Complications and survival after subcutaneous ureteral bypass device placement in 24 cats: a retrospective study (2016–2019)

Objectives The aim of this study was to document survival, complications and risk factors for the development of complications and mortality prior to discharge after placement of a subcutaneous ureteral bypass (SUB) device in cats. Methods The medical records of cats with SUB placement between January 2016 and August 2019 were retrospectively analysed. The development of complications (overall, intraoperative, perioperative, short- and long-term complications) and risk factors for mortality prior to discharge were statistically assessed with univariate binary logistic regression. All variables with a P value ⩽0.10 in the univariate analysis were assessed in a multivariate model. Variables were significant if P <0.05. Results Twenty-four cats were included; 12 (50.0%) received a unilateral SUB, 11 (45.8%) a bilateral nephrostomy tube with single cystostomy catheter and the remaining cat (4.2%) two unilateral SUBs. Nearly 80% of the cats developed complications, ranging from mild to fatal, including (partial) SUB obstruction (33.3% of complications), lower urinary tract infection (20.8%), pyelonephritis (20.8%) and sterile cystitis (12.5%). Five cats (20.8%) died prior to discharge. Six cats (25.0%) underwent revision surgery. The overall median survival time (MST) was 274 days (range 1–311 days). Complications were most common in the long-term period (14/16 cats), followed by the short-term (9/18 cats), perioperative (10/23 cats) and intraoperative (4/24 cats) periods. Older cats had an increased risk for developing perioperative complications ( P = 0.045) and were less likely to survive to discharge ( P = 0.033). An increased haematocrit at presentation was a risk factor for the occurrence of short-term complications ( P = 0.03). Conclusions and relevance Although complications similar to those previously described were observed, the complication rate was higher and the MST shorter than previously reported in cats undergoing SUB placement. Despite good short-term survival, the development of complications may necessitate regular and intensive control visits. Owners that consider SUB placement should be informed that follow-up can be strenuous and expensive.

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Lung cancer as a subsequent neoplasm: A report from the Childhood Cancer Survivor Study (CCSS).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.10551 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 10551-10551

Author(s):

Taumoha Ghosh ◽

Yan Chen ◽

Andrew C Dietz ◽

Gregory T. Armstrong ◽

Rebecca M. Howell ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Childhood Cancer ◽

Smoking Status ◽

Univariate Analysis ◽

Bone Cancer ◽

Age At Diagnosis ◽

Field Size ◽

P Value ◽

Increased Risk

10551 Background: Lung cancer has been reported as a subsequent neoplasm (SN) in childhood cancer survivors. We aimed to assess the prevalence of and risk factors for lung cancer in the CCSS. Methods: Among 25,654 five-year survivors participating in the CCSS, lung cancer was self-reported and then confirmed by pathologic record review. Cancer treatment exposures were evaluated including chemotherapy and chest radiation by field size (none, small, large) and in a dose group (0-10 Gy, 10-30 Gy, 30-40 Gy, and > 40 Gy). Standardized incidence ratios (SIR) were calculated using rates from the Surveillance, Epidemiology, and End Results program. Hazard ratios (HR) were estimated for demographic and treatment variables using Cox proportional-hazards models. Results: Forty-two survivors developed subsequent malignant lung cancer (SIR 4.0, 95% CI 2.9-5.4), including 25 carcinomas, 7 mesotheliomas and 10 others. Two additional benign neoplasms were also identified. The cumulative incidence of lung SNs was 0.18% at 30 years (95% CI 0.10-0.25). Median time from primary diagnosis was 28 years (range 11-46); median age at diagnosis was 45 years of age (range 15-65). A multivariable model, including all covariates with a p-value < 0.2 in univariate analysis, showed significant associations between lung cancer and older age at diagnosis (HR 10.5, 95% CI 1.4-76.4, for 15-21 years vs. 0-4 years), as well as with primary diagnoses (relative to leukemia, HR 8.7, 95% CI 1.1-66.0, for Hodgkin lymphoma; HR 20.7, 95% CI 1.3-331.0 for neuroblastoma; and HR 21.4, 95% CI 2.3-202.7, for bone cancer). In a treatment model, maximum chest radiation dose (HR 4.1, 95% CI 1.4-11.7, for 30-40 Gy; and HR 8.1, 95% CI 3.0-22.2, for > 40 Gy, relative to 0-10Gy), but not sex, smoking status, or chemotherapy exposures, was associated with lung cancer. Notably, six survivors who developed lung cancer received no radiation and of these, five had a primary bone cancer. At the end of follow-up, 65.9% of survivors with lung cancer were deceased vs. 14.1% of survivors without lung cancer ( p < 0.001). Conclusions: Survivors of childhood cancer are at increased risk for developing lung cancer associated with exposure to high doses of chest radiotherapy. To our knowledge, this is the first study to describe associations with neuroblastoma and bone cancer. Future studies to understand additional treatment-related risk factors beyond chest radiotherapy dose are needed.

