Racial Differences In Pediatric Venous Thromboembolism

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3176-3176
Author(s):  
Madhvi Rajpurkar ◽  
Cynthia Sabo ◽  
Ayesha Zia ◽  
Michael U Callaghan ◽  
Bulent Ozgonenel ◽  
...  
Keyword(s):  
Risk Factors ◽  
African American ◽  
Racial Differences ◽  
Positive Family History ◽  
Clinical Risk Factors ◽  
Major Surgery ◽  
Clinical Risk ◽  
History Of ◽  
Caucasian Patients ◽  
Prothrombin Gene

Abstract Abstract 3176 Background: Racial differences in the prevalence, risk factors, outcomes and recurrence rates of venous thromboembolism (VTE) have been reported in adults with the highest prevalence in African American (AA) males. Individuals of AA origin also have higher incidence of pulmonary embolism and increased mortality as compared to Caucasians. Such data are unknown in childhood VTE. Aim: Our aim was to evaluate the racial differences in risk factors, treatment response, outcomes and risks for recurrence in childhood VTE at a single center. Materials and Methods: All patients presenting to the pediatric hematology oncology service at this large urban Children's Hospital were followed prospectively from 2000–2010 and analyzed in a systematic manner. Data were analyzed using the SPSS v.17 software after approval from the institutional review board. Results: Preliminary analysis revealed that two hundred and eighteen patients with VTE were followed. There were 105 (48.2%) AA, 100 (45.9%) Caucasian (C), 4 (1.8 %) Middle Eastern (ME), 4(1.8%) Hispanic (H) and 5 Asian/Pacific islander (API) patients. Differences between AA and C were analyzed. Of the AA patients, there were 52 females (F), 53 males (M); Sites of presentation were upper extremity (UE) 12, lower extremity (LE) 24, pulmonary embolism (PE) 25, cortical sinus thrombosis (CST) 5, jugular (J) 13, vena caval (VC) 10, hepatic (H) 2 and cardiac atrial (CA) 8. Thirty six patients had more than one site at presentation. Of the Caucasian patients, there 51 F and 49 M; Sites of presentation were UE 12, LE 25, PE 17, CST 16, H 3, CA 8, VC 9, jugular 7, renal 3. Twenty four patients had more than one site of presentation. In AA patients, risk factors were persistently elevated D-Dimer and FVIII levels in 34 (32.4%) and 14 (13.3%) patients respectively; Elevated Lipoprotein (a){Lp(a)} in 24 (22.9%), positive cardiolipin antibodies (ACLA) in 11 (10.5%), ANA 18 (17.1%), and Lupus anticoagulant in 15 (14.3%) of patients. There were no patients with the Factor V Leiden (FVL) or the Prothrombin gene mutation. Clinical risk factors included the presence of central venous lines (CVL) in 58.1%, obesity in 26.7% and major surgery and immobilization in 36.2% and 30.5% respectively. Thirty percent of AA patients had positive family history of thrombosis in immediate family members. In Caucasian patients, risk factors were persistently elevated D- Dimer and FVIII levels in 19 (19%) and 13 (13%); antithrombin III deficiency in 3 (3%), heterozygous FVL in 10 (10%) and the Prothrombin gene variant in 3 (3%); Positive ACLA in 8(8 %), ANA in 11 (11%) and LA in 4 (4%), Elevated Lp(a) in 11 (11%). Clinical risk factors included presence of central venous lines (CVL) in 44.1%, obesity in 22% and major surgery and immobilization in 31% each. Interestingly, 30% of Caucasian patients had a positive family history of thrombosis in immediate family members In AA patients, 61.4% had complete (CR) or partial resolution (PR); in C patients 68.4% had CR or PR. Eleven (10%) AA and 7 (7%) C patients had recurrent events. There were no statistically significant differences in gender, laboratory and clinical risk factors and outcomes between African American and Caucasian patients analyzed. As anticipated, the FVL and Prothrombin gene variants were not seen in AA patients. Conclusions: In contrast to adults, there were no racial differences in presentation, risk factors and outcomes between Caucasian and African American patients with VTE followed at this single Children's Hospital thrombosis center. We believe this is the first report on racial differences in pediatric VTE. Larger population based studies are needed to confirm these findings. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A streamlined model for use in clinical breast cancer risk assessment maintains predictive power and is further improved with inclusion of a polygenic risk score

