Intra-Abdominal Hypertension is a Risk Factor for Increased VAP Incidence: A Prospective Cohort Study in the ICU of a Tertiary Hospital

Background: Ventilator-associated pneumonia (VAP) might be increased in cases with intra-abdominal hypertension (IAH). However, despite animal experimentation and physiological studies on humans in favor of this hypothesis, there is no definitive clinical data that IAH is associated with VAP. We therefore aimed to study whether IAH is a risk factor for increased incidence of VAP in critical care patients. This 1-center prospective observational cohort study was conducted in the intensive care unit of the University Hospital of Larissa, Greece, during 2013 to 2015. Consecutive patients were recruited if they presented risk factors for IAH at admission and were evaluated systematically for IAH and VAP for a 28-day period. Results: Forty-five (36.6%) of 123 patients presented IAH and 45 (36.6%) presented VAP; 24 patients presented VAP following IAH. Cox regression analysis showed that VAP was independently associated with IAH (1.06 [1.01-1.11]; P = .053), while there was an indication for an independent association between VAP and abdominal surgery (1.62 [0.87-3.03]; P = .11] and chronic obstructive pulmonary disease (1.79 [0.96-3.37]; P = .06). Conclusions: Intra-abdominal hypertension is an independent risk factor for increased VAP incidence in critically ill patients who present risk factors for IAH at admission to the ICU.

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Low alanine aminotransferase as a risk factor for chronic obstructive pulmonary disease in males

Scientific Reports ◽

10.1038/s41598-021-94385-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yong Jun Choi ◽

Do Sun Kwon ◽

Taehee Kim ◽

Jae Hwa Cho ◽

Hyung Jung Kim ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Risk Factor ◽

Pulmonary Disease ◽

Alanine Aminotransferase ◽

Cox Regression ◽

Significant Risk ◽

Continuous Variable ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Cox Regression Analysis

AbstractAlanine aminotransferase (ALT) levels reflect skeletal muscle volume and general performance, which are associated with chronic obstructive pulmonary disease (COPD) development and prognosis. This study aimed to investigate ALT levels as a risk factor for COPD development. This 13-year population-based retrospective observational cohort study included 422,452 participants for analysis. We classified groups according to the baseline ALT levels (groups 1–5: ALT (IU/L) < 10; 10–19; 20–29; 30–39; and ≥ 40, respectively). The incidence of COPD was the highest in group 1, decreasing as the group number increased in males, but not in females. The Cox regression analysis in males revealed that a lower ALT level, as a continuous variable, was a significant risk factor for COPD development [univariable, hazard ratio (HR): 0.992, 95% confidence interval (CI): 0.991–0.994; multivariable, HR: 0.998, 95% CI: 0.996–0.999]. In addition, COPD was more likely to develop in the lower ALT level groups (groups 1–4; < 40 IU/L), than in the highest ALT level group (group 5; ≥ 40 IU/L) (univariable, HR: 1.341, 95% CI: 1.263–1.424; multivariable, HR: 1.097, 95% CI: 1.030–1.168). Our findings suggest that males with low ALT levels should be carefully monitored for COPD development.

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Low Alanine Aminotransferase as a Risk Factor for Chronic Obstructive Pulmonary Disease in Males: A Retrospective Population-based Cohort Study

10.21203/rs.3.rs-206981/v1 ◽

2021 ◽

Author(s):

Yong Jun Choi ◽

Do Sun Kwon ◽

Taehee Kim ◽

Jae Hwa Cho ◽

Hyung Jung Kim ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Risk Factor ◽

Pulmonary Disease ◽

Alanine Aminotransferase ◽

Cox Regression ◽

Significant Risk ◽

Population Based ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Cox Regression Analysis

Abstract Alanine aminotransferase (ALT) levels reflect skeletal muscle volume and general performance scales, which are significantly associated with chronic obstructive pulmonary disease (COPD) development and prognosis. The aim of this study was to investigate the ALT levels as a risk factor for COPD development. This 13-year population-based retrospective cohort observational study included patients registered in the health check-up cohort database of the Korean National Health Insurance Service. A total of 422,452 participants were analysed. We classified groups according to the baseline ALT levels (groups 1–5: ALT (IU/L) < 10; 10–19; 20–29; 30–39; and ≥ 40, respectively). The incidence of COPD was highest in group 1, decreasing as the group number increased among in males. Cox regression analysis in males revealed that lower ALT level was a significant risk factor for COPD development (univariable, HR: 0.992, 95% CI: 0.991–0.994; multivariable, HR: 0.998, 95% CI: 0.996–0.999). In addition, in the low ALT level groups (< 40 IU/L), COPD was more likely to be developed (univariable, HR: 1.341, 95% CI: 1.263–1.424; multivariable, HR: 1.097, 95% CI: 1.030–1.168). Our findings suggest that males with low ALT levels should be carefully monitored for COPD development.