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Short term and long term survival rate and risk factors of graft rejection after deceased donor kidney transplantation: a systematic review and meta-analysis

10.21203/rs.2.21572/v1 ◽

2020 ◽

Author(s):

Seyed Mohammad Kazem Aghamir ◽

Mohammad Saatchi

Keyword(s):

Risk Factors ◽

Survival Rate ◽

Graft Rejection ◽

Patient Survival ◽

Meta Analysis ◽

Deceased Donor ◽

Patient Death ◽

Short Term ◽

Term Survival

Abstract The purpose of the current meta-analysis is to determine the short-term and long-term graft and patient survival after deceased donor (DD) transplantation, as well as to determine prognostic factors. Method : Articles published until March 2019 in PubMed, Scopus, and Google Scholar databases, reporting short-term and/or long term graft and patient survival were searched. In addition to this, we included articles that analyzed the hazard ratio (HR) of graft rejection and/or patient death caused by DD related risk factors. The summary measures of this study included the survival rate, the HR of graft rejection, and patient death in response to DD related risk factors. This study, which is the first comprehensive meta-analysis of graft and patient survival rates after transplantation from the deceased donor, showed that overall short and long-term survival of graft and patient is desirable. In addition to this, it confirms that ECD and DCD recipients have a lower graft survival rate than standard donors.

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Risk Factors for Post–Open-Globe Injury Endophthalmitis

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420932322 ◽

2020 ◽

Vol 4 (5) ◽

pp. 353-359

Author(s):

Aditya Uppuluri ◽

Marco A. Zarbin ◽

Neelakshi Bhagat

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Binary Logistic Regression ◽

Clinical Findings ◽

National Inpatient Sample ◽

Open Globe Injury ◽

Adult Group ◽

Cross Sectional ◽

Increased Risk ◽

Open Globe

Purpose: The objective of our project is to use the National Inpatient Sample Database to identify risk factors for endophthalmitis in cases of open-globe injury (OGI). Methods: This is a cross-sectional observational study of 48 627 cases of OGI from the National Inpatient Sample Database. We performed regression analysis using IBM SPSS Statistics 23. Codes from the International Classification of Disease, Ninth Revision were used to identify ocular findings and conditions. Variables with P values less than .05 on univariate analysis were included in the multivariable regression model; Bonferroni correction was applied to these results. Results: Of the 48 627 cases of OGI, 37 440 (77.0%) occurred in the adult group (21 years and older). Overall, 1018 (2.1%) cases developed posttraumatic endophthalmitis, with 74.5% cases in the adult group. Endophthalmitis developed in 293 (4.5%) eyes with an intraocular foreign body (IOFB). Results of binary logistic regression showed the clinical findings of traumatic cataracts, hypopyon, vitreous inflammation, corneal ulcers, or IOFBs were associated with an increased risk of developing endophthalmitis after OGI. Conversely, orbital fractures, rupture-type injuries, and intraocular tissue prolapse were associated with a decreased likelihood of being diagnosed with endophthalmitis. Conclusions: Endophthalmitis developed in 2.4% of pediatric OGIs and 2.0% of adult OGIs. Traumatic cataract, hypopyon, vitreous inflammation, corneal ulcer, keratitis, retinal detachment, IOFB, and diabetes increased the risk of post-open-globe endophthalmitis.

