In-Hospital Mortality and Trends Associated with Splenectomy in Patients with Immune-Mediated Thrombocytopenia (ITP).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1398-1398
Author(s):  
Samantha M. Jaglowski ◽  
John C. Byrd ◽  
Jeffrey A. Jones
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Medical Management ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Teaching Status ◽  
Observation Period

Abstract Abstract 1398 Poster Board I-420 Background: Splenectomy remains a standard treatment for ITP patients not responding to medical management, but anecdotal reports suggest that use of the procedure is in decline. We studied patterns of use and outcome of splenectomy performed for ITP at the population level. Methods: Using data from the Nationwide Inpatient Sample and ICD-9 diagnosis and procedure codes, we identified 39,543 splenectomies among hospital admissions including a diagnosis of ITP (ICD-9 287.3) from 1993-2005. Admissions were characterized by patient and hospital facility characteristics. Laparascopic procedures were identified by published procedure coding algorithms. Factors influencing in-hospital mortality for 2005 were further evaluated using multivariate logistic regression models. Results: Annual estimates for incidence of splenectomy are displayed in Figure 1. Between 1993 and 2005, there was a decrease in the total number of splenectomies performed for ITP, with the most significant drop occurring from 1997 to 2000, concurrent with the FDA approval of rituximab. Over the same period, there has been an increase in the proportion of splenectomies performed laparoscopically from 3.4% to 18.6%. Patient gender, age, presence of comorbid malignancy, and Charlson score were not significantly associated with type of splenectomy procedure. Among facility factors, only hospital teaching status was a statistically significant predictor of laparoscopic splenectomy use, early but not later in the observation period. On an annual basis, in-hospital mortality did not vary significantly over the observation period, with risks ranging from 1.5% (95% CI 0.83-2.86%) in 1993 to 4% (95% CI 2.8%-5.7%) in 1997. Annual mortality risk between open and laparoscopic procedures likewise did not significantly differ. However, over the total 13-year observation period there was a >60% increased risk of death with an open versus laparoscopic procedure (OR 1.669, p<0.0001). In 2005, 2869 splenectomy procedures were performed. Multivariate logistic regression models for in-hospital mortality that year found that presence of a malignancy (OR 9.65, p=0.003) significantly increased mortality risk. Charlson comorbidity approached statistical significance (0 v. ≥1, OR 6.83, p=0.087). Hospital bed-size (OR 0.87, p=0.73), location (rural v. urban, OR 3.80, p=0.127), and teaching status (OR 0.39, p=0.203) were not significantly associated with outcome. Conclusions: While the overall mortality risk from splenectomy in ITP is low, it is influenced by the presence of malignancy and other comorbid conditions. Further studies designed to evaluate newer medical management strategies (e.g. rituximab, thrombopoeitin mimetics, etc.) versus surgical intervention in these higher-risk populations are warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Admission Dehydration Is Associated With Significantly Lower In-Hospital Mortality After Intracerebral Hemorrhage

2021 ◽  
Vol 12 ◽  
Author(s):  
Bin Gao ◽  
Hongqiu Gu ◽  
Wengui Yu ◽  
Shimeng Liu ◽  
Qi Zhou ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Blood Urea Nitrogen ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Urea Nitrogen ◽  
Logistic Regression Models ◽  
Stroke Center

Background and Purpose: Our aim was to investigate the frequency of dehydration at admission and associations with in-hospital mortality in patients with intracerebral hemorrhage (ICH).Methods: Data of consecutive patients with ICH between August 2015 and July 2019 from the China Stroke Center Alliance (CSCA) registry were analyzed. The patients were stratified based on the blood urea nitrogen (BUN) to creatinine (CR) ratio (BUN/CR) on admission into dehydrated (BUN/CR ≥ 15) or non-dehydrated (BUN/CR &lt; 15) groups. Data were analyzed with multivariate logistic regression models to investigate admission dehydration status and the risks of death at hospital.Results: A total number of 84,043 patients with ICH were included in the study. The median age of patients on admission was 63.0 years, and 37.5% of them were women. Based on the baseline BUN/CR, 59,153 (70.4%) patients were classified into dehydration group. Patients with admission dehydration (BUN/CR ≥ 15) had 13% lower risks of in-hospital mortality than those without dehydration (BUN/CR &lt; 15, adjusted OR = 0.87, 95%CI 0.78–0.96). In patients aged &lt;65 years, admission dehydration was associated with 19% lower risks of in-hospital mortality (adjusted OR = 0.81, 95%CI 0.70–0.94. adjusted p = 0.0049) than non-dehydrated patients.Conclusion: Admission dehydration is associated with significantly lower in-hospital mortality after ICH, in particular, in patients &lt;65 years old.

