Seizures Among Patients with Brain Metastases: A Population- and Institutional-level Analysis

Objective:To test the hypothesis that subets of patients with brain metastases (BrM) without seizures at intracranial presentation are at increased risk for developing seizures, we characterized the incidence and risk factors for seizure development among seizure-naïve patients with brain metastases (BrM).Methods:We identified 15,863 and 1,453 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham and Women’s Hospital/Dana Farber Cancer Institute (2000-2015) institutional data, respectively. Cumulative incidence curves and Fine/Gray’s competing risks regression were used to characterize seizure incidence and risk factors, respectively.Results:Among SEER-Medicare and institutional patients, 1,588 (10.0%) and 169 (11.6%) developed seizures, respectively. On multivariable regression of the SEER-Medicare cohort, African American vs. White race (hazard ratio [HR]=1.45 [95% CI, 1.22-1.73], p<0.001), urban vs. non-urban residence (HR=1.41 [95% CI, 1.17-1.70], p<0.001), melanoma vs. NSCLC as primary tumor type (HR=1.44 [95% CI, 1.20-1.73], p<0.001), and receipt of brain-directed stereotactic radiation (HR=1.67 [95% CI, 1.44-1.94], p<0.001) were associated with greater seizure risk. On multivariable regression of the institutional cohort, melanoma vs. NSCLC (HR=1.70 [95% CI, 1.09-2.64], p=0.02), >4 BrM at diagnosis (HR=1.60 [95% CI, 1.12-2.29], p=0.01), presence of BrM in a high-risk location (HR=3.62 [95% CI, 1.60-8.18], p=0.002), and lack of local brain-directed therapy (HR=3.08 [95% CI, 1.45-6.52], p=0.003) were associated with greater risk of seizure development.Conclusions:The role of antiseizure medications among select patients with BrM should be re-explored, particularly for those with melanoma, a greater intracranial disease burden, and/or BrM in high-risk locations.

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Frequency, etiologies, risk factors, and sequelae of falls among patients with brain metastases: a population- and institutional-level analysis

Neuro-Oncology Practice ◽

10.1093/nop/npab061 ◽

2021 ◽

Author(s):

Nayan Lamba ◽

Fang Cao ◽

Daniel N Cagney ◽

Paul J Catalano ◽

Daphne A Haas-Kogan ◽

...

Keyword(s):

Risk Factors ◽

Brain Metastases ◽

Emergency Department Visits ◽

Urban Residence ◽

Patients With Cancer ◽

Medicare Data ◽

Medical Evaluation ◽

Charlson Comorbidity Score ◽

Medicare Patients ◽

Risk Reduction Measures

Abstract Background Falls in patients with cancer harbor potential for serious sequelae. Patients with brain metastases (BrM) may be especially susceptible to falls but supporting investigations are lacking. We assessed the frequency, etiologies, risk factors, and sequelae of falls in patients with BrM using two data sources. Methods We identified 42,648 and 111 patients with BrM utilizing Surveillance, Epidemiology, and End Results (SEER)-Medicare data (2008-2016) and Brigham/Dana Farber (BWH/DFCI) institutional data (2015), respectively, and characterized falls in these populations. Results Among SEER-Medicare patients, 10,267 (24.1%) experienced a fall that prompted medical evaluation, with cumulative incidences at 3, 6, and 12 months of 18.0%, 24.3%, and 34.1%, respectively. On multivariable Fine/Gray’s regression, older age (>81 or 76-80 vs. 66-70 years, hazard ratio [HR] 1.18 [95% CI, 1.11-1.25], p<0.001 and HR 1.10 [95% CI, 1.04-1.17], p<0.001, respectively), Charlson comorbidity score of >2 vs. 0-2 (HR 1.08 [95% CI, 1.03-1.13], p=0.002) and urban residence (HR 1.08 [95% CI, 1.01-1.16], p=0.03) were associated with falls. Married status (HR 0.94 [95% CI, 0.90-0.98], p=0.004) and Asian vs. white race (HR 0.90 [95% CI, 0.81-0.99], p=0.03) were associated with reduced fall-risk. Identified falls were more common among BWH/DFCI patients (N=56, 50.4% of cohort), resulting in emergency department visits, hospitalizations, fractures, and intracranial hemorrhage in 33%, 23%, 11%, and 4% of patients, respectively. Conclusions Falls are common among patients with BrM, especially older/sicker patients, and can have deleterious consequences. Risk-reduction measures, such as home safety checks, physical therapy, and medication optimization, should be considered in this population.

