Discharges With Triphasic Morphology as Marker of the Risk of Death in Acute Encephalopathy

2021 ◽  
pp. 155005942110467
Author(s):  
Xavier Merchán-del-Hierro ◽  
Gabriel Persi ◽  
María C. Vulycher ◽  
Carla Chicco ◽  
Emilia M. Gatto ◽  
...  
Keyword(s):  
Lower Risk ◽  
Retrospective Cohort ◽  
Acute Encephalopathy ◽  
Likelihood Ratios ◽  
Age And Gender ◽  
Predictive Values ◽  
Factors Associated ◽  
Risk Of Death ◽  
Failure Assessment ◽  
And Gender

Introduction. In clinical practice, it is difficult to define the prognosis of patients with acute encephalopathy; a syndrome characterized by cognitive dysfunction and altered sensorium. Discharges with triphasic morphology (DTM) are an electroencephalographic pattern that might be useful to establish the risk of death. The aim of this study was to define the prognostic value of DTM regarding mortality in patients with acute encephalopathy. Methods. We conducted an observational retrospective cohort study including patients with acute encephalopathy with and without DTM paired by age and gender in a 1:2 ratio. We calculated the odds ratio (OR) to determine the association between DTM and mortality. In addition, we calculated sensibility, specificity, and predictive values. Results. We included 72 patients, 24 with DTM and 48 without DTM. Mortality was higher in patients with DTM (41.6% vs 14.5%, P  =  .01). Factors associated with a higher risk of death were DTM (OR  =  4.1, 95% confidence interval [CI] 1.3-13, P  =  .01) and sequential organ failure assessment score (OR  =  1.3, 95% CI 1.04-1.67, P  =  .02). A higher Glasgow coma scale score was associated with a lower risk of death (OR  =  0.65, 95% CI 0.51-0.83, P  =  .001). The sensibility and specificity of DTM were 59% and 75%, respectively. Positive and negative likelihood ratios were 2.36 and 0.55. Discussion. Our results revealed high mortality in patients with acute encephalopathy and DTM. This electroencephalographic pattern was associated with 4 times higher risk of death. However, its usefulness for predicting death was limited.

scholarly journals To Study Demographics as Risk Factor for Mortality Associated with COVID-19 : A retrospective cohort study

2021 ◽  
Vol 14 (3) ◽  
pp. 1519-1523
Author(s):  
Amandeep Singh Bakshi ◽  
Neetu Sharma ◽  
Jasbir Singh ◽  
Sandeep Batish ◽  
Vijay Sehga
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
P Value ◽  
Chi Square ◽  
Age And Gender ◽  
Risk Of Death ◽  
Males And Females ◽  
And Gender

Objectives : Novel coronavirus disease COVID-19 has emerged as a pandemic, claiming over 1,431,513 lives ( till Nov. 27,2020 ) worldwide involving 191 countries . The objective of the study is to evaluate age and gender as a risk factor for COVID -19 related mortality . Material and Methods : It is a retrospective cohort study , where the database of indoor COVID-19 positive patients was assessed for the study. Evaluation of the role of age and gender in mortality of COVID infection by comparing dataset of 2,142 indoor COVID positive patients with two outcome groups namely ,death and discharged groups was done. Results: The age comparison between two groups namely, death and discharged groups showed a median age of 60 years (IQR 50-70) for patients who died and 52 years (IQR 36–62) for the patients who recovered from COVID (p value-<0.001). There were 9 (0.65%) pediatric patients (<12 yrs) in the group of patients who recovered .For gender analysis (n=2129), COVID patients who died were 32.5%( n=692) ,out of which 63.6%(n=440) were males and 36.4%(n=252) were females. COVID positive patients in discharged group were 67.5%(n=1437),out of which 61.2%(n=880) were males and 38.8%(n=557) were females. There was no statistical difference between the two groups for mortality risk based on gender for COVID -19 infection (chi square value of 1.09, p value=.296) and the relative risk of death in males and females who died of COVID was 1.052 (95% CI=0.92-1.204). Conclusion: COVID-19 infection is showing predilection for male gender in both death and discharged group but the males and females are equally susceptible to the risk of death .

