The Effects of the Degree of Mobility Reduction and Prespecified Risk Factors on Venous Thromboembolism Rates in Acutely Ill Medical Patients in the EXCLAIM Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1862-1862 ◽  
Author(s):  
Roger D. Yusen ◽  
Russell D. Hull ◽  
Sebastian M. Schellong ◽  
Victor F. Tapson ◽  
Manuel Monreal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Major Bleeding ◽  
P Value ◽  
Medical Patients ◽  
Standard Duration ◽  
Extended Duration ◽  
Level 1 ◽  
Reduced Mobility ◽  
Level 2

Abstract Introduction EXCLAIM showed a 44% reduction of the relative risk of venous thromboembolism (VTE) with extended-duration enoxaparin prophylaxis compared with placebo, following standard-duration prophylaxis in acutely ill medical patients (2.8% vs 4.9%; RR 0.56; 95% CI 0.39–0.80; p=0.001). We retrospectively assessed the effects of degree of reduced mobility and prespecified risk factors on the incidence of VTE in EXCLAIM. Methods EXCLAIM eligibility required a recent (≤3 days) reduction in mobility due to acute medical illness, an anticipated level 1 (total bed rest/sedentary; no bathroom privileges) or level 2 (level 1 with bathroom privileges) decreased mobility, and age ≥40 years. During the latter part of the study, a protocol amendment required patients with level 2 mobility to have ≥1 of 3 additional prespecified risk factors (history of cancer, history of VTE, age >75 years). Enrolled patients received enoxaparin 40mg SC od for 10±4 days. Randomized patients received double-blind therapy (enoxaparin 40mg SC od or placebo) for 28±4 additional days. Patients were screened for deep vein thrombosis with bilateral proximal lower extremity compression ultrasound after randomized therapy. A blinded committee adjudicated cases of suspected VTE and major bleeding. Results Of patients evaluable for VTE (pre- and post-amendment; n=4995), 42% had level 1 mobility. 43% with level 2 mobility met the amended eligibility criteria. The incidence of VTE was 3.2%. Treatment effects on VTE incidence and major bleeding rates were consistent within mobility groups, regardless of the presence of prespecified risk factors (Table). In patients with level 1 mobility, those with ≥1 prespecified risk factors had a higher VTE incidence than those without (4.8% vs 2.6%; p=0.007). In patients with level 2 mobility, those with ≥1 risk factors had a higher VTE incidence than those without (4.6% vs 1.9%; p<0.0001). Table: Effect of level of reduced mobility and prespecified risk factors on incidence of VTE and major bleeding in patients receiving extended-duration prophylaxis or placebo, following standard-duration prophylaxis Level of mobility and number of prespecified risk factors Extended-duration enoxaparin Extended-duration placebo p-value for interaction* *Non-significant p-value denotes consistent treatment effect among subgroups; n=5963 for assessment of bleeding VTE (%) Level 1 - no risk factors 2.1 3.0 0.36 Level + ≥1 risk factor 2.7 6.8 Level 2 - no risk factors 1.9 2.0 Level 2 + ≥1 risk factor 3.5 5.6 Major bleeding (%) Level 1 - no risk factors 0.4 0.0 1.00 Level 1 + ≥1 risk factor 0.6 0.0 Level 2 - no risk factors 0.8 0.4 Level 2 + ≥1 risk factor 0.8 0.4 Conclusion After acutely ill medical patients with reduced mobility received standard-duration VTE prophylaxis, the presence of prespecified risk factors was associated with an increased incidence of VTE, independent of the level of reduced mobility. The treatment effects of extended-duration prophylaxis with enoxaparin compared with placebo were consistent among subgroups.

Consistent Venous Thromboembolism Risk Reduction by Extended- Versus Standard-Duration Enoxaparin Prophylaxis in Subgroups of Acutely Ill Medical Patients in the EXCLAIM Study.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1863-1863 ◽  
Author(s):  
Victor F. Tapson ◽  
Russell D. Hull ◽  
Sebastian M. Schellong ◽  
Manuel Monreal ◽  
Meyer-Michel Samama ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Odds Ratio ◽  
Primary Diagnosis ◽  
Medical Patients ◽  
Once Daily ◽  
Standard Duration ◽  
Extended Duration ◽  
Level 1 ◽  
Reduced Mobility ◽  
Patient Subgroups