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Staphylococcus Aureus Bacteriuria as a Predictor of In-Hospital Mortality in Patients with Staphylococcus Aureus Bacteremia. Results of a Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9020508 ◽

2020 ◽

Vol 9 (2) ◽

pp. 508 ◽

Cited By ~ 1

Author(s):

Tobias Siegfried Kramer ◽

Beate Schlosser ◽

Désirée Gruhl ◽

Michael Behnke ◽

Frank Schwab ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

University Hospital ◽

Hospital Death ◽

Cox Regression Analysis

Staphylococcus aureus bloodstream infection (SA-BSI) is an infection with increasing morbidity and mortality. Concomitant Staphylococcus aureus bacteriuria (SABU) frequently occurs in patients with SA-BSI. It is considered as either a sign of exacerbation of SA-BSI or a primary source in terms of urosepsis. The clinical implications are still under investigation. In this study, we investigated the role of SABU in patients with SA-BSI and its effect on the patients’ mortality. We performed a retrospective cohort study that included all patients in our university hospital (Charité Universitätsmedizin Berlin) between 1 January 2014 and 31 March 2017. We included all patients with positive blood cultures for Staphylococcus aureus who had a urine culture 48 h before or after the first positive blood culture. We identified cases while using the microbiology database and collected additional demographic and clinical parameters, retrospectively, from patient files and charts. We conducted univariate analyses and multivariable Cox regression analysis to evaluate the risk factors for in-hospital mortality. 202 patients met the eligibility criteria. Overall, 55 patients (27.5%) died during their hospital stay. Cox regression showed SABU (OR 2.3), Pitt Bacteremia Score (OR 1.2), as well as moderate to severe liver disease (OR 2.1) to be independent risk factors for in-hospital mortality. Our data indicates that SABU in patients with concurrent SA-BSI is a prognostic marker for in-hospital death. Further studies are needed for evaluating implications for therapeutic optimization.

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Clinical characteristics and risk factors for mortality in patients with COVID-19 and chronic obstructive pulmonary disease in Wuhan, China

10.21203/rs.3.rs-102351/v1 ◽

2020 ◽

Author(s):

Hao Zeng ◽

Weiwei Huang ◽

Yujie Liu ◽

Lan Dong ◽

Qifan Zhang ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Cox Regression ◽

Multiple Organ ◽

Chronic Obstructive ◽

Close Monitoring ◽

Obstructive Pulmonary Disease ◽

Cox Regression Analysis ◽

Copd Patients ◽

Discharged Patients

Abstract Patients with COVID-19 and COPD are at high risks. However, the risk factors for mortality in COPD patients infected COVID-19 are limited. In this retrospective study, consecutive COPD cases infected COVID-19 in East District of People's Hospital of Wuhan University from Jan 11th 2020 to Mar 28th 2020 were included. Different outcomes were compared between dead and discharged patients. Cox regression analysis was performed to explore the risk factors for death. Totally, 52 cases were included (aged 64.0-79.0 years, 39 [75.0%] males). Common symptoms on admission were cough (43, 82.6%), fever (41, 78.8%) and expectoration (21, 40.3%). Thirty-eight (73.1%) patients were discharged, and 14 (26.9%) cases were dead which mainly caused by multiple organ failure (7, 50.0%) and respiratory failure (6, 42.9%). Multivariate analysis indicated that age > 70 years (HR, 7.859, 95% CI: 1.376, 44.875; P = 0.020) and count of lymphocyte ≤ 0.8×109/L (HR, 27.429, 95% CI: 3.336, 225.530; P = 0.002) were risk factors for death. The study showed that close monitoring of the risk indexes is important for early supportive care during the management of patients with COVID-19 and COPD.

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Abstract P207: Incidence of Hypertension in Colombia Similar to That Observed Decades Ago in Developed Countries: An Observation From the Chicamocha Cohort Study

Circulation ◽

10.1161/circ.131.suppl_1.p207 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Juan C Villar ◽

