Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and a known risk factor for hip osteoarthritis (OA) and total hip arthroplasty (THA) at a young age. Unfortunately, little is known about the specific factors associated with an increased risk of OA. Purpose: To (1) report the overall rate of symptomatic hip OA and/or THA in patients with FAI without surgical intervention and (2) identify radiographic features and patient characteristics associated with hip OA. Study Design: Case-control study; Level of evidence, 3. Methods: A geographic database was used to identify all patients with hip pain and radiographs between 2000 and 2016. Chart review was performed to identify patients with FAI. Patient medical records were reviewed to obtain demographic information, clinical history, physical examination findings, imaging details, and treatment details. Kaplan-Meier analysis was used to determine the rate of hip OA. Univariate and multivariate proportional hazard regression models were performed to determine risk factors for OA. Results: The study included 952 patients (649 female; 303 male; 1104 total hips) with FAI. The majority of hips had mixed type (n = 785; 71.1%), 211 (19.1%) had pincer type, and 108 (9.8%) had cam type. Mean age at time of presentation was 27.6 ± 8.7 years. Mean follow-up time was 24.7 ± 12.5 years. The rate of OA was 13.5%. THA was performed in 4% of patients. Male sex, body mass index (BMI) greater than 29, and increased age were risk factors for OA (male sex: hazard ratio [HR], 2.28; P < .01; BMI >29: HR, 2.11; P < .01; per year of increased age: HR, 1.11; P < .01.). Smoking and diabetes mellitus were not significant risk factors. No radiographic morphological features were found to be significant risk factors for OA. Conclusion: At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. BMI greater than 29, male sex, and increased age at the time of presentation with hip pain were risk factors for hip OA. The cohort consisted of a large percentage of mixed-type FAI morphologies, and no specific radiographic risk factors for OA were identified.

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A 30-year experience with mixed-type total anomalous pulmonary venous connection: a word of caution

Cardiology in the Young ◽

10.1017/s1047951116001414 ◽

2016 ◽

Vol 27 (5) ◽

pp. 870-876 ◽

Cited By ~ 5

Author(s):

Brian Kogon ◽

Jan Fernandez ◽

Subhadra Shashidharan ◽

Kirk Kanter ◽

Bahaaldin Alsoufi

Keyword(s):

Risk Factors ◽

Cardiopulmonary Bypass ◽

Pulmonary Vein ◽

Mixed Type ◽

Significant Risk ◽

Pulmonary Vein Stenosis ◽

Clinical Records ◽

Vein Stenosis ◽

Anomalous Pulmonary Venous Connection

AbstractBackgroundPatients with total anomalous pulmonary venous connection can be problematic, particularly those with mixed-type pathology. We aimed to describe a cohort of patients with mixed-type anomalous drainage, highlighting the treatment challenges, and identifying risk factors for poor outcome.MethodsWe reviewed the clinical records of patients who underwent repair for mixed-type total anomalous pulmonary venous connection between 1986 and 2015.ResultsA total of 19 patients were identified. The median age and weight of patients at surgery were 18 days (with a range from 1 to 185) and 3.4 kg (with a range from 1.9 to 6.5), respectively. Venous anatomy included a combination of duplicate supracardiac (four), supracardiac and cardiac (11), and supracardiac and infracardiac (four) drainage. Out of 19 patients, six (32%) died within 30 days or the initial hospital stay; two additional patients died from progressive pulmonary vein stenosis at 72 and 201 days, respectively, resulting in 42% mortality within the 1st year. Follow-up data were available for 8/11 long-term survivors. The median follow-up period was 7.3 years (with a range from 1.8 to 15.7). Only one patient underwent re-intervention for recurrent pulmonary vein stenosis. For surgical mortality, no statistically significant risk factors were identified, although the risk trended to be higher (p⩽0.1) with lower age and weight, an infracardiac component, and prolonged cardiopulmonary bypass. For 1-year mortality, the risk became significant (p⩽0.05) with a lower weight (p=0.01), an infracardiac component (p=0.03), and prolonged cardiopulmonary bypass (p=0.04).ConclusionThe surgical and 1-year mortality in patients with mixed-type total anomalous pulmonary venous connection is high. On the other hand, among patients who survive past the 1st year, most have good outcomes without subsequent sequelae.

