Children's Hospital-Acquired Thrombosis Database (CHAT): A Multi-Institutional Database for Prospective Identification of Independent Risk Factors

Abstract Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising but remains relatively low overall, requiring risk stratification to reduce unnecessary thromboprophylaxis exposure. Large sample sizes are needed for prospective epidemiologic risk factor studies, necessitating collaboration. Objectives: We formed the multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) web-based registry via Research Electronic Data Capture (REDCap) to identify independent HA-VTE risk factors for future clinical risk score development. Methods: This IRB-approved, retrospective chart review reveals HA-VTE risk factors from patients aged 0-21 years who developed diagnostically-validated VTE more than 48 hours after hospital admission, or after central venous line placement, at 3 pediatric hospitals from January 2012 - December 2014. We used descriptive statistics to summarize demographics, medical comorbidities and types of any applicable central lines for the initial 373 patients entered into the database, as well as characteristics of the VTEs themselves and associated laboratory testing. Further analysis is currently underway utilizing matched controls and logistic regression to identify specific odds ratios for independent risk factors. Results: The median length of time to VTE diagnosis was 9 with interquartile range (IQR) of day 4-18, 35.3% of VTE occurred in a critical care unit, and 21% were incidentally found. The distribution of VTE included deep vein thromboses (DVT) of the arms/legs (81.1%) followed by cerebral sinus venous thrombosis (7.3%), pulmonary embolism (5.4%), DVT of the abdomen (4%), and intracardiac DVT (4%) with some overlap due to patients with multiple, separate, concurrent VTE events. Demographic characteristics of the initial 373 subjects revealed median age of 3.7 years (IQR of 0.4 years to 13.8 years) at VTE diagnosis and a slight male predominance (57.4%). 62.6% of patients had significant past medical history (Figure 1) and 8% were immobile at baseline. Evaluation of hospital course revealed a multitude of acquired putative risk factors for HA-VTE (Figure 2). 75.7% of VTE were associated with a central venous catheter (CVC). Of CVC-related VTE, 72% were in the same vein as CVC, 20% were in a vein which previously held a CVC, 3.6% surrounded the CVC tip, 2.9% occurred in a vein where CVC placement was attempted but unsuccessful. 59% of patients had at least one documented infection during hospitalization, 48% of patients had surgery, 5.5% of patients underwent trauma prior to admission, and 59.7% (n=221) of patients were intubated at some point during their admission with 86.9% (n=192) of those patients developing VTE after a minimum of 24 hours of mechanical ventilation. Laboratory testing of hospitalized patients revealed 51.2% of patients had a d-dimer level obtained at time of VTE and 97.8% of those patients had an elevated level. 44% of patients had at least one thrombophilia lab test ordered. Conclusions: The initial CHAT database results demonstrate a slight male predisposition and multiple associated chronic medical illnesses and acquired hospital course co-morbidities, particularly CVCs which were involved in three-fourths of VTE events. Ongoing work includes incorporating additional institutions and utilizing control subjects to identify independent risk factors for the development of a risk score model. Long-term goals include prospective validation of the scoring system in a cohort of patients from pediatric centers not involved in development of the risk score with the ultimate plan of using the scoring system to stratify patients for future randomized clinical trials of risk-based prevention strategies to evaluate the safety and efficacy of this approach for reduction of pediatric HA-VTE incidence without unnecessary thromboprophylaxis exposure. Figure 1. Distribution of past medical history Figure 1. Distribution of past medical history Figure 2. Prevalence of acquired risk factors. *Some patients with more than 1 documented infection. ^Procedures included: dialysis, plasmapheresis, cardiac catheterization, stent placement, coiling procedure. Figure 2. Prevalence of acquired risk factors. *Some patients with more than 1 documented infection. ^Procedures included: dialysis, plasmapheresis, cardiac catheterization, stent placement, coiling procedure. Disclosures Young: Kedrion: Consultancy; Biogen Idec: Consultancy, Honoraria; Novo Nordisk: Consultancy, Honoraria; Bayer: Consultancy; Baxter: Consultancy.

