Does Heparin Have An Anti-Myeloma Effect? An Analysis On Individual Data From Three Randomized Studies of GIMEMA, Nordic and Turkish Myeloma Study Groups,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3970-3970
Author(s):  
Meral Beksac ◽  
Anders Waage ◽  
Sara Bringhen ◽  
Sigurdur Y Kristinsson ◽  
Gulsan Sucak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Board Of Directors ◽  
Thrombotic Event ◽  
Receptor Expression ◽  
Molecular Profile ◽  
Stepwise Logistic Regression ◽  
Individual Data ◽  
Advisory Committees ◽  
Stepwise Logistic Regression Analysis

Abstract Abstract 3970 Background and aim: The anti metastatic effects of heparin have been known for many decades. Such effects are dependent on the protease activated receptor expression (PAR-1 and/or CD24) by the cancer cells. The genes controlling PARs are located on chromosome 5q13. Recurrent amplification of chromosome 5q and 5p have been shown to increase survival (Avet-Loiseau H et al 2009 and Tapper W et al 2011) in myeloma. Low molecular weight heparin (LMWH) either for prophylaxis or treatment of venous thromboembolism, is frequently used in the treatment of myeloma. With an aim to separate the effect of heparin from the response achieved following Melphalan and Prednisolone (MP) plus Thalidomide, this study was initiated. Patients and methods: Individual data on 797 patients who were randomized to MP(n:393) or MPT(n:404) and published by the GIMEMA, Nordic, and the Turkish Myeloma Groups were analyzed using the SPSS 15.0 windows version. Except for the Nordic trial, LMWH was given as routine for the MPT patients. Patients who received anticoagulation as routine or following a thrombotic event were assigned to the LMWH group. Response equal to and more than partial response was included in the analysis. Comparisons were made using the Chi-Square or Mann Whitney U tests. Assessment of risk factors for response was done by the Backward- Stepwise Logistic Regression analysis. Survival analysis was performed using the Kaplan-Meier test. Results: Treatment groups (MP vs MPT) were well balanced according to prognostic factors. LMWH was given as prophylaxis (n:124, n:4) or as treatment (n: 38, n:16) in the MPT and MP groups respectively. Patients who received LMWH in the MP group exerted similar characteristics to MP patients, but more patients in the MPT+LMWH group had advanced ISS (p=0.007) compared to MPT patients. Response (≥ PR) was observed more frequently among the patients who received MP and LMWH than those who did not receive LMWH (38.4 % vs 70.6%,p=0.022). Similar effect was not observed in the MPT group. Within the MP and MPT groups responders had lower b2mg (3.8 vs 4.2, p=0.068 and 3.9 vs 4.5, p=0.028). Higher s-albumin (3.7 vs 3.4, p=0.002) was associated with better response only in the MP group. When age, creatinine, b2mg, ISS, gender, and anticoagulation were introduced into the logistic regression model including all patients, LMWH (odds ratio (OR): 1.948, 95 % CI: 1.319–2.877,p=0.001) and b2mg (OR:0.956, 95% CI:0.925–0.988, p=0.007) were found to be independent risk factors. Logistic regression performed for MP or MPT groups revealed LMWH to be significant in the MP arm (OR: 4.168, 95% CI: 1.288–13.492, p=0.017) but not in the MPT arm (OR:1.031, 95% CI: 0.61–1.745, p=0.908). Within the MPT arm, creatinine (>2 mg/dL)(OR:0.453,95 %CI: 0.218–0.939,p=0.033) and advanced ISS (OR:0.764,95% CI:0.562–1.038,p=0.085) were additional risk factors. Survival was extended when LMWH was introduced to patients who were in the MPT group (p=0.046). Conclusion: In this study, based on individual data from three large randomized trials comparing MPT and MP, we found the addition of LMWH to be significantly associated with a better response in MP patients and improved survival in MPT patients. Although the cytogenetic and molecular profile of the patients are unknown and this is a retrospective analysis, improvement of response and survival following introduction of LMWH to the MP or MPT treatment suggests an anti-myeloma activity of LMWH. Disclosures: Beksac: Janssen Cilag: Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau. Waage:Janssen-Cilag: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Mundipharma: Membership on an entity's Board of Directors or advisory committees. Bringhen:Celgene: Honoraria; Janssen-Cilag: Honoraria; Novartis: Honoraria; Merck Sharp & Dhome: Membership on an entity's Board of Directors or advisory committees. Gimsing:janssen Cilag: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Mundipharma: Membership on an entity's Board of Directors or advisory committees. Juliusson:Merck Serono: Membership on an entity's Board of Directors or advisory committees. Palumbo:celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen-Cilag: Honoraria, Membership on an entity's Board of Directors or advisory committees; Merck: Honoraria; Amgen: Honoraria.

