A Study in the Clinical Characteristics of Stenotrophomonas Maltophilia Bacteremia in Hematological Patients

Abstract Introduction: Stenotrophomonas maltophilia is an important nosocomial pathogen, particularly in immunocompromised patients, especially in patients with hematologic diseases. Methods: We reviewed the clinical characteristics and prognosis of patients with S. maltophilia bacteremia over a five-year period from January 2010 to December 2014. Species identification was performed using the automated Vitek 2 compact system (bioMe rieux). Results: The incidence of S. maltophilia bacteremia was 25.1 per 10 000 admissions in our study. Thirty-four patients (median age: 34 years; 64.7% males) with S. maltophilia bacteremia were analyzed. The S. maltophilia bacteremia related 30-day mortality was 44.1%. Risk factors associated with mortality in patients with S. maltophilia infection in the univariate and multivariate analysis were represented in Tables I and II. In the univariate analysis, risk factors included T>39.0¡æ, septic shock, respiratory failure and non-remission after treatment for primary hematological diseases (P <0.05). In the multivariate analysis, respiratory failure and non-remission status after treatment forhematological diseases were independent prognostic factors for mortality. In vitro susceptibility was higher to ciprofloxacin(82.4%), ceftazidime(70.6%), sulbactam and cefoperazone(58.8%), which was shown in Table III. Conclusion: Combination regimens with ciprofloxacin and ceftazidime, or sulbactam and cefoperazone could be alternative treatment. Novel antibiotics are required for treatment of S. maltophilia infection, as well as infection control practices of environmental reserves, rapid detection of pathogens, risk stratification strategy and appropriate treatment for primary hematologic malignancies, which might conjointly contribute to better survival outcome of S. maltophilia bacteremia. Univariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Table 1. Factor Mortality HR 95%CI P-value Withfactor Withoutfactor T>39.0¡æ 75% 16.7% 2.490 1.318-4.704 0.005 Septic shock 90.0% 25.0% 2.544 1.473-4.393 0.001 Respiratory failure 100% 20.8% 4.672 2.366-9.225 0.000 Treatment outcome for hematological diseases Remission 10.0% 85.7% 0.247 0.116-0.526 0.000 HR, hazard ratio; CI, confidence interval; HSCT, Hematopoietic stem cell transplantation Table 2. Multivariate analysis of prognostic factors associated with mortality from S. maltophilia bacteremia Factor HR 95%CI P-value Respiratory failure 2.688 1.297-5.569 0.008 Remission after treatment for hematological diseases 0.367 0.153-0.879 0.025 HR, hazard ratio; CI, confidence interval Table 3. Susceptibility pattern of the 34 patients with Stenotrophomonas maltophilia bacteremia Antimicrobial agents S (%) I (%) Ceftazidime 24(70.6%) 1(2.9%) Cefoperazone 19(44.1%) 6(17.6%) Sulbactam and Cefoperazone 20(58.8%) 5(14.7%) Piperacillin 7(20.6%) 6(17.6%) Piperacillin-Tazobactam 11(32.3%) 7(20.6%) Amikacin 6(17.6%) 0(0%) Ciprofloxacin 28(82.4%) 1(2.9%) S, susceptible; I, intermediately susceptible. Disclosures No relevant conflicts of interest to declare.

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Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

10.21203/rs.3.rs-50120/v1 ◽

2020 ◽

Author(s):

Shiyao Wang ◽

Xinran Zhang ◽

Yanhong Ren ◽

Yi Zhang ◽

Ye Tian ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Prognostic Factors ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Serum Ferritin ◽

