Risk factors for recurrent tuberculosis after successful treatment in a high burden setting: a cohort study

Abstract Background People successfully completing treatment for tuberculosis remain at elevated risk for recurrent disease, either from relapse or reinfection. Identifying risk factors for recurrent tuberculosis may help target post-tuberculosis screening and care. Methods We enrolled 500 patients with smear-positive pulmonary tuberculosis in South Africa and collected baseline data on demographics, clinical presentation and sputum mycobacterial cultures for 24-loci mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) typing. We used routinely-collected administrative data to identify recurrent episodes of tuberculosis occurring over a median of six years after successful treatment completion. Results Of 500 patients initially enrolled, 333 (79%) successfully completed treatment for tuberculosis. During the follow-up period 35 patients with successful treatment (11%) experienced a bacteriologically confirmed tuberculosis recurrence. In our Cox proportional hazards model, a 3+ AFB sputum smear grade was significantly associated with recurrent tuberculosis with a hazard ratio of 3.33 (95% CI 1.44–7.7). The presence of polyclonal M. tuberculosis infection at baseline had a hazard ratio for recurrence of 1.96 (95% CI 0.86–4.48). Conclusion Our results indicate that AFB smear grade is independently associated with tuberculosis recurrence after successful treatment for an initial episode while the association between polyclonal M. tuberculosis infection and increased risk of recurrence appears possible.

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The Insulin Gene Variable Number Tandem Repeat and Risk of Type 2 Diabetes in a Population-Based Sample of Families and Unrelated Men and Women

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-1212 ◽

2005 ◽

Vol 90 (2) ◽

pp. 1137-1143 ◽

Cited By ~ 32

Author(s):

James B. Meigs ◽

Josée Dupuis ◽

Alan G. Herbert ◽

Chunyu Liu ◽

Peter W. F. Wilson ◽

...

Keyword(s):

Type 2 Diabetes ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Age Of Onset ◽

Variable Number Tandem Repeat ◽

Variable Number ◽

Hazard Ratio ◽

Ins Vntr ◽

Increased Risk

Abnormalities in insulin regulation are central to the pathogenesis of type 2 diabetes. We assessed variation in the insulin gene variable number tandem repeat (INS VNTR) minisatellite (using the −23Hph1 A/T single nucleotide polymorphism) as a risk factor for 92 cases of incident type 2 diabetes in 883 unrelated Framingham Heart Study (FHS) subjects and in a separate sample of 698 members of 282 FHS nuclear families with 62 diabetes cases. In the unrelated sample, the −23Hph1 TT genotype frequency was 8.0% and was associated with a diabetes hazard ratio of 1.89 [95% confidence interval (CI), 1.01–3.52; P = 0.045] compared with the AA genotype using diabetes age of onset as the time failure variable in a proportional hazards model adjusted for age, offspring sex, body mass index, parental diabetes, and sex by parental diabetes interactions. In sex-stratified analyses, TT increased risk for diabetes in women (hazard ratio, 4.25; 95% CI, 1.76–10.3), but not men (hazard ratio, 1.01; 95% CI, 0.39–2.60). Using a family-based association test to assess transmission disequilibrium in the sample of related subjects, the age- and sex-adjusted z-score for diabetes associated with the T allele was 2.07 (P = 0.04), and a family-based association test using age of onset in a proportional hazards model was also statistically significant (P = 0.03), indicating that increased risk of diabetes was not attributable to population admixture. These data support the hypothesis that the INS VNTR is a genetic risk factor for type 2 diabetes, with the TT genotype accounting for about 6.6% of cases in the FHS population.

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Alcohol Use Disorders and Increased Risk of Adverse Birth Complications and Outcomes: An 11-Year Nationwide Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228515 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8515

Author(s):

Sarah Soyeon Oh ◽

Yongho Jee ◽

Eun-Cheol Park ◽

Young Ju Kim

Keyword(s):

Alcohol Use ◽

Alcohol Dependence ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Alcohol Use Disorders ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Birth Complications ◽

Increased Risk

For women who suffer from Alcohol Use Disorders (AUDs), the use of alcohol before and/or during pregnancy may result in various birth complications, including miscarriage, stillbirth, or preterm delivery. Thus, this study aimed to explore whether Alcohol Use Disorders (AUDs) are associated with increased risk of adverse birth complications and outcomes. A total of 76,799 deliveries between 2003 and 2013 in the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) were analyzed. Women with an AUD diagnosis preceding delivery were identified as individuals with alcohol dependence. A multivariate Cox proportional hazards model was used to estimate the hazard ratio of adverse birth complications and outcomes associated with alcohol dependence. Diagnosis of an AUD was associated with increased risk of adverse birth complications (Hazard Ratio [HR]: 1.15, 95% CI: 1.01–1.31, p = 0.0302). This was especially the case for women whose AUD diagnosis was in the same year as their delivery (HR: 1.53, 95% CI: 1.24–1.88, p < 0.0001). AUDs were associated with increased risk of adverse birth outcomes, especially when prevalent in the same year as a woman’s delivery. Our study confirms that the monitoring of expecting women with a diagnosis of alcohol-related problems may be useful in preventing adverse birth complications.