scholarly journals Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients With Femoral Neck Fracture After Hemiarthroplasty

2020 ◽  
Author(s):  
Rui Yue ◽  
Minghui Yang ◽  
Xiaohui Deng ◽  
Ping Zhang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Blood Cell ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Neck Fracture ◽  
Multivariate Stepwise Logistic Regression

Abstract Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 343 patients were included in the study, of which 151 (44.0%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.

scholarly journals Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture after Hemiarthroplasty

2020 ◽  
Author(s):  
Rui Yue ◽  
Minghui Yang ◽  
Xiaohui Deng ◽  
Ping Zhang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Blood Cell ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Neck Fracture ◽  
Multivariate Stepwise Logistic Regression

Abstract Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 445 patients were included in the study, of which 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.

Risk Factors for Delirium in Trauma Patients: The Impact of Ethanol Use and Lack of Insurance

2011 ◽  
Vol 77 (5) ◽  
pp. 621-626 ◽  
Author(s):  
Bernardino C. Branco ◽  
Kenji Inaba ◽  
Marko Bukur ◽  
Peep Talving ◽  
Matthew Oliver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Chronic Ethanol ◽  
Ethanol Ingestion ◽  
Stepwise Logistic Regression ◽  
Trauma Patients ◽  
Stepwise Logistic Regression Analysis ◽  
Independent Risk Factors ◽  
The Impact

The purpose of this study was to examine independent risk factors, and in particular the impact of alcohol on the development of delirium, in a cohort of trauma patients screened for ethanol ingestion on admission to hospital. The National Trauma Databank (v. 7.0) was used to identify all patients 18 years or older screened for ethanol on admission. Patients who developed delirium were compared with those who did not. Stepwise logistic regression analysis was used to identify independent risk factors for the development of delirium. A total of 504,839 patients with admission ethanol levels were identified. Of those, 2,909 (0.6%) developed delirium. Patients developing delirium were significantly older, more frequently male, and more likely to sustain thermal injuries and falls. Patients developing delirium had more comorbidities including chronic ethanol use (19.1% vs 4.5%, P < 0.001) and cardiovascular disease (21.5% vs 12.2%, P < 0.001). On admission, patients developing delirium were more likely to be intoxicated with ethanol (55.4% vs 26.5%, P < 0.001) and were more likely to be uninsured (17.8% vs 0.9%, P < 0.001). A stepwise logistic regression model identified lack of insurance, positive ethanol on admission, chronic ethanol use, Intensive Care Unit admission, age ≥ 55 years, burns, Medicare insurance, falls, and history of cardiovascular disease as independent risk factors for the development of delirium. The incidence of delirium in this trauma patient cohort was 0.6 per cent. The above risk factors were independently associated with the development of delirium. This data may be helpful in designing interventions to prevent delirium.

scholarly journals Validation of the International Prognostic Score for Thrombosis in Essential Thrombocythemia (IPSET) in Patients with Pre-Fibrotic Primary Myelofibrosis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1657-1657
Author(s):  
Paola Guglielmelli ◽  
Alessandra Carobbio ◽  
Elisa Rumi ◽  
Valerio De Stefano ◽  
Lara Mannelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Board Of Directors ◽  
Incidence Rate ◽  
Research Funding ◽  
Risk Model ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Advisory Committees ◽  
Thrombotic Risk