Abstract P609: Restarting Anticoagulant Therapy After Intracranial Hemorrhage With Atrial Fibrillation: A Nationwide Retrospective Cohort Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Jaehun Jung ◽  
Gi Hwan Bae
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Lower Risk ◽  
Retrospective Cohort ◽  
Antiplatelet Agents ◽  
Risk Of Death ◽  
Hemorrhagic Events ◽  
All Cause Mortality ◽  
Severe Hemorrhage

Background: Atrial fibrillation (AF) should be treated with anticoagulants to prevent stroke and systemic embolism. Resuming anticoagulation after intracerebral hemorrhage (ICH) poses a clinical conundrum. The absence of evidence-based guidelines to address this issue has led to wide variations in restarting anticoagulation after ICH. This study aimed to evaluate the risks and benefits of anticoagulation therapy on all-cause mortality, severe thromboembolism, and severe hemorrhage and compare the effect of novel direct oral anticoagulants (NOACs) with warfarin on post-ICH mortality in patients with AF. Methods: This retrospective cohort study was performed using health insurance claim data obtained between 2002 and 2017 from individuals with newly developed ICH with comorbid AF. We excluded participants aged < 40 years and those with traumatic ICH, subdural hemorrhage, or subarachnoid hemorrhage. The primary endpoint was all-cause mortality, and the secondary endpoints were severe thrombotic and hemorrhagic events. Anticoagulants, antiplatelet agents, and non-users were analyzed for survival with propensity score matching. Results: Among 6735 participants, 1743 (25.9%) and 1690 (25.1%) used anticoagulants and antiplatelet agents, respectively. Anticoagulant (HR, 0.321; 95% CI, 0.264-0.390; P < 0.0001) or antiplatelet users (HR, 0.393; 95% CI, 0.330-0.468; P < 0.0001) had a lower risk of all-cause mortality than non-users. However, there was no difference between the two drug users (HR, 1.183; 95% CI, 0.94-1.487; P = 0.152; reference: anticoagulant). The risk of acute thrombotic events, although not hemorrhagic events, was significantly lower in anticoagulant users than in antiplatelet users. In addition, anticoagulation between 6 to 8 weeks post-ICH showed a tendency of the lowest risk of death. Further, NOACs were associated with a lower risk of all-cause mortality than warfarin. Conclusions: Our results showed that in patients with AF, resuming anticoagulants between 6 and 8 weeks after ICH improved all-cause mortality, severe thromboembolism, and severe hemorrhage. Further, compared with warfarin, NOAC had additional benefits.

scholarly journals The association of tissue doppler E/e' ratio with poor survival is modified by gender and is attenuated with advanced age

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Wasserstrum ◽  
R Gilead ◽  
R Kuperstein ◽  
S Ben-Zekry ◽  
O Vatury ◽  
...  
Keyword(s):  
Cox Regression ◽  
Mitral Annulus ◽  
Tissue Doppler ◽  
Outcome Data ◽  
Poor Survival ◽  
Age And Gender ◽  
Risk Of Death ◽  
Increased Risk ◽  
And Gender

Abstract Introduction Contemporary guidelines recommend a universal cutoff of 14 for the ratio between early mitral flow wave and early diastolic mitral annulus velocity measured by tissue doppler (E/e' ratio). While age-dependent normal E/e' values have been suggested, outcome data is lacking. Purpose We sought to evaluate the modification effect of age and gender on the prognostic value of the E/e' ratio. Methods Consecutive patients who underwent echocardiographic evaluation between 2009 and 2021 (N=104,315) in a single tertiary cardiovascular center. Patients with left or right ventricular dysfunction, any significant valvular disease, structural heart disease or evidence of pulmonary hypertension were excluded. Cancer and mortality data were available for all subjects from national registries. Patients with a metastatic malignancy at baseline or during follow up were excluded. Cox regression models were applied. Results Overall, 44,541 patients were included in the final analysis. Mean age was 55±17, 59% were male and 63% of the exams were performed in an outpatient setting. An elevated E/e' ratio above 14 was documented in 2,598 (7%) patients. During a median follow-up of 5.7 (IQR 2.8–9.1) years, 5,015 (11.3%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death at 6 years was 23.4% (21.6–25.3) among patients with elevated E/e' ratio compared with 9.7% (9.3–10.0) among patients with E/e'&lt;14 (p Log rank &lt;0.001). This difference was less significant as age progressed (figure 1). Multivariate cox-regression model yielded consistent results such that an elevated E/e' ratio was associated with 2.66-fold increased risk of death during follow up (95% CI 2.44–2.89, p&lt;0.001), and there was a decline in the increased risk and significant as age advanced in both genders (figure 2). Interaction analysis was significant for both gender and age such the association of elevated E/e' ratio with poor survival was more significant among men compared with women and among young vs. older subjects. Among women, elevated E/e' was associated with 2.4-fold increased risk of death versus 2.7-fold increased risk among men. Similarly, the hazard ratio for death associated with elevated E/e' was 2.29 (95% CI 1.74–3.02), 1.8 (95% CI 1.5–2.1), 1.13 (95% CI 0.97–1.31) and 1.07 (95% CI 0.92–1.25) for the age groups of &lt;60, 60–70, 70–80 and &gt;80, respectively. In a sensitivity analysis, similar findings were seen in when excluding patients with mild hypertrophy (maximal wall thickness &gt;12mm) and without any mitral annulus calcification. Conclusion In apparently normal hearts, an elevated E/e' ratio is independently associated with increased mortality. This association is more pronounced among men and is attenuated with increased age. This study supports the need for gender-specific and age-specified outcome data with respect to measures of diastolic dysfunction. FUNDunding Acknowledgement Type of funding sources: None. Survival by age and gender groups E/e' &gt;14 and mortality by age and gender