Factors Associated ◽

Overall Mortality

Abstract Background: This study aims to identify prognostic factors for mortality of patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5) or anti-aminoacyl-RNA synthetase (anti-ARS) antibodies positive and acute respiratory failure in the intensive care unit.Methods: Clinical characteristics, laboratory test findings, imaging performance, and management were retrospectively collected in all cases with anti-MDA5 and anti-ARS antibodies positive, as well as follow-up survival data. Risk factors related to prognosis were identified by Cox regression analysis.Results: The 28-day mortality of all patients was 68.8% (n=44/64). The patients who died were more likely to have anti-MDA5 antibody(p<0.001), presented more Gottron papules(p=0.021) or heliotrope rash(p=0.008), had a relatively lower level of WBC(p=0.038), CRP(p=0.004), and had a higher level of LDH(p=0.029), serum ferritin(p=0.002). The main risk factors associated with 28-day mortality were anti-MDA5 antibody positive [HR 10.827 (95% CI: 4.261-27.514), p<0.001], presence of Gottron papules [2.299 (1.203-4.394), p=0.012], heliotrope rash [3.423 (1.773-6.606), p<0.001], and arthritis/arthralgia [2.365 (1.130-4.948), p=0.022). At a median of 14 (IQR 6.33-35.0) months of follow-up, the overall mortality of all patients was 75.0% (n=48/64). The non-survivors were more likely to own anti-MDA5 antibody(p<0.001), had a higher rate of Gottron papules(p=0.020) or heliotrope rash(p=0.014), had lower PFR(p=0.032) while ICU admission, and existed a higher level of serum ferritin(p=0.005). Main risk factors associated with overall mortality were consistent with risk factors for 28-day mortality. Conclusions: Anti-MDA5 antibody positive, presence of Gottron papules, heliotrope rash, or arthritis/arthralgia were the main independent risk factors of poor prognosis for IIM patients admitted to the ICU due to acute respiratory failure.

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Predictive factors of posttreatment fracture by definitive radiotherapy for uterine cervical cancer

Japanese Journal of Radiology ◽

10.1007/s11604-020-01039-8 ◽

2020 ◽

Author(s):

Kazuki Ishikawa ◽

Tsuneo Yamashiro ◽

Takuro Ariga ◽

Takafumi Toita ◽

Wataru Kudaka ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Cervical Cancer ◽

Multivariate Analysis ◽

Radiation Therapy ◽

Cancer Patients ◽

Clinical Characteristics ◽

Univariate Analysis ◽

Uterine Cervical Cancer

Abstract Purpose Fractures are known to shorten life expectancy and worsen the quality of life. The risk of fractures after radiation therapy in cervical cancer patients is known to be multifactorial. In this study, we examined risk factors for fractures in cervical cancer patients, especially by evaluating bone densities and DVH parameters for fractured bones. Materials and Methods For 42 patients, clinical characteristics, pretreatment CT bone densities, and radiation dose were compared between patients with and without fractures. Results Posttreatment fractures occurred in 25 bones among ten patients. Pretreatment CT bone densities were significantly lower in patients with fractures (P < 0.05–0.01 across sites, except for the ilium and the ischium). Although DVH parameters were also significantly associated with fractures in univariate analysis, only CT densities were significantly associated with fractures in multivariate analysis. Conclusion Pretreatment CT densities of spinal and pelvic bones, which may reflect osteoporosis, have a significant impact on the risk for posttreatment fractures.

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Risk Factors and Mortality in Pediatric Patients with Stenotrophomonas maltophilia Bacteremia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1005 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s374-s375

Author(s):

Mohammed Alsuhaibani ◽

Alanoud Aljarboua ◽

Sahar Althawadi ◽

Abdurahman Alsweed ◽

Sami Al-Hajjar

Keyword(s):

Risk Factors ◽

Stenotrophomonas Maltophilia ◽

Pediatric Patients ◽

Heart Diseases ◽

Univariate Analysis ◽

Bloodstream Infections ◽

Factors Associated ◽

Icu Admission ◽

Significant Difference ◽

The Impact

Background:Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic and nosocomial pathogen that can cause an invasive and fatal infection, particularly in hospitalized and immunocompromised patients. However, little is known about the impact of S. maltophilia bacteremia in pediatric patients. Therefore, we aimed to identify risk factors for mortality, antibiotic susceptibility of S. maltophilia, and mortality rates in pediatric patients with S. maltophilia bacteremia. Methods: We conducted a retrospective cohort study by identifying all S. maltophilia–positive blood cultures in the microbiology laboratory database between January 2007 and December 2018 from hospitalized pediatric patients (age, 1–14 years) at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. After identifying patients with S. maltophilia bacteremia, medical charts were reviewed for demographics, clinical data, and outcome within 7 days of bacteremia diagnosis. Risk factors associated with mortality in S. maltophilia bacteremia patients were determined using univariate and multivariate analyses. Results: Overall, 68% of pediatric patients with S. maltophilia bacteremia were identified. The most common underlying primary diagnoses were malignancy (29.4%), congenital heart diseases (16.2%), anemia (14.7%), and primary immunodeficiency (11.8%). All infections were nosocomial infections, and (88.2%) bacteremia cases were central-line–associated bloodstream infections. The risk factors associated with mortality as determined by univariate analysis were ICU admission (P < .001), intubation (P = .001), neutropenia (P = .008), prior use of carbapenem (P = .002), thrombocytopenia (P = .006), and respiratory colonization (P < .001). On multivariate analysis, ICU admission (P = .007; 95% CI, 0.003–0.406) and neutropenia (P = .009; 95% CI, 0.013–0.537) were the major risk factors associated with mortality. S. maltophilia was the most susceptible to trimethoprim and sulfamethoxazole (TMP/SMX, 94.1%), followed by levofloxacin (85.7%). In addition, 36 patients received TMP/SMX as monotherapy, and 11 patients received it in combination with other antibiotics (fluoroquinolone, ceftazidime, or aminoglycoside). Hence, no statistically significant difference was observed in patient mortality. The overall mortality rate within 7 days of S. maltophilia bacteremia diagnosis was 33.8%. Conclusions:S. maltophilia bacteremia is a devastating emerging infection associated with high mortality among hospitalized children. Therefore, early diagnosis and prompt management based on local susceptibility data are crucial. Various risk factors, especially ICU admission and neutropenia, are associated with S. maltophilia bacteremia mortality.Funding: NoneDisclosures: None

