Risk factors associated with recurrent cholangitis in pancreatic and hepatobiliary cancers.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 428-428
Author(s):  
Apurva Jain ◽  
Juhee Song ◽  
Milind M. Javle ◽  
Marina C. George
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Acute Cholangitis ◽  
Endoscopic Drainage ◽  
Metallic Stent ◽  
Factors Associated ◽  
Increased Risk ◽  
Covered Metallic Stent ◽  
Significant Difference ◽  
The Mean

428 Background: Acute cholangitis due to malignant biliary obstruction is frequent in patients with pancreatic and hepatobiliary cancers. Recurrent cholangitis (RC) results in repeated hospitalization and delayed cancer care. The risk factors associated with RC are not yet defined. Methods: A pilot review was done on 146 patients admitted with a diagnosis of cholangitis from 2005 to 2014. We included demographics, cancer stage, details of first admission (FA) and interventions. Univariate and multivariate Fine-Gray models were used for statistical analysis. Results: The mean age at FA was 62 yrs, 84 (58%) were males and 99 (68%) were white. Most common cancer was pancreatic 100(69%) and 27(19%) pts had primary cholangitis at FA. During FA, interventions were performed in 114(78%), of whom 51 (45%) had percutaneous drainage (PTBD) and 63 (55%) had endoscopic drainage (ED). Readmission with cholangitis was noted in 35 (24%) cases. Univariate analysis did not show a difference between PTBD and ED. However, subgroup analysis showed external only PTBD and covered metallic stent ED had lower risk of RC. These variables remained significant on multivariate analysis (Subdistribution HR= 0.00, p<.0001 for both). Multiple previous PTBD (≥2) before FA was significantly associated with increased risk of RC (Subdistribution HR= 2.64, p= 0.01) on univariate analysis. Conclusions: Having multiple previous PTBD is associated with recurrent cholangitis. Though no significant difference was noted between PTBD and ED, the subgroups indicated a trend towards less recurrent cholangitis with covered metallic stent. [Table: see text]

scholarly journals 838. Drivers of empiric carbapenem use: How important is history of extended-spectrum beta-lactamase (ESBL) infection?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S460-S460
Author(s):  
Tyler J Stone ◽  
James Beardsley ◽  
James Johnson ◽  
Christopher Ohl ◽  
Christopher Ohl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Research Support ◽  
Factors Associated ◽  
Negative Culture ◽  
Increased Risk ◽  
Culture Characteristics ◽  
The Mean ◽  
Culture Positive ◽  
Research Grant

Abstract Background CARs are first line agents for serious infections caused by ESBL producers. Likelihood of developing subsequent ESBL infection is unknown. In patients (pts) with a history (hx) of ESBL positive (ESBLP) culture, empiric therapy with a CAR has become common in hospitals. The purpose of this study was to evaluate the microbiology of subsequent infections (SI) among pts with hx of ESBLP culture and determine risk factors associated with ESBLP SI that may justify an empiric CAR. Methods This retrospective observational study was conducted at a multicenter health system. The electronic medical record (EMR) was used to generate a report of all E. coli (EC) or K. pneumoniae (KP) ESBLP cultures during 2017, an analogous report was generated for ESBL-negative (ESBLN) EC or KP. These were termed index cultures (IC). Pts were randomly selected from each report until 200 total pts were enrolled. Inpatients, outpatients, and all culture specimens were included. Pts with an ESBLP culture prior to 2017 were excluded. The EMR was reviewed up to 1 year after the IC. Pt and culture characteristics were recorded. The primary outcome was proportion of pts who developed an ESBLP SI. Risk factors associated with ESBLP SI were determined. Relapsed infection (same site, same bacteria) that occurred within 2 weeks of the IC was excluded. Results 200 pts were included, 100 with ESBLP IC and 100 with ESBLN IC. The mean age was 58 years, 84% were female, and 69% were outpatients. 86% of IC were EC and 86% were urine specimens. Within 1 year of IC, 100 pts (50%) developed a SI. 22 of these were ESBLP, 43 were ESBLN, and 35 had no or negative culture. The mean time since IC for ESBLP SI and ESBLN SI was 85 (26-226) days and 140 (15-363) days, respectively (p=0.014). When comparing time to SI, 21 (96%) ESBLP and 26 (61%) ESBLN occurred &lt; 6 months after IC (p=0.003). Among SI with culture data (n= 65), the number of ESBLP SI was higher if the IC was ESBLP (22 vs 0, p&lt; 0.001). Incidence of ESBLP or ESBLN SI in all pts with an ESBLP IC was similar (22 vs 18, p=0.428). Factors associated with ESBLP SI were hx of ESBLP IC, male gender, and time between IC and SI. Table 1. Index Culture Characteristics of Culture Positive Subsequent Infections Figure 1. Cumulative rate of ESBL-positive SI in 180 days (6 months) following IC Table 2. Univariate Analysis of Patient Characteristics Comparing ESBL-positive and ESBL-negative Culture Positive Subsequent Infections Conclusion Hx of positive culture for ESBL-producing EC or KP is associated with SI caused by ESBLP EC or KP. Pts presenting &lt; 6 months after ESBLP IC are at increased risk for ESBLP SI, justifying empiric CAR therapy. Disclosures Tyler J. Stone, PharmD, Paratek (Research Grant or Support) Elizabeth Palavecino, MD, Paratek (Grant/Research Support)Paratek (Grant/Research Support) John Williamson, PharmD, Paratek (Research Grant or Support)