scholarly journals Plasma Gelsolin Reinforces the Diagnostic Value of FGF-21 and GDF-15 for Mitochondrial Disorders

2021 ◽  
Vol 22 (12) ◽  
pp. 6396
Author(s):  
Ana Peñas ◽  
Miguel Fernández-De la Torre ◽  
Sara Laine-Menéndez ◽  
David Lora ◽  
María Illescas ◽  
...  
Keyword(s):  
Plasma Levels ◽  
Diagnostic Performance ◽  
Diagnostic Value ◽  
Mitochondrial Disorders ◽  
Protein Biomarkers ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Discrimination Ability ◽  
Plasma Gelsolin ◽  
And Gender

Mitochondrial disorders (MD) comprise a group of heterogeneous clinical disorders for which non-invasive diagnosis remains a challenge. Two protein biomarkers have so far emerged for MD detection, FGF-21 and GDF-15, but the identification of additional biomarkers capable of improving their diagnostic accuracy is highly relevant. Previous studies identified Gelsolin as a regulator of cell survival adaptations triggered by mitochondrial defects. Gelsolin presents a circulating plasma isoform (pGSN), whose altered levels could be a hallmark of mitochondrial dysfunction. Therefore, we investigated the diagnostic performance of pGSN for MD relative to FGF-21 and GDF-15. Using ELISA assays, we quantified plasma levels of pGSN, FGF-21, and GDF-15 in three age- and gender-matched adult cohorts: 60 genetically diagnosed MD patients, 56 healthy donors, and 41 patients with unrelated neuromuscular pathologies (non-MD). Clinical variables and biomarkers’ plasma levels were compared between groups. Discrimination ability was calculated using the area under the ROC curve (AUC). Optimal cut-offs and the following diagnostic parameters were determined: sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and efficiency. Comprehensive statistical analyses revealed significant discrimination ability for the three biomarkers to classify between MD and healthy individuals, with the best diagnostic performance for the GDF-15/pGSN combination. pGSN and GDF-15 preferentially discriminated between MD and non-MD patients under 50 years, whereas FGF-21 best classified older subjects. Conclusion: pGSN improves the diagnosis accuracy for MD provided by FGF-21 and GDF-15.

scholarly journals Suicide and attempted suicide among people of Caribbean origin with psychosis living in the UK

2003 ◽  
Vol 183 (1) ◽  
pp. 40-44 ◽  
Author(s):  
K. McKenzie ◽  
J. Van Os ◽  
C. Samele ◽  
E. Van Horn ◽  
T. Tattan ◽  
...  
Keyword(s):  
Suicidal Behaviour ◽  
Odds Ratio ◽  
Lower Risk ◽  
Attempted Suicide ◽  
Secondary Analysis ◽  
Negative Interaction ◽  
Age And Gender ◽  
Significant Difference ◽  
And Gender ◽  
The Uk

BackgroundA report from a 1980s cohort claimed that suicidal behaviour was four times less common in UK-resident people of Caribbean origin with psychosis than in British Whites. Since then, evidence has accumulated that the rate of suicide and suicidal ideation has been increasing.AimsTo compare rates of suicidal behaviour in people of Caribbean and British White origin in a large multi-centre sample of patients with psychosis.MethodA secondary analysis of 708 patients with psychosis followed up for 2 years. Outcome measures of reported suicide and attempted suicide were adjusted for socio-economic and clinical differences between groups at baseline.ResultsPeople of Caribbean origin had a lower risk of suicidal behaviour than British Whites (odds ratio adjusted for age and gender 0.49, 95% C1 0.26–0.92). There was a strong negative interaction between ethnic group and age: suicidal acts were four times less likely in people of Caribbean origin aged over 35 years compared with British Whites, but there was no large or significant difference in those under 35.ConclusionsThe previously reported lower relative risk of suicidal behaviour in people of Caribbean origin with psychosis is restricted to those over 35 years, suggesting that the protective effect of Caribbean origin is disappearing in younger generations.

