High Incidence of Venous Thromboembolism (VTE) in Patients with Cancer Hospitalized at a University Hospital in Chile. Efficacy of Pharmacological Thromboprophylaxis.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4119-4119
Author(s):  
Guillermo F. Conte ◽  
Gaston L. Figueroa ◽  
Arie D. Altmann ◽  
Luisa A. Donaire
Keyword(s):  
Cancer Patients ◽  
Oral Anticoagulant Therapy ◽  
University Hospital ◽  
Disease Stage ◽  
Medical Conditions ◽  
Oncologic Surgery ◽  
Increased Risk ◽  
High Incidence ◽  
Risk Patients ◽  
Pharmacological Thromboprophylaxis

Abstract Inpatients are at increased risk of VTE due to multiple factors. Cancer diagnosis is an important risk factor determined through prospective studies. The aims of this study are to know the incidence of VTE in cancer patients hospitalized due to acute medical conditions and describe the use of pharmacological thromboprophylaxis and its efficacy. Methods: Retrospective analysis of cancer patients admitted to the University of Chile Clinical Hospital due to acute medical conditions between 2003 and 2004. Exclusion criteria: VTE diagnosed at admission, oral anticoagulant therapy at admission, age <18 years, admission to Intensive Care Unit (ICU). It was necessary to confirm VTE diagnosis by ultrasonography or angio-CT scan. Results: Data of 366 patients was retrieved. The cancer origin was: gastric (38%), lung (19%), colorectal (15%), breast (10%), hepatocarcinoma (5%), others (13%). Seventy-seven percent of the cases presented an advanced disease (stage TNM III-IV). The main diagnoses at admission were: pneumonia (17%), vomits/dehydratation (16%), urinary tract infection (7%), decompensated diabetes mellitus (7%), digestive hemorrhage (7%). In 125 cases (34%) no type of pharmacological thromboprophylaxis was used; unfractionated heparin was used in 120 (33%) (5000 U sc c/8–12 hr) and low-molecular-weight heparin (dalteparin or enoxaparin) in 121 (33%). The VTE incidence was 3% (11 cases). In patients who did not receive thromboprophylaxis, the VTE incidence was 6.4% (8/125) versus 1.2% (3/241) in those who were administered heparin or LMWH (Odds Ratio=0.18 CI 95% 0.05–0.65). The group of patients who did not receive thromboprophylaxis was younger (median 60 vs. 65 years), had a higher frequency of thrombocytopenia (<150.000; 39% vs. 15%) and hypoprothrombinemia (INR>1.5; 35% vs. 14%), and a lower frequency of recent oncologic surgery (3% vs.19%). Conclusions: Cancer patients with acute medical conditions showed a high incidence of symptomatic VTE (3% in this series). One third of patients were not administered pharmacological thromboprophylaxis. The use of thromboprophylaxis in these high-risk patients was associated to a significative reduction of the VTE frequency.

Abstract TP209: Effect of Chemotherapy on Stroke Risk in Cancer Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takaya Kitano ◽  
Tsutomu Sasaki ◽  
Yasufumi Gon ◽  
Kenichi Todo ◽  
Shuhei Okazaki ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Propensity Scores ◽  
Stroke Risk ◽  
Cox Regression ◽  
Treatment Plan ◽  
University Hospital ◽  
Chemotherapy Group ◽  
Kaplan Meier ◽  
Increased Risk ◽  
The Impact