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Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

Asian Spine Journal ◽

10.4184/asj.2017.11.3.356 ◽

2017 ◽

Vol 11 (3) ◽

pp. 356-364 ◽

Cited By ~ 4

Author(s):

Carola Francisca van Eck ◽

Mitchell Stephen Fourman ◽

Amir Mohamad Abtahi ◽

Louis Alarcon ◽

William Fielding Donaldson ◽

...

Keyword(s):

Risk Factors ◽

Conservative Management ◽

Radiographic Progression ◽

Surgical Intervention ◽

Nonoperative Management ◽

Classification Systems ◽

Retrospective Clinical Study ◽

Radicular Symptoms ◽

Time Of Presentation

<sec><title>Study Design</title>Retrospective clinical study.</sec><sec><title>Purpose</title>The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.</sec><sec><title>Overview of Literature</title>According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.</sec><sec><title>Methods</title>A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.</sec><sec><title>Results</title>Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.</sec><sec><title>Conclusions</title>Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.</sec>

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Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310861 ◽

2017 ◽

Vol 102 (6) ◽

pp. 790-795 ◽

Cited By ~ 4

Author(s):

Divya P Rao ◽

Praveen J John ◽

Mohammed Hasnat Ali ◽

Ramesh Kekunnaya ◽

Subhadra Jalali ◽

...

Keyword(s):

Risk Factors ◽

Surgical Intervention ◽

Success Probability ◽

Significant Risk ◽

Glaucoma Surgery ◽

Median Number ◽

Secondary Glaucoma ◽

Younger Age ◽

Cup To Disc Ratio

PurposeTo report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma.MethodsLensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure.ResultsMedian (IQR) age at lensectomy was 12 (6–18) years, and median spherical equivalent was −14.5D (−23.7to −13). Median follow-up was 30.6 (5.4–103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6–1.8) to 0.4 (0.2–1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17–31) to 14 mm Hg (11–19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2–3) to 1 (0–2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure.ConclusionLensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy.

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The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

Psychological Medicine ◽

10.1017/s0033291721002932 ◽

2021 ◽

pp. 1-11

Author(s):

Yini Wang ◽

Xueqin Gao ◽

Zhenjuan Zhao ◽

Ling Li ◽

Guojie Liu ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Significant Risk ◽

Type D Personality ◽

Adverse Outcomes ◽

Combined Effect ◽

Continuous Variables ◽

Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

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Post-thyroidectomy bleeding: analysis of risk factors from a national registry

British Journal of Surgery ◽

10.1093/bjs/znab015 ◽

2021 ◽

Author(s):

H E Doran ◽

S M Wiseman ◽

F F Palazzo ◽

D Chadwick ◽

S Aspinall

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Thyroid Surgery ◽

Multivariable Analysis ◽

Significant Risk ◽

Bleeding Risk ◽

Redo Surgery ◽

Day Case ◽

Increased Risk ◽

Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

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The Prevalence of Radiographic Findings of Structural Hip Deformities for Femoroacetabular Impingement in Patients With Hip Pain

The American Journal of Sports Medicine ◽

10.1177/0363546519896355 ◽

2020 ◽

Vol 48 (3) ◽

pp. 647-653 ◽

Cited By ~ 1

Author(s):

Jun Zhou ◽

Heath P. Melugin ◽

Rena F. Hale ◽

Devin P. Leland ◽

Christopher D. Bernard ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Mixed Type ◽