Abstract Introduction In the EXCLAIM study, extended-duration enoxaparin prophylaxis reduced the relative risk of VTE in acutely ill medical patients by 44% compared with placebo, following standard-duration prophylaxis (2.8% vs 4.9%; RR 0.56; 95% CI 0.39–0.80; p=0.0011). We assessed the benefits of extended-duration enoxaparin prophylaxis in subgroups of acutely ill medical patients with the most prominent primary diagnoses enrolled in EXCLAIM. Methods Patients enrolled in EXCLAIM had: recent reduced mobility (≤3 days) due to a medical illness, age ≥40 years, and anticipated level 1 (total bed rest or sedentary without bathroom privileges) or level 2 (level 1 with bathroom privileges) reduced mobility with further risk factors. Eligible patients received enoxaparin 40mg SC once-daily for 10±4 days, and were then double-blind randomized and received enoxaparin 40mg SC once-daily (n=2013) or placebo (n=2027) for a further 28±4 days. Asymptomatic DVT were diagnosed by bilateral compression ultrasound after completion of the randomized treatment. Suspected cases of symptomatic DVT or PE were confirmed by objective tests. Fatal PE were confirmed by autopsy where possible. Univariate logistic regressions were conducted to estimate treatment effects in patient subgroups. The primary safety endpoint was major bleeding. Results Baseline characteristics were similar between treatments within each primary diagnosis subgroup, and the considered primary diagnoses accounted for >80% of the enrolled population. The reduced VTE incidence associated with extended-duration enoxaparin prophylaxis was consistent across subgroups of patients with different primary diagnoses (Table). The incidence of major bleeding was generally higher in patients receiving extended-duration prophylaxis (Table). Table: VTE and major bleeding in patient subgroups receiving extended-duration vs standard-duration prophylaxis/placebo Primary diagnosis Incidence of VTE (%)* Odds Ratio [95% CI]** Incidence of Major Bleeding (%)*** Odds Ratio [95% CI] Extended Enox Standard Enox/Placebo Extended Enox Standard Enox/Placebo *N=3347 evaluable patients; **Alpha adjustment for an interim analysis; ***N=4040 treated patients Heart failure, NYHA class III or IV 3.1 4.7 0.64 [0.29–1.39] 0.0 0.2 N/A Acute respiratory insufficiency 2.2 3.7 0.60 [0.27–1.34] 0.6 0.2 3.15 [0.33–30.4] Post ischemic stroke 2.1 8.3 0.24 [0.06–0.91] 0.6 0.0 N/A Acute infection without septic shock 3.6 5.3 0.66 [0.36–1.22] 0.8 0.2 5.16 [0.60–44.3] Conclusion Extended enoxaparin prophylaxis consistently reduced VTE risk in acutely ill medical patients with the most prominent primary diagnoses compared with placebo following standard-duration prophylaxis. Major bleeding was generally higher in the extended-duration enoxaparin arm, but rates of bleeding were low. These findings are consistent with the primary findings of the EXCLAIM study which demonstrated the clinical benefit of the extended-duration enoxaparin regimen.

The Impact of Age on the Efficacy and Safety of Extended-Duration Thromboprophylaxis in Acutely Ill Medical Patients with Recent Immobility: A Sub-Group Analysis from the EXCLAIM Study

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 438-438 ◽  
Author(s):  
Roger D Yusen ◽  
Russell D Hull ◽  
Sebastian M Schellong ◽  
Victor F Tapson ◽  
Manuel Monreal ◽  
...  
Keyword(s):  
Placebo Group ◽  
Major Bleeding ◽  
Medical Patients ◽  
Efficacy And Safety ◽  
Double Blind ◽  
End Point ◽  
Standard Duration ◽  
Extended Duration ◽  
Level 1 ◽  
Level 2

