Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

Abstract Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v3 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

Abstract Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v4 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v2 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Hospitalization Period ◽

Poor Outcomes

Abstract Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were retrospectively analyzed. Necessity to look for care facilities to admit or requirement of home modifications during the hospitalization period was defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v1 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Care Facilities ◽

Poor Outcomes

Abstract Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. The aim is to analyze the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were analyzed. Impairment of ADL was defined as admission to care facilities after hospital discharge, or requirement of home modification for rehabilitation at home. The following clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Mo1294 – Risk Factors of Poor Prognosis and Impairment of Activities of Daily Living in Patients with Hemorrhagic Gastroduodenal Ulcers

Gastroenterology ◽

10.1016/s0016-5085(19)38809-2 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-750

Author(s):

Junya Arai ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

Shigeyuki Kurosaki ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Gastroduodenal Ulcers

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Inadequate Protein Intake at Specific Meals Is Associated with Higher Risk of Impaired Functionality in Middle to Older Aged Mexican Adults

Journal of Aging Research ◽

10.1155/2019/6597617 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Alejandro Gaytán-González ◽

María de Jesús Ocampo-Alfaro ◽

Maritza Arroniz-Rivera ◽

Francisco Torres-Naranjo ◽

Roberto Gabriel González-Mendoza ◽

...

Keyword(s):

Risk Factor ◽

Activities Of Daily Living ◽

Daily Living ◽

Protein Intake ◽

Multinomial Logistic Regression ◽

Significant Risk ◽

Significant Risk Factor ◽

Cross Sectional ◽

Mexican Adults ◽

Cross Sectional Design

Purpose. To describe the proportions of inadequate protein intake (IPI) per day and per meal and their association with functionality in middle to older aged Mexican adults. Materials and Methods. In a cross-sectional design, we evaluated the protein intake and functionality of instrumental activities of daily living (IADL) and activities of daily living (ADL) of 190 middle to older aged Mexican adults. IPI was considered as any protein intake: <1.2 g/kg/day, <30 g/meal, or <0.4 g/kg/meal. Functionality was organized into three groups: high, middle, and low scores. The first was set as the reference, and the other was considered as impaired functionality. With a multinomial logistic regression, we analyzed the association between IPI per day and per meal with impaired functionality. Results. A high proportion of participants showed IPI per day. The meal with the highest proportion of IPI was dinner, followed by breakfast and lunch for both criteria. IPI at lunch was a significant risk factor for impaired functionality in ADL when assessed with the 30 g/meal criterion (low scores, OR 3.82 (95% CI, 1.15–12.65); middle scores, OR 2.40 [1.03–5.62]). For the 0.4 g/kg/meal criterion, IPI at dinner was a significant risk factor for IADL middle scores only (OR 7.64, [1.27–45.85]). Conclusion. IPI per meal is high in middle to older aged Mexican adults, and at specific meals, it is a significant risk factor for impaired functionality in activities of daily living.

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Methicillin-ResistantStaphylococcus aureus(MRSA) Nasal Carriage in Residents of Veterans Affairs Long-Term Care Facilities: Role of Antimicrobial Exposure and MRSA Acquisition

Infection Control and Hospital Epidemiology ◽

10.1086/665711 ◽

2012 ◽

Vol 33 (6) ◽

pp. 551-557 ◽

Cited By ~ 33

Author(s):

Nimalie D. Stone ◽

Donna R. Lewis ◽

Theodore M. Johnson ◽

Thomas Hartney ◽

Doris Chandler ◽

...

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Multivariable Analysis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Nasal Carriage ◽

Veterans Affairs ◽

Term Care

Objective.To identify risk factors associated with methicillin-resistantStaphylococcus aureus(MRSA) acquisition in long-term care facility (LTCF) residents.Design.Multicenter, prospective cohort followed over 6 months.Setting.Three Veterans Affairs (VA) LTCFs.Participants.All current and new residents except those with short stay (<2 weeks).Methods.MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE).Results.Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1–28.6];P= .002). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers.Conclusions.MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions.

