scholarly journals Phenotype, molecular characterisation and risk factors for postoperative meningitis caused by ESBL-producing-Enterobacteriaceae: a six years multi-Centre comparative cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Guanghui Zheng ◽  
Yanfei Cao ◽  
Chunhong Liu ◽  
Lingye Qian ◽  
Yumeng Cai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Binary Logistic Regression ◽  
Molecular Characteristics ◽  
Molecular Characterisation ◽  
Logistic Analysis ◽  
Comparative Cohort Study ◽  
Independent Risk Factors ◽  
Postoperative Meningitis

Abstract Background To determine the phenotype, molecular characterisation and risk factors of postoperative meningitis induced by Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in China. Methods We performed a multi-centre comparative cohort study of postoperative meningitis patients infected with Enterobacteriaceae in 4 neurosurgical centres in China from January 2014 to December 2019. Phenotype and molecular characteristics of the isolates were reviewed and tested, and independent risk factors of the EPE meningitis were evaluated by binary logistic regression. Results In total, 220 Enterobacteriaceae include 78 EPE were available in this study. 85.6% (67/78) ESBL-related genes were tested, and blaSHV (14.9%) and blaSHV + blaTEM + blaCTX-M-9 (20.9%) were found to be the most frequent mono and combined ESBL-related genes harboured by Enterobacteriaceae. On binary logistic analysis, craniotomy (OR. 2.583, 95% C.I. 1.274–5.235, P = 0.008) and malignancy (OR. 2.406, 95% C.I. 1.299–4.456, P = 0.005) were the associated independent risk factors to meningitis induced by EPE. Conclusions To the best of our knowledge, this is the largest series focusing on risk factors of EPE meningitis which has been conducted in China. Craniotomy and malignancy were independent risk factors for EPE meningitis. The risk factors identified may be further utilized in clinical practice and research to avoid and reduce the mortality in future.

scholarly journals Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Goodness Of Fit ◽  
Insertion Site ◽  
Healthcare Providers ◽  
Venous Catheter ◽  
Goodness Of Fit Test ◽  
Peripheral Venous Catheter ◽  
Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

scholarly journals Clinical Significance of CYFRA21-1, AFP, CA-153, CEA, and CA-199 in the Diagnosis of Lung Cancer Ocular Metastasis in Hypertension Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Jing Tang ◽  
Qian-Min Ge ◽  
Rong Huang ◽  
Hui-Ye Shu ◽  
Ting Su ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Logistic Regression ◽  
Sensitivity And Specificity ◽  
Cancer Metastasis ◽  
Binary Logistic Regression ◽  
Diagnostic Value ◽  
Ca 125 ◽  
Pathological Type ◽  
Independent Risk Factors

Purpose: To detect lung metastases, we conducted a retrospective study to improve patient prognosis.Methods: Hypertension patients with ocular metastases (OM group; n = 58) and without metastases (NM group; n = 1,217) were selected from individuals with lung cancer admitted to our hospital from April 2005 to October 2019. The clinical characteristics were compared by Student's t-test and chi-square test. Independent risk factors were identified by binary logistic regression, and their diagnostic value evaluated by receiver operating characteristic curve analysis.Results: Age and sex did not differ significantly between OM and NM groups; There were significant differences in pathological type and treatment. Adenocarcinoma was the main pathological type in the OM group (67.24%), while squamous cell carcinoma was the largest proportion (46.43%) in the NM group, followed by adenocarcinoma (34.10%). The OM group were treated with chemotherapy (55.17%), while the NM group received both chemotherapy (39.93%) and surgical treatment (37.06%). Significant differences were detected in the concentrations of cancer antigen (CA)−125, CA-199, CA-153, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), cytokeratin fraction 21-1 (CYFRA21-1), total prostate-specific antigen, alkaline phosphatase, and hemoglobin (Student's t-test). Binary logistic regression analysis indicated that CA-199, CA-153, AFP, CEA, and CYRFA21-1 were independent risk factors for lung cancer metastasis. AFP (98.3%) and CEA (89.3%) exhibited the highest sensitivity and specificity, respectively, while CYRFA21-1 had the highest area under the ROC curve value (0.875), with sensitivity and specificity values of 77.6 and 87.0%, respectively. Hence, CYFRA21-1 had the best diagnostic value.

scholarly journals Asphyxia and Neonatal Respiratory Distress Syndrome Are Independent Predictors of the Non-response to Inhaled Nitric Oxide in the Newborns With PPHN