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Percutaneous dilatational tracheotomy in high-risk ICU patients

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.152 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

E Luesebrink ◽

S Massberg ◽

M Orban

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

High Risk ◽

Triple Therapy ◽

Bleeding Risk ◽

Icu Patients ◽

Procedural Complications ◽

Multivariable Regression ◽

International Multicenter Study ◽

International Multicenter

Abstract Funding Acknowledgements Type of funding sources: None. Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in cardiac intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. There is a need for critical evaluation of these safety concerns. This is the first and largest international, multicenter study on PDT to date including such a high proportion of patients on antithrombotic therapy investigating whether PDT in high-risk ICU patients is associated with elevated procedural complications and analysing risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed. Procedure-related complications for each risk group were analysed until hospital discharge. Additionally, predictors of bleeding occurrence were analysed by uni- and multivariable regression models. Results In total, 671 patients receiving PDT according to Ciaglia’s technique with accompanying bronchoscopy were included. Patients were stratified into seven clinically relevant antithrombotic treatment groups. Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related, none of which required surgical intervention. In almost all cases bleedings were associated with skin bleedings from the entry site and could easily be treated with minimally invasive stitching. Subgroup analysis showed no increase in the rate of procedure-related complications in patients with elevated body mass index. In a multivariable regression model bleeding occurrence during and after PDT was independently associated with platelet count (Odds ratio [OR] 0.73, 95% confidence interval [95% CI] [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Neither PTT (OR 1.01, 95% CI [0.99, 1.02], p = 0.32), nor DAPT (OR 1.11, 95% CI [0.56, 2.04], p = 0.75) nor triple therapy (OR 0.93, 95% CI [0.49, 1.66], p = 0.82) were associated with bleeding risk. Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT whereas DAPT and triple therapy had no influence on bleeding events.

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Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa067 ◽

2020 ◽

Vol 41 (1) ◽

pp. 59-71 ◽

Cited By ~ 3

Author(s):

Torsten Schlosshauer ◽

Marcus Kiehlmann ◽

Diana Jung ◽

Robert Sader ◽

Ulrich M Rieger

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Surgical Technique ◽

Significant Risk ◽

Level Of Evidence ◽

Increased Risk ◽

Potential Risk Factors ◽

Wound Healing Problems ◽

Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

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AB0407 CARDIOVASCULAR BURDEN IN SYSTEMIC SCLEROSIS: QRISK3 VERSUS FRAMINGHAM FOR RISK ESTIMATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.327 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1232.1-1232

Author(s):

M. Di Battista ◽

S. Barsotti ◽

A. Della Rossa ◽

M. Mosca

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Systemic Sclerosis ◽

High Risk ◽

General Population ◽

Risk Score ◽

Predictive Accuracy ◽

Risk Estimation ◽

Cross Sectional

Background:Cardiovascular (CV) diseases, namely myocardial infarction and stroke, are not among the most known and frequent complications of systemic sclerosis (SSc), but there is growing evidence that SSc patients have a higher prevalence of CV diseases than the general population [1].Objectives:To compare two algorithms for CV risk estimation in a cohort of patients with SSc, finding any correlation with clinical characteristics of the disease.Methods:SSc patients without previous myocardial infarction or stroke were enrolled. Traditional CV risk factors, SSc-specific characteristics and ongoing therapies were assessed. Framingham and QRISK3 algorithms were then used to estimate the risk of develop a CV disease over the next 10 years.Results:Fifty-six SSc patients were enrolled. Framingham reported a median risk score of 9.6% (IQR 8.5), classifying 24 (42.9%) subjects at high risk, with a two-fold increase of the mean relative risk in comparison to general population. QRISK3 showed a median risk score of 15.8% (IQR 19.4), with 36 (64.3%) patients considered at high-risk. Both algorithms revealed a significant role of some traditional risk factors and a noteworthy potential protective role of endothelin receptor antagonists (p=0.003). QRISK3 was also significantly influenced by some SSc-specific characteristics, as limited cutaneous subset (p=0.01), interstitial lung disease (p=0.04) and non-ischemic heart involvement (p=0.03), with the first two that maintain statistically significance in the multivariate analysis (p=0.02 for both).Conclusion:QRISK3 classifies more SSc patients at high-risk to develop CV diseases than Framingham, and it seems to be influenced by some SSc-specific characteristics. If its predictive accuracy were prospectively verified, the use of QRISK3 as a tool in the early detection of SSc patients at high CV risk should be recommended.References:[1]Ngian GS, Sahhar J, Proudman SM, Stevens W, Wicks IP, Van Doornum S. Prevalence of coronary heart disease and cardiovascular risk factors in a national cross-sectional cohort study of systemic sclerosis. Ann Rheum Dis. 2012;71:1980-3.Disclosure of Interests:None declared