Prognostic significance of international normalised ratio and prothrombin time in Chinese acute ischaemic stroke patients

2022 ◽  
pp. postgradmedj-2021-141204
Author(s):  
Shoujiang You ◽  
Qiao Han ◽  
Xiaofeng Dong ◽  
Chongke Zhong ◽  
Huaping Du ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischaemic Stroke ◽  
Prothrombin Time ◽  
Hospital Discharge ◽  
Acute Ischaemic Stroke ◽  
Regression Models ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Increased Risk ◽  
International Normalised Ratio

BackgroundWe investigated the association between international normalised ratio (INR) and prothrombin time (PT) levels on hospital admission and in-hospital outcomes in acute ischaemic stroke (AIS) patients.MethodsA total of 3175 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included. We divided patients into four groups according to their level of admission INR: (<0.92), Q2 (0.92–0.98), Q3 (0.98–1.04) and Q4 (≥1.04) and PT. Logistic regression models were used to estimate the effect of INR and PT on death or major disability (modified Rankin Scale score (mRS)>3), death and major disability (mRS scores 4–5) separately on discharge in AIS patients.ResultsHaving an INR level in the highest quartile (Q4) was associated with an increased risk of death or major disability (OR 1.69; 95% CI 1.23 to 2.31; P-trend=0.001), death (OR, 2.64; 95% CI 1.12 to 6.19; P-trend=0.002) and major disability on discharge (OR, 1.56; 95% CI 1.13 to 2.15; P-trend=0.008) in comparison to Q1 after adjusting for potential covariates. Moreover, in multivariable logistic regression models, having a PT level in the highest quartile also significantly increased the risk of death (OR, 2.38; 95% CI 1.06 to 5.32; P-trend=0.006) but not death or major disability (P-trend=0.240), major disability (P-trend=0.606) on discharge.ConclusionsHigh INR at admission was independently associated with death or major disability, death and major disability at hospital discharge in AIS patients and increased PT was also associated with death at hospital discharge.

Abstract P394: Association Between Admission Dehydration and In-Hospital Mortality in Patients With Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Bin Gao ◽  
Hongqiu Gu ◽  
Shimeng Liu ◽  
Qi Zhou ◽  
Kang Kaijiang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Blood Urea Nitrogen ◽  
Regression Models ◽  
Fluid Management ◽  
Urea Nitrogen ◽  
Logistic Regression Models ◽  
Acute Intracerebral Hemorrhage ◽  
Stroke Center

Background and purpose: Our aim was to investigate the associations between dehydration status at admission and in-hospital mortality in patients with intracerebral hemorrhage. Methods: Data of consecutive patients with intracerebral hemorrhage between August 2015 and July 2019 based on China Stroke Center Alliance (CSCA) were analyzed. The patients were stratified based on the blood urea nitrogen (BUN) to creatinine (CR) ratio (BUN/CR) on admission, into dehydrated (BUN/CR ≥ 15) and non-dehydrated (BUN/CR < 15) groups. Data were analyzed with multi-variate logistic regression models to analyze the risks of death at hospital and baseline dehydration status. Results: A total number of 84043 patients with intracerebral hemorrhage were included in the study. The median age of patients on admission was 63.0 years, and 37.5% of them were women. Based on the baseline BUN/CR, 59153 (70.4%) patients were classified into dehydration group. Patients with admission dehydration (BUN/CR ≥ 15) had 13% lower risks of in-hospital mortality than those without dehydration (BUN/CR < 15, adjusted OR=0.87, 95%CI: [0.78-0.96]). In patients aged <65 years, patients with baseline dehydration (BUN/CR ≥ 15) showed 19% lower risks of in-hospital mortality (adjusted OR=0.81, 95%CI: [0.70-0.94].adjusted p=0.0049) than non-dehydrated patients (BUN/CR<15). Conclusion: Admission dehydration is associated with lower in-hospital mortality in intracerebral hemorrhage,which provides an imaging clue that fluid management could be important for acute intracerebral hemorrhage.

