scholarly journals AFP and eGFR are related to early and late recurrence of HCC following antiviral therapy

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takao Watanabe ◽  
Yoshio Tokumoto ◽  
Kouji Joko ◽  
Kojiro Michitaka ◽  
Norio Horiike ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Early Phase ◽  
Late Phase ◽  
Previous History ◽  
Late Recurrence ◽  
Early Recurrence ◽  
Hazard Ratio ◽  
Post Treatment ◽  
Hcc Recurrence

Abstract Background An unexpected recurrence of hepatocellular carcinoma (HCC) sometimes occurs in patients with hepatitis C virus (HCV) after treatment with direct-acting antivirals (DAAs). However, the characteristics of patients with HCC recurrence may differ depending on time after DAA treatment. We aimed to identify risk factors related to HCC recurrence according to time after DAA treatment. Methods Of 1663 patients with HCV treated with a DAA, 199 patients had a previous history of HCC. We defined HCC recurrence within 1 year after DAA treatment as ‘early recurrence’, and recurrence more than 1 year after as ‘late recurrence’. The different risk factors between the early and late phases of HCC recurrence after the end of DAA therapy were investigated. Results Ninety-seven patients experienced HCC recurrence during the study period. Incidences of recurrence were 29.8, 41.0, and 53.4% at 1, 2, and 3 years, respectively, after the end of DAA therapy. Multivariate analysis identified post-treatment α-fetoprotein (AFP) as an independent factor contributing to HCC recurrence in the early phase (hazard ratio, 1.056; 95% confidence interval, 1.026–1.087, p < 0.001) and post-treatment estimated glomerular filtration rate (eGFR) (hazard ratio, 0.98; 95% confidence interval, 0.96–0.99, p = 0.032) as a predictor of HCC recurrence in the late phase. Conclusion Patients with higher post-treatment AFP in the early phase and those with lower post-treatment eGFR in the late phase had a high risk of HCC recurrence. The risk factors associated with HCC recurrence after DAA treatment were different between the early and late phases.

Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

2021 ◽  
pp. 239719832110340
Author(s):  
Yasser A Radwan ◽  
Reto D Kurmann ◽  
Avneek S Sandhu ◽  
Edward A El-Am ◽  
Cynthia S Crowson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Confidence Interval ◽  
Cumulative Incidence ◽  
Disease Onset ◽  
Population Based ◽  
Hazard Ratio ◽  
Conduction Disorders ◽  
Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

scholarly journals Dementia, Alzheimer’s Disease, and Mortality after Hemodialysis Initiation

2018 ◽  
Vol 13 (9) ◽  
pp. 1339-1347 ◽  
Author(s):  
Mara A. McAdams-DeMarco ◽  
Matthew Daubresse ◽  
Sunjae Bae ◽  
Alden L. Gross ◽  
Michelle C. Carlson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Confidence Interval ◽  
Competing Risks ◽  
Older Patients ◽  
Disease Diagnosis ◽  
Hazard Ratio ◽  
Old Patients ◽  
Diagnosis Of Dementia

Background and objectivesOlder patients with ESKD experience rapid declines in executive function after initiating hemodialysis; these impairments might lead to high rates of dementia and Alzheimer’s disease in this population. We estimated incidence, risk factors, and sequelae of diagnosis with dementia and Alzheimer’s disease among older patients with ESKD initiating hemodialysis.Design, setting, participants, & measurementsWe studied 356,668 older (age ≥66 years old) patients on hemodialysis (January 1, 2001 to December 31, 2013) from national registry data (US Renal Data System) linked to Medicare. We estimated the risk (cumulative incidence) of diagnosis of dementia and Alzheimer’s disease and studied factors associated with these disorders using competing risks models to account for death, change in dialysis modality, and kidney transplant. We estimated the risk of subsequent mortality using Cox proportional hazards models.ResultsThe 1- and 5-year risks of diagnosed dementia accounting for competing risks were 4.6% and 16% for women, respectively, and 3.7% and 13% for men, respectively. The corresponding Alzheimer’s disease diagnosis risks were 0.6% and 2.6% for women, respectively, and 0.4% and 2.0% for men, respectively. The strongest independent risk factors for diagnosis of dementia and Alzheimer’s disease were age ≥86 years old (dementia: hazard ratio, 2.11; 95% confidence interval, 2.04 to 2.18; Alzheimer’s disease: hazard ratio, 2.11; 95% confidence interval, 1.97 to 2.25), black race (dementia: hazard ratio, 1.70; 95% confidence interval, 1.67 to 1.73; Alzheimer’s disease: hazard ratio, 1.78; 95% confidence interval, 1.71 to 1.85), women (dementia: hazard ratio, 1.10; 95% confidence interval, 1.08 to 1.12; Alzheimer’s disease: hazard ratio, 1.12; 95% confidence interval, 1.08 to 1.16), and institutionalization (dementia: hazard ratio, 1.36; 95% confidence interval, 1.33 to 1.39; Alzheimer’s disease: hazard ratio, 1.10; 95% confidence interval, 1.05 to 1.15). Older patients on hemodialysis with a diagnosis of dementia were at 2.14-fold (95% confidence interval, 2.07 to 2.22) higher risk of subsequent mortality; those with a diagnosis of Alzheimer’s disease were at 2.01-fold (95% confidence interval, 1.89 to 2.15) higher mortality risk.ConclusionsOlder patients on hemodialysis are at substantial risk of diagnosis with dementia and Alzheimer’s disease, and carrying these diagnoses is associated with a twofold higher mortality.

