Outcomes of COVID-19 and risk factors in patients with cancer - a cohort study

Abstract Background Patients with cancer who develop COVID-19 are at higher risk for severe disease and death. We aimed to study the outcomes of patients with cancer who were infected with SARS CoV2, and identify risk factors for adverse outcomes after COVID-19. Methods We included patients with cancer, who were diagnosed with SARS CoV2 between 11th April 2020 and February 2021 at a tertiary referral cancer centre in India. We collected data on age, sex, coexisting medical conditions, type of cancer, intent of cancer management, cancer treatment details, and severity and outcome of COVID-19. The primary outcome was a composite of severe COVID (defined as grade 6 or more on the WHO ordinal scale) or death within 30 days. We performed multivariable logistic regression analysis to identify risk factors for severe COVID or death. Results We obtained data on 1253 patients with cancer and SARS CoV2 infection, of whom 293 (23.6%) had hematological malignancies. The severity of COVID was mild (grade 1 to 3 on WHO ordinal scale) in 1014 (81%) patients, moderate (WHO grade 4 or 5) in 167 (13%) patients and severe (WHO grade 6 or 7) in 72 (6%) patients. The primary outcome was seen in 160 patients (12.8%) and the all-cause 30-day mortality was 10.9% (138 deaths). Advanced age [adjusted OR 1.84 (0.86; 3.94)], history of smoking [aOR 1.78 (1.10; 2.91)], palliative intent of treatment [aOR 3.57 (2.48 to 5.12)] and presence of more than 2 comorbidities [aOR 1.66 (1.03 to 2.67)] were significant risk factors for severe COVID or death. Advanced age and palliative intent of treatment remained significant risk factors for 30-day mortality. Recent systemic anti-cancer therapy, sex or cancer type did not influence outcomes. Conclusion Most patients with cancer who developed COVID-19 in our setting had mild disease; the elderly and those treated with palliative intent were at higher risk of severe COVID-19 or death. Recent cancer therapy did not impact COVID-19 severity or outcomes suggesting that in most patients with cancer, the management of cancer should continue uninterrupted during the pandemic.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

BMC Gastroenterology ◽

10.1186/s12876-020-01580-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

Abstract Background Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU. Methods In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis. Results Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR] 3.43; 95% confidence interval [CI] 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR 5.80; 95% CI 2.08–16.2), and heart disease (OR 3.05; 95% CI 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR 8.24; 95% CI 2.36–28.7). Conclusion In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Predictors of Developing Hepatocellular Carcinoma in Treated HCV-Carriers in Morocco according to University Hospital Experience

ISRN Hepatology ◽

10.1155/2013/438306 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Younès Cherradi ◽

Rajaa Afifi ◽

Hanaa Benbrahim ◽

Wafaa Essamri ◽

Imane Benelbarhdadi ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Predictive Factors ◽

Antiviral Treatment ◽

Significant Risk ◽

University Hospital ◽

Advanced Age ◽

Previously Treated Patients ◽

Previously Treated ◽

Severe Fibrosis

Introduction. Hepatitis C is the first major cause for HCC in Morocco. Antiviral treatment reduces the risk of developing HCC but few cases of HCC in HCV-treated patients were reported. We aimed to define this population’s features and to identify predictive factors of developing HCC. Patients and Methods. We included all HCV carriers who developed HCC after antiviral treatment from January 2002 to April 2010. We compare HCV-treated patients with no developed HCC to HCC population using khi-2 and Fisher Exact analysis. Results. 369 HVC-treated patients were considered, and 20 HCC were reported. The risk of HCC was not significant according to gender and genotypes (resp., P=0.63 and P=0.87). Advanced age and severe fibrosis were significant risk factors (resp., P=0.003 and P=0.0001). HCC was reported in 2.6% of sustained virological responders versus 12.5% of nonresponders (P=0.004). Conclusion. In our series, 5% of previously treated patients developed an HCC. Advanced age and severe fibrosis at HCV diagnosis are predictive factors of HCC occurrence. Sustained virological response reduces considerably the risk of HCC occurrence but screening is indicated even after SVR.

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Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective study in a tertiary center in Hong Kong

The International Journal of Artificial Organs ◽

10.1177/0391398820965584 ◽

2020 ◽

pp. 039139882096558

Author(s):

Ka Man Fong ◽

Shek Yin Au ◽

George Wing Yiu Ng ◽

Anne Kit Hung Leung

Keyword(s):

Risk Factors ◽

Bloodstream Infection ◽

Primary Outcome ◽

Significant Risk ◽

Tertiary Hospital ◽

Chinese Patients ◽

Bleeding Complications ◽

Bleeding Events ◽

Tertiary Center ◽

Independent Risk Factors

Purpose: Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications. Materials and Methods: This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay. Results: Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events. Conclusions: Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v3 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

Abstract Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were retrospectively analyzed. Admission to a care facility or the need for home adaptations during hospitalization were defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v4 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Care Facility ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Poor Outcomes

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Risk factors of poor prognosis and impairment of activities of daily living in patients with hemorrhagic gastroduodenal ulcers

10.21203/rs.3.rs-19921/v2 ◽

2020 ◽

Author(s):

Junya Arai ◽

Jun Kato ◽

Nobuo Toda ◽

Ken Kurokawa ◽

Chikako Shibata ◽

...