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245375
Author(s):  
Richard Allman ◽  
Erika Spaeth ◽  
John Lai ◽  
Susan J. Gross ◽  
John L. Hopper
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
African American ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Score ◽  
Clinical Risk Factors ◽  
Polygenic Risk Score ◽  
Gail Model ◽  
Clinical Risk

Five-year absolute breast cancer risk prediction models are required to comply with national guidelines regarding risk reduction regimens. Models including the Gail model are under-utilized in the general population for various reasons, including difficulty in accurately completing some clinical fields. The purpose of this study was to determine if a streamlined risk model could be designed without substantial loss in performance. Only the clinical risk factors that were easily answered by women will be retained and combined with an objective validated polygenic risk score (PRS) to ultimately improve overall compliance with professional recommendations. We first undertook a review of a series of 2,339 Caucasian, African American and Hispanic women from the USA who underwent clinical testing. We first used deidentified test request forms to identify the clinical risk factors that were best answered by women in a clinical setting and then compared the 5-year risks for the full model and the streamlined model in this clinical series. We used OPERA analysis on previously published case-control data from 11,924 Gail model samples to determine clinical risk factors to include in a streamlined model: first degree family history and age that could then be combined with the PRS. Next, to ensure that the addition of PRS to the streamlined model was indeed beneficial, we compared risk stratification using the Streamlined model with and without PRS for the existing case-control datasets comprising 1,313 cases and 10,611 controls of African-American (n = 7421), Caucasian (n = 1155) and Hispanic (n = 3348) women, using the area under the curve to determine model performance. The improvement in risk discrimination from adding the PRS risk score to the Streamlined model was 52%, 46% and 62% for African-American, Caucasian and Hispanic women, respectively, based on changes in log OPERA. There was no statistically significant difference in mean risk scores between the Gail model plus risk PRS compared to the Streamlined model plus PRS. This study demonstrates that validated PRS can be used to streamline a clinical test for primary care practice without diminishing test performance. Importantly, by eliminating risk factors that women find hard to recall or that require obtaining medical records, this model may facilitate increased clinical adoption of 5-year risk breast cancer risk prediction test in keeping with national standards and guidelines for breast cancer risk reduction.

scholarly journals Major clinical risk factors for seizures in febrile children aged 6 to 60 months.

2020 ◽  
Vol 27 (05) ◽  
pp. 891-894
Author(s):  
Shahid Ishaq ◽  
Ejaz Mazari ◽  
Fazal ur Rehman
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Febrile Seizures ◽  
Study Groups ◽  
Clinical Risk Factors ◽  
P Value ◽  
Chi Square ◽  
Clinical Risk ◽  
Significant Difference ◽  
History Of