Introduction. Prefibrotic myelofibrosis (pre-PMF) is a unique entity in the 2016 WHO classification of myeloproliferative neoplasms with distinct clinical phenotype and outcome [Guglielmelli P, Blood 2017]. Compared to essential thrombocythemia (ET), pre-PMF is characterized by more pronounced disease manifestations, adverse mutation profile and worse outcome. Previous studies [Rumi E, Oncotarget 2017] showed that patients (pts) with pre-PMF present a risk of vascular events similar to ET. However, no studies performed a comprehensive assessment of risk factors for thrombosis in pre-PMF. The current study aimed to identify risk factors for thrombosis and bleeding in a large series of pre-PMF pts and explore the effectiveness of contemporary prognostic models developed specifically for ET. Patients and Methods. The study included 382 pre-PMF pts, diagnosed by 2016 WHO criteria, referred by 4 Italian Centers. Previously published methods were used to genotype JAK2, MPL, CALR, EZH2, ASXL1, IDH1/2 and SRSF2; a high molecular risk (HMR) category was defined according to Vannucchi A, [Leukemia 2013]. Thrombosis‐free survival (TFS) was determined from diagnosis to the first thrombotic event. Pts were grouped according to the conventional risk stratification system [Barbui T, JCO 2011], IPSET‐thrombosis [Barbui T, Blood 2012] and revised IPSET‐thrombosis [Barbui T, BCJ 2015]. Cox-regression model was used for univariate analysis. Harrell's concordance (C) statistic was calculated to measure the incremental accuracy of multivariable models sequentially adjusted for new predictors of thrombotic risk. A P <0.05 was considered statistically significant. Results. At diagnosis, 65 pts (17%) experienced major thrombotic events which included 35 (9%) arterial and 31 (8%) venous thromboses. With a median follow-up of 6.9 y (range 0.08-32.6), 56 (15%) pts developed an arterial or venous thrombotic event, with a total incidence rate of 1.99% pts/year (pt-y); 30 (8%) were arterial and 28 (7%) venous events with incidence rate of 1.00% pt-y and 0.95% pt-y, respectively. Splanchnic vein thrombosis (SVT) represented the most frequent venous events before/at diagnosis (26%). During the follow-up, 16% and 8% of pts experienced myelofibrotic or leukemic progression, and 105 (27%) died, with incidence rate of 2.05% pt-y, 0.95% pt-y and 3.41% pt-y, respectively. In univariate analysis, factors significant for arterial thrombosis after diagnosis were age >65y (HR 2.88; P=0.005), WBC>10x109/L (HR 2.43; P=0.026), presence of >1 generic CV risk factor (HR 2.16; P=0.047), JAK2V617F (HR 3.35; P=0.027) and HMR status (HR 13.1; P=0.027). Conversely, only history of previous thrombosis (HR 3.06; P=0.005) and previous venous event (HR 5.53; P<0.0001) retained significance for predicting venous thrombosis. Pts were effectively stratified according to IPSET and conventional risk model. The risk of thrombosis in IPSET low-, intermediate-, and high-risk categories was 0.67%, 2.05% and 2.95% pt-y, and 1.47% pt-y and 2.71% pt-y in 2-tiered thrombotic risk model. (Figure 1); in revised-IPSET, 0.54%, 2.23%, 2.44% and 2.69 %pt-y in the very low, low, intermediate- and high-risk category. When WBC>10x109/L or HMR variables were incorporated into IPSET model, the C-statistic increased significantly for the prediction of arterial events: from baseline value of 0.68 to 0.74 adding WBC and 0.91 HMR status. The proportion of pts who experienced major bleeding was 3% prior/at diagnosis,and 7% during follow-up, with total incidence rate of 0.94% pt-y. In univariate analysis, predictors for major bleeding during follow-up were age >75y (HR 3.34; P=0.011), WBC>13x109/L (HR 2.33; P=0.035), presence of >1 generic CV risk factor (HR 2.41; P=0.035), particularly hypertension (HR 2.63; P=0.016) and grade-1 fibrosis (HR 2.28; P=0.05). High platelet count and treatment, including antiplatelet and anticoagulant drugs, did not reach statistical significance. Conclusions. Overall, this study identified independent risk factors for major thrombosis and bleeding in pre-PMF. Of interest, we report that HMR status predicted for arterial thrombosis during the follow-up. Pre-PMF pts showed remarkably high rate of venous thrombosis, mostly represented by SVT. The 3-tiered IPSET prognostic model for thrombosis reliably predicted occurrence of thrombotic events in pre-PMF and should be considered as standard reference. Figure 1 Disclosures Rumi: novartis: Honoraria, Research Funding. Thiele:Shire: Research Funding; Incyte: Consultancy, Honoraria, Other: Remuneration, Research Funding; Sanofi: Consultancy, Honoraria, Other: Remuneration; Novartis: Consultancy, Honoraria, Other: Remuneration, Research Funding; AOP Orphan Pharmaceuticals: Consultancy, Research Funding. Vannucchi:Incyte: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Italfarmaco: Membership on an entity's Board of Directors or advisory committees; CTI BioPharma: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