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Hemorrhage From Arteriovenous Malformations During Pregnancy

Neurosurgery ◽

10.1227/neu.0b013e318256c34b ◽

2012 ◽

Vol 71 (2) ◽

pp. 349-356 ◽

Cited By ~ 59

Author(s):

Bradley A. Gross ◽

Rose Du

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Venous Drainage ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Relative Paucity ◽

Increased Risk ◽

Risk Of Hemorrhage

Abstract BACKGROUND: Previous hemorrhage, deep venous drainage, and deep location are established risk factors for arteriovenous malformation (AVM) hemorrhage. Although pregnancy is an assumed risk factor, there is a relative paucity of data to support this neurosurgical tenet. OBJECTIVE: To elucidate the hemorrhage rate of AVMs during pregnancy. METHODS: We reviewed the records of 54 women with an angiographic diagnosis of an AVM at our institution. Annual hemorrhage rates were calculated as the ratio of the number of bleeds to total number of patient-years of follow-up. Patient-years of follow-up were tallied assuming lesion presence from birth until AVM obliteration. The Cox proportional hazards model for hemorrhage with pregnancy as the time-dependent variable was used to calculate the hazard ratio. RESULTS: Five hemorrhages in 4 patients occurred over 62 pregnancies, yielding a hemorrhage rate of 8.1% per pregnancy or 10.8% per year. Over the remaining 2461.3 patient-years of follow-up, only 28 hemorrhages occurred, yielding an annual hemorrhage rate of 1.1%. The hazard ratio for hemorrhage during pregnancy was 7.91 (P = 2.23 × 10−4), increasing to 18.12 (P = 7.31 × 10−5) when limiting the analysis to patient follow-up up to age 40. CONCLUSION: Because of the increased risk of hemorrhage from AVMs during pregnancy, we recommend intervention in women who desire to bear children, particularly if the AVM has bled. If the AVM is discovered during pregnancy, we recommend early intervention if it has ruptured; if it is unruptured, we recommend comprehensive counseling, weighing risks of intervention against continuation of pregnancy without intervention.

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856A gestational age specific prognostic model for adverse perinatal events in obese women

International Journal of Epidemiology ◽

10.1093/ije/dyab168.088 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Jeffrey Bone ◽

Sarka Lisonkova

Keyword(s):

Risk Factors ◽

British Columbia ◽

Gestational Age ◽

Proportional Hazards Model ◽

Perinatal Outcomes ◽

Cox Proportional Hazards Model ◽

Prognostic Models ◽

Chronic Hypertension ◽

Obese Women ◽

Increased Risk

Abstract Background Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors. Methods All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity. Results Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI. Conclusions Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes. Key messages Obese women require specific guidelines for timing of optimal delivery.

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Discovery of additional brain metastases on the day of stereotactic radiosurgery: risk factors and outcomes

Journal of Neurosurgery ◽

10.3171/2016.4.jns152319 ◽

2016 ◽

Vol 126 (6) ◽

pp. 1756-1763 ◽

Cited By ~ 3

Author(s):

Michael A. Garcia ◽

Ann Lazar ◽

Sai Duriseti ◽

David R. Raleigh ◽

Christopher P. Hess ◽

...

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Brain Metastasis ◽

Brain Metastases ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Significant Difference