Thrombotic Thrombocytopenic Purpura at Johns Hopkins from 1993 to 2008: Clinical Outcomes and Risk Factors for Relapse in 75 Patients.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2288-2288
Author(s):  
Huichun Zhan ◽  
Michael B. Streiff ◽  
Karen E. King ◽  
Jodi B Segal
Keyword(s):  
Risk Factors ◽  
African American ◽  
Platelet Count ◽  
Late Recurrence ◽  
Early Recurrence ◽  
First Episode ◽  
Adamts13 Deficiency ◽  
The Mean ◽  
Mean Time

Abstract Background: Since the introduction of plasmapheresis, TTP-associated mortality has declined from 90% to 10–20%. However, 20–50% of patients experience recurrent disease. The goal of this study was to describe the clinical spectrum of TTP, determine the clinical outcome of patients with TTP and identify risk factors for disease relapse or recurrence. Methods: We retrospectively reviewed consecutive TTP patients treated between January 1992 and April 2008 at the Johns Hopkins Hospital. Complete demographic, clinical, laboratory, treatment, and response data were collected. A standard treatment protocol of corticosteroids (Methylprednisolone 100 mg IV q12h) and daily plasmapheresis (1.5 plasma volumes) was used during the study period. Rituximab, azathioprine and vincristine were employed in refractory or relapsing patients at physician’s discretion. Logistic regression was used to examine the association of clinical and laboratory parameters with four ordered outcome categories in TTP survivors: relapse (&lt;30days), early recurrence (1–6 mo), late recurrence (≥ 6mo), and remission. Results: A total of 75 patients and 138 episodes of TTP were treated during the study period. Microangiopathic hemolytic anemia was noted in all cases. The median follow-up was 31.5 months (IQR 6 – 76 months). The median age was 42 years (range 13–82). Of the 75 patients, 73% were females and 56% were African American. 68% of the TTP episodes presented acutely (&lt; 1 week), while 25% were subacute (1–4 weeks) and 7% had a chronic presentation (≥ 1 month). Neurologic abnormalities were present in 67% episodes while 35% had abnormal renal function on admission; 95% and 90% resolved on discharge or during follow-up, respectively. The median platelet count on admission was 15×103/μL (range 1 – 144) and the median lactate dehydrogenase (LDH) value was 927U/L (range 152 – 5950). The mean time for platelet recovery was 10 days (range 2 – 48) while the mean time for LDH recovery was 20 days (range 2 – 100) (p &lt; 0.0001). The mean length of hospital stay for each episode was 21 days (range 1 – 84). ADAMTS13 results were available in 45 episodes (39 patients) — 69% had severe ADAMTS13 deficiency (&lt;10%), 11% had moderate deficiency (10–25%), and 20% had minimal deficiency or normal ADAMTS13 activity (&gt;25%). Inhibitors were present in 74% of episodes with severe ADAMTS13 deficiency and 60% of episodes with moderate deficiency. All patients received plasmapheresis and most (95%) received corticosteroid treatment. The mean time from admission to plasmapheresis initiation was 1.9 days (range 1– 14). The mean number of pheresis sessions required to achieve a complete remission was 17 (range 3 – 66) over a total of 22 days (range 3 – 89). The mortality rate was 4% in both first-episode patients and all TTP episodes. The relapse/recurrence rate was 44% in first-episode patients and 50% in all TTP episodes. The average time-to-relapse/recurrence was 14 months (range 0.07–93 months) and 83% of relapses or recurrences occurred during the first two years. When categorized into four different outcome groups (i.e. relapse vs. early recurrence vs. late recurrence vs. remission), patients who relapsed were more likely to be African American (p = 0.002), had a higher platelet count (p = 0.02) and white blood cell count (p = 0.009) on admission and a higher LDH value on discharge (p = 0.031). There was no significant difference in ADAMTS13 results among the four groups. In a secondary analysis when we pooled all suboptimal outcomes, we found that African American patients had an odds of remission that was just 0.42 (p=0.042) that of Caucasians. Episodes with an admission platelet count in the upper quartile (mean of 82 x103/μL) were 2.9 times (95% confidence interval 1.2 to 6.8) more likely to have a suboptimal outcome than episodes with platelet count in the lowest quartile (mean of 8 x103/μL). Analysis restricted to the first-episode patients yielded similar outcomes. Conclusion: Using a standardized protocol of daily plasmapheresis and high-dose corticosteroids we have achieved a low mortality rate (4%) in patients with TTP. Risk factors for recurrence include African American ethnicity and high platelet counts on admission. If these risk factors remain valid in prospective studies, they may prove useful in identifying TTP patient in whom more aggressive initial treatment (e.g., Rituximab, etc.) may be warranted.