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The Susceptibility of Healthy People to COVID-19 Infection and the Role of ACE2

Journal of Iranian Medical Council ◽

10.18502/jimc.v4i3.7212 ◽

2021 ◽

Author(s):

Mehdi Kushkestani ◽

Mohsen Parvani ◽

Bakhtyar Tartibian ◽

Rasoul Eslami

Keyword(s):

Risk Factors ◽

Cost Effective ◽

Normal Subjects ◽

Definitive Treatment ◽

Activity Levels ◽

Cost Effective Approach ◽

Increased Risk ◽

Physical Activity Levels ◽

Ace2 Gene

The COVID-19 virus has caused many deaths of people worldwide since the pandemic began. However, no definitive treatment for this infection has been discovered so far. It has been shown that comorbidities such as diabetes, hypertension and cardiovascular diseases are associated with an increased risk of SARS-COV-2 infection. Interestingly, SARS-COV-2, like SARS-COV, uses the ACE2 gene to enter the host cell. Also, changes or imbalance in ACE2.ACE can affect SARS-COV-2 susceptibility, related outcomes and mortality. Regarding the crucial role of ACE2 protein in COVID-19 infection, the effect of different factors such as age, BMI, physical activity levels, nutritional status, altitude, as well as blood group was assessed on the level of this protein. Further, to our knowledge, no study has been conducted to examine factors that increase or decrease the risk of COVID-19 and its related severity and outcome in normal subjects emphasizing the pivotal role of ACE2. Therefore, the primary purpose of this study was to investigate the involved mechanisms of ACE2 protein and other risk factors causing infection in different situations and finally, to introduce a safe, accurate, and cost-effective approach to prevent SARS-COV-2 infection and hard clinical outcomes in normal subjects.

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Role of Colour Doppler in High Risk Pregnancy

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210434 ◽

2021 ◽

Vol 6 (2) ◽

pp. 185-191

Author(s):

Hiral Parekh ◽

Sneha Chaudhari

Keyword(s):