OBJECTIVEHigh-resolution double-dose gadolinium-enhanced Gamma Knife (GK) radiosurgery-planning MRI (GK MRI) on the day of GK treatment can detect additional brain metastases undiagnosed on the prior diagnostic MRI scan (dMRI), revealing increased intracranial disease burden on the day of radiosurgery, and potentially necessitating a reevaluation of appropriate management. The authors identified factors associated with detecting additional metastases on GK MRI and investigated the relationship between detection of additional metastases and postradiosurgery patient outcomes.METHODSThe authors identified 326 patients who received GK radiosurgery at their institution from 2010 through 2013 and had a prior dMRI available for comparison of numbers of brain metastases. Factors predictive of additional brain metastases on GK MRI were investigated using logistic regression analysis. Overall survival was estimated by Kaplan-Meier method, and postradiosurgery distant intracranial failure was estimated by cumulative incidence measures. Multivariable Cox proportional hazards model and Fine-Gray regression modeling assessed potential risk factors of overall survival and distant intracranial failure, respectively.RESULTSThe mean numbers of brain metastases (SD) on dMRI and GK MRI were 3.4 (4.2) and 5.8 (7.7), respectively, and additional brain metastases were found on GK MRI in 48.9% of patients. Frequencies of detecting additional metastases for patients with 1, 2, 3–4, and more than 4 brain metastases on dMRI were 29.5%, 47.9%, 55.9%, and 79.4%, respectively (p < 0.001). An index brain metastasis with a diameter greater than 1 cm on dMRI was inversely associated with detecting additional brain metastases, with an adjusted odds ratio of 0.57 (95% CI 0.4–0.9, p = 0.02). The median time between dMRI and GK MRI was 22 days (range 1–88 days), and time between scans was not associated with detecting additional metastases. Patients with additional brain metastases did not have larger total radiosurgery target volumes, and they rarely had an immediate change in management (abortion of radiosurgery or addition of whole-brain radiation therapy) due to detection of additional metastases. Patients with additional metastases had a higher incidence of distant intracranial failure than those without additional metastases (p = 0.004), with an adjusted subdistribution hazard ratio of 1.4 (95% CI 1.0–2.0, p = 0.04). Significantly worse overall survival was not detected for patients with additional brain metastases on GK MRI (log-rank p = 0.07), with the relative adjusted hazard ratio of 1.07, (95% CI 0.81–1.41, p = 0.65).CONCLUSIONSDetecting additional brain metastases on GK MRI is strongly associated with the number of brain metastases on dMRI and inversely associated with the size of the index brain metastasis. The discovery of additional brain metastases at time of GK radiosurgery is very unlikely to lead to aborting radiosurgery but is associated with a higher incidence of distant intracranial failure. However, there is not a significant difference in survival.▪ CLASSIFICATION OF EVIDENCE Type of question: prognostic; study design: retrospective cohort trial; evidence: Class IV.

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Concurrence of Intraoperative Hypotension, Low Minimum Alveolar Concentration, and Low Bispectral Index Is Associated with Postoperative Death

Anesthesiology ◽

10.1097/aln.0000000000000822 ◽

2015 ◽

Vol 123 (4) ◽

pp. 775-785 ◽

Cited By ~ 55

Author(s):

Mark D. Willingham ◽

Elliott Karren ◽

Amy M. Shanks ◽

Michael F. O’Connor ◽

Eric Jacobsohn ◽

...

Keyword(s):

Clinical Trials ◽

Observational Study ◽

Bispectral Index ◽

Proportional Hazards Model ◽

Minimum Alveolar Concentration ◽

Postoperative Mortality ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Increased Risk

Abstract Background: An intraoperative concurrence of mean arterial pressure less than 75 mmHg, minimum alveolar concentration less than 0.8, and bispectral index less than 45 has been termed a “triple low” state. An association between triple low and postoperative mortality has been reported but was not replicated in a subsequent study. The authors pooled existing data from clinical trials to further evaluate the purported association in an observational study. Methods: This retrospective observational study included 13,198 patients from three clinical trials: B-Unaware, BAG-RECALL, and Michigan Awareness Control Study. Patients with greater than 15 not necessarily consecutive minutes of triple low were propensity matched to controls with similar characteristics and comorbidities. A multivariable Cox proportional hazards model was used to evaluate the association between triple low duration and postoperative mortality. Results: Thirty-day mortality was 0.8% overall, 1.9% in the triple low cohort, and 0.4% in the nontriple low cohort (odds ratio, 5.16; 95% CI, 4.21 to 6.34). After matching and adjusting for comorbidities, cumulative duration of triple low was significantly associated with an increased risk of mortality at 30 days (hazard ratio, 1.09; 95% CI, 1.07 to 1.11, per 15 min) and 90 days (hazard ratio, 1.09; 95% CI, 1.08 to 1.11, per 15 min). Conclusion: There is a weak independent association between the triple low state and postoperative mortality, and the propensity-matched analysis does not suggest that this is an epiphenomenon.

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The national burden of periprosthetic hip fractures in the US: costs and risk factors for hospital readmission

Hip International ◽

10.1177/1120700018803933 ◽

2018 ◽

Vol 29 (5) ◽

pp. 550-557 ◽

Cited By ~ 14

Author(s):

Russell A Reeves ◽

William W Schairer ◽

David S Jevsevar

Keyword(s):