Abstract Background: The EXtended CLinical prophylaxis in Acutely Ill Medical patients (EXCLAIM) trial was a randomized, double-blind, placebo-controlled, multicenter, international study that demonstrated a 38% relative risk reduction (RRR) for venous thromboembolism (VTE) with extended-duration enoxaparin prophylaxis compared with placebo (2.5% vs 4.0%; absolute difference [AD], −1.5% 95.8% CI −2.5 to −0.5%; P=0.002). Major bleeding occurred in 0.7% (20/2975) and 0.2% (7/2988) of patients who received enoxaparin and placebo, respectively (AD, 0.4% [CI 0.1% to 0.8%]; P=0.012). As age is a known independent risk factor for VTE, we conducted a pre-specified sub-analysis of the EXCLAIM trial to compare the efficacy and safety of extended-duration enoxaparin prophylaxis in patients &gt;75 years old with patients ≤75 years old. Methods: EXCLAIM eligibility required a recent (≤3 days) reduction in mobility due to acute medical illness, an anticipated level 1 (total bed rest/sedentary) or level 2 (level 1 with bathroom privileges) decreased mobility, and age ≥40 years. During the latter part of the study, a protocol amendment required patients with level 2 mobility to have ≥1 of 3 additional pre-specified risk factors (i.e., active or prior cancer, history of VTE, age &gt;75 years). Of the 7500 patients enrolled, 7415 received open-label enoxaparin 40 mg SC od for 10±4 days. Of these, 6085 were randomized to double-blind therapy (enoxaparin 40mg SC od or placebo) of 28±4 additional days duration. The incidence of VTE, the primary efficacy end point, was defined as the composite of symptomatic or asymptomatic proximal deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE), or fatal PE during the double-blind treatment period. Patients were screened for DVT with bilateral proximal lower extremity compression ultrasound at the end of randomized therapy. The incidence of major bleeding, the primary safety end point, was assessed through 48 hours after the last dose of study treatment. Results: Of the 5963 randomized patients that received at least one dose of double-blind therapy, 29.9% (1781) were &gt;75 years of age (mean age 81.5 years) and 70.1% (4182) were ≤75 years old (mean age 61.8 years). In patients &gt;75 years old, the incidence of VTE was 2.5% (18/725) in the enoxaparin group compared with 6.7% (50/743) in the placebo group (AD −4.2% [95.8% CI −6.5 to −2.0%]; P&lt;0.001). In patients ≤75 years old, the incidence of VTE was 2.4% (43/1760) with extended-duration enoxaparin treatment and 2.8% (50/1767) in the placebo group (AD −0.4%, 95.8% CI −1.5 to 0.7%; P=0.474). The incidence of major bleeding was low, but non-significantly higher with extended prophylaxis compared to placebo in patients &gt;75 years old (0.6% vs 0.2%; AD 0.3%, 95% CI −0.2 to 0.9%; P=0.282) and significantly higher in patients ≤75 years old (0.7% vs 0.2%; AD 0.5%, 95%CI 0.1 to 0.9%; P=0.041). Though the older group had a higher death rate compared to the younger group (3.2% vs 1.6%), the survival between the treatment groups was similar within the two age groups. Without extended prophylaxis (i.e., placebo group), patients &gt;75 years old had a significantly higher risk of VTE than those &lt;75 years old (6.7 % vs 2.8 %; AD 3.9%, 95.8% CI 1.9 to 5.9%; p&lt;0.001) during the first month after completing a standard 10±4 day course of enoxaparin VTE prophylaxis. Conclusions: Despite standard-duration prophylaxis with enoxaparin for 6 to 14 days, acutely ill patients &gt;75 years of age have a significantly higher risk of VTE in the following month, compared to patients ≤75 years of age. The risk-to-benefit ratio of extended-duration enoxaparin following standard-duration prophylaxis in acutely ill medical patients appears most favorable in patients &gt;75 years of age.

Extended-Duration Enoxaparin for Venous Thromboembolism Prophylaxis in Acutely Ill Medical Patients: An Evaluation of the EXCLAIM Study Based on a Recently Recommended Composite Efficacy Endpoint.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1870-1870 ◽  
Author(s):  
Sebastian M. Schellong ◽  
Russell D. Hull ◽  
Victor F. Tapson ◽  
Manuel Monreal ◽  
Meyer-Michel Samama ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Composite Endpoint ◽  
Medical Patients ◽  
Double Blind ◽  
Once Daily ◽  
All Cause Mortality ◽  
Standard Duration ◽  
Extended Duration ◽  
Level 1 ◽  
Reduced Mobility