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Children's Hospital-Acquired Thrombosis (CHAT) Registry: A Multi-Institutional Registry for Prospective Identification of Independent Risk Factors

Blood ◽

10.1182/blood.v128.22.2597.2597 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2597-2597 ◽

Cited By ~ 2

Author(s):

Arash Mahajerin ◽

Julie Jaffray ◽

Brian Vasquez ◽

Neil A Goldenberg ◽

Guy Young ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Scoring System ◽

Laboratory Testing ◽

Right Atrial ◽

Central Venous ◽

Children's Hospital ◽

Children’S Hospital ◽

Independent Risk Factors ◽

Hospital Acquired

Abstract Background: Pediatric hospital-acquired venous thromboembolism (HA-VTE) incidence is rising and many centers are instituting pediatric-specific prophylaxis programs despite a lack of evidence-based risk stratification to reduce unnecessary thromboprophylaxis exposure. Objectives: The multi-institutional Children's Hospital-Acquired Thrombosis (CHAT) Registry via Research Electronic Data Capture (REDCap) can identify independent HA-VTE risk factors for prospective validation and creation of a risk-assessment scoring system. Methods: This IRB-approved, retrospective registry reveals HA-VTE risk factors from subjects aged 0-21 years with radiographically-validated VTE ≥ 48 hours after hospital admission, or after central venous line placement, at 5 pediatric hospitals from January 2012 - June 2015. Descriptive statistics summarize demographics, medical comorbidities, characteristics of the VTEs themselves and associated laboratory testing for 555 subjects. Further analyses are currently utilizing matched controls and logistic regression to identify specific odds ratios for independent risk factors. Results: The median time to VTE diagnosis was 9 days with interquartile range (IQR) of 5-18.5 days, 34% of VTE occurred in a critical care unit, and 36.8% of subjects had been hospitalized in the 30 days prior to the index hospitalization. 22.7% of VTE events were incidentally found. VTE distribution was: deep vein thromboses of arms/legs (79.6%), cerebral sinus venous thrombosis (7%), abdominal VTE (5%), pulmonary embolism (4.3%), and other (intra-cardiac and superior vena cava/right atrial junction - 5.5%) with overlap due to some subjects with multiple, separate, concurrent VTE events. Demographic characteristics revealed median age of 3.6 years (IQR: 0.4 - 13.6 years) at VTE diagnosis and slight male predominance (55%). 66.1% of subjects had significant past medical history (Table 1) and 7.2% were immobile at baseline. Evaluation of hospital course revealed a multitude of acquired putative risk factors for HA-VTE (Table 2). 70.8% of VTE were associated with a central venous catheter (CVC). Of CVC-related VTE, 70.5% were in the same vein as CVC, 20.1% were in a vein which previously held a CVC, 10.7% surrounded the CVC tip, 2.5% occurred in a vein where CVC placement was attempted but unsuccessful. 55% of subjects had at least one documented infection during hospitalization, 42% of subjects had surgery, 20.7% had a procedure involving intravascular instrumentation (defined as dialysis, plasmapheresis, cardiac catheterization, stent placement/removal, or coiling procedure), 5% of subjects underwent trauma prior to admission with 82% of trauma classified as "major", and 59.5% of subjects were intubated at some point during their admission. Regarding medications, 31.9% of subjects were on steroids at VTE diagnosis and an additional 13.2% of subjects received steroids in the 30 days prior to VTE diagnosis, 2.2% of subjects were on estrogen with all of these subjects having started estrogen within 6 months prior to VTE diagnosis, 4.1% of subjects received asparaginase prior to VTE, 1.6% of subjects received recombinant factor VIIa prior to VTE, and 0.4% of subjects received prothrombin complex concentrates prior to VTE. Laboratory testing of hospitalized patients revealed 43.2% of patients had a d-dimer level obtained at time of VTE and 96.5% of those patients had an elevated level. 48.3% of patients had at least one thrombophilia lab test ordered. 17.8% of subjects received VTE prophylaxis - 55% of which was pharmacologic anticoagulation. Conclusions: The CHAT registry results demonstrate a slight male predisposition and multiple associated chronic medical illnesses and acquired hospital course co-morbidities, particularly CVCs which were involved in the majority of events. Ongoing work includes incorporating additional institutions to reach a goal of 1000 cases and 2000 controls to identify independent risk factors for the development of a risk-assessment scoring system. Long-term goals include prospective validation of the scoring system to serve as the basis of identifying subjects for a future randomized clinical trial of risk-based prevention strategies. Such a trial would evaluate efficacy, safety, and cost-benefit of thromboprophylaxis in hospitalized children and help inform best practices. Disclosures Young: Novo Nordisk: Consultancy, Speakers Bureau; Kedrion: Consultancy; Baxter: Consultancy; Biogen: Consultancy, Speakers Bureau.

