scholarly journals Postoperative hypothermia following non-cardiac high-risk surgery: A prospective study of temporal patterns and risk factors

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259789
Author(s):  
Itajiba Paternosti Sabbag ◽  
Fabio Barlem Hohmann ◽  
Murillo Santucci Cesar Assunção ◽  
Renato Carneiro de Freitas Chaves ◽  
Thiago Domingos Corrêa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Outcome Measure ◽  
Cox Regression ◽  
National Level ◽  
Main Outcome Measure ◽  
Strong Risk Factor ◽  
Kaplan Meier ◽  
Nationally Representative ◽  
A Prospective Study

Background and objectives Hypothermia occurs commonly during surgery and can cause postoperative complications. We aimed to describe the characteristics and outcomes of hypothermia in patients undergoing major surgeries. Methods This prospective, observational, multicenter study of a nationally representative sample included all patients over 18 years of age admitted to an intensive care unit (ICU). Thirty ICUs were selected randomly at national level. The main outcome measure was the proportion of patients who developed postoperative hypothermia in the first 24 hours of ICU admission. Patients were divided into three groups based on temperature: <35°C, <36°C, and ≥36°C (no hypothermia). Patients’ characteristics, postoperative complications, and risk factors were evaluated in all groups. To verify whether hypothermia was a strong risk factor for postoperative complications, a Kaplan–Meier curve was generated and adjusted using a Cox regression model. Results In total, 738 patients had their temperatures measured. The percentage of patients with temperature <35°C (median [Q1-Q3], 34.7°C [34.3–34.9°C]) was 19.1% (95% confidence interval [CI] = 16.1–22.5) and that of patients with temperature <36°C (median [Q1-Q3], 35.4°C [35.0–35.8°C]) was 64% (95% CI = 58.3–70.0). The percentage of surgical complications was 38.9%. Patients with hypothermia were older, had undergone abdominal surgeries, had undergone procedures of longer duration, and had more comorbidities. A postoperative temperature ≤35°C was an independent risk for composite postoperative complications (hazard ratio = 1.523, 95% CI = 1.15–2.0), especially coagulation and infection. Conclusions Inadvertent hypothermia was frequent among patients admitted to the ICU and occurred more likely after abdominal surgery, after a long procedure, in elderly patients, and in patients with a higher number of comorbidities. Low postoperative temperature was associated with postoperative complications.

scholarly journals Stroke to Dementia Associated with Environmental Risks—A Semi-Markov Model

2020 ◽  
Vol 17 (6) ◽  
pp. 1944 ◽  
Author(s):  
Kung-Jeng Wang ◽  
Chia-Min Lee ◽  
Gwo-Chi Hu ◽  
Kung-Min Wang
Keyword(s):  
Risk Factors ◽  
Chronic Diseases ◽  
Outcome Measure ◽  
Cox Regression ◽  
Environmental Risks ◽  
Support Vector ◽  
Research Database ◽  
Stroke Patients ◽  
Main Outcome Measure ◽  
Healthcare Data

Background: Most stroke cases lead to serious mental and physical disabilities, such as dementia and sensory impairment. Chronic diseases are contributory risk factors for stroke. However, few studies considered the transition behaviors of stroke to dementia associated with chronic diseases and environmental risks. Objective: This study aims to develop a prognosis model to address the issue of stroke transitioning to dementia associated with environmental risks. Design: This cohort study used the data from the National Health Insurance Research Database in Taiwan. Setting: Healthcare data were obtained from more than 25 million enrollees and covered over 99% of Taiwan’s entire population. Participants: In this study, 10,627 stroke patients diagnosed from 2000 to 2010 in Taiwan were surveyed. Methods: A Cox regression model and corresponding semi-Markov process were constructed to evaluate the influence of risk factors on stroke, corresponding dementia, and their transition behaviors. Main Outcome Measure: Relative risk and sojourn time were the main outcome measure. Results: Multivariate analysis showed that certain environmental risks, medication, and rehabilitation factors highly influenced the transition of stroke from a chronic disease to dementia. This study also highlighted the high-risk populations of stroke patients against the environmental risk factors; the males below 65 years old were the most sensitive population. Conclusion: Experiments showed that the proposed semi-Markovian model outperformed other benchmark diagnosis algorithms (i.e., linear regression, decision tree, random forest, and support vector machine), with a high R2 of 90%. The proposed model also facilitated an accurate prognosis on the transition time of stroke from chronic diseases to dementias against environmental risks and rehabilitation factors.