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Association of self-perceived income sufficiency with cognitive impairment among older adults: a population-based study in India

BMC Psychiatry ◽

10.1186/s12888-021-03257-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

T. Muhammad ◽

Shobhit Srivastava ◽

T. V. Sekher

Keyword(s):

Risk Factors ◽

Older Adults ◽

Cognitive Impairment ◽

Activities Of Daily Living ◽

Psychological Health ◽

Daily Living ◽

Basic Needs ◽

Well Being ◽

Asset Ownership ◽

Increased Risk

Abstract Background Greater cognitive performance has been shown to be associated with better mental and physical health and lower mortality. The present study contributes to the existing literature on the linkages of self-perceived income sufficiency and cognitive impairment. Study also provides additional insights on other socioeconomic and health-related variables that are associated with cognitive impairment in older ages. Methods Data for this study is derived from the 'Building Knowledge Base on Population Ageing in India'. The final sample size for the analysis after removing missing cases was 9176 older adults. Descriptive along with bivariate analyses were presented to show the plausible associations of cognitive impairment with potential risk factors using the chi-square test. Also, binary logistic regression analysis was performed to provide the relationship between cognitive impairment and risk factors. The software used was STATA 14. Results About 43% of older adults reported that they had no source of income and 7.2% had income but not sufficient to fulfil their basic needs. Older adults with income but partially sufficient to fulfil their basic needs had 39% significantly higher likelihood to suffer from cognitive impairment than older adults who had sufficient income [OR: 1.39; OR: 1.21–1.59]. Likelihood of cognitive impairment was low among older adults with asset ownership than older adults with no asset ownership [OR: 0.83; CI: 0.72–0.95]. Again, older adults who work by compulsion (73.3%) or felt mental or physical stress due to work (57.6%) had highest percentage of cognitive impairment. Moreover, older adults with poor self-rated health, low instrumental activities of daily living, low activities of daily living, low subjective well-being and low psychological health were at increased risk for cognitive impairment. Conclusion The study highlights the pressing need for care and support and especially financial incentives in the old age to preserve cognitive health. Further, while planning geriatric health care for older adults in India, priority must be given to financially backward, with no asset ownership, with poor health status, older-older, widowed, and illiterate older individuals, as they are more vulnerable to cognitive impairment.

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Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1344 ◽

2020 ◽

pp. 1-7

Author(s):

Stephanie M. Cabral ◽

Katherine E. Goodman ◽

Natalia Blanco ◽

Surbhi Leekha ◽

Larry S. Magder ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Risk Adjustment ◽

Community Hospital ◽

Significant Risk ◽

Significant Risk Factor ◽

Bivariate Analysis ◽

Patient Admissions ◽

Clostridioides Difficile ◽

Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

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Designing a bed-side system for predicting length of stay in a neonatal intensive care unit

Scientific Reports ◽

10.1038/s41598-021-82957-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Harpreet Singh ◽

Su Jin Cho ◽

Shubham Gupta ◽

Ravneet Kaur ◽

S. Sunidhi ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Length Of Stay ◽

Neonatal Intensive Care ◽

Financial Burden ◽

Significant Risk ◽

Model Performance ◽

Significant Risk Factor ◽

Validation Dataset ◽

Patient Records

AbstractIncreased length of stay (LOS) in intensive care units is directly associated with the financial burden, anxiety, and increased mortality risks. In the current study, we have incorporated the association of day-to-day nutrition and medication data of the patient during its stay in hospital with its predicted LOS. To demonstrate the same, we developed a model to predict the LOS using risk factors (a) perinatal and antenatal details, (b) deviation of nutrition and medication dosage from guidelines, and (c) clinical diagnoses encountered during NICU stay. Data of 836 patient records (12 months) from two NICU sites were used and validated on 211 patient records (4 months). A bedside user interface integrated with EMR has been designed to display the model performance results on the validation dataset. The study shows that each gestation age group of patients has unique and independent risk factors associated with the LOS. The gestation is a significant risk factor for neonates < 34 weeks, nutrition deviation for < 32 weeks, and clinical diagnosis (sepsis) for ≥ 32 weeks. Patients on medications had considerable extra LOS for ≥ 32 weeks’ gestation. The presented LOS model is tailored for each patient, and deviations from the recommended nutrition and medication guidelines were significantly associated with the predicted LOS.

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