2021 ◽  
Vol 9 ◽  
Author(s):  
Yuwei Zhao ◽  
Lei Liang ◽  
Guanghui Liu ◽  
Hong Zheng ◽  
Liying Dai ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Distress Syndrome ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Neonatal Respiratory Distress ◽  
Independent Risk Factors

Aim: Not all the neonates respond with improvement in oxygenation following inhaled nitric oxide treatment (iNO) treatment. The aim of this study was to assess the independent risk factors associated with non-response to iNO during the 2 weeks of postnatal treatment in neonates diagnosed with persistent pulmonary hypertension (PPHN).Materials and Methods: This retrospective cohort study included all newborns with PPHN who received iNO treatment for more than 24 h. Demographic, obstetric, perinatal data and clinical complications were extracted from the hospitalization records. Subjects were divided into two groups according to their response to iNO inspiration during the first 24 h of iNO treatment. No response was defined as an increase in SpO2 < 5% or the inability to sustain saturation levels in the first 24 h of iNO treatment. For descriptive statistics, χ2 and t-test analysis were used to compare categorical and continuous variables between the two groups. To evaluate independent risk factors of non-responsiveness to iNO treatment, binary logistic regression analysis were performed.Results: A total of 75 newborns were included in the study. Sixty-two cases were in the responders group, and 13 cases were in the non-responders group. Univariate analysis showed that asphyxia, neonatal respiratory distress syndrome (NRDS), pulmonary surfactant administration, meconium aspiration syndrome (MAS), the severity of pulmonary hypertension (PH), and high-frequency oscillatory ventilation (HFOV) therapy were the high-risk factors affecting the response to iNO treatment in the newborns with PPHN. The binary logistic regression analysis indicated that asphyxia and NRDS incidence were independent predictors of non-responsiveness to iNO treatment [asphyxia: OR 4.193, 95% CI 1.104–15.927, P = 0.035; NRDS: OR 0.154, 95% CI 0.036–0.647, P = 0.011]. The patients in the non-responders group had shorter iNO inspiration followed by MV duration, supplemental oxygen and hospital stay, and higher mortality. There were no significant differences in IVH, PVL, and BPD between two groups.Conclusion: In the newborns with PPHN, asphyxia and NRDS resulted as the independent risk factors of non-responsiveness to iNO therapy. Asphyxia in the newborns with PPHN is detrimental to the response to iNO treatment, while NRDS is beneficial.

Computed Tomography–Guided Microcoil Localization of Pulmonary Nodules: Effects of Multiple Punctures

2021 ◽  
Author(s):  
Ye Tian ◽  
Jianli An ◽  
Zibo Zou ◽  
Yanchao Dong ◽  
Jingpeng Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Logistic Regression ◽  
Pulmonary Nodules ◽  
Binary Logistic Regression ◽  
Pulmonary Vasculature ◽  
Binary Logistic Regression Analysis ◽  
Ct Guided ◽  
Independent Risk Factors ◽  
Multiple Puncture

Abstract Background The aim of the study is to analyze the effect of multiple punctures in computed tomography (CT)-guided microcoil localization of pulmonary nodules with other risk factors for common complications. Methods Consecutive patients who underwent CT-guided microcoil localization and subsequent video-assisted thoracoscopic surgery (VATS) between January 2020 and February 2021 were enrolled. Nodules successfully located after only one puncture were defined as the single puncture group, and nodules requiring two or more punctures were defined as the multiple puncture group. Binary logistic regression analysis was performed to assess the relationship between the number of punctures and pneumothorax and intrapulmonary hemorrhage. Results A total of 121 patients were included. There were 98 (68.1%) pulmonary nodules in the single puncture group compared with 46 (31.9%) nodules in the multiple puncture group. The frequencies of pneumothorax and intrapulmonary hemorrhage were higher in the multiple puncture group than in the single puncture group (p = 0.019 and <0.001, respectively). Binary logistic regression demonstrated that independent risk factors for developing pneumothorax included lateral positioning of the patient (p < .001) and prone positioning (p = 0.014), as well as multiple punctures (p = 0.013). Independent risk factors for intrapulmonary hemorrhage included the distance between the distal end of the coil and the surface of the pleura (p = 0.033), multiple punctures (p = 0.003), and passage through the pulmonary vasculature (p < 0.001). Conclusion Multiple punctures resulted in an increased incidence of pneumothorax and intrapulmonary hemorrhage compared with single puncture during CT-guided microcoil localization of pulmonary nodules and were independently associated with both pneumothorax and intrapulmonary hemorrhage.