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Prognostic Factors in Patients with Fanconi Anemia (FA) after Alternate Donor (AD) Hematopoietic Cell Transplantation (HCT).

Blood ◽

10.1182/blood.v106.11.564.564 ◽

2005 ◽

Vol 106 (11) ◽

pp. 564-564 ◽

Cited By ~ 1

Author(s):

Suleimman A. Alsweedan ◽

John E. Wagner ◽

Ye Tan ◽

Todd E. DeFor ◽

Margaret L. MacMillan

Keyword(s):

Prognostic Factors ◽

High Risk ◽

Acute Gvhd ◽

Cox Regression ◽

Univariate Analysis ◽

P Value ◽

Blood Product Transfusion ◽

Factors Associated ◽

Sibling Donor ◽

Prior Infection

Abstract The treatment of choice for the hematological complications in FA patients is a histocompatible sibling donor HCT. However, as FA is inherited disorder, most patients do not have an HLA-matched non-affected sibling donor and therefore require AD (HLA-mismatched sibling or unrelated) HCT with inherent increased morbidity and mortality. To identify prognostic factors for survival after AD HCT, we evaluated outcomes in 83 FA patients transplanted at the University of Minnesota from 1990 to 2004. Median age at HCT was 11.8 years (range, 0.8–48.5). 82% received bone marrow (BM) grafts and 18% received unrelated cord blood (UCB). In univariate analysis, factors associated with significantly higher 3-year survival included: age [42% (<18 years, n=67) vs 16% (>18 years, n=16) p=0.01]; recipient CMV serostatus [45% (negative, n=55) vs 19% (positive) p=0.01]; blood product transfusion 82% [(none, n=11) vs 28%(any, n= 67) p= 0.03], prior infection (gram negative bacteria or fungal) [46% (absent, n=62) vs 8%(present, n=19) p= 0.01], and use of fludarabine (FLU) in preparative regimen [45% (present, n=54) vs 24% (absent, n=29) p=0.03]. In multivariate analysis, factors associated with improved survival were young age, negative recipient CMV serostatus, no prior infections and no severe acute GVHD (Table 1). If age <18 yrs, CMV negativity, and absence of prior infections defines ‘standard risk’, 3 year survival is 68% (95% CI, 50–85%) compared to 20% (95% CI, 7–32%) for those with ‘high risk’ disease (p =0.01). Disease status at HCT, androgen use, number of malformations, gender, donor source and HLA disparity did not have a demonstrable effect on survival. Table 1: Cox regression on survival Factors Relative Risk(95% CI) P-value Note:*-reference category Model(X2=33.5, p<0.01) Age at transplant(X10) 1.62 (1.15-2.28) <0.01 Recipient CMV Negative 1.0 * Positive 3.41(1.82-6.37) <0.01 Prior Infection No 1.0 * Yes 2.33 (1.24-4.36) <0.01 Grade 3-4 acute GvHD No 1.0 * Yes 5.04 (2.34-10.88) <0.01 These data suggest that patients with FA should receive AD HCT before the development of preventable high risk features, namely older age and serious infections. FLU based preparative regimens and measures to prevent acute GVHD should also be used to improve survival. Mismatched BM and UCB donor may provide greater donor options for timely transplants in FA patients.