scholarly journals Prevalence and associated factors for Pterygium in Han and Mongolian adults: across-sectional study in inner Mongolian, China

2019 ◽  
Author(s):  
Yuhan Wang ◽  
Guangliang Shan ◽  
Linyang Gan ◽  
Yonggang Qian ◽  
Ting Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Rural Areas ◽  
Inner Mongolia ◽  
Univariate Analysis ◽  
Education Level ◽  
Study Cohort ◽  
Sectional Study ◽  
Factors Associated ◽  
Significant Difference

Abstract Background: To investigate the prevalence of and factors associated with pterygium in Han and Mongolian adults at four survey sites in Inner Mongolia, China. Methods: A population-based, cross-sectional study was conducted. Using a stratified sampling method, we eventually included 2,651 participants of at least30 years of age from a total of 3,468 eligible residents. Factors associated with pterygium were analysed using univariate analysis and logistic regression models. Results: There were 1,910 Han adults and 741 Mongolian adults included in this study. The mean± standard deviation of age for individuals in the study cohort was 48.93±11.06 years. The overall prevalence of pterygium was 6.4% (n=169), and the prevalences of bilateral and unilateral pterygium were 1.4% (n=38) and 4.8% (n=128), respectively. The most common grade of pterygium was Grade 2. After univariate analysis, eleven factors were considered in a multivariate analysis. The results indicated that age (P<0.001), education level (P<0.001), outdoor occupation (P=0.026), and time spent in rural areas (P<0.001) were significantly associated with pterygium, whereas gender and ethnicity were not risk factors. In subgroup analysis, BMI≥28 was a protective factor for Han individuals (OR 0.42, 95% CI 0.21-0.81, P=0.01), but a risk factor for Mongolian individuals (OR 2.39, 95% CI 1.02-5.58, P=0.044). The BF% in Han and Mongolian individuals had significant difference (P<0.001). Conclusions: Our results indicated that an outdoor occupation, old age and time spent in rural areas are risk factors for pterygium in Inner Mongolia. Living near an urban survey site (Hohhot and Tsining District) and having a higher education level are protective factors for pterygium. Ethnicity, gender, smoking, diabetes and high blood pressure are not associated with pterygium. Different dietary structures in Han and Mongolian adults may lead to different fat content of body and therefore contributes to the prevalence of pterygium. Keywords: Pterygium, prevalence, Han and Mongolian, risk factors, protective factors

scholarly journals Risk Factors and Mortality in Pediatric Patients with Stenotrophomonas maltophilia Bacteremia

2020 ◽  
Vol 41 (S1) ◽  
pp. s374-s375
Author(s):  
Mohammed Alsuhaibani ◽  
Alanoud Aljarboua ◽  
Sahar Althawadi ◽  
Abdurahman Alsweed ◽  
Sami Al-Hajjar
Keyword(s):  
Risk Factors ◽  
Stenotrophomonas Maltophilia ◽  
Pediatric Patients ◽  
Heart Diseases ◽  
Univariate Analysis ◽  
Bloodstream Infections ◽  
Factors Associated ◽  
Icu Admission ◽  
Significant Difference ◽  
The Impact

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

Frequency and Risk Factors of Red Blood Cell Alloimmunization in Thalassemia Major Patients in Markazi province