Postoperative Atrial Fibrillation after Minimally Invasive Direct Coronary Artery Bypass: A Single-Center, 5-Year Follow-Up Study

2021 ◽  
Vol 24 (3) ◽  
pp. E456-E460
Author(s):  
Guangpu Fan ◽  
Jing Liu ◽  
Suixin Dong ◽  
Yu Chen
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Renal Failure ◽  
Logistic Regression ◽  
Confidence Interval ◽  
Protective Factor ◽  
Artery Bypass ◽  
Binary Logistic Regression ◽  
Independent Risk Factors

Objective: To evaluate the risk factors and explore the mid-term outcomes of postoperative atrial fibrillation (POAF) after minimally invasive direct coronary artery bypass (MIDCAB). Methods: A total of 165 patients, who underwent isolated MIDCAB from 2012 to 2015, were enrolled in the study and retrospectively reviewed. Patients with preoperative arrhythmia, concomitant surgical procedures were excluded. All patients were continuously monitored for POAF until discharge, and two groups were formed: the non-POAF group (140 patients, 71.4% men, mean age 58.83±10.3 years) and the POAF group (25 patients, 84.0% men, mean age 64.52±9.0 years). Early and mid-term outcomes were evaluated, perioperative factors associated with POAF were analyzed with a binary logistic regression model, and the relationship between POAF and major adverse cardiac event (MACE) was analyzed with Cox regression model. Results: The incidence of POAF in this study was 15.15%. Patients in the POAF group had a significant higher risk of re-entry to ICU (2 cases: 2 cases=8.0%: 1.4%, P = 0.049), renal failure (2 cases: 1 case=8.0%: 0.7%, P = 0.018), and death (1 case: 0 case=4.0%: 0%, P = 0.018). Binary logistic regression showed gender (male), age were independent risk factors of POAF (P = 0.038, 95% confidence interval 1.082-16.286; P = 0.011, 95% confidence interval 1.015-1.117, respectively), preoperative ACEI or ARB usage was a protective factor of POAF (P = 0.010, 95% confidence interval 0.113-0.748). With a 5-year follow up, the overall MACE rate showed no statistical difference between the two groups (P = 0.067). Conclusions: POAF after MIDCAB was related to postoperative morbidities, such as re-entry to ICU, renal failure, and death. Gender (male) and age were independent risk factors, while preoperative ACEI or ARB usage was a protective factor. POAF has not associated the occurrence of MACE with a mid-term follow-up.

scholarly journals High Prevalence of Post-stroke Anxiety in Elderly Patients Following COVID-19 Outbreak

2021 ◽  
Vol 12 ◽  
Author(s):  
Meiling Yao ◽  
Hongjie Li ◽  
Ying Luo ◽  
Ling Li ◽  
Jian Yu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Binary Logistic Regression ◽  
Female Gender ◽  
Binary Logistic Regression Analysis ◽  
Independent Risk Factors ◽  
Cutoff Threshold

Objective: Post-stroke anxiety (PSA) is a common affective disorder in patients with ischemic stroke. The elderly are more susceptible to mental health issues, however, few studies have so far focused on PSA in elderly patients, especially in the context of the COVID-19, causing psychological issues in the general population. The aim of the present study was to assess the prevalence and risk factors of PSA in elderly patients following COVID-19 outbreak.Methods: We retrospectively analyzed 206 elderly inpatients with newly diagnosed acute ischemic stroke in the First Affiliated Hospital, Sun Yat-sen University, from January 2020 to December 2020. Patients were categorized into the PSA group and the non-PSA group based on Hamilton Anxiety Scale scores at admission (within 1 week after stroke onset). Demographic and clinical data, mental state by Mini-Mental State Examination, depression by Hamilton Depression Scales (HAMD), and stroke severity and outcome by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to analyze risk factors associated with PSA. We determined the cutoff scores for significant predictors of PSA using the area under the curve (AUC) and receiver operating characteristic.Results: Of the 206 stroke patients, 62 (30.1%) developed anxiety. Binary logistic regression analysis showed that female gender [adjusted odds ratio (aOR): 2.288, 95% confidence interval (CI):1.021–5.128, P = 0.044], high NIHSS scores [aOR: 1.264, 95% CI: 1.074–1.486, P = 0.005] and HAMD scores [aOR: 1.345, 95% CI: 1.215–1.490, P &lt; 0.001] were independent risk factors for PSA. The cutoff threshold for the NIHSS scores was 3.5 points with an AUC of 0.64 and the cutoff threshold for HAMD scores was 5.5 points with an AUC of 0.89.Conclusion: Our results showed a high incidence of PSA in elderly patients after the COVID-19 outbreak. Female gender, high NIHSS and HAMD scores were the independent risk factors for PSA.