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Determination of Risk Factors Associated With Walking Disorders After Anterior Cruciate Ligament Surgery With Hamstring Graft : A Controlled Multicenter Study

10.20944/preprints202009.0430.v1 ◽

2020 ◽

Author(s):

Marine Gaignon ◽

Jean Mazeas ◽

Maude Traullé ◽

Amaury Vandebrouck ◽

Pascal Duffiet ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Multivariate Analysis ◽

Cruciate Ligament ◽

Univariate Analysis ◽

Test Group ◽

Healthy Population ◽

Hamstring Graft ◽

Factors Associated ◽

Anterior Cruciate

Today, rupture of the anterior cruciate ligament is the most common heavy injury in athletes, but it can also occur in sedentary subjects. Its treatment, always adapted to the lifestyle, age and will of the patient, often remains surgical. However, despite its frequency and universality, there are still walking disorders following the operation. These disorders sometimes persist for several months, or even several years after surgery. The present study is therefore interested in determining the risk factors linked to walking disorders following reconstruction of the anterior cruciate ligament. The objective of this study is to determine what risk factors associated with walking disorders are after reconstruction of the anterior cruciate ligament by hamstring graft. This study focused on factors that may exist at 3 and 6 months postoperatively. Two populations participated in this study, a healthy population and a population having benefited from reconstruction of the anterior cruciate ligament. The operated test group is divided into two subgroups, one with a postoperative period of 3 months and the second at 6 months. All subjects were subjected to the same protocol, their gait on the treadmill was analyzed and evaluated with an Optogait® analysis system. A univariate analysis was carried out first. Then, a multivariate analysis by adjustment method was carried out in order to eliminate the potential confounding factors. The comparison of the results between the populations in the univariate analysis shows an absence of significant results however there are trends. The statistical results of the multivariate analysis showed interactions in the two subgroups of the operated population.In fact, it turns out that at 3 months there is a tendency to worse gait disorders in subjects with a high BMI reflecting overweight, when an associated surgical procedure has taken place on the meniscus, in subjects over 35 years of age and males. On the other hand, at 6 months, the tendency to worsening is visible only in the strata represented by subjects with a BMI corresponding to overweight, as well as in subjects having benefited from a meniscal suture associated with ACL reconstruction. .The results of the present study show that there are certain factors which tend to increase the risk of these walking disorders after reconstruction of the anterior cruciate ligament by hamstring graft, these factors are different depending on the time postoperative.

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Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia infections

Journal of Laboratory Physicians ◽

10.4103/0974-2727.199639 ◽

2017 ◽

Vol 9 (02) ◽

pp. 132-135 ◽

Cited By ~ 3

Author(s):

Priyam Batra ◽

Purva Mathur ◽

Mahesh C. Misra

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Stenotrophomonas Maltophilia ◽

Clinical Characteristics ◽

Resistance Pattern ◽

Pathogenic Potential ◽

Factors Associated ◽

Venous Catheterization ◽

Potential Pathogen ◽

Independent Risk Factors

Abstract INTRODUCTION: Stenotrophomonas maltophilia earlier had limited pathogenic potential, but now with growing degree of immunosuppression in general population, it is being recognized as an important nosocomial pathogen. METHODOLOGY: A retrospective 7 years study was carried out to determine the clinical characteristics of all patients with Stenotrophomonas infections, antibiotic resistance pattern, and risk factors associated with hospital mortality. All patients with Stenotrophomonas culture positivity were identified and their medical records were reviewed. Risk factor associated with hospital mortality was analyzed. RESULTS: A total of 123 samples obtained from 88 patients were culture positive. Most patients presented with bacteremia (45, 51%) followed by pneumonia (37, 42%) and skin and soft tissue infections (6, 7%). About 23 of 88 Stenotrophomonas infected patients had co-infection. Percentage resistance to cotrimoxazole; 8 (5.4%) was lower than that for levofloxacin; 18 (12%). Twenty-eight patients died during hospital stay. Intensive Care Unit admission (P = 0.0002), mechanical ventilation (P = 0.0004), central venous catheterization (P = 0.0227), urethral catheterization (P = 0.0484), and previous antibiotic intake (P = 0.0026) were independent risk factors associated with mortality. CONCLUSION: Our findings suggest that Stenotrophomonas can cause various infections irrespective of patient’s immune status and irrespective of potential source. Thus, Stenotrophomonas should be thought of as potential pathogen and its isolation should be looked with clinical suspicion.