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Risk Factors for Hospital-Acquired Venous Thromboembolism in Children: Findings from the Children's Hospital-Acquired Thrombosis (CHAT) Registry

Blood ◽

10.1182/blood-2018-99-119968 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 142-142

Author(s):

Brian R. Branchford ◽

Julie Jaffray ◽

Stacy E. Croteau ◽

Michael Silvey ◽

Nihal Bakeer ◽

...

Keyword(s):

Risk Factors ◽

Medical History ◽

Research Funding ◽

Venous Catheter ◽

Past Medical History ◽

Central Venous ◽

History Of ◽

Hospital Acquired ◽

Active Cancer ◽

Or History

Abstract Introduction Pediatric hospital-acquired venous thromboembolism (HA-VTE) rates are increasing along with associated mortality, short- and long-term morbidity, and healthcare costs. National process improvement efforts are underway to decrease HA-VTE in children, but risk-stratified prevention strategies will be safest and most effective if informed by robust risk factor data. The objective of this work was to identify risk factors for HA-VTE in children via a multicenter study Methods The Children's Hospital-Acquired Thrombosis (CHAT) Registry is a multi-institutional pediatric HA-VTE registry that we created to generate a risk-prediction model for future use in clinical trials of thromboprophylaxis. Designed as a retrospective case-control study, CHAT Registry data has been entered by 7 U.S. pediatric institutions for subjects admitted between January 1, 2012 and December 31, 2016. Cases (aged 0-21 years) that developed HA-VTE during the admission were matched by institution and admission year with 1:1 frequency to randomly sampled non-HA-VTE controls. Univariate analyses tested associations between risk factors and the development of HA-VTE. Analyses utilized weighted logistic regression, in which controls were weighted by the inverse sampling probability in order to recreate the population from which the controls were sampled. Year of admission and hospital sites were included in the assessment of each predictor to control for effects of time and treating hospital. Results 825 HA-VTE cases and 841 controls from participating hospitals comprise the analytical cohort (total 1,666 hospital admissions). HA-VTE cases showed a male predominance (58%). The majority, 73%, were related to central venous catheters (CVCs). HA-VTE most commonly occurred in the lower extremity (32%) followed by upper extremity (16%), thorax/neck (16%), cerebral sinovenous (5%), abdomen (5%), lung (3%), cardiac (2%), and other (22%). VTE were asymptomatic or identified incidentally in 21% of cases. Subjects were most commonly located in an intensive care unit (ICU) (58%) when diagnosed with a VTE, followed by general medical ward (23%), hematology/oncology unit (13%), surgical unit (3%), emergency department (1%), and other (1%). Significant association with HA-VTE incidence (Table 1) was found with infancy compared to other age groups, prior hospitalization within 1 month (Odds Ratio [OR] 3.6, 95% Confidence Interval [CI] 2.7-4.8) compared to no recent prior admission, admission to ICU (cardiac/pediatric ICU OR 10.1, 95% CI 6.0-17.1 and NICU OR 9.0, 95% CI 5.2-15.7) or hematology/oncology units (OR 2.7, 95% CI 1.6-6.0) compared to admission to general pediatric ward, complete immobility acutely (OR 32.3, 95% CI 13.2-79.2 ) compared to no loss of mobility from baseline, chronic bed-bound/wheelchair-bound immobility (OR 2.2, 95% CI 1.4-3.6), and a past medical history of protein-losing state (OR 34.6, 95% CI 4.1-290.9), inflammatory/autoimmune disease (OR 31.8, 95% CI 3.9-262.1), congenital heart disease (OR 28.5, 95% CI 12.7-64.2), central venous catheter placed on the day of admission (OR 22.0, 95% CI 14.2-34.1) or prior to admission (OR 5.2, 95% CI 3.4-7.9) thrombophilia/VTE (OR 9.7, 95% CI 2.6-35.5), TPN dependence (OR 8.0, 95% CI 1.6-39.3), or history of cancer (OR 1.5, 95% CI 1.0-2.4) compared to the absence of past medical history. Additionally, active cancer conferred an overall odds ratio of 2.0, with the recurrent/metastatic subtype conferring an OR of 3.4 compared to other active cancer subtypes. Conclusions The multi-institution CHAT Registry contains a larger dataset of pediatric HA-VTE cases and controls than any similar collection published to date. Key demographic and clinical factors associated with HA-VTE include infant age, male sex, ICU admission, central venous catheter, decreased mobility, cancer, use of certain medications, or certain past medical history (protein-losing state, congenital heart disease, inflammatory/autoimmune condition, thrombophilia or history of VTE, and TPN dependence). Further analysis is being performed on these and other risk factors to develop a pediatric-specific HA-VTE risk-prediction model for future validation in an even larger multi-institutional cohort. This validated risk model will then be used to identify children at high risk of HA-VTE to guide preventative strategies to decrease the incidence in the pediatric population. Disclosures Jaffray: CSL Behring: Consultancy, Research Funding; Octapharma: Consultancy; Bayer: Consultancy. Croteau:Tremeau Pharmaceuticals: Consultancy; Baxalta/Shire: Consultancy, Research Funding; Biomarin: Consultancy; Bioveritiv: Consultancy; Catalyst Biosciences: Consultancy; CSL-Behring: Consultancy; Genetech: Consultancy, Research Funding; Novo Nordisk: Consultancy; Octapharma: Consultancy, Honoraria, Research Funding; Pfizer: Research Funding; Spark Therapeutics: Research Funding; Bayer: Consultancy. Silvey:Bayer: Honoraria; Pfizer: Honoraria; CSL Behring: Honoraria; Octapharma: Honoraria. Young:Bioverativ: Consultancy, Honoraria; Bayer: Consultancy; CSL Behring: Consultancy, Honoraria; Genentech/Roche: Consultancy, Honoraria; Kedrion: Consultancy; Novo Nordisk: Consultancy, Honoraria; Shire: Consultancy, Honoraria. Mahajerin:Genentech Inc.: Consultancy.