2019 ◽  
Author(s):  
Aziz Eghbali MD ◽  
Roghaieh.Rahimi-Afzal MD ◽  
Sarvenaz Mehrabi MD ◽  
Seyed Amir Sanatkar MD ◽  
Morteza Mousavi-Hasanzadeh MD
Keyword(s):  
Risk Factors ◽  
Blood Transfusion ◽  
Genetic Disorders ◽  
Demographic Data ◽  
Thalassemia Major ◽  
Blood Groups ◽  
The Body ◽  
Factors Associated ◽  
Significant Difference ◽  
The Mean

Background: Thalassemia is one of the most common genetic disorders throughout the world. Blood transfusion plays an important role in the treatment of thalassemia but it leads to numerous complications such as iron overload and alloimmunization. This study evaluated the frequency and risk factors associated with alloimmunization in thalassemia major patients living in Markazi province, Iran. Materials and Methods: In this descriptive study, 48 thalassemia major patients who underwent blood transfusion at Amirkabir hospital were included. Patients' demographic data were recorded using a questionnaire. In order to perform alloimmunization screening and autoantibody assessment, patients were referred to Tehran Blood Transfusion Organization Laboratory. Results: The current study was performed on 48 patients with thalassemia major,. The mean age of patients was 12.5 ± 8.3 years. Among patients 26 (54.16%) were male and 22 (45.83%) were female, 13 patients (27.08%) had alloantibodies. Among 48 patients, 19 (39.58%) had undergone splenectomy. The patients' age of the first blood transfusion ranged from 1 month to 14 months      and the mean age of the first blood transfusion was 9.5 ± 7.08 months. The blood transfusion intervals in patients were from 21 days to 40 days and the blood volume received at each transfusion session was 10-15 cc/kg of the body weight. In the current study, the data analysis indicated no significant correlation between alloantibodies and RH phenotype (P=0.43), patients' gender (P=0.9), or blood groups (P=0.4); whereas, a significant correlation was found between alloantibodies and splenectomy (P=0.02) as an increase in the prevalence of alloantibodies was reported in splenectomised patients. Conclusion: No significant difference was found between the patients with and without alloantibodies in terms of the prevalence of Rh phenotype, gender, and blood groups. However, there was a significant difference between the patients with and without alloantibodies in terms of splenectomy. Key words: Allo-immunization, Risk factors, Thalassemia major  

scholarly journals Characteristics of circumferential vesico-vaginal fistulas: A cross-sectional and multicentric study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Moussa Kaboré ◽  
Brahima Kirakoya ◽  
Adama Ouattara ◽  
Clotaire Alexis Marie Kiemdiba Donega Yameogo ◽  
Stéphanie Dominique Amida Nama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Marital Status ◽  
Logistic Regression Model ◽  
Analytical Study ◽  
Univariate Analysis ◽  
Cross Sectional ◽  
Multicentric Study ◽  
Factors Associated ◽  
Two Factors ◽  
The Mean

The objective of the study was to determine the risk factors for development of circumferential fistula. We carried out a crosssectional, multicentric and analytical study over 7 years period, from 1st January, 2010 to 31 December, 2016. We compared circumferential and non- circumferential fistula patients in order to determine the risk factors for circumferential fistula development. Circumferential fistula accounted for 20% (91/456) of all vesico-vaginal fistulas. The mean age of the 456 patients was 35.9 years±12.15 (min 15 years; max 72 years). On univariate analysis, factors associated with the risk of circumferential fistula were: residence (P=0.039; OR=1.7), parity (P=0.04; OR=0.47), marital status before fistula (P=0.002; 4.3), duration of labor (P=0.041; OR=2.7) and fistula aetiology (P=0.038; OR=2.54). In a logistic regression model, two factors remained significant: marital status before fistula (P=0.029; OR=0.13) and duration of labor (P=0.017; OR=0.26). Circumferential fistula occurs in urban, primiparous, unmarried women who have been in labor for more than 41 hours.

