Involvement of L5-S1 level as an independent risk factor for adverse outcomes after surgical treatment of lumbar pyogenic spondylitis: A multivariate analysis

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110355
Author(s):  
Sung Cheol Park ◽  
Sam Yeol Chang ◽  
GeunWu Gimm ◽  
Sujung Mok ◽  
Hyoungmin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Treatment Failure ◽  
Significant Risk ◽  
Binary Logistic Regression ◽  
Adverse Outcomes ◽  
Polymicrobial Infection ◽  
Pyogenic Spondylitis ◽  
Independent Risk Factors ◽  
Thorough Debridement

Purpose: To identify the independent risk factors for adverse outcomes and determine the effect of L5-S1 involvement on the outcome of surgical treatment of lumbar pyogenic spondylitis (PS). Methods: A retrospective analysis was performed for all consecutive patients who underwent surgery for lumbar PS between November 2004 and June 2020 at a single institution. The patients were divided into two groups based on the outcomes: good and adverse (treatment failure, relapse, or death). Treatment failure was defined as persistent or worsening pain with C-reactive protein (CRP) reduction less than 25% from preoperative measurement or requiring additional debridement. Relapse was defined as the reappearance of symptoms and signs with an elevated white blood cell count, erythrocyte sedimentation rate, and CRP after the first period of treatment. Binary logistic regression analyses were performed to identify the independent risk factors for adverse outcomes. Results: Twenty-four (21.2%) of the 113 patients were classified as having adverse outcomes: treatment failure, relapse, and death occurred in 15, 7, and 2 patients, respectively. The involvement of L5-S1 (adjusted odds ratio [aOR] = 6.561, P = 0.004), Methicillin-resistant Staphylococcus aureus (MRSA) infection (aOR = 6.870, P = 0.008), polymicrobial infection (aOR = 12.210, P = 0.022), and Charlson comorbidity index (CCI; P = 0.005) were identified as significant risk factors for adverse outcomes. Conclusion: Involvement of L5-S1, MRSA, polymicrobial infection, and CCI were identified as independent risk factors for adverse outcomes after surgical treatment of lumbar PS. Because L5-S1 is anatomically demanding to access anteriorly, judicious access and thorough debridement are recommended in patients requiring anterior debridement of L5-S1.

scholarly journals Different Clinical Characteristics and Impacts of Carbapenem-Resistance on Outcomes Between Acinetobacter Baumannii and Pseudomonas Aeruginosa Bacteraemia: A Multicentre Prospective Observational Study

2021 ◽  
Author(s):  
Chan Mi Lee ◽  
Young-Jun Kim ◽  
Sook-In Jung ◽  
Seong Eun Kim ◽  
Wan Beom Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Risk Factor ◽  
Treatment Failure ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Carbapenem Resistance ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistance (CR) causes poor clinical outcomes and has limited treatment options. We aim to evaluate the differences in clinical characteristics and impact of carbapenem-resistance on outcomes between Acinetobacter baumannii (ABA) and Pseudomonas aeruginosa (PAE) bacteraemia. Methods: We prospectively identified all patients with ABA and PAE bacteraemia in 10 hospitals over a 1-year period and collected their detailed clinical information. Treatment failure was defined as all-cause 30-day mortality, persistent bacteraemia, or recurrence within 30 days.Results: We included 304 ABA and 241 PAE bacteraemia cases. CR was detected in 216 ABA (71%) and 55 PAE (23%). Treatment failure was significantly higher in CR-ABA than in CR-PAE (60.6% vs. 34.5%, P = 0.001). Multivariate analyses were stratified by patient data according to CR and the appropriateness of empirical therapy. For ABA patients, severe sepsis or septic shock and high Pitt bacteraemia score were independent risk factors for treatment failure in the inappropriate empirical antibiotics group. Pneumonia was a significant risk factor in the appropriate group. For PAE patients, hospital-acquired infection and high Pitt bacteraemia score were independent risk factors for treatment failure in both groups. CR was an independent risk factor in ABA for treatment failure in both the inappropriate (adjusted odds ratio [aOR]: 6.17, 95% confidence interval [CI]: 1.13-33.75, P = 0.036) and appropriate empirical treatment groups (aOR: 4.15, 95% CI: 1.16-14.84, P = 0.029), but not for patients with PAE bacteraemia. Conclusions: We demonstrated significant differences in the clinical characteristics and impact of CR on the clinical outcomes between ABA and PAE bacteraemia. Our findings suggest that different approaches may be needed to treat ABA and PAE bacteraemia.