Imaging Modality ◽

Alpha Angle ◽

Young Patients ◽

Radiographic Finding ◽

Hip Pain ◽

Radiographic Findings ◽

Protrusio Acetabuli ◽

Center Edge

Background: Radiography is the initial imaging modality used to evaluate femoroacetabular impingement (FAI), and diagnostic radiographic findings are well-established. However, the prevalence of these radiographic findings in patients with hip pain is unknown. Purpose: The purpose was 3-fold: (1) to determine the overall prevalence of radiographic FAI deformities in young patients presenting with hip pain, (2) to identify the most common radiographic findings in patients with cam-type FAI, and (3) to identify the most common radiographic findings in patients with pincer-type FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A geographic database was used to identify patients aged 14 to 50 years with hip pain between the years 2000 to 2016. The following were evaluated on radiographs: cam type: typical pistol grip deformity, alpha angle >55°; pincer type: crossover sign (COS), coxa profunda or protrusio acetabuli, lateral center edge angle (LCEA) ≥40°, Tönnis angle <0°; and mixed type: both cam- and pincer-type features. Posterior wall sign (PWS) and ischial spine sign (ISS) were also evaluated. The prevalence of each was determined. Descriptive statistics were performed on all radiographic variables. Results: There were 1893 patients evaluated, and 1145 patients (60.5%; 1371 hips; 374 male and 771 female; mean age, 28.8 ± 8.4 years) had radiographic findings consistent with FAI. Of these hips, 139 (10.1%) had cam type, 245 (17.9%) had pincer type, and 987 (72.0%) had mixed type. The prevalence of a pistol grip deformity and an alpha angle >55° was 577 (42.1%) and 1069 (78.0%), respectively. The mean alpha angle was 66.9°± 10.5°. The prevalence of pincer-type radiographic findings was the following: COS, 1062 (77.5%); coxa profunda, 844 (61.6%); ISS, 765 (55.8%); PWS, 764 (55.7%); Tönnis angle <0°, 312 (22.8%); LCEA ≥40°, 170 (12.4%); and protrusio acetabuli, 7 (0.5%). Conclusion: The overall prevalence of radiographic findings consistent with FAI in young patients with hip pain was 60.5%. Radiographic findings for mixed-type FAI were the most prevalent. The most common radiographic finding for cam-type FAI was an alpha angle >55°. The most common radiographic finding for pincer-type FAI was the COS.

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MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00021 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0002

Author(s):

Brendon C. Mitchell ◽

Matthew Y. Siow ◽

Alyssa Carrol ◽

Andrew T. Pennock ◽

Eric W. Edmonds

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Shoulder Instability ◽

Surgical Intervention ◽

Operation Time ◽

Demographic Variables ◽

Return To Sports ◽

Suture Anchors ◽

Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

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Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction

The Bone & Joint Journal ◽

10.1302/0301-620x.100b3.bjj-2017-0837.r1 ◽

2018 ◽

Vol 100-B (3) ◽

pp. 285-293 ◽

Cited By ~ 6

Author(s):

A. Nakamae ◽

N. Adachi ◽

M. Deie ◽

M. Ishikawa ◽

T. Nakasa ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Articular Cartilage ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Significant Risk ◽

Articular Cartilage Damage ◽

Anterior Cruciate

Aims To investigate the risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament (ACL) reconstruction. Patients and Methods A total of 174 patients who underwent second-look arthroscopic evaluation after anatomical ACL reconstruction were enrolled in this study. The graded condition of the articular cartilage at the time of ACL reconstruction was compared with that at second-look arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction technique, meniscal conditions, and other variables were assessed by regression analysis as risk factors for progression of damage to the articular cartilage. Results In the medial compartment, multivariable logistic regression analysis indicated that partial medial meniscectomy (odds ratio (OR) 6.82, 95% confidence interval (CI) 2.11 to 22.04, p = 0.001), pivot-shift test grade at the final follow-up (OR 3.53, CI 1.39 to 8.96, p = 0.008), BMI (OR 1.15, CI 1.03 to 1.28, p = 0.015) and medial meniscal repair (OR 3.19, CI 1.24 to 8.21, p = 0.016) were significant risk factors for progression of cartilage damage. In the lateral compartment, partial lateral meniscectomy (OR 10.94, CI 4.14 to 28.92, p < 0.001) and side-to-side differences in anterior knee laxity at follow-up (OR 0.63, p = 0.001) were significant risk factors. Conclusion Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite r anatomical ACL reconstruction. Cite this article: Bone Joint J 2018;100-B:285–93.