A comparison of the prevalence of the metabolic syndrome and its components among native Japanese and Japanese Brazilians residing in Japan and Brazil

2007 ◽  
Vol 14 (4) ◽  
pp. 508-514 ◽  
Author(s):  
Andiara Schwingel ◽  
Yoshio Nakata ◽  
Lucy S. Ito ◽  
Wojtek J. Chodzko-Zajko ◽  
Ryosuke Shigematsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Urban Areas ◽  
Significant Heterogeneity ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Significant Difference ◽  
Japanese Ancestry

Background This study investigated the prevalence of risk factors associated with the metabolic syndrome (MetSyn) among individuals of Japanese descent exposed to different cultural environments. Design A cross-sectional study to assess component risk factors for the diagnosis of MetSyn was undertaken in urban areas in Japan and Brazil. A total of 773 men and women aged 35 years or over were included in three groups: 249 native Japanese, 269 Brazilian individuals of Japanese ancestry residing in Japan, and 255 Brazilian individuals of Japanese ancestry residing in Brazil. Results Higher rates of metabolic abnormalities with respect to central obesity and serum lipid profiles were observed among Brazilian individuals of Japanese ancestry residing in Brazil compared with those residing in Japan and native Japanese. Likewise, an increased risk of hypertension was observed among Japanese Brazilian individuals residing in Japan. The prevalence of MetSyn in men was significantly higher among Brazilians of Japanese ancestry residing in Brazil (37.5%) compared with those residing in Japan (25.3%) or native Japanese (21.4%), whereas no significant difference was observed among women. In the logistic model, Brazilian individuals of Japanese ancestry residinginBrazil weretwice as likely to develop MetSyn compared with native Japanese, whereas no significant differences were found among those residing in Japan. Conclusions These findings underscore the significant heterogeneity in risk factors among communities of Japanese ancestry residing in Brazil and Japan, and suggest that immigrants exposed to the Brazilian cultural environment are more susceptible to the development of risk factors associated with MetSyn than native Japanese.

scholarly journals Risk Factors of New Vertebral Compression Fracture After Percutaneous Kyphoplasty or Vertebroplasty: A Retrospective Study of 752 Patients

2021 ◽  
Author(s):  
Bo-bo Zhang ◽  
Zhong-wei Song ◽  
Ying Wang ◽  
Zhi-wei Ren ◽  
Wei-zhou Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Compression Fracture ◽  
Osteoporosis Treatment ◽  
Vertebral Compression Fractures ◽  
Height Loss ◽  
Mineral Density ◽  
Compression Fractures ◽  
Factors Associated ◽  
Significant Difference

Abstract Summary Irregularly postoperative anti-osteoporosis treatment (AOT), number of treated vertebrae (NTV) ≥ 2, bone mineral density (BMD) ≤－3.0 SDs, body mass index (BMI) <18.5kg/m2 or BMI ≥ 24kg/m2, vertebral height loss ratio (VHLR)＞20% were strong risk factors associated with new vertebral compression fractures (NVCF) after percutaneous vertebroplasty or kyphoplasty (PVP/PKP) in patients with osteoporotic vertebral compression fractures (OVCF). There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention.Introduction NVCF have been connected to PVP/PKP surgery for patients with VCF. There are some debates about whether new vertebral body fractures are simply a result of the natural progression of osteoporosis or whether they should be regarded as a consequence of augmentation. We tried to investigate and identify the risk factors which may be relevant to NVCF after PVP/PKP surgery in OVCF patients.Methods The authors retrospectively analyzed the occurrence of NVCF in 752 patients treated with PVP or PKP for OVCF. Possible risk factors, such as age, gender, refracture time (RT), AOT, NTV, BMD, BMI, and VHLR, were assessed.All methods are carried out in accordance with relevant guidelines and regulations.Results Significant differences (P<0.05) were found between the NVCF and control groups with regard to AOT, number of treated vertebrae, BMD, BMI, and VHLR by univariate analysis. And irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI < 18.5 kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were found to be the significant factors in multivariate analysis. To evaluate a direct and more precise effect of the procedures on untreated vertebrae, the NVCF group was subdivided into adjacent and remote fracture groups. All of factors have no significant difference between two subgroups.Conclusion In the current study, the incidence of NVCF after PVP/PKP is 9.58%. Irregularly AOT, NTV ≥ 2, BMD ≤－3.0 SDs, BMI <18.5kg/m2 or BMI ≥ 24kg/m2, VHLR＞20% were strong risk factors associated with NVCF after PVP/PKP in patients with OVCF. There was no difference between NVCF occurred adjacent or remote after PKP/PVP intervention and that might be the result of the osteoporosis itself. All of those should be addressed during preoperative communication and postoperative management.

scholarly journals On-farm risk factors associated with Leptospira shedding in New Zealand dairy cattle

2020 ◽  
Vol 148 ◽  
Author(s):  
Y. Yupiana ◽  
E. Vallée ◽  
P. Wilson ◽  
J. F. Weston ◽  
J. Benschop ◽  
...  
Keyword(s):  
Risk Factors ◽  
Statistical Power ◽  
Univariate Analysis ◽  
Water Source ◽  
Drinking Water Source ◽  
Face To Face ◽  
Factors Associated ◽  
Clinically Normal ◽  
Increased Risk ◽  
On Farm