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Risk and Prognostic Factors for Intracranial Hemorrhage in Elderly Patients with Immune Thrombocytopenia

Blood ◽

10.1182/blood-2020-136461 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 14-15

Author(s):

Jia-Ning Zhang ◽

Peng Zhao ◽

Kaiyan Liu ◽

Ming Hou ◽

Yanqiu Han ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Prognostic Factors ◽

Head Trauma ◽

Risk Score ◽

Conditional Logistic Regression ◽

Univariate Analysis ◽

P Value ◽

Poor Prognostic Factor ◽

Life Threatening

Introduction: Immune thrombocytopenia (ITP) is a hematological disease associated with thrombocytopenia and bleeding diathesis. Intracranial hemorrhage (ICH) is the most devastating complication in ITP patients. Prophylaxis for ICH is indispensable due to its high mortality. However, the morbidity of ICH is quite low, which makes general prophylaxis unrealistic. A previous study demonstrated risk stratification of ICH in ITP patients before 60 years of age(Platelets, 2020). However, few studies have analyzed the risk factors and outcomes in ICH in elderly ITP patients. Thus, ascertaining the characteristics of ICH in elderly ITP patients is in urgent need to make effective assessments and provide personalized prophylaxis. Here, a retrospective study of a series of ITP patients who developed ICH ≥ 60 years of age was conducted to explore potential risk and prognostic factors, which may contributes to identifying the feasible personalized prophylaxis for ICH in elderly ITP patients. Patients and methods: A total of 44 patients incorporated in the study were over 60 years of age with a diagnosis of primary ITP before the onset of ICH. All measures were chronologically performed before the onset of ICH. Univariate and multivariate analyses were conducted using conditional logistic regression model. Each variables with a p-value < 0.10 in the univariate analysis and well-reported factors were included in the multivariate analysis. A stepwise approach was used to exclude variables with a p-value > 0.10. Results: Platelet counts at ITP diagnosis were significantly lower among patients who developed ICH afterwards (P=0.004). Platelet counts were dichotomized and coded into binary variables. The cut off value was 25,000/μL according to the ROC curve and Youden index. Estimation by the Kaplan-Meier method indicated that the morbidity of ICH was higher among patients with a baseline platelet count less than 25,000/μL (P=0.001). Bleeding severity was also included in the analysis. The control group had a significantly higher probability of no bleeding(P=0.008), while the case group was more likely to suffer life-threatening bleeding(P=0.006). The anatomic sites of bleeding manifestations were then examined. There existed significant difference between cases and controls with respect to skin bleeding (P=0.002), oral cavity bleeding (P < 0.001), gastrointestinal bleeding (P=0.022) and hematuria (P < 0.001). Univariate analysis also revealed that patients with a complication of diabetes mellitus (P=0.007) exhibited a significantly lower incidence of ICH, and fewer patients over 75 years of age developed ICH(P=0.021). Patients who had suffered head trauma before the end point of follow-up had a significantly higher probability of developing ICH (P=0.016). Moreover, patients with a duration of ITP no more than 7 days showed potential relevance (P=0.016). Multivariate analysis was conducted using a conditional logistic regression model. A stepwise approach identified a platelet count ≤ 25,000/μL at ITP diagnosis(OR=3.389, 95% CI 1.290-8.907, P=0.013), head trauma (OR=9.753, 95% CI 1.029-92.414, P=0.047), ITP duration less than 7 days (OR=6.741, 95% CI 1.348-33.712, P=0.020) and life-threatening bleeding(OR=13.077, 95% CI 1.104-154.865, P=0.041) as independent risk factors for ICH in elderly ITP patients. A simple predictive model was established according to the results above. Patients were segregated into a low-risk (Score=0), an intermediate-risk (Score=1-3) and high-risk (Score≥4) groups. Significant differences (P < 0.001) were observed in the frequencies of ICH between the 3 risk groups (Table 1). Kaplan-Meier estimations of ICH incidence were markedly different among the risk groups (Figure 1). As for prognostic factors, skin bleeding (OR=17.400, 95% CI 1.926-157.190, P=0.011) was identified as an independent poor prognostic factor. No significance was found with respect to age, platelet count or ITP duration. Conclusion: Our study revealed that platelet count ≤ 25,000/μL at ITP diagnosis, head trauma, ITP duration < 7 days and life-threatening bleeding are all independent risk factors for ICH in elderly ITP patients. A simple predictive model was established using these factors, and skin bleeding was a poor prognostic factor for ICH in elderly ITP patients. Disclosures No relevant conflicts of interest to declare.