scholarly journals Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection

2020 ◽  
Author(s):  
Zhigang Wang ◽  
Min Ge ◽  
Tao Chen ◽  
Cheng Chen ◽  
Qiuyan Zong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Aortic Dissection ◽  
Emergency Surgery ◽  
Acute Aortic Dissection ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Long Term Outcomes ◽  
Independent Risk Factors

Abstract Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement therapy (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed postoperative CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Results: Before propensity score matching, univariate analysis showed that there were significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (P <0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr and CPB time were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P <0.001) and long-term overall cumulative survival (P <0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003). Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.

scholarly journals Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection

2020 ◽  
Author(s):  
Zhigang Wang ◽  
Min Ge ◽  
Tao Chen ◽  
Cheng Chen ◽  
Qiuyan Zong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Acute Aortic Dissection ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Long Term Outcomes ◽  
Replacement Treatment ◽  
Independent Risk Factors

Abstract Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement treatment (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed severe postoperative acute kidney injury (AKI) requiring CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. Significant variables by univariate analysis were included in binary logistic regression analysis. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. One-to-one pair matching was performed using nearest neighbor matching without replacement within 0.02 standard deviations of the logit of the propensity score as caliper width. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Differences between the 2 groups were determined by log-rank tests. Results: Before propensity score matching, univariate analysis showed that there significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (p<0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr (OR=1.008, 95% CI:1.002-1.014, P=0.005) and CPB time (OR=1.022, 95% CI:1.003-1.042, P=0.026) were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P<0.001) and long-term overall cumulative survival (P<0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003).Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.

scholarly journals Fluid Homeostasis May Predict the Prognosis of Non-infectious Fever After Total Knee Arthroplasty Within 7-Day: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Nafei Xu ◽  
Taotao Xu ◽  
Xiaoxue Tan ◽  
Lujie Xu ◽  
Menghua Ye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Intraoperative Blood Loss ◽  
Drainage Fluid ◽  
Postoperative Drainage ◽  
Total Knee ◽  
Independent Risk Factors

Background: In the perioperative management of Total Knee Arthroplasty (TKA), postoperative fever has always been a concern. Current research focuses on infectious fever, and there is no relevant research on the occurrence of non-infectious fever (NIF) and its risk factors. Hence, the aim of this study was to clarify the risk factors for NIF after TKA, and construct an easy-to-use nomogram.Methods: A retrospective cohort study was conducted. Consecutive patients undergoing primary unilateral TKA were divided into the non-infectious fever group and the control group. Clinicopathological characters were collected from electronic medical records. Univariate Logistic regression was used to analyze the related independent risk factors. The optimal threshold for each selected factor and combined index was determined when the Youden index achieved the highest value. And the predictive nomogram was developed by these independent factors.Results: Ultimately, 146 patients were included in this study. Of them, 57 (39.04%) patients experienced NIF. Results of the univariable logistic regression analysis indicated that intraoperative blood loss (OR, 1.002; 95% CI, 1.000–1.0004), postoperative drainage fluid volume (OR, 1.003; 95% CI, 1.001–1.006) and frequency of blood transfusion (n = 1; OR, 0.227; 95% CI, 0.068–0.757) were independent risk factors of NIF occurrence. The predictive nomogram that incorporated the above independent risk factors was developed, and it yielded an areas under the curves (AUC) of 0.731 (95% CI: 0.651–0.801; P &lt; 0.0001) with 54.39% sensitivity and 82.02% specificity.Conclusions: Non-infectious fever after TKA prolongs the time of antibiotic use and hospital stay. Our results demonstrated that the nomogram may facilitate to predict the individualized risk of NIF occurrence within 7-day by intraoperative blood loss, postoperative drainage fluid volume and frequency of blood transfusion.

scholarly journals Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Blanca Lorman-Carbó ◽  
◽  
Josep Lluís Clua-Espuny ◽  
Eulàlia Muria-Subirats ◽  
Juan Ballesta-Ors ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Cohort Study ◽  
High Risk ◽  
Intracerebral Haemorrhage ◽  
Incidence Density ◽  
Chronic Patients ◽  
Independent Risk Factors ◽  
Clinical Records

Abstract Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. Results 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)]. Conclusions In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. Trial registration This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

Sign in / Sign up

Export Citation Format

Share Document