scholarly journals Early alterations of circulating immune cell counts in severe trauma patients are related to later occurrence of nosocomial infection, sepsis and mortality

2019 ◽  
Author(s):  
Xijie Dong ◽  
Chuntao Wang ◽  
Xinghua Liu ◽  
Xiangjun Bai ◽  
Zhanfei Li
Keyword(s):  
Risk Factors ◽  
Nosocomial Infection ◽  
Predictive Value ◽  
Injury Severity ◽  
Immune Cell ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Trauma ◽  
Pronounced Increase ◽  
Cell Counts ◽  
Independent Risk Factors

Abstract Background: Severe trauma leads to extensive disturbances of the innate and adaptive arms of the immune system, which in turn may affect the prognosis. The main objective of this study was to investigate the relationship between the alterations of circulating immune cell counts in the early stage of severe trauma and the later occurrence of nosocomial infection, sepsis and mortality. Methods: This was a retrospective study of 876 patients with an Injury Severity Score (ISS) ≥ 16. Demographic data, the absolute counts of neutrophil, lymphocyte and monocyte (ANC, ALC and AMC) on days 1, 3, and 7 (D1, D3, and D7) after trauma, and whether nosocomial infection, sepsis or death occurred within 60 days were recorded. Ratios were calculated between immune cell counts of each two time points, namely day 3/day 1 (D3/D1) and day 7/day 3 (D7/D3). Patients were grouped based on ISS and the occurrence of nosocomial infection, sepsis or death. Comparative studies were conducted between each two groups. Univariate and multivariate logistic regression analysis were used to identify variables related to the risk of nosocomial infection, sepsis, and mortality. Receiver operating characteristic (ROC) curve was plotted to assess the predictive value of various risk factors. Results: More severe trauma leads to more pronounced increase in ANC and more slowly recovery of ALC. In patients with subsequent nosocomial infection and sepsis, ANC was higher and ALC recovery was slower than those without nosocomial infection and sepsis within 7 days. In non-survivors, ALC had not recovered and AMC (D3) and AMC (D7) was lower than survivors within 7 days. ALC (D3) and ALC (D3/D1) are independent risk factors for nosocomial infection and sepsis. ALC (D3), ALC (D3/D1), ALC (D7) and AMC (D7) are independent risk factors for death. The combination of ALC (D3/D1) and ALC (D3) had a good predictive value for the occurrence of nosocomial infection, sepsis, and mortality. Conclusions: More severe trauma causes more intense interference to circulating immunocyte counts. Worse alterations in circulating immunocyte counts within 7 days may increase the risk of subsequent nosocomial infection, sepsis and mortality.

scholarly journals The Trajectory of Alterations in Immune-Cell Counts in Severe-Trauma Patients Is Related to the Later Occurrence of Sepsis and Mortality: Retrospective Study of 917 Cases

2021 ◽  
Vol 11 ◽  
Author(s):  
Xijie Dong ◽  
Chuntao Wang ◽  
Xinghua Liu ◽  
Xiangjun Bai ◽  
Zhanfei Li
Keyword(s):  
Risk Factors ◽  
Predictive Value ◽  
Injury Severity ◽  
Immune Cell ◽  
Early Stage ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Cell Counts ◽  
Independent Risk Factors ◽  
The Relationship