Objectives: Febrile seizures (FS) are the most common type of seizures and typically transpire in children with ages from 6 to 60 months. This study was planned to find out major clinical risk factors for seizures in febrile children who were aged 6 to 60 months. A total of 100 febrile children aged 6 to 60. Study Design: Analytical Study. Setting: Department of Neurology, Children’s Hospital and the Institute of Child Health, Multan. Period: From 1st April 2018 to 31st December 2018. Material & Methods: Group A had 40 children with febrile seizures while group B had 60 febrile children but without seizures. Demographic features along with family history of (H/O) epilepsy as well as family history of febrile seizure, types of seizure and infection diseases were noted and analyzed using SPSS version 20. Odds ratio was calculated for various risk factors. Chi square test was applied and P value < 0.05 was considered as significant. Results: Out of a total of 100 children, there were 54 (54.0%) male and 46 (46.0%) female. There was no statistical difference in terms of gender between the two groups (p value = 0.566). Overall, mean age of the children was 26.02 months with standard deviation of 13.4 months. There were 28 (70.0%) children who reported with simple seizures while complex seizures were found in 12 (30.0%) cases. Statistically significant difference (p value = 0.001) was seen in terms of types of infections between the two study groups. When risk of seizures for various risk factors was calculated, family H/O FS, family H/O epilepsy, and upper RTI were as 14, 7 and 3 times respectively and turned out to be the major risk factors for seizures in febrile children. Conclusions: Family H/O FS, family H/O epilepsy and upper RTIs are the major risk factors related with seizures in febrile children. Measures to prevent these risk factors can decrease the burden of FS in our population.

scholarly journals Examining the Relationship between Biopsychosocial History and Clinical Profiles Following Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 765-765
Author(s):  
K Emami ◽  
A M Sufrinko ◽  
M W Collins ◽  
A P Kontos ◽  
E A Rossi
Keyword(s):  
Risk Factors ◽  
Motion Sickness ◽  
Clinical Profile ◽  
Clinical Risk Factors ◽  
Post Injury ◽  
Chi Square ◽  
Clinical Risk ◽  
History Of ◽  
Concussion History ◽  
Clinical Profiles

Abstract Purpose To determine if clinical risk factors (e.g., migraine history, motion sickness, concussion history) place an individual at risk for specific clinical profiles (e.g., posttraumatic migraine, vestibular) designated by a clinician following concussion. Methods Fifty (22M; 28F) symptomatic, concussed patients (17.02±3.14 years old) were evaluated within 21days post-injury. Demographics and medical history were obtained, including history of migraine, motion sickness, ADHD, learning disability (LD), oculomotor disorder, psychiatric diagnoses, and prior concussion. The presence of each clinical profile was determined by a clinician, based on synthesis of evaluation findings, including neurocognitive testing, symptom report, and vestibular/oculomotor screening results. Chi-square analyses were used to explore associations between risk factors and clinical profile post-injury. Results Chi-square analyses found that female sex was associated with increased odds (OR=5.25,95% CI[1.55, 17.77]) of vestibular clinical profile, X2(1, n=50)=7.55, p=.006. History of concussion was associated with increased odds (OR=7.10,95%CI[1.39,35.87]) of the PTM profile (X2[1, n=50]=6.56, p=.01) and increased odds (OR=9.85,95%CI[1.00,96.67]) of anxiety/mood profile (X2 1, n=50]=5.24, p=.022. Further, history of motion sickness was associated with increased odds OR=10.2,95%CI[1.2,86.69] of the PTM profile (X2[1, n=50]=6.11, p=.013). No other relationships were found. Conclusion Some clinical risk factors were associated with post-injury clinical profiles consistent with prior literature, while others were not. For example, females were more likely to have a vestibular profile. While motion sickness was associated with PTM, history of migraine was not. Concussion history, which has inconsistent findings for re-injury outcomes, was associated with increased likelihood of PTM and anxiety/mood profiles. Findings add to the literature supporting relationships among risk factors and clinical outcomes.

scholarly journals Biological versus Clinical Risk Factors in Acute Myeloid Leukemia: Is There a Winner?