scholarly journals Mortality dynamics of Pseudomonas aeruginosa bloodstream infections and the influence of defective OprD on mortality: prospective observational study

2019 ◽  
Vol 74 (9) ◽  
pp. 2774-2783 ◽  
Author(s):  
Eun-Jeong Yoon ◽  
Dokyun Kim ◽  
Hyukmin Lee ◽  
Hye Sun Lee ◽  
Jeong Hwan Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Cox Regression ◽  
Bloodstream Infections ◽  
Clinical Settings ◽  
Kaplan Meier ◽  
Steep Decrease

Abstract Background To assess the mortality dynamics of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality. Methods A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics. Results During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency. Conclusions BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa (17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

P6157Indexed coronary volume - A potential novel low-dose CCTA derived predictor for cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Benetos ◽  
M Goncalves ◽  
E Von Felten ◽  
G Rampidis ◽  
O Clerc ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Events ◽  
Low Dose ◽  
Cox Regression ◽  
Calcium Score ◽  
Kaplan Meier ◽  
Lv Mass ◽  
Traditional Risk Factors ◽  
Artery Disease

Abstract Background Coronary computed tomography angiography (CCTA) provides incremental prognostic information over traditional risk factors in patients with suspected coronary artery disease. However, little is known about the long-term predictive performance of CCTA-derived coronary volumes and mid-diastolic left ventricular (LV) mass. Purpose To assess long-term prognostic value of coronary volumes and mid-diastolic LV mass as novel potential imaging predictors derived from low-dose prospectively ECG-triggered CCTA. Methods Consecutive patients with suspected or known coronary artery disease, referred for low-dose CCTA, were included. Patients with previous revascularization were excluded. The following parameters were evaluated: calcium score, segment involvement score (SIS: 1 point for each coronary segment with presence of plaque), coronary volume, mid-diastolic LV mass and coronary volume indexed to LV mass. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fatal myocardial infarction and revascularization (PCI or CABG). The association between CCTA measures and the occurrence of events was quantified using cox regression hazard and Kaplan Meier analysis. Results A total of 147 consecutive patients were included in the study. Of them, 93 (63.3%) were male and 79 (53.7%) hat one or more traditional cardiovascular risk factors. There was a weak but statistical significant inverse correlation between indexed coronary volume and both calcium score (R=-0.3, p=0.01) and SIS (R=-0.24, p=0.005). After a median follow-up of 5.8 years 30 MACE occurred in 25 patients, including 3 deaths, 26 revascularizations and 1 non-fatal myocardial infarction. In univariate cox regression hazard analysis calcium score (HR=12.69, 95% CI 2.99–53.83, p<0.001), SIS (HR=1.66, 95% CI 1.43–1.94, p<0.001), LV mass (HR=1.02, 95% CI 1.01–1.03, p=0.007) and indexed coronary volume (HR=0.89, 95% 0.82–0.96, p=0.004) were associated with outcome. In multivariate analysis, indexed coronary volume, remained an independent predictor for MACE when adjusted for traditional risk factors and SIS (HR=0.93, 95% CI 0.87–1.00, p=0.05), while LV mass did not reach statistical significance (p=0.46). By ROC curve analysis, a value of 21.85 mm3/gr was defined as optimal cutoff for indexed coronary volume. In Kaplan Meier plots, patients with low indexed coronary volume (<21.85 mm3/gr) showed higher event rates (log rank p<0.001) compared to high indexed coronary volume (≥21.85 mm3/gr). Conclusions Indexed coronary volume, derived from low-dose CCTA, independently predicts cardiovascular events. Larger studies are mandated to confirm the predictive value of this potential new biomarker.

scholarly journals Waist-to-Hip Ratio, Cardiovascular Outcomes, and Death in Peritoneal Dialysis Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Winnie S. Su ◽  
Catherine M. Clase ◽  
K. Scott Brimble ◽  
Peter J. Margetts ◽  
Trevor J. Wilkieson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Obesity ◽  
Inflammatory Markers ◽  
Cox Regression ◽  
Primary Objective ◽  
Waist To Hip Ratio ◽  
Kaplan Meier ◽  
Analysis Survival ◽  
A Prospective Study ◽  
The Relationship