BackgroundSevere trauma is believed to disrupt the homeostasis of the immune system, and lead to dramatic changes in the circulating immune-cell count (ICC). The latter fluctuates widely over time. Knowledge about the relationship between these dramatic changes and dynamic fluctuations and the late prognosis of trauma patients is sparse. We investigated the relationship between the trajectory of alterations in the circulating ICC within 7 days in severe-trauma patients and subsequent sepsis and mortality.MethodsA retrospective analysis of 917 patients with an Injury Severity Score ≥16 was undertaken. The absolute neutrophil, lymphocyte, and monocyte counts (ANC, ALC, and AMC, respectively) on days 1, 3, and 7 (D1, D3, and D7, respectively) after trauma, and whether sepsis or death occurred within 60 days, were recorded. As the disordered circulating ICCs fluctuated widely, their time-varying slopes (D3/D1 and D7/D3) were calculated. Patients were divided into “sepsis” and “non-sepsis” groups, as well as “alive” and “death” groups. Comparative studies were conducted between every two groups. Univariate and multivariate logistic regression analyses were used to identify variables related to the risk of sepsis and mortality. Receiver operating characteristic curves were plotted to assess the predictive value of various risk factors.ResultsMore severe trauma caused more pronounced increases in the ANC and slower recovery of the ALC within 7 days. The ALC (D3), ANC (D7), ALC (D3/D1), and ANC (D7/D3) were independent risk factors for sepsis. The ALC (D3), ALC (D7), AMC (D7), and ALC (D3/D1) were independent risk factors for mortality. A combination of the ALC (D3) and ALC (D3/D1) exerted a good predictive value for sepsis and death.ConclusionsThe trajectory of alterations in the circulating ICC in the early stage after trauma is related to subsequent sepsis and mortality.

scholarly journals Association of Biomarkers Related to Preoperative Inflammatory and Coagulation with Postoperative In-Hospital Deaths in Patients with Type A Acute Aortic Dissection

2021 ◽  
Author(s):  
Ming Li ◽  
Haifeng Sun ◽  
Suochun Xu ◽  
Yang Yan ◽  
Haichen Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Predictive Value ◽  
Multivariate Logistic Regression Analysis ◽  
Type A ◽  
Hospital Deaths ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background: The aim of this study was to analyze the predictive value of biomarkers related to preoperative inflammatory and coagulation in the prognosis of patients with type A acute aortic dissection (AAD). Methods: A total of 206 patients with type A AAD who had received surgical treatment were enrolled. Patients were divided into two groups according to whether they died during hospitalization. Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) between the two groups were compared. Univariate and multivariate logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of D-dimer, FIB, PLT, WBC, NEU and CRP in the prognosis of the patients. Results: Univariate logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariate logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for in-hospital deaths of patients with type A AAD. ROC curve analysis indicated that FIB+PLT combination is provided with the highest predictive value for in-hospital deaths.Conclusion: Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the prognosis of such patients. Combined use of FIB and PLT may improve the accuracy and accessibility of clinical prognostic assessment.

scholarly journals The Clinical Values of Afamin, Triglyceride and PLR in Predicting Risk of Gestational Diabetes During Early Pregnancy

2021 ◽  
Vol 12 ◽  
Author(s):  
Xuechun Wang ◽  
Xiuqiong Zheng ◽  
Jianying Yan ◽  
Rongli Xu ◽  
Mu Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Predictive Value ◽  
Maternal Age ◽  
Multivariate Logistic Regression Analysis ◽  
Oral Glucose ◽  
Aneuploidy Screening ◽  
Independent Risk Factors

ObjectiveTo establish a model to predict gestational diabetes mellitus (GDM) based on the clinical characteristics, early pregnancy (10-12 weeks gestation) peripheral blood routine, and biochemical indicators, and to explore its predictive efficiencies.MethodsData from 607 pregnant women with GDM were compared to the data from 833 pregnant women without GDM admitted to the Obstetrics Department of Fujian Maternity and Child Health Hospital (affiliated to Fujian Medical University) from May 2018 to December 2018 were retrospectively included. The ages of the pregnant women, paternal ages, number of pregnancies, number of deliveries, pre-pregnancy heights/weights, and the calculated body mass indexes (BMI) were recorded. In all participants, 10-12 weeks of pregnancy, afamin concentration, routine blood work, prenatal aneuploidy screening, and biochemical testing were performed. At weeks 24-28 of gestation, patients underwent oral glucose tolerance test (OGTT) for GDM screening.ResultsMultivariate logistic regression analysis showed that maternal age, early pregnancy afamin level, triglycerides, and platelet/lymphocyte ratio (PLR) were independent risk factors for gestational diabetes. The formula for predicting GDM probability was as follows: P = 1/1 + exp( − 6.054 + 0.774 × triglycerides + 0.002 × afamin + 0.155 × age − 0.012 × PLR)]. From the established ROC curve, the area under the curve (AUC) was 0.748, indicating that the model has a good degree of discrimination. When the predictive probability cut-off value was set on 0.358, sensitivity, specificity, positive predictive value, and negative predictive value were 69.2%, 68.3%, 42.5%, and 86.2%, respectively, and the accuracy rate was 70.2%. The Hosmer-Lemeshow test results showed that the goodness of the model fit has a good calibration ability (χ2 = 12.269, df=8, P=0.140).ConclusionsMaternal age, early pregnancy afamin level, triglycerides, and PLR are independent risk factors for gestational diabetes. When combined, the above indicators are helpful for prediction, early diagnosis, and intervention of gestational diabetes.