Introduction: Chemotherapy may be a cause of cancer-associated stroke, but whether it increases stroke risk remains uncertain. We aimed to clarify the impact of chemotherapy on stroke risk in cancer patients. Methods: We investigated 27,932 patients enrolled in a hospital-based cancer registry at Osaka University Hospital between 2007 and 2015. The registry collects clinical data, including cancer status (site and stage), on all patients treated for cancer. Of them, 19,006 patients with complete data were included. A validated algorithm was used to identify stroke events within 2 years of cancer diagnosis. Patients were divided based on whether their initial treatment plan included chemotherapy. The association between chemotherapy and stroke was analyzed using the Kaplan-Meier method and stratified Cox regression. Results: Of the 19,006 patients, 5,887 (31%) patients were in the chemotherapy group. Non-targeted chemotherapy was used in 5,371 patients. Stroke occurred in 44 patients (0.75%) in the chemotherapy group and 51 patients (0.39%) in the no-chemotherapy group. Kaplan-Meier curve analysis showed that patients in the chemotherapy group had a higher stroke risk than patients in the no-chemotherapy group (HR 1.84; 95% CI 1.23-2.75; Figure [A]). However, this difference was insignificant after adjustment for cancer status using inverse probability of treatment weighting with propensity scores (HR 1.20; 95% CI 0.76-1.91; Figure [B]). Similarly, in the stratified Cox regression model, chemotherapy was not associated with stroke after adjustment for cancer status (HR 1.26; 95% CI 0.78-2.03). These findings were consistent with analysis wherein the effect of chemotherapy was treated as a time-dependent covariate (HR 1.02; 95% CI 0.55-1.88). Conclusions: In this population, the elevated stroke risk in cancer patients who received chemotherapy was presumably due to advanced cancer stage; chemotherapy was not associated with the increased risk of stroke.

scholarly journals Glutathione S-transferase M1 (GSTM1) and T1 (GSTT1) variants and breast cancer risk in Burkina Faso

2019 ◽  
Vol 10 (1) ◽  
pp. 175-183 ◽  
Author(s):  
Isabelle Touwendpoulimdé Kiendrebeogo ◽  
Abdou Azaque Zoure ◽  
Pegdwendé Abel Sorgho ◽  
Albert Théophane Yonli ◽  
Florencia Wendkuuni Djigma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Patients ◽  
Sporadic Breast Cancer ◽  
Disease Stage ◽  
Breast Cancer Patients ◽  
Glutathione S Transferase ◽  
Increased Risk ◽  
Increased Susceptibility

AbstractBackground and objectiveBreast cancer remains the most common cause of cancer mortality in women. The aim of this study was to investigate associations between genetic variability in GSTM1 and GSTT1 and susceptibility to breast cancer.MethodsGenomic DNA was extracted from blood samples for 80 cases of histologically diagnosed breast cancer and 100 control subjects. Genotyping analyses were performed by PCR-based methods. Associations between specific genotypes and the development of breast cancer were examined using logistic regression to calculate odds ratios [1] and 95% confidence intervals (95%CI).ResultsNo correlation was found between GSTM1-null and breast cancer (OR = 1.83; 95%CI 0.90-3.71; p = 0.10), while GSTT1-null (OR = 2.42; 95%CI 1.17-5.02; p= 0.01) was associated with increased breast cancer risk. The GSTM1/GSTT1 double null was not associated with an increased risk of developing breast cancer (OR = 2.52; 95%CI 0.75-8.45; p = 0.20). Furthermore, analysis found no association between GSTM1-null (OR =1.12; 95%CI 0.08-15.50; p = 1.00) or GSTT1-null (OR = 1.71; 95%CI 0.13-22.51; p = 1.00) and the disease stage of familial breast cancer patients or sporadic breast cancer patients (GSTM1 (OR = 0.40; 95%CI 0.12-1.32; p = 0.20) and GSTT1 (OR = 1.41; 95%CI 0.39-5.12; p = 0.75)). Also, body mass index (BMI) was not associated with increased or decreased breast cancer risk in either GSTM1-null (OR = 0.60; 95%CI 0.21-1.68; p = 0.44) or GSTT1-null (OR = 0.60; 95%CI 0.21-1.68; p =0.45).ConclusionOur results suggest that only GSTT1-null is associated with increased susceptibility to breast cancer development.