Abstract Introduction The EXCLAIM study has shown that in acutely ill medical patients who have received a standard 10-day period of prophylaxis with enoxaparin, extended-duration prophylaxis with enoxaparin for 4 weeks reduces the relative risk of the primary composite endpoint of asymptomatic proximal deep-vein thrombosis (DVT), symptomatic DVT or pulmonary embolism (PE), and fatal PE by 44% compared with placebo (2.8% vs 4.9%; RR 0.56; 95% CI 0.39–0.80; p=0.0011). We assessed the consistency of these results using the composite efficacy endpoint recently proposed for venous thromboembolism (VTE) prophylaxis studies by the European Committee for Medicinal Products for Human Use (CHMP) which, in addition, takes all-cause mortality into account. Methods Patients enrolled in the EXCLAIM study had a recent reduced mobility (≤3 days) due to a medical illness, were aged 40 years or older, and had anticipated level 1 (total bed rest or sedentary without bathroom privileges) or level 2 (level 1 with bathroom privileges) reduced mobility with further risk factors. Eligible patients received enoxaparin 40mg SC once-daily for 10±4 days. Patients were then double-blind randomized and received either enoxaparin 40mg SC once-daily or placebo for a further 28±4 days. Asymptomatic DVT were diagnosed by bilateral compression ultrasound after completion of the randomized treatment period. Suspected cases of symptomatic DVT or PE were confirmed by objective tests. Fatal PE were confirmed by autopsy where possible. Data were analyzed using the CHMP-recommended composite efficacy endpoint of proximal DVT, adjudicated PE and all-cause mortality. Results Eligible patients enrolled at 370 sites in 20 countries received standard-duration prophylaxis with enoxaparin. Of these, 4114 patients were double-blind randomized and 4040 received extended-duration prophylaxis with enoxaparin (n=2013) and placebo (n=2027), respectively. Extended-duration enoxaparin reduced the relative risk of the CHMP composite endpoint by 26% compared with placebo (5.8% vs 7.9%; RR 0.74; 95% CI 0.58–0.95; p=0.018). Conclusion The significant reduction in the incidence of the primary efficacy endpoint associated with the use of extended-duration enoxaparin compared with placebo, following standard duration enoxaparin, was consistent when applying both the pre-defined EXCLAIM and the CHMP-recommended composite endpoints, the latter of which included all-cause mortality in addition to proximal DVT and adjudicated PE.

scholarly journals Upper Extremity Deep Vein Thrombosis in Acute Leukemia and Non-Hodgkin's Lymphoma: Analysis of the California Cancer Registry

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 932-932
Author(s):  
Christina Poh ◽  
Ann M Brunson ◽  
Theresa H.M. Keegan ◽  
Ted Wun ◽  
Anjlee Mahajan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Steering Committee ◽  
Vein Thrombosis ◽  
California Cancer Registry ◽  
Increased Risk ◽  
Deep Vein