Risk Factors ◽

High Risk ◽

Perinatal Outcome ◽

Umbilical Artery ◽

High Risk Pregnancy ◽

Colour Doppler ◽

High Risk Factors ◽

Risk Pregnancy ◽

A Prospective Study

This was a prospective study conducted in pregnant patients with high risk factors who got admitted in the Department of Obstetrics and Gynaecology at Care Hospital, Jamnagar during the period from May 2018 to September 2020. Background: High-risk pregnancies causes many adverse perinatal outcomes. Doppler ultrasound is a non-invasive technique to study the feto-maternal circulation to guide the clinical management. Objective: This study aims at evaluating the role of colour Doppler in high-risk pregnancies and their perinatal outcome. Materials and Methods: This was a prospective study carried out for 29 months in the Department of Radiology with antenatal women in the age group of 18-35 years with singleton pregnancy of gestational age of <28 weeks to >35 weeks having high-risk factors considered in study. The risk factors considered were pregnancy induced hypertension (PIH), gestational diabetes, anemia, oligohydramnios, polyhydramnios and IUGR. Doppler study of umbilical artery and fetal middle cerebral artery (MCA) arteries was done and amniotic fluid index (AFI) was measured. Parameters in the form of resistive index, pulsatility index, and systolic/diastolic ratio were taken. obstetric history was taken with regular interval follow up. Results: The study was carried out with 50 patients. High-risk pregnancy was more common in the age group of 21-25 years. The most common high-risk factor in pregnancy was oligohydramnios which accounted for 30% of cases. Out of 50 high-risk pregnancies, 5 (10 %) of cases resulted in intrauterine growth restriction (IUGR). Out of 50 high-risk cases, in 36 cases, umbilical artery findings were abnormal. 3 patients had intrauterine death (IUD) and 27 patients had poor perinatal outcome. Umbilical artery abnormality showed significant sensitivity and negative predictive value for adverse (poor + IUD) perinatal. Correlation was seen between high risk pregnancy and need of emergency caesarean section and induction and associated adverse perinatal outcome. Conclusion: Combination of different arterial waveform study enhance the diagnostic accuracy in identifying those intrauterine growth restricted foetuses that were at risk. Keywords: Colour Doppler, high risk pregnancy, perinatal outcome.

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Association between Risk Factors for Vascular Dementia and Adiponectin

BioMed Research International ◽

10.1155/2014/261672 ◽

2014 ◽

Vol 2014 ◽

pp. 1-13 ◽

Cited By ~ 17

Author(s):

Juhyun Song ◽

Won Taek Lee ◽

Kyung Ah Park ◽

Jong Eun Lee

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Signal Transduction ◽

Vascular Dementia ◽

Case Control ◽

Case Control Studies ◽

Insulin Signal Transduction ◽

Increased Risk ◽

The Brain

Vascular dementia is caused by various factors, including increased age, diabetes, hypertension, atherosclerosis, and stroke. Adiponectin is an adipokine secreted by adipose tissue. Adiponectin is widely known as a regulating factor related to cardiovascular disease and diabetes. Adiponectin plasma levels decrease with age. Decreased adiponectin increases the risk of cardiovascular disease and diabetes. Adiponectin improves hypertension and atherosclerosis by acting as a vasodilator and antiatherogenic factor. Moreover, adiponectin is involved in cognitive dysfunction via modulation of insulin signal transduction in the brain. Case-control studies demonstrate the association between low adiponectin and increased risk of stroke, hypertension, and diabetes. This review summarizes the recent findings on the association between risk factors for vascular dementia and adiponectin. To emphasize this relationship, we will discuss the importance of research regarding the role of adiponectin in vascular dementia.

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Metabolome-defined obesity and the risk of future diabetes and mortality

10.1101/2021.11.03.21265744 ◽

2021 ◽

Author(s):

Filip Ottosson ◽

Einar Smith ◽

Ulrika Ericson ◽

Salvatore Di Somma ◽

Paola Antonini ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Population Based ◽

Normal Weight ◽

Plasma Metabolites ◽

Italian Population ◽

Related Risk ◽

Increased Risk ◽

All Cause Mortality ◽

Future Diabetes

Background Obesity is a key risk factor for type 2 diabetes, however, up to 20% of patients are normal weight. Our aim was to identify metabolite patterns reproducibly predictive of BMI, and subsequently to test if lean individuals who carry an obese metabolome are at hidden high risk of obesity related diseases, such as diabetes. Methods We measured 109 metabolites in fasted plasma samples of 7663 individuals from two Swedish and one Italian population-based cohort. Ridge regression models were used to predict BMI using the plasma metabolites. Individuals with a predicted BMI either more than 5 kg/m2 higher (overestimated) or lower (underestimated) than their actual BMI were characterized as outliers and further investigated for obesity related risk factors and future risk of diabetes and mortality. Results The plasma metabolome could predict BMI in all cohorts (r2 = 0.48, 0.26 and 0.19). The overestimated group had a BMI similar to individuals correctly predicted as normal weight, similar waist circumference, were not more likely to change weight over time but had a 2 times higher risk of future diabetes and an 80 % increased risk of all-cause mortality. These associations remained after adjustments for obesity-related risk factors and lifestyle parameters. Conclusions We found that lean individuals with an obese metabolome, have an increased risk for diabetes and all-cause mortality compared to lean individuals with a healthy metabolome. Metabolomics may be used to identify hidden high-risk individuals, in order to initiate lifestyle and pharmacological interventions.