scholarly journals A New Rapid Approach for Predicting Death in Coronavirus Patients: The Development and Validation of the COVID-19 Risk-Score in Fars Province (CRSF)

2022 ◽  
Author(s):  
Mehrdad Sharifi ◽  
Mohammad Hossein Khademian ◽  
Razieh Sadat Mousavi-Roknabadi ◽  
Vahid Ebrahimi ◽  
Robab Sadegh
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Predictive Value ◽  
Assessment Tool ◽  
Fars Province ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Development And Validation ◽  
Underlying Diseases

Background:Patients who are identified to be at a higher risk of mortality from COVID-19 should receive better treatment and monitoring. This study aimed to propose a simple yet accurate risk assessment tool to help decision-making in the management of the COVID-19 pandemic. Methods: From Jul to Nov 2020, 5454 patients from Fars Province, Iran, diagnosed with COVID-19 were enrolled. A multiple logistic regression model was trained on one dataset (training set: n=4183) and its prediction performance was assessed on another dataset (testing set: n=1271). This model was utilized to develop the COVID-19 risk-score in Fars (CRSF). Results: Five final independent risk factors including gender (male: OR=1.37), age (60-80: OR=2.67 and >80: OR=3.91), SpO2 (≤85%: OR=7.02), underlying diseases (yes: OR=1.25), and pulse rate (<60: OR=2.01 and >120: OR=1.60) were significantly associated with in-hospital mortality. The CRSF formula was obtained using the estimated regression coefficient values of the aforementioned factors. The point values for the risk factors varied from 2 to 19 and the total CRSF varied from 0 to 45. The ROC analysis showed that the CRSF values of ≥15 (high-risk patients) had a specificity of 73.5%, sensitivity of 76.5%, positive predictive value of 23.2%, and negative predictive value (NPV) of 96.8% for the prediction of death (AUC=0.824, P<0.0001). Conclusion:This simple CRSF system, which has a high NPV,can be useful for predicting the risk of mortality in COVID-19 patients. It can also be used as a disease severity indicator to determine triage level for hospitalization.

scholarly journals Risk Factors and Outcomes of Hospital Acquired Pneumonia in Young Bangladeshi Children

Life ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1030
Author(s):  
Abu Sadat Mohammad Sayeem Bin Shahid ◽  
Tahmina Alam ◽  
Lubaba Shahrin ◽  
K. M. Shahunja ◽  
Md. Tanveer Faruk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severe Acute Malnutrition ◽  
Multivariate Logistic Regression Analysis ◽  
Acute Malnutrition ◽  
Persistent Diarrhea ◽  
Multivariate Logistic Regression ◽  
Resource Limited ◽  
Hospital Acquired Pneumonia ◽  
Independent Risk Factors ◽  
Hospital Acquired

Hospital acquired pneumonia (HAP) is common and often associated with high mortality in children aged five or less. We sought to evaluate the risk factors and outcome of HAP in such children. We compared demographic, clinical, and laboratory characteristics in children <5 years using a case control design during the period of August 2013 and December 2017, where children with HAP were constituted as cases (n = 281) and twice as many randomly selected children without HAP were constituted as controls (n = 562). HAP was defined as a child developing a new episode of pneumonia both clinically and radiologically after at least 48 h of hospitalization. A total of 4101 children were treated during the study period. The mortality was significantly higher among the cases than the controls (8% vs. 4%, p = 0.014). In multivariate logistic regression analysis, after adjusting for potential confounders, it was found that persistent diarrhea (95% CI = 1.32–5.79; p = 0.007), severe acute malnutrition (95% CI = 1.46–3.27; p < 0.001), bacteremia (95% CI = 1.16–3.49; p = 0.013), and prolonged hospitalization of >5 days (95% CI = 3.01–8.02; p < 0.001) were identified as independent risk factors for HAP. Early identification of these risk factors and their prompt management may help to reduce HAP-related fatal consequences, especially in resource limited settings.