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Abstract 15869: Off-Pump Coronary Artery Bypass Grafting is Associated With Higher Rate of Percutaneous Coronary Intervention at 8-Year Follow-Up

Circulation ◽

10.1161/circ.130.suppl_2.15869 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Fabio Barili ◽

Stefano Rosato ◽

Paola D’Errigo ◽

Alessandro Parolari ◽

Lorenzo Menicanti ◽

...

Keyword(s):

Risk Factor ◽

Univariate Analysis ◽

Hazard Ratio ◽

P Value ◽

Term Survival ◽

Off Pump ◽

Pump Cabg ◽

The Impact

Introduction: The debate on the advantages and limitations of off-pump (OPCAB) vs on pump CABG has not still arrived to a conclusion and concerns still exist on graft patency. This study was designed to compare the impact on mortality and morbidity of OPCAB and on-pump CABG, with a specific focus on mid-term need for percutaneous cardiac intervention (PCI). Methods: The PRIORITY project was designed to evaluate the mid-long term outcomes of 2 large prospective multicenter cohort studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG performed both on-pump and off-pump were derived from clinical dataset and linked to 2 administrative datasets. Time-to event analyses were performed in a competing risk framework to evaluate the potential role of surgical techniques on outcomes. Results: The population consisted of 11020 patients who underwent isolated CABG (27.2% OPCAB). Several risk factor but surgical technique independently affected in-hospital mortality. The incidence of postoperative PCI was significantly higher in OPCAB group (p<0.05) and the multivariate logistic regression demonstrated that on-pump CABG was the only factor that protects from PCI after surgery (OR 0.61). Although unadjusted long-term survival was significantly worst for OPCAB (Log-rank p-value 0.00), the adjustment for factors found significant in the univariate analysis did not confirm OPCAB as a risk factor for mortality (hazard ratio was 0.96 ± 0.05, p-value 0.407). On the contrary, the significantly better cumulative incidence function of hospitalization for PCI at follow-up (Gray test p-value 0.00) in the on-pump group was confirmed even by the adjustment for confounding factors (p-value 0.00, adjusted hazard ratio 0.70 ± 0.07) and hence OPCAB was demonstrated to be an independent risk factor for PCI with an hazard that is 42% higher than on-pump CABG. Conclusions: This study demonstrated that OPCAB did not affect short and long-term mortality. Nonetheless, it was a risk factor for re-hospitalization for PCI.

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Abstract 15412: Long-term Outcomes of the Truncal Valve in Truncus Arteriosus

Circulation ◽

10.1161/circ.142.suppl_3.15412 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Laura Gellis ◽

Geoffrey Binney ◽

Minmin Lu ◽

Laith Alshawabkeh ◽

John E Mayer ◽

...

Keyword(s):

Risk Factors ◽

Hospital Discharge ◽

Univariate Analysis ◽

Truncus Arteriosus ◽

Coronary Ostium ◽

Long Term Outcomes ◽

Term Survival ◽

Factors Associated ◽

Single Coronary Ostium

Objectives: Long-term survival in patients with truncus arteriosus (TA) is favorable, but there remains significant morbidity associated with need for ongoing re-interventions. The purpose of this study was to understand the long-term outcomes of the truncal valve (TV) and identify risk factors associated with the need for TV intervention. Methods: We retrospectively reviewed 170 patients who underwent initial TA repair at our institution from 1985-2015. Analysis of long-term outcomes was performed on the 148 patients who survived greater than 30 days post-operatively and to hospital discharge using multivariable competing risks Cox regression modeling. Results: Median follow up time was 12.6 years (IQR 5.0, 22.1 years) after full repair. Freedom from death or transplant at 1, 5, 10, and 20 years was 93.1 ± 2.1%, 88.0 ± 2.7%, 86.2 ± 3.0% and 78.3 ± 4.1%. Thirty patients (20%) underwent at least one intervention on the TV (22 repairs, 21 replacements). Freedom from any TV intervention at 1, 5, 10 and 20 years was 99 ± 1%, 94 ± 8%, 82 ± 9%, and 70 ± 5%. Of those with TV repair, 59% subsequently underwent TV replacement. Independent risk factors for need for TV intervention included ≥moderate TV regurgitation (TVR) (HR 4.77, p<0.001) or stenosis (HR 4.12, p<0.001) prior to full repair, and ≥moderate TVR at initial hospital discharge after full repair (HR 8.6, p<0.001). A single coronary ostium was also independently associated with need for TV intervention (HR 6.94, p=0.01). Quadricuspid valve morphology and TV repair at initial TA repair, risk factors in univariate analysis, were not independent predictors on multivariable analysis. Overall, 28% of patients progressed to ≥moderate TVR and to Z-scores of greater than 5 for valve dimensions. Conclusion: Long-term need for TV intervention remains significant. Moderate or worse initial TVR or stenosis, residual TVR after initial TA repair, and single coronary ostium are risk factors associated with need for subsequent TV intervention.