Background Venous thromboembolism (VTE) is a known complication in patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL) and non-Hodgkin's lymphoma (NHL). However, the cumulative incidence, risk factors, rate of subsequent VTE and impact on mortality of upper extremity deep vein thrombosis (UE DVT) in these diseases is not well-described. Methods Using the California Cancer Registry, we identified patients with a first primary diagnosis of AML, ALL and NHL from 2005-2014 and linked these patients with the statewide hospitalization and emergency department databases to identify an incident UE DVT event using specific ICD-9-CM codes. Patients with VTE prior to or at the time of malignancy diagnosis or who were not treated with chemotherapy were excluded. We determined the cumulative incidence of first UE DVT, adjusted for the competing risk of death. We also examined the cumulative incidence of subsequent VTE (UE DVT, lower extremity deep vein thrombosis (LE DVT) and pulmonary embolism (PE)) and major bleeding after incident UE DVT. Using Cox proportional hazards regression models, stratified by tumor type and adjusted for other prognostic covariates including sex, race/ethnicity, age at diagnosis, neighborhood, sociodemographic status and central venous catheter (CVC) placement, we identified risk factors for development of incident UE DVT, the effect of incident UE DVT on PE and/or LE DVT development, and impact of incident UE DVT on cancer specific survival. The association of CVC placement with incident UE DVT was not assessed in acute leukemia patients, as all who undergo treatment were assumed to have a CVC. Results are presented as adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results Among 37,282 patients included in this analysis, 6,213 had AML, 3,730 had ALL and 27,339 had NHL. The 3- and 12-month cumulative incidence of UE DVT was 2.6% and 3.6% for AML, 2.1% and 3% for ALL and 1.0% and 1.6% for NHL respectively (Figure 1A). Most (56-64%) incident UE DVT events occurred within the first 3 months of malignancy diagnosis. African Americans (HR 1.66; CI 1.22-2.28) and Hispanics (HR 1.35; CI 1.10-1.66) with NHL had an increased risk of incident UE DVT compared to non-Hispanics Whites. NHL patients with a CVC had over a 2-fold increased risk of incident UE DVT (HR 2.05; CI 1.68-2.51) compared to those without a CVC. UE DVT was a risk factor for development of PE or LE DVT in ALL (HR 2.53; CI 1.29-4.95) and NHL (HR 1.63; CI 1.11-2.39) but not in AML. The 12-month cumulative incidence of subsequent VTE after an incident UE DVT diagnosis was 6.4% for AML, 12.0% for ALL and 7.6% for NHL. 46-58% of subsequent VTEs occurred within the first 3 months of incident UE DVT diagnosis. The majority of subsequent VTEs were UE DVT which had a 12-month cumulative incidence of 4.6% for AML, 6.6% for ALL and 4.0% for NHL (Figure 1B). The 12-month cumulative incidence of subsequent LE DVT was 1.3% for AML, 1.6% for ALL and 1.9% for NHL (Figure 1C). The 12-month cumulative incidence of subsequent PE was 0.4% for AML, 4.1% for ALL and 1.8% for NHL (Figure 1D). The 12-month cumulative incidence of major bleeding after an UE DVT diagnosis was 29% for AML, 29% for ALL and 20% for NHL. Common major bleeding events included gastrointestinal (GI) bleeds, epistaxis and intracranial hemorrhage. GI bleeding was the most common major bleeding event among all three malignancies (14.2% in AML, 9.6% in ALL and 12.4% in NHL). The rate of intracranial hemorrhage was 6% in AML, 3.5% in ALL and 1.7% in NHL. A diagnosis of incident UE DVT was associated with an increased risk of cancer-specific mortality in all three malignancies (HR 1.38; CI 1.16-1.65 in AML, HR 2.16; CI 1.66-2.82 in ALL, HR 2.38; CI 2.06-2.75 in NHL). Conclusions UE DVT is an important complication among patients with AML, ALL and NHL, with the majority of UE DVT events occurring within the first 3 months of diagnosis. The most common VTE event after an index UE DVT was another UE DVT, although patients also had subsequent PE and LE DVT. UE DVT was a risk factor for development of PE or LE DVT in ALL and NHL, but not in AML. Major bleeding after an UE DVT was high in all three malignancies (&gt;20%), with GI bleeds being the most common. UE DVT in patients with AML, ALL and NHL is associated with increased risk of mortality. Disclosures Wun: Janssen: Other: Steering committee; Pfizer: Other: Steering committee.

Individual and Combined Evaluation of Specific Inflammatory Biomarkers along with Neutrophil, Lymphocyte, and Platelet Counts in Predicting Poststroke Disability Severity Among Acute Ischemic Stroke Patients in a Tertiary Hospital in Pampanga, Philippines

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S103-S103
Author(s):  
E R Marcadejas ◽  
M P Lagman ◽  
A S Mendoza ◽  
R E Marzan ◽  
A Z Manongdo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Hospital ◽  
Inflammatory Biomarkers ◽  
Lymphocyte Ratio ◽  
Advance Research ◽  
Level 1 ◽  
And Gender ◽  
Level 2