Recurrence of First Afebrile Unprovoked Seizure and Parental Consanguinity: A Hospital-Based Study

2020 ◽  
Vol 35 (10) ◽  
pp. 643-648
Author(s):  
Miral A. Al Momani ◽  
Basima Almomani ◽  
Salar Bani Hani ◽  
Andrew Lux
Keyword(s):  
University Hospital ◽  
Unprovoked Seizure ◽  
Recurrent Attack ◽  
Parental Consanguinity ◽  
Pediatric Clinic ◽  
Increased Risk ◽  
High Incidence ◽  
History Of

Purpose: The aim of the current study was to determine the incidence, clinical characteristics, and risk factors associated with the recurrence of first unprovoked seizure in children. Methods: A retrospective, observational study was conducted at King Abdullah University Hospital in Jordan. Children aged from 1 month to 16 years old who attended the hospital between January 2013 to December 2017 were evaluated on the basis of medical records, from the first visit and for a 1-year follow-up period. Results: During the study period, a total of 290 cases with first unprovoked seizure were included. The incidence of first unprovoked seizure was 441 cases per 100 000 patient visits to the pediatric clinic. More than half of the cases developed a second attack (55.3%). Children with parental consanguinity were almost 3 times more likely to develop a second attack of seizure compared to those without parental consanguinity (odds ratio [OR] = 2.785, 95% confidence interval [CI] = 1.216-6.378, P = .015) and patients who had a history of focal type of seizure were almost twice as likely to develop seizure recurrence (OR = 1.798, 95% CI = 1.013-3.193, P = .045). Conclusions: The current results showed a high incidence of first unprovoked seizure among children in Jordan. Parental consanguinity and focal seizure were associated with the increased risk of recurrent attack. This finding highlights the need for public education regarding the outcomes of parental consanguinity to improve the patient’s quality of life.

Recurrence rates in patients with uterine papillary serous cancer with and without breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16529-e16529
Author(s):  
Jessica E. Stine ◽  
Stuart Pierce ◽  
Paola A. Gehrig ◽  
John Nakayama ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Recurrence Rate ◽  
Late Stage ◽  
Early Stage ◽  
Disease Stage ◽  
Serous Carcinoma ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Risk Patients ◽  
Papillary Serous Carcinoma

e16529 Background: Women with uterine papillary serous carcinoma (UPSC) are at increased risk for breast cancer and the converse is true. A genetic association between breast cancer and UPSC was recently described and counseling women faced with more than one cancer diagnosis can be difficult. Our objective was to evaluate recurrence rates of women with UPSC to those with UPSC and a personal history of breast cancer (UPSCBR). Methods: Data was collected for UPSCBR patients at two academic institutions between 7/1990 and 7/2012. Patient demographics, pathology, disease stage, and treatments were recorded. A UPSC literature review was performed focusing on recurrences per number of at-risk patients by stage. We used the fixed effect Mantel-Haenszel method to estimate the common pooled effect (recurrence rate) for the UPSC studies and compared these to UPSCBR patients. Results: Forty-three UPSCBR patients were identified. Median age at diagnosis was 72 (49-93). Twenty-six patients were Caucasian, 14 African-American and 3 other. Twenty-four (56%) had early stage at diagnosis (IA-IC) and 19 (44%) had late stage (III-IV). All but one underwent surgical staging/debulking; 36 (90%) were optimally debulked. Twelve (50%) early stage and 17 (89.5%) late stage patients underwent adjuvant therapy with radiation and/or chemotherapy. Nine studies were identified with available recurrence data for early stage UPSC; 8 for late stage. The recurrence rate for stage IA UPSCBR patients was 2/11 (18%) [95% CI: 2 to 52%] compared to 11% [95% CI: 9.8 to 13%] in the UPSC literature. In IB/IC UPSCBR patients we had 3/13 (23%) [95% CI: 5 to 54%] recur versus 21% [95% CI: 19 to 23%]. In later stages III/IV, 7/19 (37%) [95% CI:16 to 62%] UPSCBR patients had recurrences compared to 58% [95% CI: 56 to 60%] of UPSC patients. Conclusions: There is an association between breast cancer and UPSC with regard to incidence. We failed to find evidence of an appreciable difference in recurrence rates between our UPSCBR patients and UPSC patient groups from other reported studies. While diagnosis with two primary malignancies can be challenging for patients, this does not appear to impact their risk of recurrence.