Abstract This study aimed to evaluate risk factors associated with shedding of pathogenic Leptospira species in urine at animal and herd levels. In total, 200 dairy farms were randomly selected from the DairyNZ database. Urine samples were taken from 20 lactating, clinically normal cows in each herd between January and April 2016 and tested by real-time polymerase chain reaction (PCR) using gyrB as the target gene. Overall, 26.5% of 200 farms had at least one PCR positive cow and 2.4% of 4000 cows were shedding Leptospira in the urine. Using a questionnaire, information about risk factors at cow and farm level was collected via face-to-face interviews with farm owners and managers. Animals on all but one farm had been vaccinated against Hardjo and Pomona and cows on 54 of 200 (27%) farms had also been vaccinated against Copenhageni in at least one age group (calves, heifers and cows). Associations found to be statistically significant in univariate analysis (at P < 0.2) were assessed by multivariable logistic regression. Factors associated with shedding included cattle age (Odds ratio (OR) 0.82, 95% CI 0.71–0.95), keeping sheep (OR 5.57, 95% confidence interval (CI) 1.46–21.25) or dogs (OR 1.45, 95% CI 1.07–1.97) and managing milking cows in a single as opposed to multiple groups (OR 0.45, 95% CI 0.20–0.99). We conclude that younger cattle were more likely to be shedding Leptospira than older cattle and that the presence of sheep and dogs was associated with an increased risk of shedding in cows. Larger herds were at higher risk of having Leptospira shedders. However, none of the environmental risk factors that were assessed (e.g. access to standing water, drinking-water source), or wildlife abundance on-farm, or pasture were associated with shedding, possibly due to low statistical power, given the low overall shedding rate.

Factors at Admission That Are Predictive of Increased In-Hospital Bleeding in Acutely Ill Medical Patients: Findings from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 264-264
Author(s):  
Hervé Decousus ◽  
Rainer B. Zotz ◽  
Victor F. Tapson ◽  
Beng H. Chong ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Univariate Analysis ◽  
Medical Illness ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Significant Difference ◽  
Clinically Significant

Abstract Background Although clinical studies have not shown a significant difference between the risk of bleeding in acutely ill medical patients receiving pharmacologic venous thromboembolism (VTE) prophylaxis and those receiving placebo, fear of bleeding may lead physicians to withhold pharmacologic prophylaxis for patients who should receive it. We therefore aimed to determine the incidence of, and risk factors for in-hospital bleeding in hospitalized acutely ill medical patients in IMPROVE, an international, observational registry. Methods Patients aged ≥18 years, hospitalized ≥3 days with an acute medical illness have been enrolled consecutively since July 2002. Exclusion criteria: therapeutic antithrombotics/thrombolytics at admission, major surgery or trauma during 3 months prior to admission, and VTE treatment within 24 hours of admission. Patients bleeding immediately before, or at admission were excluded from this analysis. Factors present at admission and associated with increased risk of in-hospital bleeding (defined as major or clinically significant nonmajor [Büller et al. N Engl J Med2003;349:1695–702]) were identified by univariate analysis (p&lt;0.15) and included in a multiple logistic regression model (significant at p&lt;0.05). The model was adjusted for patients’ length of stay in hospital. Results Data were from 5960 patients enrolled up to 31 March 2005 in 49 hospitals (12 countries). In-hospital bleeding occurred in 170 (2.9%) patients: 68 (1.1%) major and 102 (1.7%) clinically significant nonmajor bleeding. Independent risk factors for in-hospital bleeding are shown in the Table. In-hospital prophylaxis with low-molecular-weight and unfractionated heparin were not independently associated with an increased risk of bleeding when added to the analysis (p=0.51 and 0.38, respectively). In patients with 0, 1, 2 or ≥3 of these risk factors, the incidences of major in-hospital bleeding were 0.1%, 0.4%, 1.2% and 5.2%, respectively. Conclusions In this unselected patient population, the rate of major in-hospital bleeding was low (1.1%) and similar to that in the MEDENOX study (1.0%), a major clinical study of VTE prophylaxis. Factors that we identified will be valuable for predicting the risk of in-hospital bleeding in acutely ill medical patients. Table. Factors predictive of an increased risk of in-hospital bleeding in acutely ill medical patients Factor Odds ratio 95% confidence interval Active gastroduodenal ulcer 5.38 2.90–10.00 Bleeding disorder 4.54 2.02–10.19 Hepatic failure 3.34 1.80–6.19 Serum creatinine &gt;1.5 mg/dL 2.29 1.63-3.21 Current cancer 2.08 1.43-3.03 Central venous catheter 2.00 1.31-3.05 ICU/CCU stay 1.92 1.23-3.02 Immobile ≥ 4 days 1.75 1.24-2.46 Ischemic heart disease 1.57 1.02-2.40