scholarly journals Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi’an stroke registry study of China[1]

2020 ◽  
Author(s):  
Zhongzhong Liu ◽  
Wenjuan Lin ◽  
Qingli Lu ◽  
Jing Wang ◽  
Pei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Multivariate Logistic Regression ◽  
Factors Affecting ◽  
Nihss Score ◽  
Minor Ischemic Stroke ◽  
Independent Risk Factors

Abstract Background: The incidences of stroke recurrence, disability, and all-cause death of patients with minor ischemic stroke (MIS) remain problematic. The aim of the present was to identify risk factors associated with adverse outcomes at 1-year after MIS in the Xi’an region of China. Methods: The cohort of this prospective cohort study included MIS patients aged 18–97 years with a National Institutes of Health Stroke Scale (NIHSS) score of ≤ 3 who were treated in any of four hospitals in Xi’an region of China between January and December 2015. The 1-year percentage of stroke recurrence, disability, and all-cause death were evaluated. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. Results: Among the 1,121 patients included for analysis, the percentage of stroke recurrence, disability, and all-cause death at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause death. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. Conclusions: The 1-year outcomes of MIS is not optimistic in the Xi’an region of China, especially high percentage of disability. In this study, we found the risk factors affecting 1-year stroke recurrence, disability and, all-cause death which need further verification in the subsequent studies.

scholarly journals Pneumocystis pneumonia in patients with primary nephrotic syndrome: analysis of 18 cases

2020 ◽  
Author(s):  
Xiaohan You ◽  
Ji Zhang ◽  
Qiongxiu Zhou ◽  
Jianna Zhang
Keyword(s):  
Risk Factors ◽  
Nephrotic Syndrome ◽  
Pneumocystis Pneumonia ◽  
Prednisone Dose ◽  
Primary Nephrotic Syndrome ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Independent Risk Factors ◽  
Cd4 Cell

Abstract Background: The aim of this study was to analysis the clinical features, risk factors and outcomes of patients with primary nephrotic syndrome (PNS) who developed pneumocystis pneumonia (PCP).Methods: We systematically reviewed medical records from 18 PNS patients with PCP admitted to our hospital from April 2007 to April 2019. A total of 180 cases were randomly selected as controls from PNS inpatients without infection. Results: In PCP patients, the mean age at presentation was 48.5 years, mean duration of prednisone treatment was 3.7 months and mean prednisone dose on admission was 31.3 mg/d, the most common clinical manifestation was fever (100%) and average PaO2 on admission was 59.5 mmHg. Eight patients (44.4%) had coexisting infections, most often was cytomegalovirus (4 patients), 11 patients (61.1%) had ICU admission and 9 patients (50%) had mechanical ventilation. PCP patients had more prednisone, more immunosuppressive therapy, lower CD4+ cell counts and hemoglobin, and higher serum creatinine than those without infections (p<0.05). Logistic regression analysis showed that PNS patients with prednisone usage and lower CD4+ cell counts were independent risk factors of more likely to have PCP compared to controls (OR =3.39, p=0.002; OR =0.64, p=0.021p<0.05). All patients survived after treatment. Conclusion: PCP was not unusual in PNS patients, and the most important risk factors were prednisone usage and a lower CD4+ cell count, but however, these patients had a good outcome after enough treatments.

scholarly journals Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Ischaemic Attack ◽  
Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

scholarly journals The independent risk factors of early diarrhoea in enteral nutrition for ICU patients

2019 ◽  
Vol 47 (10) ◽  
pp. 4929-4939 ◽  
Author(s):  
Weiting Chen ◽  
Hehao Wang ◽  
Yingzi Chen ◽  
Danqin Yuan ◽  
Renhui Chen
Keyword(s):  
Risk Factors ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Early Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Severity Of Illness ◽  
Icu Patients ◽  
Feeding Method ◽  
Prokinetic Agents ◽  
Independent Risk Factors