Objectives. The primary objective of this study was to determine the relationship between waist-to-hip ratio (WHR), cardiovascular (CV) events, and mortality in peritoneal dialysis (PD) patients. A secondary objective was to investigate the association between abdominal obesity and systemic inflammatory markers.Methods. This is a prospective study of 22 prevalent PD patients. WHR was measured at baseline. C-reactive protein (CRP), tumour necrosis factor-α(TNF-α), and interleukin-6 (IL-6) were measured. Main outcomes were first CV event and death from all causes. Survival analysis was used to examine the relationship between anthropomorphic measures and clinical outcomes.Results. Mean follow-up period was 3.1 years. In Kaplan-Meier analysis, survival was lower in those with higher WHR (P=.002). In Cox regression, WHR independently predicted mortality and first CV event after adjustment for known ischemic heart disease (hazard ratio [HR] 1.17, confidence interval [CI] 1.05–1.30 for death; HR 1.13, CI 1.01–1.26 for CV event). WHR correlated with serum TNF-α(r=0.45;P=.05).Conclusion. The results of this study suggest WHR may be a risk factor for increased CV events and mortality in PD patients. Abdominal obesity is also associated with inflammatory markers. Larger studies are warranted to confirm these findings.

scholarly journals Preoperative Nutritional Status and Risk Factors Associated with Delayed Discharge in Geriatric Patients Undergoing Gastrectomy: A Single-Center Retrospective Study

2021 ◽  
Author(s):  
Xining Zhao ◽  
Jie Liu ◽  
Ying Wang ◽  
Yuying Yang ◽  
Yan Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Postoperative Complications ◽  
Geriatric Patients ◽  
Cox Regression ◽  
Significant Risk ◽  
Related Factors ◽  
Factors Associated ◽  
Delayed Discharge ◽  
Significant Difference

Abstract Background Preoperative malnutrition is an independent risk factor for postoperative complications and survival for gastric cancer (GC) patients. This study aimed to investigate the prevalence of malnutrition and the risk factors associated with the delayed discharge of geriatric patients undergoing gastrectomy. Material and Methods A retrospective study of GC patients (age ≥ 65) who underwent gastrectomy at Zhongshan Hospital from January 2018 to May 2020 was conducted. Clinical data, including demographic information, medical history, surgery-related factors, and perioperative nutritional management were collected and analyzed. Results A total of 783 patients were reviewed. The overall frequency of malnutrition was 31.3% (249/783). The levels of albumin, prealbumin, and hemoglobin were lower in the malnutrition group compared with the well-nourished group. Moreover, 51 (6.5%) patients received preoperative total parenteral nutritional support. All patients received postoperative parenteral nutrition; 194 (77.9%) patients in the malnutrition group received an infusion of carbohydrates with composite amino acid and 55 (22.1%) received total nutrient admixture. No significant difference was found in the duration of postoperative nutrition between the groups (P>0.05). The malnutrition group was associated with a higher rate of surgical site infections (SSIs) (P<0.001). Multivariate cox regression revealed that age >70 years, length of surgery >180 min, and postoperative complications were significant risk factors associated with delayed discharge. Conclusion Malnutrition is relatively common in elderly patients undergoing gastrectomy. Age, length of surgery, and postoperative complications are important risk factors associated with delayed discharge. Elderly GC patients with risk factors urgently require specific attention to shorten hospital stays.

scholarly journals Risk factors associated with delay in diagnosis and mortality in patients with COVID-19 in the city of Rio de Janeiro, Brazil

2020 ◽  
Vol 25 (suppl 2) ◽  
pp. 4131-4140
Author(s):  
Alexandre de Fátima Cobre ◽  
Beatriz Böger ◽  
Mariana Millan Fachi ◽  
Raquel de Oliveira Vilhena ◽  
Eric Luiz Domingos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rio De Janeiro ◽  
Cox Regression ◽  
Age Groups ◽  
Mortality Rates ◽  
Male Gender ◽  
Delay In Diagnosis ◽  
Kaplan Meier ◽  
Delays In Diagnosis ◽  
The City