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Risk factors associated with prolonged viral clearance in patients with a refractory course of COVID-19: a retrospective study

PeerJ ◽

10.7717/peerj.12535 ◽

2021 ◽

Vol 9 ◽

pp. e12535

Author(s):

Weitao Zhuang ◽

Shujie Huang ◽

Dongya Wang ◽

Lulu Zha ◽

Wei Xu ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Serum Level ◽

Univariate Analysis ◽

High Serum ◽

Viral Clearance ◽

Study Cohort ◽

Clinicopathologic Characteristics ◽

Illness Onset ◽

Factors Associated

Background This study aimed to characterize a cohort of patients with a refractory course of COVID-19, and to investigate factors associated with the duration of viral clearance (DoVC). Materials & Methods A total of 65 patients with refractory COVID-19 were retrospectively enrolled from Huoshenshan Hospital. Univariate analysis and multivariate analysis were performed to examine the potential association between clinicopathologic characteristics and the DoVC. Results The median DoVC in the overall study cohort was 48 days (ranged from 21 to 104 days). Multivariate analysis indicated that fever at illness onset (Hazard ratio (HR) = 4.897, 95% CI [1.809–13.260], p = 0.002), serum level of aspartate aminotransferase (AST) > 21.8 IU/L (HR = 3.010, 95% CI [1.195–7.578], p = 0.019), and titer of SARS-CoV-2 IgG > 142.09 AU/ml (HR = 3.061, 95% CI [1.263–7.415], p = 0.013) were the three independent risk factors associated with delayed viral clearance. Conclusion The current study suggested that clinical characteristics such as fever at illness onset, a high serum level of AST or SARS-CoV-2 IgG were associated with delayed viral clearance. Patients with these characteristics might need a more individualized treatment strategy to accelerate their recovery from the refractory COVID-19.

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Cut-out Risk Factor Analysis after Intramedullary Nailing for the Treatment of Extracapsular Fractures of the Proximal Femur: A Retrospective Study

10.21203/rs.3.rs-948144/v1 ◽

2021 ◽

Author(s):

Jae Youn Yoon ◽

Saehan Park ◽

Taehyun Kim ◽

Gun-Il Im

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Surgical Treatment ◽

Clinical Outcomes ◽

Univariate Analysis ◽

High Body Mass Index ◽

Positive Correlation ◽

Factors Associated ◽

Group 2 ◽

Group 1

Abstract BackgroundsThe basic method of surgical treatment for extracapsular hip fracture (ECF), including intertrochanteric fracture and basicervical fracture (BCF), is osteosynthesis. Intramedullary nails are among the most commonly used fixation devices for such fractures. Our study aimed to report the clinical outcomes of ECF treatment with two different nail devices and to analyze the risk factors associated with screw cut-out.MethodsWe retrospectively reviewed the medical records of 273 patients (300 cases) from a single institution who underwent surgical treatment for ECF between January 2013 and October 2018. Overall, 138 patients were eligible for the study and were divided into two groups according to the osteosynthesis device used. We evaluated the clinical outcomes of fracture surgery and performed univariate and multivariate regression analyses to identify risk factors associated with screw cut-out in each group.ResultsWe used proximal femoral nails (group 1) to treat 83 patients and cephalomedullary nails (group 2) to treat 55 patients. Nine cut-outs (group 1, 6 cases; group 2, 3 cases) occurred during follow-up. The patients’ high body mass index (BMI) (p=0.019), BCFs (p=0.007), non-extramedullary reduction in the anteroposterior and lateral planes (p=0.032 and p=0.043, respectively), and anti-rotation screw pull-outs (p=0.041) showed a positive correlation to screw cut-out in the univariate analysis of group 1. In group 2, only BCFs was positively correlated (p=0.020). In the multivariate analysis of group 1, the patients’ BMIs (p=0.024) and BCFs (p=0.024) showed a positive correlation with cut-out. Meanwhile, the multivariate analysis of group 2 did not identify any factors associated with cut-out.ConclusionsThe cut-out risk was significantly higher in the BCF cases, regardless of the nail design used. Considerable attention should be paid to treating such unstable fractures. We expect that new-generation nails using a helical blade, or interlocking derotation and interlocking screws may improve surgical outcomes.

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