scholarly journals Staphylococcus aureusNasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter?

2010 ◽  
Vol 31 (6) ◽  
pp. 584-591 ◽  
Author(s):  
Hitoshi Honda ◽  
Melissa J. Krauss ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Amy M. Richmond ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Methicillin Resistance ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Patient Specific ◽  
Icu Patients ◽  
Icu Admission

Background.Staphylococcus aureusis an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin-resistantS. aureus(MRSA) is a risk factor for subsequentS. aureusinfection. However, MRSA-colonized patients may have more comorbidities than methicillin-susceptibleS. aureus(MSSA)-colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.Objective.To determine whether MRSA-colonized patients who are admitted to medical and surgical ICUs are more likely to develop anyS. aureusinfection in the ICU, compared with patients colonized with MSSA or not colonized withS. aureus,independent of predisposing patient risk factors.Design.Prospective cohort study.Setting.A 24-bed surgical ICU and a 19-bed medical ICU of a 1,252-bed, academic hospital.Patients.A total of 9,523 patients for whom nasal swab samples were cultured forS. aureusat ICU admission during the period from December 2002 through August 2007.Methods.Patients in the ICU for more than 48 hours were examined for an ICU-acquired S.aureusinfection, defined as development ofS. aureusinfection more than 48 hours after ICU admission.Results.S. aureuscolonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU-acquiredS. aureusinfection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU-acquiredS. aureusinfection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07-7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52-4.01]).Conclusion.ICU patients colonized with S.aureuswere at greater risk of developing aS. aureusinfection in the ICU. Even after adjusting for patient-specific risk factors, MRSA-colonized patients were more likely to developS. aureusinfection, compared with MSSA-colonized or noncolonized patients.

scholarly journals Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hirosato Doi ◽  
Keita Sasajima ◽  
Masanori Takahashi ◽  
Taira Sato ◽  
Iichirou Ootsu ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Confidence Interval ◽  
Previous History ◽  
Vital Signs ◽  
Hazard Ratio ◽  
Recurrent Bleeding ◽  
Diverticular Hemorrhage ◽  
History Of ◽  
Enhanced Computed Tomography ◽  
Colonic Diverticular Hemorrhage

Aim. This study was aimed to clarify the effectiveness of conservative treatment without performing early colonoscopy and the indications for early colonoscopy in patients with colonic diverticular hemorrhage. Methods. This retrospective study included 142 participants who were urgently hospitalized due to bloody stools and were diagnosed with colonic diverticular hemorrhage between April 2012 and December 2016. At the time of hospital visit, only when both shock based on vital signs and intestinal extravasation on abdominal contrast-enhanced computed tomography were observed, early colonoscopy was performed within 24 hours after hospitalization. However, in other cases, patients were conservatively treated without undergoing early colonoscopy. In cases of initial treatment failure in patients with shock, interventional radiology (IVR) was performed without undergoing early colonoscopy. Results. Conservative treatment was performed in 137 (96.5%) patients, and spontaneous hemostasis was achieved in all patients. By contrast, urgent hemostasis was performed in five (3.5%) patients; three and two attained successful hemostasis via early colonoscopy and IVR, respectively. There were no significant differences between two groups in terms of early rebleeding (7.3% vs. 0%,P=0.690) and recurrent bleeding (22.7% vs. 20.0%, P=0.685). The factors associated with the cumulative recurrent bleeding rates were a previous history of colonic diverticular hemorrhage (hazard ratio 5.63, 95% confidence interval 2.68–12.0, P<0.0001) and oral administration of thienopyridine derivative (hazard ratio 3.05, 95% confidence interval 1.23–7.53, P=0.016). Conclusions. In this series, conservative treatment without early colonoscopy was successful in patients with colonic diverticular hemorrhage.