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

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.

Prenatal and neonatal risk factors for schizophrenia

1997 ◽  
Vol 170 (2) ◽  
pp. 128-133 ◽  
Author(s):  
Christina M. Hultman ◽  
Arne Öhman ◽  
Sven Cnattingius ◽  
Ing-Marie Wieselgren ◽  
Leif H. Lindström
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Subsequent Development ◽  
Summary Score ◽  
Obstetric Complications ◽  
Physical Size ◽  
Small Head ◽  
Schizophrenic Patients ◽  
Independent Risk Factors ◽  
Birth Records

BackgroundThe present study examines the effects of independent, single pre- and perinatal risk factors and rates of obstetric complications upon the subsequent development of schizophrenia.MethodThis study was based on prospectively recorded birth records of 107 cases (82 with schizophrenic disorders and 25 with other psychotic reactions) and 214 controls, individually matched by gender and time and place of birth. Variables univariately associated with significantly elevated risk were entered in a logistic regression model.ResultsA high non-optimality summary score (> or = 7 complications of 34 possible) was a significant risk estimate for the total index group (OR 4.58, 95% CI 1.74–12.03) and the 82 schizophrenic patients (OR 3.67, CI 1.30–10.36). Patients with 2–6 complications also had an increased, although lower, risk (OR 1.67, CI 1.02–2.75). A disproportionate birth weight for body length (OR 3.57, CI 1.77–7.19) and a small head circumference (OR 3.93, CI 1.32–11.71) were the strongest independent risk factors.ConclusionsA contribution of obstetric complications to the risk of schizophrenia was confirmed. Only aberrations in physical size remained as individual independent risk factors.

Features of the course of coronavirus infection in patients with diabetes mellitus

2022 ◽  
pp. 18-21
Author(s):  
Vladimir Anatolievich Klimov ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Human Population ◽  
Fatal Outcome ◽  
Significant Risk ◽  
Adverse Outcomes ◽  
Concomitant Disease ◽  
Patients With Diabetes ◽  
Coronavirus Infection ◽  
Population Mortality

Diabetesmellitus, overweight and the age of a patient over 65 years old are identified by clinicians as themain factors that can complicate the course of the coronavirus infection and increase the likelihood of fatal outcome. Although in the general human population mortality from coronavirus fluctuateswithin 3–5 %, sometimes very significantly differing in individual countries, this level can reach 15–25 % among patientswith diabetes, especially for those receiving insulin therapy. Diabetes mellitus as a concomitant disease in COVID-19 is considered one of the most significant risk factors for the development of adverse outcomes due to a more severe course of infection in conditions of hyperglycemia and other aggravating factors.

Risk factors for post-polypectomy bleeding; a retrospective case-control study of a high-volume colonoscopy center

2021 ◽  
Author(s):  
Dimitrios Eleftheriadis ◽  
Christina Imalis ◽  
Guido Gerken ◽  
Heiner Wedemeyer ◽  
Jan Duerig
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Ileocecal Valve ◽  
Binary Logistic Regression ◽  
High Volume ◽  
Binary Logistic Regression Analysis ◽  
Care Hospital ◽  
Retrospective Case ◽  
Polyp Size ◽  
Epinephrine Injection

Abstract Background and aim Post-polypectomy bleeding (PPB) remains an uncommon although serious complication of colonoscopy. The aim of this study is to determine the PPB-prevalence in a secondary care hospital and its associated risk factors. Patients and methods We collected data from 581 patients, with the removal of 1593 polyps between August 2017 and August 2019. A univariate binary logistic regression analysis was conducted retrospectively. Results PPB occurred in only 10 cases, representing 1.7% of patients: immediate in 1.2% and delayed in 0.5%. The number of removed polyps per patient [4.5 (SD 2.59) for hemorrhagic vs. 2.74 (SD 1.98) for non-hemorrhagic group] and the propofol dose [232 mg (SD 93.07) for hemorrhagic vs. 133 mg (SD 57.28) for non-hemorrhagic group] were relevant patient-related risk factors. The polyp-based analysis showed the polyp size [18.4 mm (SD 10.44) for hemorrhagic vs. 4.42 mm (SD 4.29) for non-hemorrhagic group], the morphology [wide-based: OR 24.83 (95 % CI 2.76 – 223.44), pedunculated: OR 56.67 (95 % CI 5.03 – 638.29)], the location at ileocecal valve [OR 20.48, 95 % CI 1.81 – 231.97)], and the polypectomy method [hot snare piecemeal with epinephrine injection: OR 75.38 (95 % CI 7.67 – 741.21)] as significant risk factors for PPB, too. Conclusions The low rate of PPB confirms the safety of the procedure in non-tertiary, high-volume colonoscopy centers. The number of polyps removed per patient, the polyp size, morphology and location, as well as the sedation dose and the method of polypectomy were shown as relevant risk factors.