scholarly journals Effect of Early Non-Hematologic Treatment Toxicity on Complete Remission (CR) and Time to CR in Acute Myeloid Leukemia Patients Undergoing Remission Induction Chemotherapy

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2279-2279
Author(s):  
Surbhi Sidana ◽  
Mayur Narkhede ◽  
Tomas Radivoyevitch ◽  
Moshe C. Ornstein ◽  
Cassandra Fincher ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Logistic Regression ◽  
Complete Remission ◽  
Board Of Directors ◽  
Myeloid Leukemia ◽  
Stepwise Logistic Regression ◽  
Advisory Committees ◽  
Disease Characteristics ◽  
High K ◽  
Acute Myeloid

Abstract Background: Acute Myeloid Leukemia (AML) patients (pts) being screened for clinical trials are often excluded based on laboratory values outside the normal range because of concerns of early treatment-related toxicities that can lead to adverse outcomes including death or delayed time to complete remission (CR). It has been shown that the time to achieve CR (Tc) has greater prognostic value in predicting survival than achieving CR per se (Estey et al., Blood 2002). In this study we assessed correlations between pretreatment risk factors and early (within 30 days of induction) treatment-related non-hematologic toxicities (TNHT) following IC, and between these toxicities and Tc and the probability of achieving CR. Methods: Adult pts diagnosed with AML (excluding acute promyelocytic leukemia) at the Cleveland Clinic from 10/08 - 11/12 who underwent IC with 7+3 (cytarabine and anthracycline) and had complete toxicity data were included. Variables including demographics, AML disease characteristics, abnormal laboratory measurements at diagnosis and during treatment, treatment response, and ICU stay, were assessed. The outcome of interest were development of non-fatal early TNHT and its effect on CR and Tc. TNHT were mapped as linear distance beyond the normal laboratory range and were set to zero if within limits. This was done for serum sodium (Na), potassium (K), bicarbonate, liver enzymes (AST, ALT), total bilirubin, INR (international normalized ratio), serum creatinine and albumin. These metrics were analyzed as a function of covariates at diagnosis using standard linear regression. They were then treated as covariates in logistic regression models of CR and in linear models of Tc. Akaike’s Information Criterion (AIC) was used in stepwise logistic regression model selection. Due to multiple testing, parameters are reported as significant only if p<0.01. Results: Of 91 pts, 58% (n=53) were female, 80% (n=73) were Caucasian, 64% (n=58) were younger than 60 years, the median age at treatment was 53.4 years (range 22.2 to 77.2), 13.2% (n=12) received 2 cycles of induction therapy and 30% of pts (n=27) required ICU care. Disease characteristics (per WHO classification) were – AML with recurrent cytogenetic abnormalities 31% (n=28), secondary AML 27% (n=24), therapy-related AML 6% (n=5), AML not otherwise specified 34% (n=31), myeloid sarcoma 1% (n=1) and unknown 1% (n=1). Cytogenetic risk groups per CALGB 8461 were – favorable 15% (n=14), intermediate 54% (n=49), unfavorable 23% (n=21), monosomal karyotype 7% (n=12) and unknown cytogenetics (n=7). BMI groups at diagnosis included normal (18.5-24.9, 28%), overweight (25-29.9, 29%), moderately obese (30-39.9, 29%), severely obese (>40, 12%) and one was underweight. All patients developed TNHT following IC: 98% (n=89) had electrolyte abnormalities, 26% (n=24) had elevated serum creatinine levels and 99% (n=89) had abnormal liver function indicated by AST, ALT, bilirubin, albumin and INR. Overall, 68% pts achieved CR, 9% (n=8) had complete response with incomplete recovery of counts, 10% (n=9) had persistent disease and in 12, determination of CR was not done due to early death or severe debilitation. Of all pretreatment variables, advancing age correlated with worsening hypoalbuminemia (p=0.0076); higher WBC with worsening hyperkalemia (p=0.001); absolute neutrophil counts with high K (p=.0002); and LDH with high K levels (p<< 0.0001) and elevations in ALT (p=0.0004) and AST (p=0.0002). Among early TNHT, worsening hyperkalemia (p=0.004) and acidemia (low bicarbonate levels) (p=0.008) correlated with less likelihood of achieving CR. In a multivariate analysis using stepwise logistic regression and AICs, none of the covariates in the final model for CR retained significant P values. None of the covariates independently predicted for Tc in the best fitted stepwise regression linear model. Conclusion: In pts considered fit to undergo 7+3 IC with potential curative intent, none of the baseline pretreatment variables independently predicted for early TNHT and occurrence of TNHT did not affect the probability of CR or Tc. Our data suggest that decisions regarding clinical trial eligibility or intensive therapy should be based on predicted risk of early treatment-related death rather than arbitrary age cut-offs and or abnormal laboratory values. Disclosures Sekeres: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen Corp: Membership on an entity's Board of Directors or advisory committees; Boehringer-Ingelheim Corp: Membership on an entity's Board of Directors or advisory committees. Mukherjee:GlaxoSmithKline: Research Funding.