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Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems

Urologia Internationalis ◽

10.1159/000512055 ◽

2020 ◽

pp. 1-7

Author(s):

Klaus-Peter Dieckmann ◽

David Marghawal ◽

Uwe Pichlmeier ◽

Christian Wülfing

Keyword(s):

Risk Factors ◽

Central Venous Access ◽

Multivariable Analysis ◽

Venous Access ◽

Germ Cell Tumours ◽

Thromboembolic Events ◽

Central Venous ◽

Testicular Germ Cell ◽

Testicular Germ Cell Tumours ◽

Independent Risk Factors

Background: Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. Patients, Methods: TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. Results: Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9–191.6); chemotherapy OR = 7.8 (95% CI 2.3–26.6); CVA OR = 30.5 (95% CI 11.0–84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5–82.4) and CVA (OR = 9.0; 95% CI 2.9–27.5) as independent risk factors. Conclusions: Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.

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A New Preoperative Risk Score for Predicting Postoperative Complications in Elderly Patients Undergoing Hepatectomy

World Journal of Surgery ◽

10.1007/s00268-021-05985-w ◽

2021 ◽

Author(s):

Koichi Tomita ◽

Itsuki Koganezawa ◽

Masashi Nakagawa ◽

Shigeto Ochiai ◽

Takahiro Gunji ◽

...