Suicidal/self-harm behaviors among cancer patients: a population-based competing risk analysis

2020 ◽  
pp. 1-10
Author(s):  
Vera Yu Men ◽  
Clifton Robert Emery ◽  
Tai-Chung Lam ◽  
Paul Siu Fai Yip
Keyword(s):  
Cancer Patients ◽  
Cumulative Incidence ◽  
Competing Risk ◽  
Contributing Factors ◽  
Age And Gender ◽  
Psychiatric Comorbidities ◽  
Risk Of Death ◽  
Self Harm ◽  
And Gender ◽  
The Impact

Abstract Background Cancer patients had elevated risk of suicidality. However, few researches studied the risk/protective factors of suicidal/self-harm behaviors considering the competing risk of death. The objective of this study is to systematically investigate the risk of suicidal/self-harm behaviors among Hong Kong cancer patients as well as the contributing factors. Methods Patients aged 10 or above who received their first cancer-related hospital admission (2002–2009) were identified and their inpatient medical records were retrieved. They were followed for 365 days for suicidal/self-harm behaviors or death. Cancer-related information and prior 2-year physical and psychiatric comorbidities were also identified. Competing risk models were performed to explore the cumulative incidence of suicidal/self-harm behavior within 1 year as well as its contributing factors. The analyses were also stratified by age and gender. Results In total, 152 061 cancer patients were included in the analyses. The cumulative incidence of suicidal/self-harm behaviors within 1 year was 717.48/100 000 person-years. Overall, cancer severity, a history of suicidal/self-harm behaviors, diabetes and hypertension were related to the risk of suicidal/self-harm behaviors. There was a U-shaped association between age and suicidal/self-harm behaviors with a turning point at 58. Previous psychiatric comorbidities were not related to the risk of suicidal/self-harm behaviors. The stratified analyses confirmed that the impact of contributing factors varied by age and gender. Conclusions Cancer patients were at risk of suicidal/self-harm behaviors, and the impacts of related factors varied by patients' characteristics. Effective suicide prevention for cancer patients should consider the influence of disease progress and the differences in age and gender.

scholarly journals Risk Factors of Cholera Transmission in AL-Hudeidah, Yemen (Preprint)

2021 ◽  
Author(s):  
Abdulqawi Mohammed Qaserah ◽  
Mohammed Abdullah AL-Amad ◽  
Abdulwahed Abduljabbar Al Serouri ◽  
Yousef Saleh Khader
Keyword(s):  
Risk Factors ◽  
Drinking Water ◽  
Fruits And Vegetables ◽  
Severe Dehydration ◽  
Cholera Outbreak ◽  
Age And Gender ◽  
Factors Associated ◽  
Water Chlorination ◽  
And Gender ◽  
Structured Questionnaire

BACKGROUND Yemen has recently faced the largest cholera outbreak in the world since late September 2016. In 2019, 858,667 cases with 1,024 deaths were reported in 2019 where AL-Hudeidah was one of the most affected areas. OBJECTIVE This study aimed to determine the risk factors associated with cholera transmission in AL-Hudeidah city. METHODS A total of 104 cholera cases (57 females and 47 males) who presented to cholera treatment centers in Al Hudeidah city with three or more watery stools in a 24-hour period and with moderate or severe dehydration were identified. Each case was matched by age and gender with two controls who were living in the next house of the case. A semi-structured questionnaire was used to collect data on behavioral and environmental risk factors such as drinking water form public wells, storing water in containers, consumption of unwashed vegetables or fruits and sharing toilet. RESULTS The median age was 20 years (range: 5-80) for cases and 23 (range: 5-85) for controls. Only 6% of cases and 4% of controls were employed. Multivariate analysis showed that eating unwashed vegetables or fruits (OR 7.0, 95% CI: 1.6 – 30.6; P =0.012), storing water in containers (OR = 3, 95% CI: 1.3-7.3; P =0.013), drinking water from public well (OR= 2.5, 95% CI: 1.1-5.7: P= 0.022) and using public toilet (OR 5.2, 95% CI :1.1-24.4; P =0.038) were significantly associated with cholera. CONCLUSIONS Drinking water form public wells, storing water in containers, consumption of unwashed vegetables or fruits and sharing toilet are main risk factors of Cholera. Therefore, increasing awareness of population toward the importance of water chlorination and washing fruits and vegetables through health education campaign is strongly recommended.

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