Abstract Introduction/Objective Numerous studies considered Neutrophil-to-Lymphocyte ratio (NLR), Platelet-to-Lymphocyte ratio (PLR), and Mean Platelet Volume (MPV) as inflammatory biomarkers in assessing the functional outcomes of Acute Ischemic Stroke (AIS) Patients. Presumably, no other study has evaluated all three markers in varying levels of combinations. The study aims to evaluate the predictive potential of specific CBC parameters (Neutrophils, Lymphocytes, and Platelets), their individual ratios (NLR, PLR, and MPV), and their combinations (NLR-PLR, NLR- MPV, PLR-MPV, and PLR-NLR-MPV). Methods/Case Report This retrospective study involved 52 AIS patients from a hospital in Pampanga, Philippines, at least 18 years of age, have no pre-existing conditions and prior treatments/medications. Modified Rankin Scale (mRS) score, medical history, age, and gender were gathered. Specific CBC parameters upon admission were analyzed to derive individual ratios. The combined biomarkers, categorized into Levels 2, 1, and 0, indicate high values for all biomarkers involved, high values for any of the biomarkers (one or two high value/s for PLR-NLR-MPV), and no high values for any of the biomarkers, respectively. Results (if a Case Study enter NA) Results showed that elevated NLR (OR=14.5; p=0.021) and MPV (OR=24.1; p=0.047) are risk factors in developing evident poststroke disability (mRS 2-5) and mortality (mRS 6), respectively. Furthermore, level 2 NLR-MPV (OR=77.0; p=0.040) and PLR-MPV (OR=105; p=0.027) are risk factors on mortality. Level 2 PLR-NLR (OR=15.0; p=0.021) and level 1 NLR-MPV (OR=13.5; p=0.024) are risk factors in developing evident poststroke disability. Lastly, levels 1 (OR=13.5; p=0.024) and 2 (OR=77.0; p=0.040) PLR-NLR-MPV are risk factors in developing evident poststroke disability and mortality, respectively. Conclusion Patients with neutrophilia, elevated NLR, level 2 PLR-NLR, and level 1 NLR-MPV and PLR-NLR-MPV are more likely to develop evident poststroke disability; while patients with elevated MPV and Level 2 NLR-MPV, PLR- MPV, and PLR-NLR-MPV pose higher mortality risk. Greater sample size is recommended for studies with the same purpose to advance research for better AIS outcomes.

scholarly journals Risk factors for hypertensive crisis in children with acute glomerulonephritis

2016 ◽  
Vol 56 (2) ◽  
pp. 101
Author(s):  
Sherly Yuniarchan ◽  
Risky Vitria Prasetyo ◽  
Ninik Asmaningsih Soemyarso ◽  
Mohammad Sjaifullah Noer
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Pediatric Population ◽  
Hypertensive Crisis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
P Value ◽  
Acute Glomerulonephritis ◽  
Female Ratio

Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.Objective To analyze the risk factors for hypertensive crisis in children with AGN.Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.

Extended-duration thromboprophylaxis in acutely ill medical patients with recent reduced mobility: Methodology for the EXCLAIM study

2006 ◽  
Vol 22 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Russell D. Hull ◽  
Sebastian M. Schellong ◽  
Victor F. Tapson ◽  
Manuel Monreal ◽  
Meyer-Michel Samama ◽  
...  
Keyword(s):  
Medical Patients ◽  
Extended Duration ◽  
Reduced Mobility

Multilevel Recidivism Prediction

2011 ◽  
Vol 38 (8) ◽  
pp. 840-853 ◽  
Author(s):  
Eyitayo Onifade ◽  
Jodi Petersen ◽  
Timothy S. Bynum ◽  
William S. Davidson
Keyword(s):  
Risk Factors ◽  
Prediction Models ◽  
Block Group ◽  
Risk Levels ◽  
Hierarchical Logistic Regression ◽  
Recidivism Prediction ◽  
Level 1 ◽  
The Relationship ◽  
Neighborhood Typology ◽  
Level 2

Risk assessments such as the Youth Level of Service/Case Management Inventory (YLS/CMI) that predict delinquency outcomes based on proximal risk factors may benefit from an incorporation of distal risk factors in their prediction models. This study utilized a juvenile probationer sample and block group SES data in exploring the differential predictive validity of the YLS/CMI with youth of similar person-centered risk levels from different criminogenic neighborhood types. The study entailed an exploratory factor analysis of block group socioeconomic variables, which were used in a cluster analysis to create criminogenic neighborhood typology system. Hierarchical logistic regression was used to analyze the relationship among recidivism (Level 1), risk score (Level 1), neighborhood SES factors (Level 2), and neighborhood types (Level 2). Significant interactions were found across levels among variables, suggesting the risk—recidivism relationship was moderated by neighborhood socioeconomic ecology. Implications for practice and policy are discussed.