Keyword(s):

Risk Factors ◽

Skeletal Muscle ◽

Postoperative Complications ◽

Elderly Patients ◽

Risk Score ◽

Surgical Procedure ◽

Evaluation Method ◽

Preoperative Risk ◽

Preoperative Serum ◽

Independent Risk Factors

Abstract Background Postoperative complications are not rare in the elderly population after hepatectomy. However, predicting postoperative risk in elderly patients undergoing hepatectomy is not easy. We aimed to develop a new preoperative evaluation method to predict postoperative complications in patients above 65 years of age using biological impedance analysis (BIA). Methods Clinical data of 59 consecutive patients (aged 65 years or older) who underwent hepatectomy at our institution between 2017 and 2020 were retrospectively analyzed. Risk factors for postoperative complications (Clavien-Dindo ≥ III) were evaluated using multivariate regression analysis. Additionally, a new preoperative risk score was developed for predicting postoperative complications. Results Fifteen patients (25.4%) had postoperative complications, with biliary fistula being the most common complication. Abnormal skeletal muscle mass index from BIA and type of surgical procedure were found to be independent risk factors in the multivariate analysis. These two variables and preoperative serum albumin levels were used for developing the risk score. The postoperative complication rate was 0.0% with a risk score of ≤ 1 and 57.1% with a risk score of ≥ 4. The area under the receiver operating characteristic curve of the risk score was 0.810 (p = 0.001), which was better than that of other known surgical risk indexes. Conclusion Decreased skeletal muscle and the type of surgical procedure for hepatectomy were independent risk factors for postoperative complications after elective hepatectomy in elderly patients. The new preoperative risk score is simple, easy to perform, and will help in the detection of high-risk elderly patients undergoing elective hepatectomy.

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Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

Korean Journal of Anesthesiology ◽

10.4097/kja.20035 ◽

2020 ◽

Vol 73 (6) ◽

pp. 542-549

Author(s):

Taeha Ryu ◽

Baek Jin Kim ◽

Seong Jun Woo ◽

So Young Lee ◽

Jung A Lim ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Odds Ratio ◽

Arthroscopic Surgery ◽

Sitting Position ◽

Past Medical History ◽

Frequent Adverse Event ◽

Increased Risk ◽

Potential Risk Factors ◽

Independent Risk Factors

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

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A New Rapid Approach for Predicting Death in Coronavirus Patients: The Development and Validation of the COVID-19 Risk-Score in Fars Province (CRSF)

Iranian Journal of Public Health ◽

10.18502/ijph.v51i1.8310 ◽

2022 ◽

Author(s):

Mehrdad Sharifi ◽

Mohammad Hossein Khademian ◽

Razieh Sadat Mousavi-Roknabadi ◽

Vahid Ebrahimi ◽

Robab Sadegh

Keyword(s):

Risk Factors ◽

Risk Score ◽

Predictive Value ◽

Assessment Tool ◽

Fars Province ◽

Risk Of Mortality ◽

Risk Patients ◽

Independent Risk Factors ◽

Development And Validation ◽

Underlying Diseases

Background:Patients who are identified to be at a higher risk of mortality from COVID-19 should receive better treatment and monitoring. This study aimed to propose a simple yet accurate risk assessment tool to help decision-making in the management of the COVID-19 pandemic. Methods: From Jul to Nov 2020, 5454 patients from Fars Province, Iran, diagnosed with COVID-19 were enrolled. A multiple logistic regression model was trained on one dataset (training set: n=4183) and its prediction performance was assessed on another dataset (testing set: n=1271). This model was utilized to develop the COVID-19 risk-score in Fars (CRSF). Results: Five final independent risk factors including gender (male: OR=1.37), age (60-80: OR=2.67 and >80: OR=3.91), SpO2 (≤85%: OR=7.02), underlying diseases (yes: OR=1.25), and pulse rate (<60: OR=2.01 and >120: OR=1.60) were significantly associated with in-hospital mortality. The CRSF formula was obtained using the estimated regression coefficient values of the aforementioned factors. The point values for the risk factors varied from 2 to 19 and the total CRSF varied from 0 to 45. The ROC analysis showed that the CRSF values of ≥15 (high-risk patients) had a specificity of 73.5%, sensitivity of 76.5%, positive predictive value of 23.2%, and negative predictive value (NPV) of 96.8% for the prediction of death (AUC=0.824, P<0.0001). Conclusion:This simple CRSF system, which has a high NPV,can be useful for predicting the risk of mortality in COVID-19 patients. It can also be used as a disease severity indicator to determine triage level for hospitalization.