Objective To investigate the prevalence of and factors associated with diarrhoea in the early stage of enteral nutrition in critically ill patients in intensive care units (ICUs). Methods This prospective, multicentre, observational study enrolled consecutive patients who were newly admitted to ICUs and received enteral nutrition treatment. Events were observed continuously for 7 days or until patients were transferred out of the ICU after enteral nutrition. Demographic and clinical data, enteral nutrition data, diarrhoea-related data and outcomes were recorded. A multivariate logistic regression analysis was used to analyse the risk factors for diarrhoea. Results The study included 533 patients, of whom 164 (30.8%) developed diarrhoea. Diarrhoea was most commonly observed on the first to third days after starting enteral nutrition treatment. The median (interquartile range) duration of diarrhoea was 2 (1–3) days. The administration of gastrointestinal prokinetic agents, the increase in acute physiological and chronic health scores and the pyloric posterior feeding method were independent risk factors for diarrhoea. Conclusion The increased severity of illness, the administration of gastrointestinal prokinetic agents and the pyloric posterior feeding method were independent risk factors for diarrhoea in critically ill ICU patients undergoing enteral nutrition treatment.

scholarly journals Risk factors for non-diabetic renal disease in diabetic patients

2020 ◽  
Author(s):  
Sheila Bermejo ◽  
Ester González ◽  
Katia López-Revuelta ◽  
Meritxell Ibernon ◽  
Diana López ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Analytical Data ◽  
Multivariate Logistic Regression Analysis ◽  
Older Age ◽  
Diabetic Patients ◽  
Diabetic Renal Disease ◽  
Patients With Diabetes ◽  
Renal Prognosis ◽  
Independent Risk Factors

Abstract Background Diabetic patients with kidney disease have a high prevalence of non-diabetic renal disease (NDRD). Renal and patient survival regarding the diagnosis of diabetic nephropathy (DN) or NDRD have not been widely studied. The aim of our study is to evaluate the prevalence of NDRD in patients with diabetes and to determine the capacity of clinical and analytical data in the prediction of NDRD. In addition, we will study renal and patient prognosis according to the renal biopsy findings in patients with diabetes. Methods Retrospective multicentre observational study of renal biopsies performed in patients with diabetes from 2002 to 2014. Results In total, 832 patients were included: 621 men (74.6%), mean age of 61.7 ± 12.8 years, creatinine was 2.8 ± 2.2 mg/dL and proteinuria 2.7 (interquartile range: 1.2–5.4) g/24 h. About 39.5% (n = 329) of patients had DN, 49.6% (n = 413) NDRD and 10.8% (n = 90) mixed forms. The most frequent NDRD was nephroangiosclerosis (NAS) (n = 87, 9.3%). In the multivariate logistic regression analysis, older age [odds ratio (OR) = 1.03, 95% CI: 1.02–1.05, P &lt; 0.001], microhaematuria (OR = 1.51, 95% CI: 1.03–2.21, P = 0.033) and absence of diabetic retinopathy (DR) (OR = 0.28, 95% CI: 0.19–0.42, P &lt; 0.001) were independently associated with NDRD. Kaplan–Meier analysis showed that patients with DN or mixed forms presented worse renal prognosis than NDRD (P &lt; 0.001) and higher mortality (P = 0.029). In multivariate Cox analyses, older age (P &lt; 0.001), higher serum creatinine (P &lt; 0.001), higher proteinuria (P &lt; 0.001), DR (P = 0.007) and DN (P &lt; 0.001) were independent risk factors for renal replacement therapy. In addition, older age (P &lt; 0.001), peripheral vascular disease (P = 0.002), higher creatinine (P = 0.01) and DN (P = 0.015) were independent risk factors for mortality. Conclusions The most frequent cause of NDRD is NAS. Elderly patients with microhaematuria and the absence of DR are the ones at risk for NDRD. Patients with DN presented worse renal prognosis and higher mortality than those with NDRD. These results suggest that in some patients with diabetes, kidney biopsy may be useful for an accurate renal diagnosis and subsequently treatment and prognosis.

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