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
M. Malagola ◽  
N. Polverelli ◽  
V. Cancelli ◽  
E. Morello ◽  
A. Turra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Myeloid Leukemia ◽  
Myelodysplastic Syndrome ◽  
Myeloid Leukemia ◽  
Clinical Risk Factors ◽  
Decision Algorithm ◽  
Platelet Recovery ◽  
Clinical Risk ◽  
History Of ◽  
Acute Myeloid

We present a case of a patient with a three-month history of peripheral blood cytopenia without a confirmed diagnosis of myelodysplastic syndrome, who developed a favourable-risk acute myeloid leukemia (AML), according to the European Leukemia Net (ELN) criteria. The patient achieved a complete remission with incomplete platelet recovery (CRi) after induction. The patient achieved the morphological CR after the first consolidation and completed the first-line treatment with a syngeneic stem cell transplantation (SCT). A disease relapse occurred after one year of CR (blast cell count in the bone marrow 15%), and the patient was offered a haplo-SCT, which he refused due to personal reasons. In this paper, we discuss the interplay between clinical and biological risk factors in non-high-risk AML patients and speculate that some old clinical risk factors (e.g., age of the patient, achievement of CR after induction, and previous history of myelodysplastic syndrome) may still impact on the treatment decision algorithm of some of these patients.

scholarly journals Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nicholas A. Marston ◽  
Giorgio E.M. Melloni ◽  
Yared Gurmu ◽  
Marc P. Bonaca ◽  
Frederick K. Kamanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Genetic Risk ◽  
Genetic Risk Score ◽  
Risk Groups ◽  
Clinical Risk Factors ◽  
Cardiometabolic Disease ◽  
Polygenic Risk Score ◽  
Clinical Risk ◽  
History Of

Background: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality and has a known genetic contribution. We tested the performance of a genetic risk score for its ability to predict VTE in 3 cohorts of patients with cardiometabolic disease. Methods: We included patients from the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk), PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin), and SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus) trials (history of a major atherosclerotic cardiovascular event, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE genetic risk score based on 297 single nucleotide polymorphisms with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared with available clinical risk factors (age, obesity, smoking, history of heart failure, and diabetes) and common monogenic mutations. Results: A total of 29 663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles ( P -trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI, 1.23–2.89; P =0.004) and 2.70-fold (95% CI, 1.81–4.06; P <0.0001) higher risk of VTE compared with patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the genetic risk score was associated with a 47% (95% CI, 29–68) increased risk of VTE ( P <0.0001). Conclusions: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia.

P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S E Lee ◽  
G Pontone ◽  
I Gottlieb ◽  
M Hadamitzky ◽  
J A Leipsic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
High Risk ◽  
Obstructive Coronary Artery Disease ◽  
Clinical Risk Factors ◽  
Clinical Risk ◽  
Obstructive Lesion ◽  
History Of ◽  
Artery Disease

Abstract Background It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP. Purpose We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP. Methods Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions. Results A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05). Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use. Conclusion The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline. Acknowledgement/Funding This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).

Abstract P251: The Impact of Clinical Risk Factors on Risk of Peripheral Arterial Disease in Men

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Michel M Joosten ◽  
Jennifer K Pai ◽  
Eric B Rimm ◽  
Donna Spiegelman ◽  
Murray A Mittleman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Clinical Risk Factors ◽  
Individual Risk ◽  
Clinical Risk ◽  
Hazard Ratios ◽  
History Of ◽  
Peripheral Arterial

Background: Previous studies have examined individual risk factors in relation to peripheral arterial disease (PAD) but the combined effects of these factors are largely unknown. We investigated the degree to which clinical risk factors may explain the risk of PAD among men. Methods: We prospectively followed 45,596 men from the Health Professional Follow-up Study without a history of cardiovascular disease at baseline during a 22-year period (1986–2008). We defined four clinical risk factors - smoking, history of type 2 diabetes, hypertension, and hypercholesterolemia - that were updated biennially during follow-up. Cox proportional hazard models were used to compare PAD risk across individual and joint risk factors. Results: During 874,769 person-years of follow-up, 497 confirmed PAD cases occurred. All four clinical risk factors were significantly and independently associated with a higher risk of PAD after multivariate adjustment (Figure). Risk of PAD more than doubled (hazard ratio: 2.14; 95% confidence interval [95% CI]: 1.95–2.35) for each additional risk factor compared with the group free of risk factors. Men without any of the four risk factors had a relative risk of PAD of 0.19 compared with all other men (95% CI: 0.11–0.31). In 96.8% (95% CI: 95.2–98.3%) of the PAD cases, at least one of the four risk factors was present. Overall, 8 out of 10 cases of PAD appeared to be attributable to these four conventional risk factors. Conclusion: The great majority of PAD can be explained by four conventional risk factors. Figure legend: Hazard ratios for incident peripheral arterial disease (PAD) according to individual and joint risk factors. Hazard ratios are adjusted for age, height, aspirin use, family history of myocardial infarction before age 60 y, geographical region, body mass index, physical activity, alcohol consumption (and each of the other three binary clinical risk factors in the individual risk factor analyses).