scholarly journals Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients with Femoral Neck Fracture After Hemiarthroplasty

2021 ◽  
Author(s):  
Rui Yue ◽  
Minghui Yang ◽  
Xiaohui Deng ◽  
Ping Zhang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Blood Cell ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Neck Fracture ◽  
Multivariate Stepwise Logistic Regression

Abstract Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 445 patients were included in the study, of which 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.

scholarly journals Prediction of Endometrial Hyperplasia and Cancer among Premenopausal Women with Abnormal Uterine Bleeding

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Luca Giannella ◽  
Lillo Bruno Cerami ◽  
Tiziano Setti ◽  
Ezio Bergamini ◽  
Fausto Boselli
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Prediction Model ◽  
Endometrial Hyperplasia ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Stepwise Logistic Regression ◽  
Simultaneous Presence ◽  
Endometrial Pathology

Objective. To create a prediction model including clinical variables for the prediction of premalignant/malignant endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB). Methods. This is an observational retrospective study including 240 premenopausal women with AUB referred to diagnostic hysteroscopy. Based on the presence of endometrial hyperplasia (EH) or cancer (EC), the women were divided into cases (EH/EC) and controls (no EH/EC). Univariate, stepwise logistic regression and ROC curve analysis were performed. Results. 12 women had EH/EC (5%). Stepwise logistic regression analysis showed that EH/EC associated significantly with BMI ≥ 30 (OR=7.70, 95% CI 1.90 to 31.17), diabetes (OR=9.71, 95% CI 1.63 to 57.81), and a thickened endometrium (OR=1.20, 95% CI 1.08 to 1.34, criterion > 11 mm). The AUC was 0.854 (95% confidence intervals 0.803 to 0.896, p<0.0001). Considering the pretest probability for EH/EC of 5%, the prediction model with a positive likelihood ratio of 8.14 showed a posttest probability of 30%. The simultaneous presence of two or three risk factors was significantly more common in women with EH/EC than controls (50% vs. 6.6 and 25% vs. 0%, respectively, p<0.0001). Conclusion. When premenopausal vaginal bleeding occurs in diabetic obese women with ET > 11 mm, the percentage of premalignant/malignant endometrial pathology increases by 25%. It is likely that the simultaneous presence of several risk factors is necessary to significantly increase the probability of endometrial pathology.