ID: 12: THE ROLE OF ALCOHOL ABUSE AND TOBACCO USE IN THE INCIDENCE OF EARLY ACUTE CORONAY SYNDROME

2016 ◽  
Vol 64 (4) ◽  
pp. 922.2-923
Author(s):  
H Alkhawam ◽  
M Mariya Fabisevich ◽  
R Sogomonian ◽  
JJ Lieber ◽  
R Madanieh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Alcohol Abuse ◽  
Synergistic Effect ◽  
Tobacco Use ◽  
P Value ◽  
Healthcare Intervention ◽  
Tobacco Abuse ◽  
History Of

BackgroundTobacco abuse and alcohol dependence have been established as risk factors for atherosclerotic heart disease (ASHD). Their potential synergistic effect, however, have not been previously evaluated.Abstract ID: 12 Table 1Alcohol abuse/ DependenceAlcoholic abuse (n=172)Alcoholic- Smoker (n=51)Alcoholic Non-Smoker (n=121)Mean age (years)55.151.156.195% CI(52–58)(48–54.2)(54.6–57.6)Non-Alcohol abuse/DependenceNon-Alcoholic (n=7904)Non-Alcoholic Smoker (n=909)Non-alcoholic Non-smoker (n=6995)Mean age (years)63.856.371.395% CI(63.6–63.9)(55–57.7)(71–71.6)p Value<0.0010.02<0.001Objective/PurposeTo investigate the synergistic role of alcohol abuse/dependence and tobacco use in the early incidence of ACS.MethodsA retrospective chart analyses of 8076 patients diagnosed with ACS between 2000 to 2014, defined by ICD-9 codes for acute MI, alcohol abuse/dependence and tobacco use. Average age of ACS was calculated for the general population. Patients were then divided into 4 subgroups based on alcohol abuse/dependence and tobacco use status as follows: non-alcoholic non-smokers, non-alcoholic smokers, alcoholic non-smokers and alcoholic smokers.ResultsThe mean age of our 8076 ACS patients population was ∼59.5 (95% CI 59.2–59.8). Patients with history of alcohol abuse/dependence appeared to develop ACS ∼8.7 years younger than their non-alcoholic counterparts. When tobacco use is incorporated as a risk factor, those with both alcohol abuse/dependence and tobacco use seemed to develop ACS ∼5 years earlier than those with history of either alone, and ∼20 years earlier when compared to those with neither alcohol abuse/dependence nor tobacco use.(table 1 summarizes mean age of ACS incidence in our study subgroups).ConclusionsAlcohol abuse/dependence appears to be a risk factor for earlier ACS. In our population, the average age of ACS incidence in alcoholic patients was significantly earlier than non-alcoholic patients. Furthermore, alcoholic patients who also used tobacco developed ACS at an even younger age when compared to those who had history of either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect of these two risk factors in developing early ACS. Healthcare intervention in this population through screening, counseling and education regarding alcohol abuse/dependence and smoking cession is warranted to reduce early ACS.

scholarly journals Screening of Hemoglobin A1c in Gestational Diabetes among women attending metabolic clinic at a tertiary care hospital in Uttar Pradesh

2019 ◽  
Vol 10 (2) ◽  
pp. 26-30
Author(s):  
Vivek Sinha ◽  
Poonam Kachhawa
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Factor ◽  
Family History ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
P Value ◽  
Close Monitoring ◽  
History Of

Background: Gestational diabetes mellitus (GDM) is a common medical condition that complicates pregnancies..Gestational diabetes mellitus (GDM) is a diabetic metabolic disorder that occurs in 4% of all pregnant women and 14% of ethnic groups with more prevalence of type II diabetes. It can be defined as increased or abnormal insulin resistance, decreased insulin sensitivity or glucose intolerance with first diagnosis during pregnancy. Aims and Objectives: The purpose of this study was to evaluate the diagnostic screening value of the HbA1c, prevalence of GDM and associated risk factors. Materials and Methods: The study was conducted at the metabolic clinic; in the department of Biochemistry located at SIMS, Hapur. A semi-structured pretested questionnaire was used for data collection. Following the DIPSI guidelines, patients with plasma glucose values >140 mg/dl were labeled as GDM. Statistical methods used were OR (CI95%), percentage, Chi square. Results: Out of 500, 6.72% had GDM. Among all GDM patients, 64.71% had age more than 30 years, 70.59% had BMI more than 25, 41.18% had gravida more than 3 and p- value was significant with regard to age and BMI. P value was found to be significant for risk factors namely positive family history of Diabetes Mellitus, history of big baby and presence of more than one risk factor. Conclusion: GDM is associated with high BMI, early pregnancy loss, family history of DM and previous history of big baby and there could be more than one risk factor. Thus universal screening followed by close monitoring of the pregnant women for early detection of GDM may help improving maternal and fetal outcomes.

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