scholarly journals Risk Factors for Early Recurrence Following Ablation for Accessory Pathways

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Audrey Dionne ◽  
Kimberlee Gauvreau ◽  
Edward O’Leary ◽  
Douglas Y. Mah ◽  
Dominic J. Abrams ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Accessory Pathway ◽  
Early Recurrence ◽  
Hazard Ratio ◽  
Atrioventricular Reentrant Tachycardia ◽  
Electroanatomic Mapping System ◽  
Increased Risk ◽  
Consolidation Time

Background: Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation. Methods: Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up. Results: From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1–1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063–4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92–9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP. Conclusions: In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.

Abstract 190: Risk Factors and Outcomes of Hyperbilirubinemia Following Transcatheter Aortic Valve Replacement

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Stephanie Jou ◽  
Li Zhang ◽  
Batyrjan Bulibek ◽  
Mohammad El-Hajjar ◽  
Augustin Delago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Confidence Interval ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hazard Ratio ◽  
P Value ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

Background: It has been established that postoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, hyperbilirubinemia after transcatheter aortic valve replacement (TAVR) has not yet been a subject of clinical research. We evaluated the incidence and risk factors of post-TAVR hyperbilirubinemia, and aimed to determine its prognostic significance. Methods: A retrospective observational study was conducted on 241 consecutive TAVR patients between January 2011 and December 2014 in our institution. We excluded 15 patients with documented chronic hepatic or biliary disorders, or prior liver transplant. Hyperbilirubinemia was defined as any value above the upper limit of normal total bilirubin within 1 week of TAVR. Results: Eighty-two patients out of 226 (36.3%) had post-TAVR hyperbilirubinemia. After adjustment for confounders, there was no significant difference in in-hospital mortality (3.7% (3 of 82) vs. 1.4% (2 of 144); p-value = 0.26) and 1-year mortality (7.3% (6 of 82) vs 5.6% (8 of 144); p-value = 0.60) between patients with and without elevated bilirubin following TAVR. However, there was a trend for hyperbilirubinemic patients to have a longer intensive care unit stay (145.3 +/-202.2 hours vs. 113.2 +/-93.4 hours; p-value = 0.14) and hospital stay (14.1 +/-11.2 days vs. 12.1 +/-8.6 days; p-value = 0.16). Multivariable analysis revealed that preoperative hyperbilirubinemia (hazard ratio 62.88, 95% confidence interval 15.80 to 250.32; p-value <0.0001) and preoperative atrial fibrillation (hazard ratio 2.40, 95% confidence interval 1.21 to 4.78; p-value = 0.01) were strongly associated with post-TAVR hyperbilirubinemia. Conclusions: The cause of post-TAVR hyperbilirubinemia may be multifactorial. It is not a rare event and may impact the short-term outcomes. Thus, monitoring bilirubin should be considered an integrated part of TAVR patient care. Optimal management of post-TAVR hyperbilirubinemia remains challenging.

scholarly journals Gallstone Disease and the Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Observational Studies

2016 ◽  
Vol 106 (1) ◽  
pp. 21-27 ◽  
Author(s):  
S. Upala ◽  
A. Sanguankeo ◽  
V. Jaruvongvanich
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Confidence Interval ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Hazard Ratio ◽  
Cross Sectional ◽  
Increased Risk

Objectives: Gallstone disease shares certain risk factors with cardiovascular disease, particularly metabolic risk factors. Patients with gallstone disease may be at increased risk of cardiovascular disease. Several recent studies exploring the effect of gallstone disease on cardiovascular disease outcomes demonstrated inconsistent results. Design: We conducted a systematic review and meta-analysis of cohort, case–control, and cross-sectional studies that compared the risk of developing cardiovascular disease events in patients with gallstone disease versus non-gallstone disease controls. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the pooled hazard ratio, odd ratio, and 95% confidence interval. Results: Data were extracted from six studies involving 176,734 cases and 803,714 controls. The pooled hazard ratio of cardiovascular events in patients with gallstone disease was 1.28 (95% confidence interval: 1.23–1.33, I2 = 42%). The pooled odd ratio of cardiovascular events in patients with gallstone disease was 1.82 (95% confidence interval: 1.47–2.24, I2 = 68%). Conclusions: Our study demonstrated a statistically significant increase in the risk of cardiovascular disease among patients with gallstone disease.