scholarly journals Clinical Significance of CYFRA21-1, AFP, CA-153, CEA, and CA-199 in the Diagnosis of Lung Cancer Ocular Metastasis in Hypertension Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing Tang ◽  
Qian-Min Ge ◽  
Rong Huang ◽  
Hui-Ye Shu ◽  
Ting Su ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Logistic Regression ◽  
Sensitivity And Specificity ◽  
Cancer Metastasis ◽  
Binary Logistic Regression ◽  
Diagnostic Value ◽  
Ca 125 ◽  
Pathological Type ◽  
Independent Risk Factors

Purpose: To detect lung metastases, we conducted a retrospective study to improve patient prognosis.Methods: Hypertension patients with ocular metastases (OM group; n = 58) and without metastases (NM group; n = 1,217) were selected from individuals with lung cancer admitted to our hospital from April 2005 to October 2019. The clinical characteristics were compared by Student's t-test and chi-square test. Independent risk factors were identified by binary logistic regression, and their diagnostic value evaluated by receiver operating characteristic curve analysis.Results: Age and sex did not differ significantly between OM and NM groups; There were significant differences in pathological type and treatment. Adenocarcinoma was the main pathological type in the OM group (67.24%), while squamous cell carcinoma was the largest proportion (46.43%) in the NM group, followed by adenocarcinoma (34.10%). The OM group were treated with chemotherapy (55.17%), while the NM group received both chemotherapy (39.93%) and surgical treatment (37.06%). Significant differences were detected in the concentrations of cancer antigen (CA)−125, CA-199, CA-153, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), cytokeratin fraction 21-1 (CYFRA21-1), total prostate-specific antigen, alkaline phosphatase, and hemoglobin (Student's t-test). Binary logistic regression analysis indicated that CA-199, CA-153, AFP, CEA, and CYRFA21-1 were independent risk factors for lung cancer metastasis. AFP (98.3%) and CEA (89.3%) exhibited the highest sensitivity and specificity, respectively, while CYRFA21-1 had the highest area under the ROC curve value (0.875), with sensitivity and specificity values of 77.6 and 87.0%, respectively. Hence, CYFRA21-1 had the best diagnostic value.

scholarly journals Prognostic Nutritional Index Is a Better Predictor of Perioperative Adverse Outcomes in Patients With Femoral Fractures: a Retrospective Study

2021 ◽  
Author(s):  
Miao He ◽  
Qinghong Fan ◽  
Yuhang Zhu ◽  
Dexing Liu ◽  
Xingxing Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nutritional Assessment ◽  
Femoral Fractures ◽  
Prognostic Nutritional Index ◽  
Adverse Outcomes ◽  
Major Influence ◽  
Binary Logistic Regression Analysis ◽  
Complication Rates ◽  
Nutritional Index ◽  
Independent Risk Factors