Keyword(s):

Risk Factors ◽

Activities Of Daily Living ◽

Daily Living ◽

Poor Prognosis ◽

Significant Risk ◽

Significant Risk Factor ◽

Advanced Age ◽

Gastroduodenal Ulcers ◽

Hospitalization Period ◽

Poor Outcomes

Abstract Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. We analyzed the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were retrospectively analyzed. Necessity to look for care facilities to admit or requirement of home modifications during the hospitalization period was defined as ADL decline. The clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.

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Catheter Failure and Mortality in Hemodialysis Patients with Tunneled Cuffed Venous Catheters in a Single Center

Blood Purification ◽

10.1159/000455062 ◽

2017 ◽

Vol 43 (4) ◽

pp. 321-326 ◽

Cited By ~ 1

Author(s):

Min Shi ◽

Tianlei Cui ◽

Liang Ma ◽

Li Zhou ◽

Ping Fu

Keyword(s):

Risk Factors ◽

Median Survival ◽

Vascular Access ◽

Patient Survival ◽

Survival Rates ◽

Significant Risk ◽

Advanced Age ◽

Survival Duration ◽

Diabetic Mellitus

Background: As of now, only a few studies have focused on the failure of tunneled cuffed venous catheter (tCVC) and mortality of hemodialysis (HD) patients using tCVC as long-term vascular access, whose vascular condition for arteriovenous fistula was not very satisfactory. In this study, we aimed to provide information about the first tCVC failure and survival rates of patients in this population. Methods: Fifty-nine patients who used tCVC from January 1, 2009 to December 31, 2014 in our HD center were analyzed in this retrospective study and followed up either until their death or until December 31, 2015. The first tCVC and patient survival rates were analyzed. Results: The incidence of catheter-related infections was 0.3 per 1,000 patient-days. The median survival duration of first tCVC was 45.0 (95% CI 29.3-69.7) months and the median survival time of all patients was 56.3 (95% CI 34.1-78.5) months by Kaplan-Meier analysis. Advanced age (hazard ratio [HR] 1.055, p < 0.05) and diabetic mellitus (HR 4.147, p < 0.05) at the initiation of HD were significant risk factors of first tCVC failure, while male (HR 2.712, p < 0.05) and cardiovascular diseases (CVDs; HR 4.139, p < 0.05) were significant risk factors for patient mortality as deduced by Cox proportional hazards methods. Conclusions: The study highlighted that first tCVC survival rates and patient survival rates were high in HD patients who were using tCVCs as long-term vascular access, with low incidence of catheter-related infections. In the study it was found that advanced age and diabetic mellitus at the initiation of HD influenced first tCVC failure, whereas male and CVDs seemed to be risk factors for patient mortality.

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Risk factors and prophylaxis of irinotecan induced cholinergic syndrome in sight of supportive care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.216 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 216-216

Author(s):

Hiroyuki Fujii ◽

Taizo Hirata ◽

Takuya Mura ◽

Yuko Okada ◽

Takuo Ito ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Response Rate ◽

Univariate Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Anticancer Therapy ◽

Cancer Type ◽

Chemotherapeutic Regimen ◽

Cholinergic Syndrome

216 Background: Irinotecan Induced Cholinergic Syndrome (IICS), manifesting in such events as early diarrhea and diaphoresis, is well-known adverse effect of irinotecan. These symptoms occur within the first 24 hours of irinotecan administration and can be ameliorated with anticholinergic agents. Although IICS is transient and tends to be underestimated, diarrhea and abdominal pain during drug infusion are inflictive and make patients reluctant to undergo anticancer therapy. Methods: First, to identify the risk factors that are associated with IICS, 132 consecutive patients who were treated with a chemotherapeutic regimen that included irinotecan at Kure Medical Center between 2012 and 2017 were retrospectively analyzed from the aspect of sex, age, dose, cancer type, regimen, kidney function, and renal function. Secondly, to determine the response rate of butylscopolamine bromide for IICS, we injected butylscopolamine bromide 20mg into the irinotecan infusion bag and administered both agents through the intravenous line together to patients who experienced IICS. Results: IICS occurred 14 of 132 patients (10.6%); these 14 patients were given butylscopolamine bromide by coinjection for total 119 cycles. Univariate analysis indicated that dose (p = 0.0029), cancer type (p = 0.0023) and regimen (p = 0.0005) was associated with IICS. Patients with symptoms tended to be administered a higher irinotecan dose than those without symptoms (127.9±20.4mg/m2 and 99.6±34.1mg/m2). By logistic regression analysis, a higher dose (dose > 105mg/m2) was identified a significant risk factor for IICS (Odds Ratio = 10.9; 95% Confidence Interval: 2.0 to 96.7; p = 0.0121). 13 patients (105 cycles) of 14 patients (119 cycles) who were administered butylscopolamine bromide, experienced complete or partial improvement of IICS. The response rate was nearly 90%. Conclusions: A higher dose of irinotecan is a significant risk factor for IICS. To avoid creating a disincentive for patients to undergo anticancer therapy, the prevention of IICS is paramount. As prophylaxis of IICS, mixing butylscopolamine bromide into the irinotecan infusion bag was remarkably effective.