Risk factors for wound complications and 30-day mortality after major lower limb amputations in patients with peripheral arterial disease

Vascular ◽  
2017 ◽  
Vol 26 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Koichi Morisaki ◽  
Terutoshi Yamaoka ◽  
Kazuomi Iwasa
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Major Amputation ◽  
Hazard Ratio ◽  
Wound Complications ◽  
Albumin Concentration ◽  
Knee Amputation ◽  
Peripheral Arterial

Purpose Risk factors for wound complications or 30-day mortality after major amputation in patients with peripheral arterial disease remain unclear. We investigated the outcomes of major amputation in patients with peripheral arterial disease. Methods Patients who underwent major amputation from 2008 to 2015 were retrospectively analyzed. The main outcome measures were risk factors for wound complications and 30-day mortality after major lower limb amputations. Major amputation was defined as above-knee amputation or below-knee amputation. Wound complications were defined as surgical site infection or wound dehiscence. Results In total, 106 consecutive patients underwent major amputation. The average age was 77.3 ± 11.2 years, 67.9% of patients had diabetes mellitus and 35.8% were undergoing hemodialysis. Patients who underwent primary amputation constituted 61.9% of the cohort, and the proportions of above-knee amputation and below-knee amputation were 66.9% and 33.1%, respectively. The wound complication rate was 13.3% overall, 10.3% in above-knee amputation, and 19.5% in below-knee amputation. Multivariate analysis showed that the risk factors for wound complications were female sex (hazard ratio, 4.66; 95% confidence interval, 1.40–17.3; P = 0.01) and below-knee amputation (hazard ratio, 4.36; 95% confidence interval, 1.20–17.6; P = 0.03). The 30-day mortality rate was 7.6%, pneumonia comprised the most frequent cause of 30-day mortality, followed by sepsis and cardiac death. Multivariate analysis showed that a low serum albumin concentration (hazard ratio, 3.87; 95% confidence interval, 1.12–16.3; P = 0.03) was a risk factor for 30-day mortality. Conclusions Female sex and below-knee amputation were risk factors for wound complications. A low serum albumin concentration was a risk factor for 30-day mortality after major amputation in Japanese patients with peripheral arterial disease.

Stability of Cerebral Aneurysms After Stent-Assisted Coil Embolization

Neurosurgery ◽  
2015 ◽  
Vol 77 (2) ◽  
pp. 208-217 ◽  
Author(s):  
Won-Sang Cho ◽  
Hyun Sook Hong ◽  
Hyun-Seung Kang ◽  
Jeong Eun Kim ◽  
Young Dae Cho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Propensity Score ◽  
Confidence Interval ◽  
Coil Embolization ◽  
Neurological Complication ◽  
Cerebral Aneurysms ◽  
Hazard Ratio ◽  
Stent Group ◽  
Incomplete Occlusion

Abstract BACKGROUND: The availability of stents has widened the indications of endovascular intervention for cerebral aneurysms. OBJECTIVE: To elucidate the effect of stents on radiologic outcomes and to analyze the risk factors for aneurysmal recanalization via propensity score matching. METHODS: From the 735 aneurysms treated with coil embolization with stents (n = 187) and without stents (n = 548) between 2009 and 2011, 157 propensity score-matched case pairs were selected. The recanalization rates and relevant risk factors were analyzed. The mean follow-up interval was 24.1 ± 11.3 months (range, 6-48 months) and 22.9 ± 11.4 months (range, 6-56 months) in the stent and nonstent groups, respectively (P = .388). RESULTS: The stent group demonstrated lower recanalization rates than the nonstent group during both the 6-month (1.9% vs 10.2%, P = .004) and the final follow-up periods (8.3% vs 18.5%, P = .005). The multivariate analysis identified the following significant factors for recanalization: the use of stents (hazard ratio, 0.40; 95% confidence interval, 0.21-0.76, P = .005), larger aneurysm size (hazard ratio, 1.21; 95% confidence interval, 1.11-1.31, P &lt; .001), and initially incomplete occlusion (hazard ratio, 2.39; 95% confidence interval, 1.28-4.43, P = .006). The incidence of permanent neurological complication tended to be higher in the stent group than in the nonstent group (3.2% vs 0%, P = .063). CONCLUSION: In this propensity score-matched analysis, stent implantation reduced the overall recanalization of the coiled cerebral aneurysms. However, the use of stents should be carefully decided upon.

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