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The Danish comorbidity in liver transplant recipients study (DACOLT): a non-interventional prospective observational cohort study

BMC Gastroenterology ◽

10.1186/s12876-021-01733-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Magda Teresa Thomsen ◽

Julie Høgh ◽

Andreas Dehlbæk Knudsen ◽

Anne Marie Reimer Jensen ◽

Marco Gelpi ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplant ◽

Transplant Recipients ◽

Short Term ◽

Term Survival ◽

Blood Samples ◽

Liver Transplant Recipients ◽

Short Term Survival

Abstract Background Liver transplantation is the only curative treatment for patients with end-stage liver disease. Short-term survival has improved due to improved surgical techniques and greater efficacy of immunosuppressive drugs. However, long-term survival has not improved to the same extent as the short-term survival, and the 10-year survival after liver transplantation is 60%. In addition to liver- and transplant-related causes, comorbidities such as cardiovascular, pulmonary, renal, and metabolic diseases have emerged as leading causes of morbidity and mortality in liver transplant recipients. The objective of this study is to assess the burden of comorbidities and identify both liver- and transplant-related risk factors as well as traditional risk factors that contribute to the pathogenesis of comorbidity in liver transplant recipients. Methods/design The Danish Comorbidity in Liver Transplant Recipients (DACOLT) study is an observational, longitudinal study. We aim to include all adult liver transplant recipients in Denmark (n = approx. 600). Participants will be matched by sex and age to controls from the Copenhagen General Population Study (CGPS) and the Copenhagen City Heart Study (CCHS). Physical and biological measures including blood pressure, ankle–brachial index, spirometry, exhaled nitric oxide, electrocardiogram, transthoracic echocardiography, computed tomography (CT) angiography of the heart, unenhanced CT of chest and abdomen and blood samples will be collected using uniform protocols in participants in DACOLT, CGPS, and CCHS. Blood samples will be collected and stored in a research biobank. Follow-up examinations at regular intervals up to 10 years of follow-up are planned. Discussion There is no international consensus standard for optimal clinical care or monitoring of liver transplant recipients. This study will determine prevalence, incidence and risk factors for comorbidity in liver transplant recipients and may be used to provide evidence for guidelines on management, treatment and screening and thereby contribute to improvement of the long-term survival. Trial registration ClinicalTrials.gov: NCT04777032; date of registration: March 02, 2021.

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Differential Gene Expression Using RNA Sequencing Between Elderly Acute Myeloid Leukemia (AML) Patients with Long Versus Short-Term Survival

Blood ◽

10.1182/blood.v128.22.1683.1683 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1683-1683

Author(s):

Amy M Trottier ◽

Adnan Mansoor ◽

Carolyn J. Owen ◽

Ariz Akhter ◽

Etienne Mahe ◽

...