Abstract We investigated the predictors of delay in the diagnosis and mortality of patients with COVID-19 in Rio de Janeiro, Brazil. A cohort of 3,656 patients were evaluated (Feb-Apr 2020) and patients’ sociodemographic characteristics, and social development index (SDI) were used as determinant factors of diagnosis delays and mortality. Kaplan-Meier survival analyses, time-dependent Cox regression models, and multivariate logistic regression analyses were conducted. The median time from symptoms onset to diagnosis was eight days (interquartile range [IQR] 7.23-8.99 days). Half of the patients recovered during the evaluated period, and 8.3% died. Mortality rates were higher in men. Delays in diagnosis were associated with male gender (p = 0.015) and patients living in low SDI areas (p < 0.001). The age groups statistically associated with death were: 70-79 years, 80-89 years, and 90-99 years. Delays to diagnosis greater than eight days were also risk factors for death. Delays in diagnosis and risk factors for death from COVID-19 were associated with male gender, age under 60 years, and patients living in regions with lower SDI. Delays superior to eight days to diagnosis increased mortality rates.

scholarly journals Baseline Serum sLOX-1 Concentrations Are Associated with 2-Year Major Adverse Cardiovascular and Cerebrovascular Events in Patients after Percutaneous Coronary Intervention

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Zi-wen Zhao ◽  
Yi-wei Xu ◽  
Shu-mei Li ◽  
Jin-jian Guo ◽  
Jian-min Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Prognostic Value ◽  
Cox Regression ◽  
Coronary Intervention ◽  
Enzyme Linked Immunosorbent Assay ◽  
Baseline Serum ◽  
Kaplan Meier ◽  
Cerebrovascular Events ◽  
Percutaneous Coronary

Background. Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) may be a potential biomarker of coronary artery disease (CAD) and stroke. Objective. We aimed to investigate the association and prognostic value of elevated sLOX-1 concentrations with regard to long-term major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with CAD undergoing primary percutaneous coronary intervention (PCI). Methods. A total of 1011 patients were enrolled. Serum sLOX-1 concentrations were detected by the enzyme-linked immunosorbent assay (ELISA). Patients were followed for 2 years. Multivariate Cox regression and Kaplan-Meier survival curve were explored to assess the association between sLOX-1 and MACCEs. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of sLOX-1. Results. Two-year MACCEs were associated with serum sLOX-1 concentrations (HR 1.278, 95% CI 1.019-1.604, P=0.034), left main disease (HR 2.938, 95% CI 1.246-6.925, P=0.014), small-caliber stents used (HR 2.207, 95% CI 1.189-4.095, P=0.012), and total stent length (HR 1.057, 95% CI 1.005-1.112, P=0.030). Serum sLOX-1 concentration≥1.10 ng/ml had maximum sensitivity and specificity in predicting the occurrence of 2-year MACCEs (P<0.001). Patients with higher serum sLOX-1 concentrations showed a significantly higher incidence of MACCEs in the Kaplan-Meier curve (P<0.001). The combination of any of the risk factors identified in multiple Cox regression was associated with a stepwise increase in MACCE rate (P<0.001). Conclusions. High baseline serum sLOX-1 concentration predicts 2-year MACCEs and shows an additional prognostic value to conventional risk factors in patients after primary PCI. sLOX-1 determination might play a complementary role in the risk stratification of patients with CAD treated with PCI.

scholarly journals Risk factors for caries-free time: longitudinal study in early childhood

2017 ◽  
Vol 51 ◽  
pp. 118 ◽  
Author(s):  
Maria Beatriz Barreto de Sousa Cabral ◽  
Eduardo Luiz Andrade Mota ◽  
Maria Cristina Teixeira Cangussu ◽  
Maria Isabel Pereira Vianna ◽  
Fabiana Raynal Floriano
Keyword(s):  
Risk Factors ◽  
Dental Caries ◽  
Day Care ◽  
Cox Regression ◽  
Sleep Time ◽  
Bottle Feeding ◽  
Free Time ◽  
Northeastern Brazil ◽  
Caries Experience ◽  
Kaplan Meier

OBJECTIVE: To estimate time in days from the beginning of follow-up up to the development of dental caries in children under 30 months and to assess risk factors potentially affecting the development of the disease. METHODS: The study population of the cohort study were children attending public, private, and charitable day care centers in Salvador, Northeastern Brazil, followed up for fourteen months. We used the multivariate Cox regression to estimate risk and Kaplan-Meier method to estimate the caries-free time. RESULTS: Of the 495 children studied, 112 developed caries (22.6%). Mean caries-free time was 248.6 (SD = 96.2) days. The comparasion of curves by age group (> 24 months) and children attending public day care showed more caries in a shorter period (p < 0.00). The following variables were important risk factors for increased rate of caries: district of origin (HR = 1.88, 95%CI 1.27–2.77), category of day care (HR = 3.88, 95%CI 2.04–7.38), age (HR = 1.77, 95%CI 1.15–2.74), bottle-feeding before sleep time after the age of 12 months (HR = 1.62, 95%CI 1.04–2.51), presence of active white spots (HR = 2.70, 95%CI 1.07–6.80), and living in non-masonry house (HR = 1.68, 95%CI 1.02–2.76). The highest hazard ratio (HR = 4.60, 95%CI 2.80–7.42) was found for previous caries experience. CONCLUSIONS: Social variables were considered as of high risk for the development of dental caries.