Risk Factors ◽

Hip Fractures ◽

Hospital Readmission ◽

Proportional Hazards Model ◽

Hospital Readmissions ◽

Cox Proportional Hazards Model ◽

Treatment Pathways ◽

Factors Associated ◽

Increased Risk ◽

Revision Tha

Introduction: Periprosthetic hip fractures (PPFX) are serious complications that result in increased morbidity, mortality and healthcare costs. Decreasing hospital readmissions has been a recent healthcare focus, but little is known about the overall costs associated with PPFX or the risk factors associated with readmissions. We investigated patient demographics, treatment types, 30- and 90-day readmission rates, direct costs, and patient risk factors associated with PPFX readmission. Methods: We used the 2013 Nationwide Readmissions Database to select patients who underwent total hip arthroplasty (THA), revision THA, and PPFX treated with open reduction internal fixation (ORIF) or revision THA. Survival analysis was used to evaluate the 90-day all-cause hospital readmission rate, and risk factors were identified using a Cox proportional hazards model, adjusting for patient and hospital characteristics. Results: We identified 1269 patients with PPFX treated with ORIF and 3254 treated with revision THA. 90-day readmissions were 20.9% and 27.3%, respectively. Patients with PPFX were older, female, and had multiple medical comorbidities. Patient factors associated with increased risk of readmission include: age; comorbidities; and discharge to skilled nursing facility; Medicare or Medicaid insurance. Hospital factors associated with increased risk of readmission include: large hospitals; nonprofits; metropolitan and teaching hospitals. The cost of readmission for PPFX treated with ORIF was $17,206 and revision THA was $16,504. Discussion: Periprosthetic hip fractures have high rates of hospital readmission, implying a significant burden to the healthcare system. Identifying risk factors is an important step towards identifying treatment pathways that can improve outcomes.

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Effect of multiple episodes of acute kidney injury on mortality: an observational study

Clinical Kidney Journal ◽

10.1093/ckj/sfz199 ◽

2020 ◽

Author(s):

Heather Walker ◽

Nicosha De Souza ◽

Simona Hapca ◽

Miles D Witham ◽

Samira Bell

Keyword(s):

Acute Kidney Injury ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Kidney Injury ◽

Patient Characteristics ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Increased Risk

Abstract Background Patients who survive an episode of acute kidney injury (AKI) are more likely to have further episodes of AKI. AKI is associated with increased mortality, with a further increase with recurrent episodes. It is not clear whether this is due to AKI or as a result of other patient characteristics. The aim of this study was to establish whether recurrence of AKI is an independent risk factor for mortality or if excess mortality is explained by other factors. Methods This observational cohort study included adult people from the Tayside region of Scotland, with an episode of AKI between 1 January 2009 and 31 December 2009. AKI was defined using the creatinine-based Kidney Disease: Improving Global Outcomes definition. Associations between recurrent AKI and mortality were examined using a Cox proportional hazards model. Results Survival was worse in the group identified to have recurrent AKI compared with those with a single episode of AKI [hazard ratio = 1.49, 95% confidence interval (CI) 1.37–1.63; P < 0.001]. After adjustment for comorbidities, stage of reference AKI, sex, age, medicines that predispose to renal impairment or, in the 3 months prior to the reference AKI, deprivation and baseline estimated glomerular filtration rate (eGFR), recurrent AKI was independently associated with an increase in mortality (hazard ratio = 1.25, 95% CI 1.14–1.37; P < 0.001). Increasing stage of reference AKI, age, deprivation, baseline eGFR, male sex, previous myocardial infarction, cerebrovascular disease and diuretic use were all associated with an increased risk of mortality in patients with recurrent AKI. Conclusions Recurrent AKI is associated with increased mortality. After adjusting for patient characteristics, the increase in mortality is independently associated with recurrent AKI and is not solely explained by other risk factors.

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Risk Factors Associated with Time to First Infection and Time to Failure on CAPD

Peritoneal Dialysis International ◽

10.1177/089686088300303s04 ◽

1983 ◽

Vol 3 (3_suppl) ◽

pp. 14-17 ◽

Cited By ~ 10

Author(s):

Paul N. Corey ◽

Cathy Steele

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Serum Creatinine ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Time To Failure ◽

Continuous Variables ◽

Risk Of Failure ◽

Increased Risk

The Cox proportional hazards model was used to identify prognostic risk factors for time to first infection and time to failure among 183 patients on chronic ambulatory peritoneal dialysis (CAPD). This methodology permits continuous variables such as albumin and blood pressure to be used in the predictive equation avoiding arbitrary categorization. Initial serum creatinine and albumin were found to be related to the risk of first infection. Serum creatinine increases the risk whereas albumin is protective. Age and blood pressure are related to an increased risk of failure on CAPD whereas albumin is associated with a lower risk. The occurrence of the first infection almost doubles the risk of failure. Patients who have “high” albumin and “low” blood pressure have a 75th percentile for time to failure on CAPD which is more than 1000 days longer than those who have both “low” albumin and “high” blood pressure.

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Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa324 ◽

2020 ◽

Author(s):

Yuko Yamaguchi ◽

Marta Zampino ◽

Toshiko Tanaka ◽

Stefania Bandinelli ◽

Yusuke Osawa ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Differentiation Factor ◽

Hazards Model ◽

Increased Risk ◽

The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P<.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

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