scholarly journals FC 048IS AKI IN COVID-19 PATIENTS ASSOCIATED WITH INCREASED LENGTH OF STAY AND MORTALITY?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jennifer Ng ◽  
Kristi Sun ◽  
Phoebe Sharratt ◽  
Mark Harber ◽  
Vasantha Muthuppalaniappan
Keyword(s):  
Length Of Stay ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Final Analysis ◽  
Adverse Outcomes ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean

Abstract Background and Aims Acute kidney injury (AKI) affects 22% of hospitalised patients and is associated with a 21.9% increased risk of mortality in non COVID-19 presentations. Studies of patients hospitalised with COVID-19 have estimated the prevalence of AKI between 5.1-36.6%. The objective of the study was to identify the prevalence of AKI in COVID-19 patients requiring admissions and associated adverse outcomes. Method We conducted a retrospective observational cohort study of all patients admitted to hospital with a diagnosis of COVID-19 from 10th March to 7th May 2020. COVID-19 status was defined by a positive COVID-19 PCR nasopharyngeal and oropharyngeal swabs. Patients younger than 18 years of age were excluded from final analysis. Demographic data, past medical history and blood results were obtained from electronic health records. AKI was defined according to KDIGO criteria. Results 382 patients (219 Male) were included in the final analysis. The median age of patients was 69 years (Range 18-99). AKI occurred in 153 (40%) patients (103 Male), with a median age of 74 years. 111 (72.5%) patients had AKI on admission, 42 (27.5%) developed AKI while hospitalised. Average clinical frailty score (CFS) in the AKI group was 4. Median creatinine kinase in the AKI group was 213 (IQR 149-1260). The peak stages of AKI were Stage 1 in 100/153 (65.3%), Stage 2 in 29/153 (19%) and Stage 3 in 24/153 (15.7%). Of AKI patients 14/153 (9.2%) required renal replacement therapy. The mean peak serum creatinine was 246umol/L which was on Day 5 of admission and Day 11 of symptoms on average. 90/153 (58.8%) patients had recovery of kidney function which includes 7 patients (50%) patients becoming dialysis independent. 40/76 (53%) patients who required respiratory support with either CPAP or mechanical ventilation had evidence of AKI compared to 113/304 (37%) of non-ventilated patients. Amongst patients with AKI, 61/153 (40%) died, 64/153 (42%) were discharged, 20/153 (13%) remain in hospital and 8/153 (5%) were transferred to another hospital with 4 of the patients still requiring dialysis. In comparison, in patients with no AKI, 43/228 (19%) died, 174/228 (76%) were discharged, 9/228 (4%) remain in hospital and 2/228 (1%) were transferred to another hospital. Length of stay (LoS) of patients included in the study ranged from 0 to 102 days. The mean LoS in the AKI group was 18.1 ± 17.5 days (Range 0-102). The mean LoS in the non-AKI group was 10.5 ± 13.30 days (Range 0-84). There was a significant difference in the LoS between the 2 groups, p&lt;0.01 (95% CI: 4.1, 11.1). Of all 153 AKI patients 61 (40%) deaths occurred, compared to 43/228 (19%) in the non-AKI group, this difference was significant, p&lt;0.01, OR= 2.89 (95% CI: 1.81, 4.58). Suggesting that patients with AKI had a 74% chance of increased death. Univariate analysis showed that age, males, baseline eGFR, albumin, CFS and Charlson comorbidity index were predictors of AKI. Multivariate analysis showed that independent predictors of AKI included males, black and Asian race, baseline eGFR and albumin. An increase in baseline eGFR by 1ml/min in COVID-19 patients was associated with a 2.4% risk reduction in death, p&lt;0.01, OR= 0.976 (95% CI: 1.02, 1.03). Conclusion AKI is a poor prognosticator in patients with COVID-19 with prolonged hospitalisation and increased mortality.

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