scholarly journals Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

2021 ◽  
Vol 10 (8) ◽  
pp. 1752
Author(s):  
Brunella Posteraro ◽  
Giulia De Angelis ◽  
Giulia Menchinelli ◽  
Tiziana D’Inzeo ◽  
Barbara Fiori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Central Italy ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Kaplan Meier ◽  
Large Teaching Hospital ◽  
Hospital Acquired

The aim of this study was to characterize COVID-19 (SARS-CoV-2-infected) patients who develop bloodstream infection (BSI) and to assess risk factors associated with in-hospital mortality. We conducted a retrospective observational study of adult patients admitted for ≥48 h to a large Central Italy hospital for COVID-19 (1 March to 31 May 2020) who had or had not survived at discharge. We included only patients having blood cultures drawn or other inclusion criteria satisfied. Kaplan–Meier survival or Cox regression analyses were performed of 293 COVID-19 patients studied, 46 patients (15.7%) had a hospital-acquired clinically relevant BSI secondary to SARS-CoV-2 infection, accounting for 58 episodes (49 monomicrobial and 9 polymicrobial) in total. Twelve episodes (20.7%) occurred at day 3 of hospital admission. Sixty-nine species were isolated, including Staphylococcus aureus (32.8%), Enterobacterales (20.7%), Enterococcus faecalis (17.2%), Candida (13.8%) and Pseudomonas aeruginosa (10.3%). Of 69 isolates, 27 (39.1%) were multidrug-resistant organisms. Twelve (54.5%) of 22 patients for whom empirical antimicrobial therapy was inappropriate were infected by a multidrug-resistant organism. Of 46 patients, 26 (56.5%) survived and 20 (43.5%) died. Exploring variables for association with in-hospital mortality identified > 75-year age (HR 2.97, 95% CI 1.15–7.68, p = 0.02), septic shock (HR 6.55, 95% CI 2.36–18.23, p < 0.001) and BSI onset ≤ 3 days (HR 4.68, 95% CI 1.40–15.63, p = 0.01) as risk factors independently associated with death. In our hospital, mortality among COVID-19 patients with BSI was high. While continued vigilance against these infections is essential, identification of risk factors for mortality may help to reduce fatal outcomes in patients with COVID-19.

scholarly journals Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease

2021 ◽  
Vol 7 (9) ◽  
pp. 697
Author(s):  
Eva L. Yashphe ◽  
Ron Ram ◽  
Irit Avivi ◽  
Ronen Ben-Ami
Keyword(s):  
Risk Factors ◽  
Causes Of Death ◽  
Cox Regression ◽  
Hematologic Malignancy ◽  
Elevated Serum ◽  
Related Factors ◽  
Late Mortality ◽  
Relative Contribution ◽  
Kaplan Meier ◽  
Invasive Mold Infections

Background: Invasive mold infections (IMI) are leading infectious causes of mortality among patients with hematological malignancies. Objectives: To determine the relative contribution of host, disease, and treatment-related factors to patient survival. Methods: An observational, retrospective cohort study reviewing the medical records of patients with hematological malignancy and IMI (2006–2016). Causes of death were classified up to 90 days after diagnosis. Kaplan–Meier and Cox regression analyses were used to determine risk factors for early, late, and overall mortality. Results: Eighty-six patients with IMI were included; 29 (34%) and 41 (47%) died within 6 and 12 weeks of diagnosis, respectively. Death was attributed to IMI in 22 (53.6%) patients, all of whom died within 45 days of diagnosis. Risk factors for early mortality were elevated serum galactomannan, treatment with amphotericin B, IMI progression 3 weeks after diagnosis, and lymphoma undergoing HCT. Late mortality was associated with relapsed/refractory malignancy and elevated serum galactomannan. Conclusions: In this single-center study of patients with IMI, infections were the most frequent causes of death, and time-dependent risk factors for death were identified. These results may help direct risk-assessment and monitoring of patients undergoing treatment of IMI.

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