scholarly journals Sociodemographic, Epidemiological, and Clinical Risk Factors for Childhood Pulmonary Tuberculosis in Severely Malnourished Children Presenting With Pneumonia

2015 ◽  
Vol 2 ◽  
pp. 2333794X1559418 ◽  
Author(s):  
Mohammod Jobayer Chisti ◽  
Tahmeed Ahmed ◽  
Abu S. M. S. B. Shahid ◽  
K. M. Shahunja ◽  
Pradip Kumar Bardhan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Tuberculosis ◽  
Severe Acute Malnutrition ◽  
Positive Tuberculin Skin Test ◽  
Clinical Risk Factors ◽  
Acute Malnutrition ◽  
Working Mother ◽  
Clinical Risk ◽  
Resource Limited ◽  
History Of

We aimed to evaluate sociodemographic, epidemiological, and clinical risk factors for pulmonary tuberculosis (PTB) in children presenting with severe acute malnutrition (SAM) and pneumonia. Children aged 0 to 59 months with SAM and radiologic pneumonia from April 2011 to July 2012 were studied in Bangladesh. Children with confirmed PTB (by culture and/or X-pert MTB/RIF) (cases = 27) and without PTB (controls = 81; randomly selected from 378 children) were compared. The cases more often had the history of contact with active PTB patient ( P < .01) and exposure to cigarette smoke ( P = .04) compared with the controls. In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with working mother ( P = .05) and positive tuberculin skin test (TST; P = .02). Thus, pneumonia in SAM children is a common presentation of PTB and further highlights the importance of the use of simple TST and/or history of contact with active TB patients in diagnosing PTB in such children, especially in resource-limited settings.

scholarly journals Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Yamashita ◽  
H Tanaka ◽  
K Hatazawa ◽  
Y Tanaka ◽  
K Sumimoto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Previous History ◽  
Left Ventricular ◽  
Clinical Risk Factors ◽  
Lv Function ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
History Of