Acquisition of Methicillin-Resistant Staphylococcus aureus in a Large Intensive Care Unit

2003 ◽  
Vol 24 (5) ◽  
pp. 322-326 ◽  
Author(s):  
Caroline Marshall ◽  
Glenys Harrington ◽  
Rory Wolfe ◽  
Christopher K. Fairley ◽  
Steve Wesselingh ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multivariate Analyses ◽  
University Hospital ◽  
Trauma Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Mrsa Colonization ◽  
Previous Admission

AbstractObjectives:To determine the prevalence of MRSA colonization on admission to the ICU and the incidence of MRSA colonization in the ICU.Design:Prospective cohort study.Setting:University hospital.Participants:Patients admitted to the ICU in 2000-2001.Methods:Patients were screened for MRSA with nose, throat, groin, and axilla swabs on admission and discharge. MRSA acquisition was defined as a negative admission screen and a positive discharge screen. Risk factors analyzed included previous wards/current unit, gender, age, and length of stay prior to and in the ICU. Univariate and multivariate analyses were performed using logistic regression.Results:Of screened patients, 6.8% were MRSA colonized on admission to the ICU. Some patients (11.4%) became newly colonized during their stay in the ICU. Factors that remained significant in the multivariate analysis of MRSA colonization on admission were previous admission to various wards and length of stay prior to ICU admission of more than 3 days. In the multivariate analysis of MRSA acquisition in the ICU, being a trauma patient and length of stay in the ICU greater than 2 days remained significant. Thirty-six percent of patients had both admission and discharge swabs taken. This percentage increased in the presence of a supervisory nurse.Conclusion:Significant acquisition of MRSA occurs in the ICU of our hospital, with trauma patients at increased risk. Patients who had been on the cardiothoracic ward prior to the ICU had a lower risk of MRSA colonization on admission. Presence of a supervisory nurse improved compliance with screening.

Prevalence of depression among relatives of cancer patients in Jordan: A cross-sectional survey

2011 ◽  
Vol 9 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Nizar M. Mhaidat ◽  
Suleiman A. Ai-Sweedan ◽  
Karem H. Alzoubi ◽  
Sayer I. Alazzam ◽  
Mohammed N. Banihani ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Depression Scale ◽  
Chronically Ill ◽  
University Hospital ◽  
Psychological Status ◽  
Disease Stage ◽  
Psychological State ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Prevalence Of Depression

AbstractObjective:Depression is common among chronically ill patients and their relatives. In this article, we investigated the prevalence of depression among relatives of cancer patients in Jordan, and studied the relation between several socio-demographic, disease- and treatment-related factors, together with the occurrence of depression among those relatives.Method:A cross-sectional survey study was conducted at a major university hospital in Jordan. Relatives of cancer patients were interviewed for socio-demographic information, and medical records were checked for information about disease and treatment of patient. Psychological status of the relative was assessed using the Hospital Anxiety & Depression Scale (HADS).Results:The prevalence of depression in our sample was 81.9%. Age and degree of relatedness were significantly correlated with the occurrence of depression among relatives of cancer patients. Significant correlations were also detected between depression among patient's relatives and the stage of the disease. Positive predictive factors for depression included relatives being middle aged, close relatedness, patients being in advanced disease stage, and on chemotherapy or undergoing surgery for cancer treatment.Significance of results:Depression is prevalent among relatives of cancer patients. Therefore, more attention is needed to detect changes in the psychological state of vulnerable relatives of cancer patients, in an effort to reduce the occurrence of depression.

scholarly journals Adverse Childhood Experiences (ACEs) in Newly-Diagnosed Childhood and Adolescent/Young Adult (AYA) Cancer Patients with Hematologic Malignancies