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Abstract WP164: Role of Risk Factors in the Paradoxical Effect of Smoking on Peri-procedural Stroke in SAMMPRIS

Stroke ◽

10.1161/str.44.suppl_1.awp164 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Christine A Holmstedt ◽

Tanya N Turan ◽

Michael J Lynn ◽

Bethany F Lane ◽

Jean Montgomery ◽

...

Keyword(s):

Risk Factors ◽

Odds Ratio ◽

Multivariate Analyses ◽

Smoking Status ◽

Active Form ◽

Intracranial Stenosis ◽

Contributory Factor ◽

Increased Risk ◽

Never Smokers

Background: A previous SAMMPRIS analysis of patients randomized to stenting showed that peri-procedural ischemic infarcts were significantly associated with diabetes, basilar stenosis, age, and smoking status with never smokers having a higher risk (odds ratio = 8.8, p< 0.001). We sought to determine if this finding could be due to a higher burden of other risk factors in never smokers. Method: Baseline features in 213 patients undergoing stenting in SAMMPRIS were compared between never smokers vs. former and current smokers in univariate and multivariate analyses. Logistic regression was used to determine the effect of smoking on peri-procedural ischemic infarcts after adjusting for factors related to smoking. Data: Univariate results are shown in Table 1. Never smokers were significantly (P<0.05) more likely to be female, diabetic, hypertensive, and have another intracranial stenosis, but in multivariate analyses only hypertension and another intracranial stenosis remained significantly (P<0.05) associated with smoking status. In a multivariate model that incorporated hypertension and another intracranial stenosis along with smoking status, diabetes, basilar stenosis, and age, smoking status remained significant with an increased risk among patients who never smoked (odds ratio = 5.3, p = 0.005). Conclusion: While never smokers had significantly higher rates of some risk factors compared to active or previous smokers, these risk factors do not explain all the increased risk of early stroke in never smokers after stenting in SAMMPRIS. Another contributory factor may be that smoking accelerates the conversion of clopidogrel to its active form.

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Abstract 78: Risk Factors Associated with Failure of Aggressive Medical Therapy in the SAMMPRIS Trial

Stroke ◽

10.1161/str.45.suppl_1.78 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Michael F Waters ◽

Brian L Hoh ◽

Michael J Lynn ◽

Tanya N Turan ◽

Colin P Derdeyn ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Medical Therapy ◽

Primary Endpoint ◽

Univariate Analysis ◽

Baseline Risk ◽

Medical Group ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Background: The SAMMPRIS trial showed that aggressive medical therapy was more effective than stenting for preventing stroke in high-risk patients with symptomatic intracranial stenosis. However, 15% of patients in the medical group still had a primary endpoint (any stroke or death within 30 days of enrollment or stroke in the territory beyond 30 days) during a median follow-up of 32.7 months. We sought to determine baseline risk factors that were associated with a primary endpoint in the medical arm of SAMMPRIS. Methods: Data on 227 patients randomized to the medical group in SAMMPRIS were analyzed. Baseline demographic features, vascular risk factors, qualifying event, brain imaging and angiographic features were analyzed. The hazard ratio and p-value from a Cox proportional hazard regression model relating time until a primary endpoint to each factor were calculated. Results: Female gender, diabetes, stroke as the qualifying event (especially non-penetrator stroke), old infarct in the territory of the stenotic artery, and > 80% stenosis were associated (p < 0.10) with a higher risk of the primary endpoint on univariate analysis (see accompanying table) (multivariate analysis will be available by the time of ISC). Variables not associated with a higher risk of a primary endpoint in the medical arm included: age, race, antithrombotic therapy at the time of a qualifying event, time from qualifying event to enrollment (< 7 days vs. > 7 days), and location of stenosis. Conclusions: Several features were associated with an increased risk of the primary endpoint in the medical group in SAMMPRIS. On univariate analysis, the most important risk factors were an old infarct in the territory of the stenotic artery and stroke (especially non-penetrator stroke) as the qualifying event. These features will be useful for identifying particularly high-risk patients who should be targeted for future clinical trials testing alternative therapies to aggressive medical management.

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