Abstract Background The sequential or concurrent use of two different types of agents such as anthracyclines and trastuzumab may increase myocardial injury and cancer therapeutics-related cardiac dysfunction (CTRCD), which is often the result of the combined detrimental effect of the two therapies for breast cancer patients. For risk stratification to detect the development of CTRCD, the current position paper from the European Society of Cardiology (ESC) lists several factors associated with risk of cardiotoxicity following treatment with chemotherapy. However, the association between clinical risk factors and left ventricular (LV) function in breast cancer patients is currently unclear. Purpose Our purpose was to investigate the impact of baseline risk factors on LV function in patients with preserved LV ejection fraction (LVEF) who have undergone anthracycline or trastuzumab chemotherapy for breast cancer. Methods We studied 86 breast cancer patients treated with anthracyclines, trastuzumab, or both. Mean age was 59±13 years and LVEF was 67±5%. In accordance with the current definition, CTRCD was defined as a decline in LVEF of &gt;10% to an absolute value of &lt;53% after chemotherapy. Based on the 2016 ESC position paper, clinical risk factors for CTRCD were defined as: (1) a cumulative total doxorubicin dose of ≥240 mg/m2, (2) age ≥65-year-old, (3) body mass index ≥30 kg/m2, (4) a previous history of radiation therapy to chest or mediastinum, (5) B-type natriuretic peptide ≥100pg/mL, (6) a previous history of cardiovascular disease, (7) atrial fibrillation, (8) hypertension, (9) diabetes mellitus, (10) current or ex-smoker. Results The relative decrease in LVEF after chemotherapy for patients with more than four risk factors was significantly greater than that for patients without (−9.3±10.8% vs. −2.2±10.2%; p=0.02). However, this finding did not apply to patients with more than one, two or three risk factors. Patients with more than four risk factors also tended to show a higher prevalence of CTRCD than those without (14.3% vs. 2.8%, p=0.12). Moreover, patients with more than four risk factors were more likely to have higher LV mass index (109.3±29.0 g/m2 vs. 83.2±21.0g /m2, p&lt;0.001), lower global longitudinal strain (18.4±2.8% vs. 20.0±2.6%, p=0.06) and higher E/e' (10.4 (8.9–13.0) vs. 9.0 (7.4–10.9), p=0.06) compared to those without. Conclusions Association between clinical risk factors and LV dysfunction following chemotherapy became stronger with an increase in the number of risk factors in breast cancer patients, and was especially strong for patients treated with chemotherapy who had more than four risk factors. Our findings can thus be expected to have clinical implications for better management of patients with breast cancer referred for chemotherapy. Funding Acknowledgement Type of funding source: None

scholarly journals Risk Factors for Aspiration Pneumonia After Receiving Liquid-Thickening Recommendations

2021 ◽  
pp. 019459982110491
Author(s):  
Hiroaki Masuda ◽  
Rumi Ueha ◽  
Taku Sato ◽  
Takao Goto ◽  
Misaki Koyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aspiration Pneumonia ◽  
Performance Status ◽  
Significant Risk ◽  
Poor Performance ◽  
Clinical Risk Factors ◽  
Poor Performance Status ◽  
Clinical Risk ◽  
History Of ◽  
Laryngeal Sensation

Objective We examined the influence of liquid thickness levels on the frequency of liquid penetration-aspiration in patients with dysphagia and evaluated the clinical risk factors for penetration-aspiration and aspiration pneumonia development. Study Design A case series. Setting Single-institution academic center. Methods We reviewed medical charts from 2018 to 2019. First, we evaluated whether liquid thickness levels influence the frequency of liquid penetration-aspiration in patients with dysphagia. Penetration-aspiration occurrence in a videofluoroscopic swallowing study was defined as Penetration-Aspiration Scale (PAS) scores ≥3. Second, the association between liquid thickness level and penetration-aspiration was analyzed, and clinical risk factors were identified. Moreover, clinical risk factors for aspiration pneumonia development within 6 months were investigated. Results Of 483 patients, 159 showed penetration-aspiration. The thickening of liquids significantly decreased the incidence of penetration-aspiration ( P < .001). Clinical risk factors for penetration-aspiration were vocal fold paralysis (odds ratio [OR], 1.99), impaired laryngeal sensation (OR, 5.01), and a history of pneumonia (OR, 2.90). Twenty-three patients developed aspiration pneumonia while undertaking advised dietary changes, including liquid thickening. Significant risk factors for aspiration pneumonia development were poor performance status (OR, 1.85), PAS score ≥3 (OR, 4.03), and a history of aspiration pneumonia (OR, 7.00). Conclusion Thickening of liquids can reduce the incidence of penetration-aspiration. Vocal fold paralysis, impaired laryngeal sensation, and history of aspiration pneumonia are significant risk factors of penetration-aspiration. Poor performance status, PAS score ≥3, and history of aspiration pneumonia are significantly associated with aspiration pneumonia development following recommendations on thickening liquids. Level of Evidence 3.

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