Abstract Background: Surgery is usually the best treatment for patients with femoral fractures. However, the incidence of perioperative adverse outcomes in such cases is quite high. Nutrition has a major influence on fracture healing, and malnutrition is associated with higher complication rates, higher mortality rates, and longer hospitalisation periods. In this study, we aimed to identify independent risk factors and assess the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. Methods: This retrospective observational study included 343 patients who underwent surgery for a single femur fracture at the Affiliated Hospital of Zunyi Medical University in 2018. Binary logistic regression analysis was applied to identify significant independent risk factors. The discriminatory ability of independent predictors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). Results: In total, 159 patients (46.4%) had perioperative adverse outcomes. PNI (OR: 0.819, 95% CI: 0.754–0.889, P < 0.001), age (OR: 1.042, 95% CI: 1.020–1.066, P < 0.001), time to admission (OR: 1.404, 95% CI: 1.117–1.765, P = 0.004), hypertension (OR: 1.912, 95% CI: 1.049–3.488, P = 0.034), combined injures (OR: 2.739, 95% CI: 1.338–5.607, P = 0.006), and operation types (OR: 3.696, 95% CI: 1.913–7.138, P < 0.001) were independent factors for perioperative adverse outcomes. Based on the AUC (PNI: 0.772, 95% CI: 0.723–0.821, P < 0.001; age: 0.678, 95% CI: 0.622–0.734, P < 0.001; time to admission: 0.585, 95% CI: 0.525–0.646, P = 0.006), the PNI had the optimal discrimination ability, indicating its superiority over other independent predictors (age vs. PNI, P = 0.002; time to admission vs. PNI, P < 0.001). Conclusions: This study showed that the PNI was a better and effective independent predictor of perioperative adverse outcomes in patients with femoral fractures. Our findings suggest that nutritional assessment at admission and appropriate intervention strategies are necessary for patients with femoral fractures.

scholarly journals Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 29
Author(s):  
Chia-Ying Ho ◽  
Yu-Chien Wang ◽  
Shy-Chyi Chin ◽  
Shih-Lung Chen
Keyword(s):  
Risk Factors ◽  
Airway Obstruction ◽  
Parapharyngeal Space ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Deep Neck Infection ◽  
Acute Epiglottitis ◽  
Neck Infection ◽  
Submandibular Space ◽  
Independent Risk Factors

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

scholarly journals Impacts of Multidrug-Resistant Pathogens and Inappropriate Initial Antibiotic Therapy on the Outcomes of Neonates with Ventilator-Associated Pneumonia

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 760
Author(s):  
Hsiao-Chin Wang ◽  
Chen-Chu Liao ◽  
Shih-Ming Chu ◽  
Mei-Yin Lai ◽  
Hsuan-Rong Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Treatment Failure ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Neurological Sequelae ◽  
Independent Risk Factors

It is unknown whether neonatal ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) pathogens and inappropriate initial antibiotic treatment is associated with poor outcomes after adjusting for confounders. Methods: We prospectively observed all neonates with a definite diagnosis of VAP from a tertiary level neonatal intensive care unit (NICU) in Taiwan between October 2017 and March 2020. All clinical features, therapeutic interventions, and outcomes were compared between the MDR–VAP and non-MDR–VAP groups. Multivariate regression analyses were used to investigate independent risk factors for treatment failure. Results: Of 720 neonates who were intubated for more than 2 days, 184 had a total of 245 VAP episodes. The incidence rate of neonatal VAP was 10.1 episodes/per 1000 ventilator days. Ninety-six cases (39.2%) were caused by MDR pathogens. Neonates with MDR–VAP were more likely to receive inadequate initial antibiotic therapy (51.0% versus 4.7%; p < 0.001) and had delayed resolution of clinical symptoms (38.5% versus 25.5%; p = 0.034), although final treatment outcomes were comparable with the non-MDR–VAP group. Inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. The VAP-attributable mortality rate and overall mortality rate of this cohort were 3.7% and 12.0%, respectively. Independent risk factors for treatment failure included presence of concurrent bacteremia (OR 4.83; 95% CI 2.03–11.51; p < 0.001), septic shock (OR 3.06; 95% CI 1.07–8.72; p = 0.037), neonates on high-frequency oscillatory ventilator (OR 4.10; 95% CI 1.70–9.88; p = 0.002), and underlying neurological sequelae (OR 3.35; 95% CI 1.47–7.67; p = 0.004). Conclusions: MDR–VAP accounted for 39.2% of all neonatal VAP in the neonatal intensive care unit (NICU), but neither inappropriate initial antibiotics nor MDR pathogens were associated with treatment failure. Neonatal VAP with concurrent bacteremia, septic shock, and underlying neurological sequelae were independently associated with final worse outcomes.

Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective study in a tertiary center in Hong Kong

2020 ◽  
pp. 039139882096558
Author(s):  
Ka Man Fong ◽  
Shek Yin Au ◽  
George Wing Yiu Ng ◽  
Anne Kit Hung Leung
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Primary Outcome ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Chinese Patients ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Tertiary Center ◽  
Independent Risk Factors

Purpose: Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications. Materials and Methods: This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay. Results: Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events. Conclusions: Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.

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