Child awareness of and access to cigarettes: impacts of the point-of-sale display ban in England

2018 ◽  
Vol 28 (5) ◽  
pp. 526-531 ◽  
Author(s):  
Anthony A Laverty ◽  
Eszter Panna Vamos ◽  
Christopher Millett ◽  
Kiara C-M Chang ◽  
Filippos T Filippidis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Drug Use ◽  
Regression Models ◽  
Multivariate Logistic Regression ◽  
Tobacco Advertising ◽  
Point Of Sale ◽  
Logistic Regression Models ◽  
Annual Survey ◽  
Perceived Difficulty ◽  
Ease Of Access

IntroductionEngland introduced a tobacco display ban for shops with >280 m2 floor area (‘partial ban’) in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes.MethodsData come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11–15 years for 2010–2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shopsResultsDuring the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did.DiscussionTobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.

Abstract TP321: Is Weekend Admission Associated With Increased 30-day Stroke Mortality? The Effect of Adjustment Using a Claims-Based Stroke Severity Index

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Cheng-Yang Hsieh ◽  
Sheng-Feng Sung
Keyword(s):  
Logistic Regression ◽  
Regression Models ◽  
Severity Index ◽  
Case Mix ◽  
Stroke Severity ◽  
Stroke Mortality ◽  
Multivariate Logistic Regression ◽  
Stroke Patients ◽  
Logistic Regression Models ◽  
Case Mix Adjustment

Introduction: Whether weekend admission is associated with increased stroke mortality in Taiwan remains uncertain, partly because of an inadequate case-mix adjustment in other studies using an insurance claims databases. Hypothesis: Adding the 7-item claims-based stroke severity index (SSI) to a multivariate logistic regression model might alter the analysis of the effect of weekend admission on 30-day stroke mortality. Methods: We identified, in the Taiwan Longitudinal Health Insurance Database, which is linked with the National Death Registry, patients hospitalized for acute ischemic stroke between 2001 and 2013. The primary outcome was mortality 30 days post-admission. In base logistic regression models with and without the SSI, we tested the odds ratio (OR) of 30-day mortality in patient admitted on weekends using the covariates of age, sex, year of admission, Charlson’s comorbidity index, brain surgery, physician specialty and surgical volume, hospital ownership, accreditation, and patient volume. Results: We analyzed 46,007 consecutive hospitalized stroke patients (mean age: 68.8 ± 12.0 years; male: 59%), with an SSI of 7.5 ± 5.3 (range: 4.1-27.1), 23.0% were admitted on the weekend, and 4.2% died within 30 days. Patients who died within 30 days were more likely to have been admitted on a weekend (4.9% vs. 4.0%, p < 0.001). Nevertheless, patients admitted on a weekend had a higher SSI than those admitted on a weekday (7.8 vs. 7.4, p < 0.001). In multivariate logistic regression models, weekend admission was associated with 30-day mortality (OR: 1.22, 95% CI: 1.10-1.35) in the base model but not in the base model plus SSI (OR: 1.07, 95% CI: 0.95-1.20). Conclusions: We confirmed that, after stroke severity had been adjust by adding the SSI, weekend admission did not increase the 30-day mortality of stroke patients in Taiwan. A case-mix adjustment in comparative outcome studies of stroke patients is important when using an insurance claims database.

scholarly journals Effects of Older Adult Driving Resumption on All-Cause Mortality

2019 ◽  
Vol 75 (10) ◽  
pp. 2263-2267
Author(s):  
Kendra L Ratnapradipa ◽  
Jing Wang ◽  
Marla Berg-Weger ◽  
and Mario Schootman
Keyword(s):  
Logistic Regression ◽  
Older Adult ◽  
Mortality Risk ◽  
Odds Ratio ◽  
Regression Models ◽  
Adjusted Odds Ratio ◽  
Community Dwelling ◽  
Driving Cessation ◽  
Logistic Regression Models ◽  
All Cause Mortality

Abstract Objectives Driving cessation is associated with adverse social and health outcomes including increased mortality risk. Some former drivers resume driving. Do resumed drivers have a different mortality risk compared to former drivers or continued drivers? Method We analyzed National Health and Aging Trends Study (2011–2015) data of community-dwelling self-responding ever drivers (n = 6,189) with weighted stratified life tables and discrete time logistic regression models to characterize mortality risk by driving status (continued, resumed, former), adjusting for relevant sociodemographic and health variables. Results Overall, 14% (n = 844) of participants died and 52% (n = 3,209) completed Round 5. Former drivers had the highest mortality (25%), followed by resumed (9%) and continued (6%) drivers. Former drivers had 2.4 times the adjusted odds of mortality compared with resumed drivers (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI] = 1.51, 3.83), with no difference between continued and resumed drivers (aOR = 1.22; 95% CI = 0.74, 1.99). Discussion Those who resumed driving had better survival than those who did not. Practice implications include driver rehabilitation and retraining to safely promote and prolong driving.