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4108-4108
Author(s):  
Lindsay F Schwartz ◽  
Marcia M Tan ◽  
Julie S McCrae ◽  
Tiffany Burkhardt ◽  
Kirsten K. Ness ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Premature Mortality ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Health Issues ◽  
Mental Health Issues ◽  
Increased Risk

Abstract Background and Aims: Childhood and adolescent/young adult (AYA) cancer survivors are at increased risk for emotional distress, chronic health conditions, and premature mortality compared to peers with no cancer history. Some, but not all, of this increased risk is explained by cancer- and treatment-related exposures. Because cancer treatment remains necessary to achieve cure, it is critical to identify and target other factors to reduce sub-optimal outcomes. Adverse Childhood Experiences (ACEs) are traumatic events occurring during childhood, such as experiencing violence and/or neglect, which are associated with poor mental health, chronic health conditions, and premature mortality in the adult general population. Little is known on how ACEs impact health in children and AYAs with cancer. Research indicates that otherwise healthy individuals exposed to ACEs experience fewer adverse health outcomes if they possess resilience, which can be learned. This provides a potential target for intervention. This pilot study aimed to identify demographic characteristics associated with ACEs and resilience as well as associations between ACEs, resilience, and the presence of chronic medical conditions, mental health issues, and substance abuse in children and AYAs with cancer. Methods: Childhood and AYA leukemia and lymphoma patients undergoing cancer treatment at the University of Chicago were included for analysis (N=38, 55.26% female, 50% non-Hispanic white, mean age at assessment 14.74±6.97 years). Participants ≤17 years old completed the study with one parent/caregiver. ACEs were measured using age-specific instruments adapted from the original ACEs study by Kaiser Permanente and the Centers for Disease Control and Prevention. Resilience was analyzed using age-specific instruments provided by the Resilience Research Centre, and resilience scores were categorized as low (≤62), moderate (63-70), high (71-76), and exceptional (≥77). For participants 0-11 years old, a parent/guardian completed the study on their behalf. 12-17 year old participants and their parent/guardian both completed the study, and participants over 18 completed the study alone. Descriptive statistics characterized demographic, biologic, treatment, and health behavior variables. The association between total scores for ACEs and resilience were measured using Pearson's correlation. Regression analysis assessed ACEs (logistic model) and resilience scores (linear model) adjusting for age, sex, race/ethnicity, household income, and insurance type. Participants were then stratified, and two sample t-tests compared potential outcomes based on ACE exposures. Results: 23 participants (60.53%) reported prior ACEs (mean total number of ACEs 1.45±1.77; range 1-7), and the mean resilience score for participants was 73.76±9.61 (range 49-85) indicating high resilience overall. Regression analyses showed the odds of reporting ACEs increased with age (OR: 1.18; 95% CI: 1.02-1.37), while resilience scores decreased with age (β=0.76; t(32)=-2.74, p=0.01) holding other variables constant. Sex, race/ethnicity, household income, and insurance type were not associated with ACEs or resilience scores. There was a strong negative correlation between the total number of ACEs and resilience, r(36)=-0.57, p<0.01; the total number of ACEs explained 32% of the variation in resilience scores. Compared to participants who did not report prior ACEs, those with ACEs were more likely to report chronic medical conditions, t(31.41)=-2.47, p=0.02, prior psychiatric diagnoses or mental health issues, t(34.16)=-2.13, p=0.04, as well as substance abuse t(31.41)=-2.47, p=0.02. Conclusions: ACEs were associated with endorsement of chronic medical conditions, mental health issues, and substance abuse in our sample of childhood and AYA patients currently receiving cancer treatment. As the total number of ACEs increased, resilience scores decreased for participants. The results of this study provide the groundwork for further investigations of ACEs and resilience in large cohorts of childhood and AYA cancer patients and survivors. This future work could provide valuable information for creating and implementing interventions designed for childhood and AYA cancer patients and survivors who have experienced ACEs, thus potentially reducing additional morbidity and premature mortality for these high-risk patients. Disclosures No relevant conflicts of interest to declare.