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Quality of Life and Psychological Distress during Cancer: A Prospective Observational Study Involving Liver Cancer Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i47a33047 ◽

2021 ◽

pp. 576-585

Author(s):

Madeeha Malik ◽

Iqra Parveen Kiyani ◽

Shazana Rana ◽

Azhar Hussain ◽

Muhammad Bin Aslam Zahid

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Liver Cancer ◽

Medical History ◽

Cancer Patients ◽

Study Design ◽

Negative Impact ◽

Past Medical History ◽

Symptom Scale

Introduction: Liver Cancer is aggressive cancer and patients are mostly screened and diagnosed when they become symptomatic at advanced. Disease severity, depression, fatigue, joint pain, and poor appetite have been reported as strong determinants of quality of life (QoL) among liver cancer patients. Aims: The objective of the study was to assess the quality of life and depression among liver cancer patients in Pakistan. Study Design: A descriptive cross-sectional study design was used. Place and Duration of Study: The study was conducted in healthcare facilities of Islamabad and Rawalpindi, Pakistan between June 2020-December 2020. Methodology: Two pre-validated questionnaires i.e. EORTC QLQ-C30 and HADS were self-administered to a sample of 100 liver cancer patients selected using a convenience sampling technique for measuring QoL and depression, respectively. After data collection, data was cleaned, coded, and entered in SPSS. Results: The results highlighted that the lowest scores observed in the domain of symptom scale were: Nausea and Vomiting (23.72, ± 28.238), Dyspnea (25.27, ± 26.90), Constipation (26.03, ± 34.75) followed by Diarrhea (22.63, ± 28.42), whereas highest scores in the symptom scale were observed in the domain of fatigue (37.69, ± 20.06), pain (40.37, ± 18.44), insomnia (41.65, ± 32.37) and financial difficulties (60.33, ± 33.830). On the other hand, highest score on the functional scale was observed for physical functioning (64, ± 21.76) and the lowest score was observed in social functioning (53.19, ± 20.66). Conclusion: The present study concluded that liver cancer had a negative impact on risk factors/past medical history, co-morbidities, and poor socio-economic of life across all domains along with moderate depression in liver cancer patients. Illiteracy, advanced liver cancer stage, risk factors/past medical history, co-morbidities and poor socio-economic status negatively affected functional and symptom scale. Appropriate health educational and psychological interventional programs targeting patients should be initiated to improve awareness and reduce depression among liver cancer patients.

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Risk Factors and Outcomes of Hospital Acquired Pneumonia in Young Bangladeshi Children

Life ◽

10.3390/life11101030 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1030

Author(s):

Abu Sadat Mohammad Sayeem Bin Shahid ◽

Tahmina Alam ◽

Lubaba Shahrin ◽

K. M. Shahunja ◽

Md. Tanveer Faruk ◽

...

Keyword(s):

Risk Factors ◽

Severe Acute Malnutrition ◽

Multivariate Logistic Regression Analysis ◽

Acute Malnutrition ◽

Persistent Diarrhea ◽

Multivariate Logistic Regression ◽

Resource Limited ◽

Hospital Acquired Pneumonia ◽

Independent Risk Factors ◽

Hospital Acquired

Hospital acquired pneumonia (HAP) is common and often associated with high mortality in children aged five or less. We sought to evaluate the risk factors and outcome of HAP in such children. We compared demographic, clinical, and laboratory characteristics in children <5 years using a case control design during the period of August 2013 and December 2017, where children with HAP were constituted as cases (n = 281) and twice as many randomly selected children without HAP were constituted as controls (n = 562). HAP was defined as a child developing a new episode of pneumonia both clinically and radiologically after at least 48 h of hospitalization. A total of 4101 children were treated during the study period. The mortality was significantly higher among the cases than the controls (8% vs. 4%, p = 0.014). In multivariate logistic regression analysis, after adjusting for potential confounders, it was found that persistent diarrhea (95% CI = 1.32–5.79; p = 0.007), severe acute malnutrition (95% CI = 1.46–3.27; p < 0.001), bacteremia (95% CI = 1.16–3.49; p = 0.013), and prolonged hospitalization of >5 days (95% CI = 3.01–8.02; p < 0.001) were identified as independent risk factors for HAP. Early identification of these risk factors and their prompt management may help to reduce HAP-related fatal consequences, especially in resource limited settings.