Keyword(s):

Gene Expression ◽

Rna Sequencing ◽

Research Funding ◽

P Value ◽

Short Term ◽

Term Survival ◽

Elderly Aml ◽

Long Term Survivors ◽

Short Term Survival

Abstract Introduction Advances in genetic sequencing have shed light on the biological underpinnings of AML, however, the vast majority of previous work has focused on young patients, with little evidence-based data in the elderly population. Older age at diagnosis is a well-known poor prognostic factor, however prognostication within the older age group itself remains a challenge making therapeutic decision making particularly difficult. In this pilot project we studied the transcriptomes of short and long-lived elderly AML patients to gain insight into the potential molecular differences and signaling pathways that may help better prognosticate patients within this unique population. Methods Elderly patients (age > 65 and not fit for induction chemotherapy) with newly diagnosed AML (excluding APL) between 2011 - 2015, inclusive, with an available diagnostic bone marrow biopsy sample were considered for inclusion in this retrospective analysis. Patients were divided into two groups: long-term survivors (survival ≥ 6 months) and short-term survivors (survival < 2 months). RNA sequencing was performed on 12 patients in the long-term survivors group and 24 patients in the short-term survivors group. RNA sequencing was conducted using the Illumina platform (Illumina NextSeq 500) and data analysis was performed with TopHat and Cufflinks software. Results Baseline clinical characteristics were similar between the short-term and long-term survival groups as shown in Table 1. RNA sequencing revealed 41 genes with statistically significant (p-values < 0.001 and false-discovery q-values < 0.001) differential expression between the long-term and short-term survival groups. See Figure 1 for a heat map reflecting the gene expression values between groups. Of these 41 genes several are known to be involved in key cellular functions and signaling pathways including RNA post-transcription regulation, apoptosis, p53 regulation, and the mTOR pathway. However, only a few have previously been studied in AML (e.g. ERG, PCK2, and ABCG1) and none have been examined in the context of elderly AML patients. Twelve of the 41 differentially expressed genes were small nucleolar RNAs (snoRNAs), a class of regulatory RNAs involved in post-transcriptional modification of ribosomal RNA. These were found to be down regulated in the short-term survivors compared to the long-term survivors (p-value range 0.00005 - 0.001). This is a novel finding. Although recent studies have found differences in snoRNA expression in AML and ALL compared to healthy donors there are no published studies examining the role of snoRNA in the prognosis of AML. CYFIP2 is involved in caspase activation and cellular apoptosis and was found to be relatively under expressed in the short-term survivors group (p-value 0.008). WRAP53 plays an important role in the regulation of p53 expression and was found to be under-expressed in the long-term survivors. PRR5L is associated with mTORC2 and was found to be relatively over-expressed in the long-term survivors (p-value 0.00002). Due to the small sample sizes of this pilot project multivariate analysis was not conducted. In addition to the individual genes, these results highlight differences in several pathways, namely the mTOR, and p53 tumor suppressor/caspase apoptotic pathways, which may be associated with prognosis for elderly patients with newly diagnosed AML and deserve further investigation. The finding of down regulation of numerous snoRNAs in elderly patients with poor outcome also warrants further detailed study with larger sample sizes to fully elucidate their potential prognostic value. Figure 1: Heat Map highlighting the differential gene expressions from RNA sequencing for long-term compared to short-term survivors. Conclusion We have identified distinctly different gene expression profiles in elderly AML patients with long-term compared to short-term survival. These differentially expressed genes provide biologic insight into AML in the elderly as well as highlight candidate pathways and cellular mechanisms on which to base future detailed study to enable accurate prognostication and improved therapeutic decision making in this understudied population. Figure 1 Figure 1. Disclosures Owen: Roche: Honoraria, Research Funding; Janssen: Honoraria; Lundbeck: Honoraria, Research Funding; Abbvie: Honoraria; Novartis: Honoraria; Gilead: Honoraria, Research Funding; Pharmacyclics: Research Funding; Celgene: Honoraria, Research Funding. Geddes:Celgene: Other: Advisory Board, Research Funding.

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A study of risk factors for catheter associated urinary tract infection

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180525 ◽

2018 ◽

Vol 5 (2) ◽

pp. 334 ◽

Cited By ~ 3

Author(s):

Leelakrishna P. ◽

Karthik Rao B.

