO 9 mg/m2 x 1 on d 4. Pts with MDS were eligible if they had [1] RAEB-1 and either hgb &lt; 8 gm/dl, platelet &lt; 50,000/mm3, neutrophils &lt; 1000/mm3, or cytogenetics other than 5q-, 20q-, -y, or normal, [2] RAEB-2, or [3] CMML. Pts with AML (newly diagnosed or relapsed) were eligible if they were ineligible for anthracycline-based therapy (poor performance status: 2 pts; low ejection fraction or high cumulative dose of anthracyclines: 6 pts, both reasons: 4 pts). The median age was 66, M:12, F:10. Diagnoses: RAEB-1: 4, RAEB-2: 5, CMML: 1, AML, newly dx’d: 7, AML relapsed: 5. Cytogenetics were high risk: 10, intermediate risk: 11 pts, low risk: 1 pt. Overall, 18% had a complete response (CR) after one cycle of therapy. Three pts (14%) had a partial response (PR), of which one had a CR after a second course of therapy. Of the pts with AML: CR: 2/12, PR: 2/12, Failure (F): 5/12, Toxic Death (TD): 3/12. For pts with MDS: CR: 2/10, PR: 1/10, F: 5/10, TD: 2/10. Toxicities included neutropenic fever/sepsis, mucositis, diarrhea, increased LFTs, hemorrhage. One pt with a history of ABVD and RT to chest for HD developed direct pulmonary toxicity due to chemotherapy (diffuse pulmonary infiltrates, biopsy proven toxic lung damage). Although overall response rate is modest, some pts had remarkable responses: One pt with RAEB-1, transfusion dependent and multiple high risk cytogenetics (−5, −7, multiple others) remains in CR (including cytogenetic CR) 7 months post treatment. A second pt with RAEB-1, transfusion dependent and multiple high risk cytogenetics (−5, −7, multiple others) had a PR after one course, but was unable to receive further chemotherapy due to toxicity. The latter pts suggest that this regimen should be studied further in pts with MDS, poor risk cytogenetics and low blast counts.

Risk factors for poor performance status in cancer patients: A multivariate analysis in 3,585 patients

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 9628-9628 ◽  
Author(s):  
R. Nair ◽  
M. Shirodkar ◽  
M. Mallath ◽  
A. D’Cruz ◽  
P. Shukla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Cancer Patients ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status

Patient risk factors and pegfilgrastim use in cabazitaxel-treated prostate cancer pateints in an academic setting.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 224-224
Author(s):  
Marina Dusevic Kaymakcalan ◽  
Sherri Stuver ◽  
Christopher Sweeney ◽  
Toni K. Choueiri ◽  
Aymen Elfiky
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Performance Status ◽  
Poor Performance ◽  
Prior History ◽  
Poor Performance Status ◽  
Castration Resistant Prostate Cancer ◽  
Exact Test ◽  
Potential Risk Factors ◽  
The Impact

224 Background: Cabazitaxel can offer a survival advantage in patients (pts) with metastatic castration resistant prostate cancer (mCRPC). Febrile neutropenia (FN) has emerged as a serious complication, with a rate of 8% in the TROPIC trial (de Bono, Lancet 2010). Prophylaxis with pegfilgrastim (P) can decrease the risk of FN, although predictors of FN continue to evolve. We performed an analysis on the effect of prophylactic P use on FN and the impact of certain risk factors on FN rates. Methods: We conducted a retrospective analysis of mCRPC patients treated with cabazitaxel from June 2010 to August 2013 at Dana-Farber Cancer Institute. Patient clinical and treatment variables were extracted. Fisher’s exact test was used to evaluate the association between potential risk factors and FN. Results: A total of 89 patients were treated at our institution and included in this analysis. All patients received at least one dose of cabazitaxel and received a mean of four cycles. Five pts (5.6%) developed FN; 3 out of 70 (4.3%) receiving P and 2 out of 19 (10.5%) not receiving P (p=0.3). Of the 24 patients that started cabazitaxel at a reduced dose, none developed FN. No toxic death was reported. Among several risk factors including P use, age older than 65, pre-existing neutropenia, prior chemotherapy, pre-existing infection, poor performance status, liver and renal dysfunction, and recent surgery, only a prior history of palliative radiation had a significant association with FN (p=.002). Conclusions: The rate of FN in a large academic practice is similar to what was reported in the TROPIC trial. Prior radiation may be a risk factor for FN in cabazitaxel-treated mCRPC patients. Other factors that may help better predict the risk of FN in different groups of patients receiving cabazitaxel must be identified.

scholarly journals Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nicholas A. Marston ◽  
Giorgio E.M. Melloni ◽  
Yared Gurmu ◽  
Marc P. Bonaca ◽  
Frederick K. Kamanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Genetic Risk ◽  
Genetic Risk Score ◽  
Risk Groups ◽  
Clinical Risk Factors ◽  
Cardiometabolic Disease ◽  
Polygenic Risk Score ◽  
Clinical Risk ◽  
History Of

Background: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality and has a known genetic contribution. We tested the performance of a genetic risk score for its ability to predict VTE in 3 cohorts of patients with cardiometabolic disease. Methods: We included patients from the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk), PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin), and SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus) trials (history of a major atherosclerotic cardiovascular event, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE genetic risk score based on 297 single nucleotide polymorphisms with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared with available clinical risk factors (age, obesity, smoking, history of heart failure, and diabetes) and common monogenic mutations. Results: A total of 29 663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles ( P -trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI, 1.23–2.89; P =0.004) and 2.70-fold (95% CI, 1.81–4.06; P <0.0001) higher risk of VTE compared with patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the genetic risk score was associated with a 47% (95% CI, 29–68) increased risk of VTE ( P <0.0001). Conclusions: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia.

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