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Significant risk factors for malignant transformation of ovarian endometrioma during dienogest treatment: a case report and retrospective study

Journal of Medical Case Reports ◽

10.1186/s13256-019-2236-z ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Michiko Honda ◽

Wataru Isono ◽

Akira Tsuchiya ◽

Ako Saito ◽

Hiroko Tsuchiya ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Malignant Transformation ◽

Accurate Determination ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Advanced Age ◽

Ovarian Endometrioma ◽

Surgical History ◽

The University

Abstract Background To determine the prevalence of and risk factors for malignant transformation of ovarian endometrioma during dienogest therapy, which is very rare, we examined multiple cases of malignant transformation of ovarian endometrioma during dienogest therapy and performed a multivariate analysis of the records in our hospital. Methods The medical records of 174 patients who underwent DNGT for the treatment of OMA from June 1, 2011, to May 31, 2018, were reviewed retrospectively with the approval of the Human Ethical Committee of the University of Teikyo Hospital. And we provided one representative case of MT with obtaining written informed consent. To assess the effects of six representative factors, including advanced age, parity, surgical history, and endometrial cyst characteristics (including 3 factors), on the possibility of malignant transformation, we performed a multivariate logistic regression analysis. Results Of the 174 cases, 4 were diagnosed with malignant transformation, and these cases are reported. In the multivariate analysis, advanced age (P = 0.0064), nullipara (P = 0.0322), and enlargement (P = 0.0079) showed significant differences for malignant transformation occurrence. All 4 malignant transformation cases were among the 19 patients who had all of these 3 factors. Conclusions For a more accurate determination of the treatment approach, a larger sample size will be needed to determine the risk factors for malignant transformation during dienogest therapy.

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Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy

Cancer Research and Treatment ◽

10.4143/crt.2019.242 ◽

2020 ◽

Vol 52 (2) ◽

pp. 586-593 ◽

Cited By ~ 1

Author(s):

Qiang Wang ◽

Fengxia Xiao ◽

Fei Qi ◽

Xiaopeng Song ◽

Yonghua Yu

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Dna Methyltransferase ◽

Tumor Volume ◽

Significant Risk ◽

High Grade Glioma ◽

Residual Tumor ◽

World Health ◽

High Grade ◽

Who Grade

PurposeFractionated radiotherapy as well as concomitant and adjuvant chemotherapy such as temozolomide for postoperative high-grade glioma (HGG) patients improves progression-free survival and overall survival. Multiple factors such as chemotherapy, radiotherapy, tumor grade, residual tumor volume, and genetic modifications might play a role in the formation of cognitive impairment. The risk factors of cognitive impairment in postoperative patients with HGG receiving radiotherapy and chemotherapy remains a concern in this population. The purpose of this study was to identify risk factors for cognitive impairment in patients of postoperative HGG.Materials and MethodsA total of 229 patients with HGG who underwent surgery were analyzed. Cognitive impairment was defined as a decrease of Cognitive Assessment Montreal (MoCA)’s score in at least two cognitive domains or any MoCA’s score of less than 26 points at the time of study compared with baseline level. Multiple potential risk factors including methylated status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter, glioma World Health Organization (WHO) grade, residual tumor volume, education, and sex were analyzed. Cox univariate and multivariate regression analysis was used to detect the significant risk factors for cognitive impairment.ResultsAt the end of follow-up among the 229 patients, 147 patients (67%) developed cognitive impairment. 82 patients (36%) remained in normal cognitive condition. In multivariate analysis, unmethylated MGMT promoter (hazard ratio [HR], 1.679; 95% confidence interval [CI], 1.212 to 2.326; p=0.002), glioblastoma (HR, 1.550; 95% CI, 1.117 to 2.149; p=0.009), and residual tumor volume > 5.58 cm3 (HR, 1.454; 95% CI, 1.047 to 2.020; p=0.026) were independent risk factors for cognitive impairment.ConclusionMethylated status of the MGMT promoter, glioma WHO grade, and residual tumor volume might be risk factors for the cognitive impairment in postoperative patients with HGG.

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