Forced Sexual Victimization Among Youth in Custody: Do Risk Factors Vary by Gender and Perpetrator?

2019 ◽  
Vol 100 (2) ◽  
pp. 151-172
Author(s):  
Eileen M. Ahlin
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Logistic Regression ◽  
National Survey ◽  
Regression Models ◽  
Sexual Victimization ◽  
Multivariate Logistic Regression ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Using Data

There is relatively little literature examining risk factors associated with sexual victimization among youth in custody. The current study explored whether risk of forced sexual victimization among youth in custody differs by gender or perpetrator. Using data from a sample of 8,659 youth who participated in the National Survey of Youth in Custody, multivariate logistic regression models were employed to investigate gender differences in risk factors associated with overall forced sexual victimization and staff-on-inmate and inmate-on-inmate forced sexual victimization. Findings suggest that gender differences are more pronounced when perpetrator type is considered.

scholarly journals Youth Working in Tobacco Farming: Effects on Smoking Behavior and Association with Health Status

2019 ◽  
Author(s):  
Ethel Alderete ◽  
Jennifer Livaudais-Toman ◽  
Celia Kaplan ◽  
Steven E. Gregorich ◽  
Raúl Mejía ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Health Status ◽  
Regression Models ◽  
Smoking Behavior ◽  
Economic Benefits ◽  
Social Consequences ◽  
Multivariate Logistic Regression ◽  
Accidental Injury ◽  
Logistic Regression Models ◽  
Serious Injury

Abstract Background Cultivation of tobacco raises concerns about detrimental health and social consequences for youth, but tobacco producing countries only highlight economic benefits. We compared sociodemographic and health-related characteristics of school-age youth who worked and did not work in tobacco farming and assessed the effects on smoking behavior and health at one year.Methods We used existing data collected in the province of Jujuy, Argentina where 3188 youth 13 to 17 years of age from a random middle school sample responded to longitudinal questionnaires in 2005 and 2006. Multivariate logistic regression models predicted association of tobacco farming work with health status and smoking behavior at one year.Results 22.8% of youth in the tobacco growing areas of the province were involved in tobacco farming. The mean age of initiation to tobacco farming was 12.6 years. Youth working in farming had higher rates of fair or poor versus good or excellent self-perceived health (30.3% vs. 19.0%), having a serious injury (48.5% vs. 38.5%), being injured accidentally by someone else (7.5% vs. 4.6%), being assaulted (5.5% vs. 2.6%), and being poisoned by exposure to chemicals (2.5% vs. 0.7%). Youth working in tobacco farming also had higher prevalence of ever (67.9% vs. 55.2%), current (48.0% vs. 32.6%) and established smoking (17.8% vs. 9.9%). In multivariate logistic regression models tobacco farming in 2005 was associated with significant increased reporting of serious injury (OR=1.4; 95%CI 1.1-2.0), accidental injury by someone else (OR=1.5; 95% 1.0-2.1), assault (OR=2.2; 95% CI 1.3-3.8), and poisoning by exposure to chemicals (OR=2.5; 95% CI 1.2-5.4). Tobacco farming in 2005 predicted established smoking one year later (OR=1.5; 95% CI 1.1-2.0).Conclusion Youth who work in tobacco faming face a challenging burden of adversities that increase their vulnerability. Risk assessments should guide public policies to protect underage youth working in tobacco farming. (298 words)

scholarly journals Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions

2020 ◽  
Vol 13 (10) ◽  
pp. 2172-2177
Author(s):  
Nguyen Hoai Nam ◽  
Peerapol Sukon
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Models ◽  
Significant Risk ◽  
Gestation Length ◽  
Stillbirth Rate ◽  
Multivariate Logistic Regression ◽  
Crown Rump Length ◽  
Logistic Regression Models ◽  
Factors Associated

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

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