scholarly journals Cross-Border Malaria Drivers and Risk Factors on the Brazil-Venezuela Border Between 2016 and 2018

2021 ◽  
Author(s):  
Kinley Wangdi ◽  
Erica Wetzler ◽  
Paola Marchesini ◽  
Leopoldo Villegas ◽  
Sara Canavati
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Malaria Elimination ◽  
Malaria Incidence ◽  
Imported Malaria ◽  
Surveillance Systems ◽  
Cross Border ◽  
Imported Case ◽  
Multivariable Logistic Regression ◽  
Imported Cases

Abstract Background Globally, cross-border importation of malaria has become a challenge to malaria elimination. The border areas between Brazil and Venezuela have experienced high numbers of imported cases due to increased population movement and migration out of Venezuela. This study aimed to identify risk factors for imported malaria and delineate imported malaria hotspots in Roraima, Brazil and Bolivar, Venezuela between 2016 and 2018.MethodsData on malaria surveillance cases from Roraima, Brazil and Bolivar, Venezuela from 2016 to 2018 were obtained from national surveillance systems: the Brazilian Malaria Epidemiology Surveillance Information System (SIVEP-Malaria), the Venezuelan Ministry of Health and other non-government organizations. A multivariable logistic regression model was used to identify the risk factors for imported malaria. Spatial autocorrelation in malaria incidence was explored using Getis-Ord (Gi*) statistics.ResultsDuring the study period, there were 11,270 (24.3%) and 4,072 (0.7%) imported malaria cases in Roraima, Brazil and Bolivar, Venezuela, respectively. In the multivariable logistic regression for Roraima, men were 28% less likely to be an imported case compared to women (Adjusted Odds Ratio [AOR]= 0.72; 95% confidence interval [CI] 0.665, 0.781). Ages 20-29 and 30-39 were 90% (AOR=1.90; 95% CI 1.649, 2.181) and 54% (AOR=1.54; 95% CI 1.331, 1.782) more likely to be an imported case compared to the 0-9 year age group, respectively. Imported cases were 197 times (AOR=197.03; 95% CI 175.094, 221.712) more likely to occur in miners than those working in agriculture and domestic work. In Bolivar, cases aged 10-19 (AOR=1.75; 95% CI 1.389, 2.192), 20-29 (AOR=2.48; 95% CI 1.957, 3.144), and 30-39 (AOR=2.29; 95% CI 1.803, 2.913) were at higher risk of being an imported case than those in the 0-9 year old group, with older age groups having a slightly higher risk compared to Roraima. Compared to agriculture and domestic workers, tourism, timber and fishing workers (AOR=6.38; 95% CI 4.393, 9.254) and miners (AOR=7.03; 95% CI 4.903, 10.092) were between six and seven times more likely to be an imported case. Spatial analysis showed the risk was higher along the international border in the municipalities of Roraima, Brazil.ConclusionTo achieve malaria elimination, cross-border populations in the hotspot municipalities will need targeted intervention strategies tailored to occupation, age and mobility status. Furthermore, all stakeholders, including implementers, policymakers, and donors, should support and explore the introduction of novel approaches to address these hard-to-reach populations with the most cost-effective interventions.

scholarly journals Epidemiology of Imported Malaria in Netrokona District of Bangladesh 2013-2018: Analysis of Surveillance Data

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Md Abdul Karim ◽  
M. Moktadir Kabir ◽  
Md Ashraf Siddiqui ◽  
Md Shahidul Islam Laskar ◽  
Anjan Saha ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Service Providers ◽  
Descriptive Analysis ◽  
Seasonal Fluctuation ◽  
Imported Malaria ◽  
Strategy Development ◽  
Cross Border ◽  
Population Type ◽  
Imported Cases ◽  
The Government

Introduction. Netrokona is one of the first phase malaria elimination targeted 8 districts of Bangladesh by 2021. The district constitutes only 7% of the population but contributes half of the malaria cases in that area. Most of the cases of that district are imported from Meghalaya State of India. The study was conducted to understand the epidemiology of these imported malaria cases for further strategy development to prevent both imported and introduced cases. Methodology. The study was retrospectively conducted on the malaria cases confirmed by microscopy and/or RDT by the government and/or NGO service providers between 2013 and 2018. The information of the cases was collected from the verbal “investigation” report of individual malaria confirmed cases. The respondents of the “investigation” were either the patients or their family members. Out of the 713 cases during the study period, descriptive analysis of 626 cases (based on the completeness of “investigation form”) of the district was done using MS Excel version 2016. Results. Proportion of imported malaria in Netrokona district increased from 60% in 2013 to 95% in 2018 which persists throughout the year with a little seasonal fluctuation. The overall contribution of these imported cases is 93% by cross-border workers by population type and 84%, 66%, and 95% by male, labour, and tribal population considering the factors of sex, occupation, and ethnicity, respectively. Population aged between 15 and 49 years contributed 82% of these imported cases. All of these cases occurred in the internationally bordering belt with Meghalaya State of India. Species-wise distribution revealed lower P. falciparum (63%) and higher mixed (28%) infection in imported cases compared to the 71% Pf and 20% mixed infection among the indigenous infections whereas P. vivax is similar in both cases. Conclusion. Imported malaria is an emerging issue that has a potential risk of increased local transmission which might be a challenge to malaria elimination in that area. Appropriate interventions targeting the cross-border workers are essential to prevent the introduced cases and subsequently avoid reestablishment when elimination of the disease is achieved.