Prognostic Factors for Developing Thrombosis in Polycytemia Vera: A Retrospective Analysis of 331 Patients with Long-Term Follow-up Highlights the Importance of White Blood Cells Levels

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 48-49
Author(s):  
Samantha Ferrari ◽  
Chiara Pagani ◽  
Mariella D'Adda ◽  
Nicola Bianchetti ◽  
Annamaria Pelizzari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
High Risk ◽  
Board Of Directors ◽  
Advisory Board ◽  
Advisory Committees ◽  
Risk Status ◽  
History Of ◽  
Wbc Count

Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by erythrocytosis, constitutively active mutations in JAK2 and an increased susceptibility to thrombotic events (TEs). There is still controversy about the role of increased hematocrit and of other variables including elevated white blood cell count as risk factors for the occurrence of TEs. A better definition of the relative prognostic importance of hematologic parameters would help us to better tailor the therapeutic approach to PV patients (pts), which is currently mainly based on the use of acetilsalycilic acid (ASA), venesection and hydroxyurea . The aim of our study was to analyze if any clinical or laboratory variables were significantly associated to the occurrence of TEs both at PV diagnosis and during the course of the disease in a large series of PV pts uniformly followed at a single Center over a period of 29.5 years from January 1986 to June 2019. Clinical and laboratory data were obtained from the time of diagnosis until death, progression to acute leukemia or last follow-up. Hematocrit (Hct), hemoglobin (Hb), white blood cell (WBC) and platelet (PLT) levels were recorded for each patient at least every 6 months. Among a total of 331 pts, the median age was 65 years (range 30-92 years), and 56% were male. "High risk" features (age ≥ 60 years and/or history of prior thrombosis) were present in 221 pts (66.7%). The incidence of cardiovascular risk factors was: hypertension 64%, diabetes 15%, hyperlipidemia 28%, history of active or remote smoking 41%. Patients on ASA were 279 (84%), 19 (6%) were on oral anticoagulation, while 27 (8%) were on ASA+oral anticoagulant. At PV diagnosis 54 pts (16%) presented with thrombosis, arterial in 32 (59%) and venous in 22 (41%). A previous TE was recorded in 57 pts (17%): in 43 (75%) arterial, in 12 (22%) venous and in 2 (3%) mixed (arterial+venous). Previous thrombosis was the only variable significantly associated with the presence of a TE at PV diagnosis (P=0.02). After PV diagnosis, with a median follow-up of 81 months (range 1-374 months), 63 pts (19%) experienced a TE and 11 of them a further episode, for a total of 74 TEs. The incidence rate (pts/year) of TEs was 2.7%. Forty-two events were arterial (57%), 31 were venous (42%) and 1 (1%) was mixed. It was the first TE for 37 pts. Cerebrovascular accidents and deep-venous thrombosis were the most frequent arterial and venous TEs both at PV diagnosis and throughout the disease course, with a relative incidence of 50% and 32% respectively. The table compares the characteristics of patients who did or did not develop a TE after PV diagnosis. At univariate analysis, PV high risk status, a previous TE and hyperlipidemia at PV diagnosis were significantly associated with a subsequent TE. Among hematologic variables an elevated WBC count at the time of thrombosis, but not Hct or PLT levels, was highly significantly associated with the development of a TE. At multivariate analysis, WBC count ≥10.4 x 10^9/L and hyperlipidemia maintained their independent prognostic value, while high risk status and a previous TE lost their prognostic significance. Both at univariate and multivariate analysis, hyperlipidemia at diagnosis (P=0.009 and P=0.002) and high WBC count at thrombosis (P=0.001 and P=&lt;0.0001) predicted for arterial thromboses, while only a history of prior thrombosis (P=0.03) predicted for venous ones. In conclusion, our analysis confirms that elevated WBC count at the moment of the event more than increased hematocrit is associated to the development of thrombosis in PV pts. We also found that hyperlipidemia was an independent risk factor for arterial thrombosis, calling for an accurate management of increased lipid levels. Whether a reduction of the WBC count during the course of PV may reduce the frequency of TE remains to be demonstrated by prospective studies. Table Disclosures D'Adda: Novartis: Other: Advisory board; Incyte: Other: Advisory board; Pfizer: Other: Advisory board. Rossi:Daiichi Sankyo: Consultancy, Honoraria; Sanofi: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Astellas: Membership on an entity's Board of Directors or advisory committees; Novartis: Other: Advisory board; Alexion: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria; Celgene: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Jazz: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Allogeneic Red Blood Cell Transfusion Rate and Risk Factors After Hemiarthroplasty in Elderly Patients With Femoral Neck Fracture