Incidence of deep venous thrombosis associated with central venous catheters (DVT-CVC) in cancer patients: A multicenter study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8627-8627 ◽  
Author(s):  
J. Feliu ◽  
R. Lecumberri ◽  
A. Jerez ◽  
A. Cantalapiedra ◽  
T. García ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Epidemiologic Study ◽  
Tumor Stage ◽  
Antithrombotic Prophylaxis ◽  
Increased Risk ◽  
Basal Plasma ◽  
Cancer Tumor ◽  
Risk Patients ◽  
History Of ◽  
Plasma Markers

8627 Background: The reported incidence of DVT-CVC is extremely variable (0.3–28.3% for symptomatic thrombosis and 27–66% for asymptomatic thrombosis). Data in regarding new catheter materials and insertion techniques are very limited. Likewise, the use of antithrombotic prophylaxis in cancer patients with a CVC remains debatable. Methods: A prospective epidemiologic study was performed, which included adult patients with active cancer and no history of venous thromboembolism, in whom a long term CVC was inserted. Patients were followed-up for 90 days and a bilateral upper extremity Doppler-ultrasound was performed on days 45±5 and 90±5. Likewise, basal blood samples were taken and have been analyzed for hypercoagulability markers and prothrombotic factors. Results: Inclusion period lasted from July 2004 until May 2005. 141 patients have completed the follow up, with a mean age of 52.1±14.3 years (range 21–87). The cumulative incidence of DVT-CVC was 14.2% (20/141): 6.4% were symptomatic (9/141) and 8.9% were asymptomatic (11/123). All thrombotic events, excluding 4 cases, occurred before day 45. Neither age, gender, type of tumor (solid or haematological cancer), tumor stage, type of CVC (Port or tunnelled), number of lumens, side of insertion, platelet count or use of antithrombotic prophylaxis were significantly associated with the incidence of DVT-CVC, although only 1/8 patients with DVT-CVC receiving antithrombotic prophylaxis (12.5%) used high risk prophylaxis. Patients with prior central catheters tended to have a greater incidence of DVT-CVC (P=0.10). None of the basal plasma markers analyzed (fibrinogen, D dimer, F VIII, proteine C resistance, prothrombin fragments 1+2, thrombin-antithrombin complex) have been significantly associated with increased risk of DVT-CVC. Conclusions: DVT-CVC is a frequent complication in cancer patients, as with solid tumors so with haematologic malignancies. The incidence of DVT-CVC seems to be specially high the first few weeks following catheter placement. None of the basal plasma markers analyzed in this study have been associated with the incidence of DVT-CVC. New studies must be performed to allow identification of at risk patients who might benefit from antithrombotic prophylaxis. No significant financial relationships to disclose.

Trastuzumab-related cardiotoxicity among older breast cancer patients.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 600-600
Author(s):  
Mariana Chavez-Mac Gregor ◽  
Ning Zhang ◽  
Thomas A. Buchholz ◽  
Yufeng Zhang ◽  
Jiangong Niu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Large Cohort ◽  
Heart Valve Disease ◽  
Breast Cancer Patients ◽  
Entire Cohort ◽  
Increased Risk ◽  
Risk Patients ◽  
Artery Disease ◽  
Medicare Database