Luz X Martínez ◽

Yeny Z Castellanos ◽

Skarlet M Vásquez ◽

Víctor M Herrera

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Incidence Rate ◽

Latin American ◽

Cox Regression ◽

Population Attributable Fraction ◽

Developed Countries ◽

Cox Regression Analysis ◽

Incident Cases ◽

The Impact

Background: Overweight is a modifiable risk factor for high blood pressure (BP). Despite the increasing prevalence of both conditions in the Latin American population, there are no estimates of either the incidence of hypertension or the impact of overweight on it that inform the design and evaluation of individual and community-based preventive interventions in the region. Methods: We conducted a prospective cohort study in a sample of normotensive, blood donors from Bucaramanga, Colombia, who were free of transfusion-transmitted infectious and cardiovascular diseases at baseline. Participants were re-evaluated after a median follow-up of 12 years to determine the incidence of hypertension defined as: 1) Self-reported diagnosis with evidence of pharmacological treatment; 2) Systolic BP >140 mmHg or diastolic BP >90 mmHg (average of two measures in seated position); or 3) Current systolic/diastolic BP >120/80 mmHg with evidence of increments >10/5 mmHg from baseline. We estimated crude incidence rates of hypertension and age- and sex-adjusted hazard ratios (HRs) for baseline overweight (body mass index ≥25 kg/m2) using Cox regression analysis. The population attributable fraction (PAF) for overweight was also assessed. Results: We followed 594 participants (baseline mean age = 38.0 years; 64% male; adherence rate = 78%) at risk of hypertension among which we observed 164 incident cases: Cumulative incidence of 27.6%; incidence rate of 23.4 cases per 1,000 person-years. Incidence rate was similar in men and women (23.4 vs. 23.2 per 1,000 person-years; p>0.05) and tended to increase with age (17.4, 21.2, and 27.8 per 1,000 person-years among participants <30, 30-39, and ≥40 years old, respectively; p>0.05). Participants with overweight at baseline had twice the risk of developing hypertension than participants with normal weight (adjusted-HR = 2.00, 95%CI: 1.11, 3.61). The estimated PAF was 25.7%, considering a national prevalence of overweight equal to 34.6%. Conclusion: The incidence of hypertension in our study is similar to that reported two decades ago in cohorts from developed countries, which is consisting with the ongoing epidemiological transition in Latin America. We also confirmed the role of overweight as a risk factor for hypertension, accounting for about 1 out 4 incident cases. This finding highlights the importance of addressing overweight in our population.

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Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽

10.1177/0333102413513181 ◽

2013 ◽

Vol 34 (5) ◽

pp. 327-335 ◽

Cited By ~ 22

Author(s):

Knut Hagen ◽

Eystein Stordal ◽

Mattias Linde ◽

Timothy J Steiner ◽

John-Anker Zwart ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cox Regression ◽

Subsequent Development ◽

Population Based ◽

Health Study ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

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Multifactorial individualised programme for hamstring muscle injury risk reduction in professional football: protocol for a prospective cohort study

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000758 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000758

Author(s):

Johan Lahti ◽

Jurdan Mendiguchia ◽

Juha Ahtiainen ◽

Luis Anula ◽

Tuomas Kononen ◽

...

Keyword(s):

Cohort Study ◽

Risk Reduction ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Injury Risk ◽

Cox Regression ◽

University Hospital ◽

Professional Football ◽

Hamstring Muscle ◽

Cox Regression Analysis

IntroductionHamstring muscle injuries (HMI) continue to plague professional football. Several scientific publications have encouraged a multifactorial approach; however, no multifactorial HMI risk reduction studies have been conducted in professional football. Furthermore, individualisation of HMI management programmes has only been researched in a rehabilitation setting. Therefore, this study aims to determine if a specific multifactorial and individualised programme can reduce HMI occurrence in professional football.Methods and analysisWe conducted a prospective cohort study over two seasons within the Finnish Premier League and compare the amount of HMI sustained during a control season to an intervention season. Injury data and sport exposure were collected during the two seasons (2019–2020), and a multifactorial and individualised HMI risk reduction programme will be implemented during intervention season (2020). After a hamstring screening protocol is completed, individual training will be defined for each player within several categories: lumbo-pelvic control, range of motion, posterior chain strength, sprint mechanical output and an additional non-individualised ‘training for all players’ category. Screening and respective updates to training programmes were conducted three times during the season. The outcome will be to compare if there is a significant effect of the intervention on the HMI occurrence using Cox regression analysis.Ethics and disseminationApproval for the injury and sport exposure data collection was obtained by the Saint-Etienne University Hospital Ethics Committee (request number: IORG0007394; record number IRBN322016/CHUSTE). Approval for the intervention season was obtained from the Central Finland healthcare District (request and record number: U6/2019).

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Risk Factors of Pneumonia Associated with Mechanical Ventilation

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020656 ◽

2020 ◽

Vol 17 (2) ◽

pp. 656 ◽

Cited By ~ 1

Author(s):

Maria Kózka ◽

Aurelia Sega ◽

Katarzyna Wojnar-Gruszka ◽

Agnieszka Tarnawska ◽

Agnieszka Gniadek

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Hemorrhagic Shock ◽

Pulmonary Disease ◽

High Risk Group ◽

University Hospital ◽

Medical Documentation ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

The University

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5–15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP.

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Risk factors for exacerbations and pneumonia in patients with chronic obstructive pulmonary disease: a pooled analysis

Respiratory Research ◽

10.1186/s12931-019-1262-0 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Benjamin F. Hartley ◽

Neil C. Barnes ◽

Sally Lettis ◽

Chris H. Compton ◽

Alberto Papi ◽

...

Keyword(s):

Risk Factors ◽

Chronic Obstructive Pulmonary Disease ◽

Risk Factor ◽

Lung Function ◽

Pooled Analysis ◽

Chronic Obstructive ◽

First Year ◽

Obstructive Pulmonary Disease ◽

Gold Stage ◽

Exacerbation Risk

Abstract Background Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. Methods This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox’s proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation. Results Five studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m2. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year. Conclusions The probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m2. Analyses of this type may help the development of COPD risk equations.

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