2021 ◽  
Vol 12 ◽  
Author(s):  
Rui Yue ◽  
Minghui Yang ◽  
Xiaohui Deng ◽  
Ping Zhang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Blood Cell ◽  
Advanced Age ◽  
Stepwise Logistic Regression ◽  
Neck Fracture ◽  
Low Bmi ◽  
Multivariate Stepwise Logistic Regression

ObjectiveThis study aimed to determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) after hemiarthroplasty (HA) in elderly patients with femoral neck fracture (FNF).MethodsThe subjects of the study were elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital between March 2018 and June 2019 for HA treatment due to an FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analyses were performed to determine the post-operative ABT rate and its risk factors.ResultsThere were 445 patients in the study, of whom 177 (39.8%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and a low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients.ConclusionABT after HA is a common phenomenon in elderly patients with FNF. Their post-operative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced by taking these factors into account. When the same patient had three risk factors (preoperative low hemoglobin, advanced age, and low BMI), the risk of ABT was very high (78.3%). Also, when patients have two risk factors of preoperative low hemoglobin and low BMI, the risk of ABT was also high (80.0%).

scholarly journals Association of Hypertriglycerideamia with Ischaemic Stroke

2016 ◽  
Vol 32 (1) ◽  
pp. 34-38
Author(s):  
Biplob Kumar Das ◽  
Kanak Jyoti Mondal
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Ischaemic Stroke ◽  
Significant Risk ◽  
Serum Triglyceride ◽  
Control Group ◽  
Case Group ◽  
Stepwise Logistic Regression ◽  
Serum Triglyceride Level ◽  
Analysis Model

Stroke is one of the foremost causes of morbidity, mortality and is a socioeconomic challenge. This is particularly true for developing countries like Bangladesh, where health support system including the rehabilitation system is not within the reach of common people. Hypertriglycerademia has an effective influence in the pathogenesis of Ischaemic Stroke (IS). So, the focus of this study was to evaluate and assess the association of serum triglyceride level in patients of IS. This case control study was carried out in the Department of Neurology in collaboration with Department of Biochemistry, BSMMU, Dhaka from July 2011 to June 2013. In this study, 60 diagnosed cases of ischaemic stroke patients and 60 age and sex matched healthy controls were enrolled. Risk factors of Ischemic Stroke (IS) patients were assessed ( adjusted Odds Ratio) in comparison with healthy adults. In this study, being married [OR. 1.95, 95% CI (0.40-9.42), p=0.409] , smoker [OR.1.65, 95% CI (0.57 - 4.82),p= 0.357], DM [OR. 1.48, 95% CI (0.36-6.06), p=0.582 ], IHD [OR. 1.51, 95% CI (0.29 – 7.89), p=0.624] , HTN [OR. 3.66, 95% CI (1.11–12.12), p=0.033] , overweight [OR.2.31, 95% CI (0.77 – 6.91), 0.135] and obesity [OR. 16.19, 95% CI (1.31–200.6), p=0.030] , increased level of serum TC [OR.8.24, 95% CI (2.07 – 32.83), p=0.003], TG [OR. 9.40, 95% CI (1.17 -75.86), p=0.035], LDL [OR. 0.45, 95% CI (0.10–2.05), p=0.308],and decreased level of HDL [OR. 3.37, 95% CI (1.03 - 12.25), p=0.045] were found as risk factors in developing IS. Independent t-test was done to find out the statistically significant differences of continuous variables like serum lipid profile between case and control group. The mean (SD) value of TG which is focus of this study, was found 237.67 (61.74) in case group, and 169.97 (26.95) in control group which was highly statistically significant (p < 0.0001). All of the significant variables were entered into stepwise logistic regression analysis model. From the logistic regression model, it can be finally concluded that hypertension, obesity, increased level of TC, increased level of TG and decreased level of HDL were statistically significant risk factors for development of IS. Bangladesh Journal of Neuroscience 2016; Vol. 32 (1): 34-38

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