600 Background: The use of trastuzumab in the adjuvant setting is associated with reduction in mortality and recurrence. Although trastuzumab is extremely well tolerated, its use is associated with congestive heart failure (CHF). The incidence of this complication in the general population remains largely unknown, especially in older patients. In this study we evaluated the rates and risk factors associated with trastuzumab-related CHF in a large cohort of older breast cancer patients. Methods: Breast cancer patients ≥ 66 years with full Medicare coverage, diagnosed with stage I-III breast cancer between 2005-2007, and treated with chemotherapy were identified in the Surveillance, Epidemiology and End Results-Medicare (SEER-Medicare) database. Chemotherapy and trastuzumab use, comorbidities and CHF were identified using ICD-9 and HCPCS codes. Analyses included descriptive statistics, Cox proportional hazard model using trastuzumab as a time-dependent variable and logistic regression. Results: A total of 3,983 patients were included, 847 (21.7%) of them received trastuzumab, median age of the entire cohort was 71 years old. Among trastuzumab users the rate of CHF was 28.6% compared to 18.1% in non-trastuzumab users (p<.0001). After adjusting for demographic and clinical characteristics, comorbidities, and type of chemotherapy used, trastuzumab users were more likely to develop CHF than non-trastuzumab users (HR 1.74; 95% CI 1.47-2.06). Among trastuzumab users, older age did not further increase the risk, however history of coronary artery disease (OR 2.23; 95%CI 1.56-3.19), heart valve disease (OR 1.41; 95%CI 1.41-2.88) and emphysema -as a proxy for smoking- (OR 2.03; 95% CI 1.13-3.63) significantly increased the risk of CHF. There was a trend for increased risk of CHF associated with anthracycline use (OR 1.36; 95% CI 0.93-2.00). Conclusions: In this large cohort of older breast cancer patients, the risk of CHF among trastuzumab users was 1.74 times higher than non-trastuzumab users, which is higher than what has been reported in younger clinical trial participants. Among older breast cancer patients treated with trastuzumab, cardiac comorbidities and emphysema may identify high risk patients.

scholarly journals High Incidence of Amoxicillin-Induced Crystal Nephropathy in Patients Receiving High Dose of Intravenous Amoxicillin

2020 ◽  
Vol 9 (7) ◽  
pp. 2022 ◽  
Author(s):  
Anne-Sophie Garnier ◽  
Juliette Dellamaggiore ◽  
Benoit Brilland ◽  
Laurence Lagarce ◽  
Pierre Abgueguen ◽  
...  
Keyword(s):  
Rare Complication ◽  
Kidney Injury ◽  
Female Gender ◽  
Primary Objective ◽  
University Hospital ◽  
High Dose ◽  
Medical Reason ◽  
Crystal Nephropathy ◽  
Increased Risk ◽  
High Incidence

Background: Amoxicillin (AMX)-induced crystal nephropathy (AICN) is considered as a rare complication of high dose intravenous (IV) AMX administration. However, recently, its incidence seems to be increasing based on French pharmacovigilance centers. Occurrence of AICN has been observed mainly with IV administration of AMX and mostly under doses over 8 g/day. Given that pharmacovigilance data are based on declaration, the real incidence of AICN may be underestimated. Thus, the primary objective of the present study was to determine the incidence of AICN in the current practice. Materials and Methods: We conducted a retrospective study between 1 January 2015 and 31 December 2017 in Angers University Hospital. Inclusion criteria were age over 18 years-old and IV AMX administration of at least 8 g/day for more than 24 h. Patients admitted directly into the intensive care units were excluded. Medical records of patients that developed Kidney Disease:Improving Global Outcome (KDIGO) stage 2–3 acute kidney injury (AKI) were reviewed by a nephrologist and a specialist in pharmacovigilance. AICN was retained if temporality analysis was conclusive, after exclusion of other causes of AKI, in absence of other nephrotoxic drug administration. Results: A total of 1303 patients received IV AMX for at least 24 h. Among them, 358 (27.5%) were exposed to AMX doses of at least 8 g/day and were included. Patients were predominantly males (68.2%) with a mean age of 69.1 years-old. AMX was administered for a medical reason in 78.5% of cases. Patients received a median dose of AMX of 12 g/day (152.0 mg/kg/day). Seventy-three patients (20.4%) developed AKI, 42 (56.8%) of which were KDIGO stage 2 or 3. Among the latter, AICN diagnosis was retained in 16 (38.1%) patients, representing an incidence of 4.47% of total patients exposed to high IV AMX doses. Only female gender was associated with an increased risk of AICN. AMX dose was not significantly associated with AICN development. Conclusion: This study suggests a high incidence of AICN in patients receiving high IV AMX doses, representing one third of AKI causes in our study. Female gender appeared as the sole risk factor for AICN in this study.

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