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Clinical Characteristics in Patients with Hospital-Acquired Pneumonia Caused by Extensively Drug-Resistant Acinetobacter baumannii, A Multicenter Retrospective Study

10.21203/rs.3.rs-116166/v1 ◽

2020 ◽

Author(s):

Yujun Li ◽

Xiaomei Huang ◽

Yuyao Wang ◽

Chuzhi Pan ◽

Zexun Mo ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Apache Ii ◽

Apache Ii Score ◽

Drug Resistant ◽

Central Venous ◽

Hospital Acquired Pneumonia ◽

Hospital Acquired ◽

Lactamase Inhibitor

Abstract Background Extremely drug-resistant (XDR) Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

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Prevalence and risk factors for pelvic organ prolapse in female citizens of Baku

Kazan medical journal ◽

10.17816/kmj2018-187 ◽

2018 ◽

Vol 99 (2) ◽

pp. 187-194

Author(s):

M Sh Askerova ◽

L M Rzakulieva

Keyword(s):

Risk Factors ◽

Secondary Education ◽

Pelvic Organ Prolapse ◽

Family History ◽

Medical History ◽

Positive Family History ◽

Age Groups ◽

Pelvic Organ ◽

Physical Work ◽

Past Medical History

Aim. Study of prevalence and risk factors of pelvic organ prolapse in females in Baku. Methods. Statistical observation unit was a woman aged 45-74 years. The sample size (710 women) was determined taking into account probable prevalence of pelvic organ prolapse (20% according to literature) and margin of error (3%). All women were invited to maternity welfare centre, and a thorough examination was performed after their written consent was obtained. Results. The proportion of women aged 45-49, 50-54, 55-59, 60-64, 65-69, and 70-74 years was 26.5±1.7, 24.9±1.6, 23.1±1.6, 10.9±1.2, 8.2±1.0 and 6.4±0.9%, respectively. Prevalence of obesity in the named groups was 31.9, 34.5, 35.4, 36.4, 27.8 and 34.8%. Proportion of women with secondary and specialized secondary education was 58.5, 58.8, 53.7, 51.9, 51.7 and 67.4% resepctively. Among women of the corresponding age groups, physical work was recorded in 47.9, 53.7, 59.8, 58.4, 13.8 and 17.4% of cases, respectively. In past medical history, no surgeries were observed in 68.1, 77.4, 73.2, 77.9, 84.5 and 84.8% of cases, resepectively. Some women had no labour in past medical history (2.1, 2.3, 2.5, 2.6, 3.5 and 4.3% in the same age groups). Statistically significantly prevalence of pelvic organ prolapse increases among those aged 60 years and older (51.6±3.6% at age 45-49 years and ≥76.6±4.8% at age 60 years and older, р=0.001), with a body mass index less than 25.0 and more than 30 kg/м2 (69.7±3.3 and 66.7±3.0%, р=0.01), with high parity and remarkable family history (63.0±2.6, р=0.01), severe connective tissue dysplasia (72.6±2.5%, р=0.001), in postmenopausal period (63.8±2.0%, р=0.01), and depending on education level (88.0±2.4% among those with pre-secondary education: р=0.001). Relative risk of pelvic organ prolapse in the population of Baku is lower compared to the literature data in the background of obesity, but is higher in the background of positive family history and depending on the amount of deliveries (p=0.05). Conclusion. In Baku 59.9±1.8% of women aged 45-75 years have pelvic organ prolapse of different severity, incomplete uterine and vaginal prolapse are more prevalent (41.3±1.8 per 100 women); prevalence of pelvic organ prolapse is higher in women aged 60 years or older compared to those aged 45-49 (76.6±4.8% vs 51.6±3.6%, р=0.001).

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