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Closed System ◽

Univariate Analysis ◽

Significant Risk ◽

P Value ◽

Indwelling Catheters ◽

Increased Risk ◽

Catheter Size ◽

Tract Infections

Background: Catheter associated urinary tract infections (CAUTIs) are the most common causes of UTIs in postoperative cases. Many risk factors are associated with its incidence. The present study was conducted with the aim to determine the related risk factors and to identify the causative agents contributing to the urinary tract infection.Methods: This prospective study was conducted on 210 patients meeting the requirements of inclusion criteria during September 2012 to February 2014. Detailed history of the patients was recorded. Urine culture was done at different time intervals to identify the causative agent suggestive to CAUTI. Univariate analyses of the association of each variable with CAUTI and multivariable logistic regression were done to predict CAUTI outcome.Results: The mean age of study participants was 51.61 years. Among them 141 were males and 69 were female patients. On univariate analysis purpose for urine catheterization, place of catheterization, breach in the closed system of drainage, duration of catheterization, hemoglobin value less than 10, raised renal parameters with serum creatinine more than 1.5 were all significantly associated with development of CAUTI (p value 0.000). Sex of the patient (p value 0.279) and catheter size (p value 0.279) was not found to have a significant correlation with increased risk of CAUTI. On multivariate analysis, age, catheter size, diabetes, duration of catheterization, a breach in the closed system of catheter drainage and sex were found to be the significant risk factors associated with CAUTI (p<0.05).Conclusion: An understanding of the risk factors in development of CAUTI, significantly helps in reducing the additional burden on the health care system. Measures such as shortening the duration of catheterization, strict control of diabetes and sterile precautions in insertion and maintenance of indwelling catheters can help in prevention CAUTI.

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Long-Term Survival, Causes of Death, and Trends in 5-Year Mortality After Intracerebral Hemorrhage: The Tromsø Study

Stroke ◽

10.1161/strokeaha.120.032750 ◽

2021 ◽

Author(s):

Maria Carlsson ◽

Tom Wilsgaard ◽

Stein Harald Johnsen ◽

Liv-Hege Johnsen ◽

Maja-Lisa Løchen ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Intracerebral Hemorrhage ◽

Causes Of Death ◽

Population Based ◽

Term Survival ◽

Long Term Survival ◽

Risk Of Death ◽

Increased Risk

Background and Purpose: Data on long-term survival after intracerebral hemorrhage (ICH) are scarce. In a population-based nested case-control study, we compared long-term survival and causes of death within 5 years in 30-day survivors of first-ever ICH and controls, assessed the impact of cardiovascular risk factors on 5-year mortality, and analyzed time trend in 5-year mortality in ICH patients over 2 decades. Methods: We included 219 participants from the population-based Tromsø Study, who after the baseline participation had a first-ever ICH between 1994 to 2013 and 1095 age- and sex-matched participants without ICH. Cumulative survival was presented using the Kaplan-Meier method. Hazard ratios (HRs) for mortality and for the association between cardiovascular risk factors and 5-year mortality in 30-day survivors were estimated by stratified Cox proportional hazards models. Trend in 5-year mortality was assessed by logistic regression. Results: Risk of death during follow-up (median time, 4.8 years) was increased in the ICH group compared with controls (HR, 1.62 [95% CI, 1.27–2.06]). Cardiovascular disease was the leading cause of death, with a higher proportion in ICH patients (22.9% versus 9.0%; P <0.001). Smoking increased the risk of 5-year mortality in cases and controls (HR, 1.59 [95% CI, 1.15–2.19]), whereas serum cholesterol was associated with 5-year mortality in cases only (HR, 1.39 [95% CI, 1.04–1.86]). Use of anticoagulants at ICH onset increased the risk of death (HR, 2.09 [95% CI, 1.09–4.00]). There was no difference according to ICH location (HR, 1.15 [95% CI, 0.56–2.37]). Five-year mortality did not change during the study period (odds ratio per calendar year, 1.01 [95% CI, 0.93–1.09]). Conclusions: Survival rates were significantly lower in cases than in controls, driven by a 2-fold increased risk of cardiovascular death. Smoking, serum cholesterol, and use of anticoagulant drugs were associated with increased risk of death in ICH patients. Five-year mortality rates in ICH patients remained stable over time.

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