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Abstract P023: Risk Factors Associated with Progression of Subclinical Diastolic Dysfunction in a Multiethnic Population

Circulation ◽

10.1161/circ.129.suppl_1.p023 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Lili Zhang ◽

Jian Shan ◽

Cynthia Taub

Keyword(s):

Risk Factors ◽

Renal Disease ◽

Diastolic Dysfunction ◽

Significant Risk ◽

Left Ventricular ◽

Cumulative Probability ◽

Factors Associated ◽

Hispanic Patients ◽

Multiethnic Population

Background: Subclinical diastolic dysfunction is defined as echocardiographic evidence of left ventricular diastolic dysfunction and normal ejection fraction (EF) without congestive heart failure (HF) symptoms/diagnosis. Our study, for the first time, sought to examine risk factors associated with progression from subclinical diastolic dysfunction to overt HF in a large multiethnic population. Methods: The study population included patients with asymptomatic diastolic dysfunction and EF ≥ 50% assessed by transthoracic echocardiogram between 2003 and 2008 at Montefiore Medical Center, Bronx, NY. Patients with preexisting HF, valvular heart disease or atrial fibrillation prior were excluded. The end point was the development of HF by September 1, 2013. Multivariable adjusted Cox proportional hazards models, determined by stepwise selection method, were performed to examine risk factors associated with the development of HF. All analyses were also performed with adjustment and stratification of race. Results: A total of 7,879 patients, with 21% European Americans (EA), 36% African Americans (AA), 31% Hispanics, and 12% others or unknown, were included in the analysis. Mean follow up time was 6.3 years. Mean age of the cohort was 68±12, with 63% women. The overall cumulative probability of development of HF was 17% (19% in EA, 17% in AA, 19% in Hispanic patients) during the follow up period. In multivariable Cox proportional hazard regression analysis, renal disease (hazard ratio (HR)=1.6, 95% confidence interval (CI) 1.3-2.0, P<0.001) and hemoglobin levels (HR=0.9, 95% CI 0.9-1.0, P=0.001) were significantly associated with the development of HF in overall population. In stratification analysis, age (P=0.012) and hypertension (P=0.007) were independent risk factors for HF in Hispanic patients, but not in EA and AA. Conclusions: In a large multiethnic population with subclinical diastolic dysfunction, renal disease and hemoglobin levels were independently associated with development of HF in overall population.. Age and hypertension were significant risk factors for HF only in Hispanic patients. These results may have important implications in preventing the development of HF from subclinical stage.

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Risk Factors for Alanine Aminotransferase Elevations in a Prospective Cohort of HIV-Infected Tanzanian Adults Initiating Antiretroviral Therapy

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325958219884939 ◽

2019 ◽

Vol 18 ◽

pp. 232595821988493

Author(s):

Sabina F. Mugusi ◽

David Sando ◽

Ferdinand M. Mugusi ◽

Claudia Hawkins ◽

Said Aboud ◽

...

Keyword(s):

Risk Factors ◽

Antiretroviral Therapy ◽

Alanine Aminotransferase ◽

Prospective Cohort ◽

Combination Antiretroviral Therapy ◽

Demographic Information ◽

P Values ◽

Increased Risk ◽

Male Sex

Introduction: Serum alanine aminotransferase (ALT) elevations are common among HIV-infected patients on combination antiretroviral therapy (cART). Approach: We conducted a prospective cohort study of 3023 HIV-infected Tanzanian adults initiating cART. We assessed risk factors for mild/moderate ALT elevations >40 IU/L and severe ALT elevations >200 IU/L. Results: We found that over a median follow-up of 32.5 months (interquartile range: 19.4-41.5), 44.8% of participants had at least 1 incident ALT elevation >40 IU/L of which 50.1% were persistent elevations. Risk factors for incident ALT elevation >40 IU/L included male sex, CD4 count <100 cells/μL, d4T+3TC+NVP cART, and triglycerides ≥150 mg/dL ( P values <.05). Hepatitis B coinfection and alcohol consumption increased the risk of severe ALT elevations >200 IU/L ( P values: <.05). Conclusion: Incident mild and moderate ALT elevations are common among Tanzanians initiating cART, and the clinical and demographic information can identify patients at increased risk.

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