scholarly journals Efficacy and safety of 5 mg olanzapine for nausea and vomiting management in cancer patients receiving carboplatin: integrated study of three prospective multicenter phase II trials

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Senri Yamamoto ◽  
Hirotoshi Iihara ◽  
Ryuji Uozumi ◽  
Hitoshi Kawazoe ◽  
Kazuki Tanaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cancer Patients ◽  
Phase Ii ◽  
Low Dose ◽  
Nausea And Vomiting ◽  
Efficacy And Safety ◽  
Multivariable Logistic Regression ◽  
Related Risk ◽  
Total Control

Abstract Background The efficacy of olanzapine as an antiemetic agent in cancer chemotherapy has been demonstrated. However, few high-quality reports are available on the evaluation of olanzapine’s efficacy and safety at a low dose of 5 mg among patients treated with carboplatin regimens. Therefore, in this study, we investigated the efficacy and safety of 5 mg olanzapine for managing nausea and vomiting in cancer patients receiving carboplatin regimens and identified patient-related risk factors for carboplatin regimen-induced nausea and vomiting treated with 5 mg olanzapine. Methods Data were pooled for 140 patients from three multicenter, prospective, single-arm, open-label phase II studies evaluating the efficacy and safety of olanzapine for managing nausea and vomiting induced by carboplatin-based chemotherapy. Multivariable logistic regression analyses were performed to determine the patient-related risk factors. Results Regarding the endpoints of carboplatin regimen-induced nausea and vomiting control, the complete response, complete control, and total control rates during the overall study period were 87.9, 86.4, and 72.9%, respectively. No treatment-related adverse events of grade 3 or higher were observed. The multivariable logistic regression models revealed that only younger age was significantly associated with an increased risk of non-total control. Surprisingly, there was no significant difference in CINV control between the patients treated with or without neurokinin-1 receptor antagonist. Conclusions The findings suggest that antiemetic regimens containing low-dose (5 mg) olanzapine could be effective and safe for patients receiving carboplatin-based chemotherapy.

scholarly journals Prevalence, characteristics and risk factors of imported and local malaria cases in North-Western Province, Zambia: a cross-sectional study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Maureen N. Chipoya ◽  
Nzooma M. Shimaponda-Mataa
Keyword(s):  
Risk Factors ◽  
Cross Sectional Study ◽  
Malaria Prevalence ◽  
Imported Malaria ◽  
Full Blood Count ◽  
Sectional Study ◽  
Cross Sectional ◽  
Western Province ◽  
Imported Cases ◽  
North Western

Abstract Background Imported malaria is a major challenge for countries that are in malaria elimination stage such as Zambia. Legitimate cross-border activities add to the risk of transmission, necessitating determination of prevalence, characteristics and risk factors of imported and local malaria. Methods This cross-sectional study was conducted in 103 consented child and adult patients with clinical malaria symptoms, from selected health facilities in north-western Zambia. Patient demographic data and blood samples for malaria microscopy and full blood count were obtained. Chi-square and penalized logistic regression were performed to describe the characteristics and assess the risk factors of imported and local malaria in North-Western Province. Results Overall, malaria prevalence was 78.6% with 93.8% Plasmodium falciparum and 6.2% other species. The local cases were 72 (88.9%) while the imported were 9 (11.1%) out of the 81 positive participants. About 98.6% of the local cases were P. falciparum compared to 55.6% (χ2 = 52.4; p < 0.01) P. falciparum among the imported cases. Among the imported cases, 44% were species other than P. falciparum (χ2 = 48; p < 0.01) while among the local cases only 1.4% were. Gametocytes were present in 44% of the imported malaria cases and only in 2.8% of the local cases (χ2 = 48; p < 0.01). About 48.6% of local participants had severe anaemia compared to 33.3% of participants from the two neighbouring countries who had (χ2 = 4.9; p = 0.03). In the final model, only country of residence related positively to presence of species other than P. falciparum (OR = 39.0, CI [5.9, 445.9]; p < 0.01) and presence of gametocytes (OR = 23.1, CI [4.2, 161.6]; p < 0.01). Conclusion Malaria prevalence in North-Western Province is high, with P. falciparum as the predominant species although importation of Plasmodium ovale and Plasmodium malariae is happening as well. Country of residence of patients is a major risk factor for malaria species and gametocyte presence. The need for enhanced malaria control with specific focus on border controls to detect and treat, for specific diagnosis and treatment according to species obtaining, for further research in the role of species and gametocytaemia in imported malaria, cannot be overemphasized.

scholarly journals From malaria control to elimination in South Africa: The researchers’ perspectives

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Khumbulani W. Hlongwana ◽  
Joyce Tsoka-Gwegweni
Keyword(s):  
South Africa ◽  
Community Involvement ◽  
Malaria Elimination ◽  
Surveillance Systems ◽  
Cross Sectional Survey ◽  
Eligibility Criteria ◽  
Cross Sectional ◽  
Cross Border ◽  
Malaria Episodes ◽  
Structured Questionnaire

Background: Global decline in malaria episodes over the past decade gave rise to a debate to target malaria elimination in eligible countries. However, investigation regarding researchers’ perspectives on barriers and facilitating factors to effective implementation of a malaria elimination policy in South Africa (SA) is lacking.Aim: The aim of this study was to investigate the malaria researchers’ knowledge, understandings, perceived roles, and their perspectives on the factors influencing implementation of a malaria elimination policy in SA.Setting: Participants were drawn from the researchers who fulfilled the eligibility criteria as per the protocol, and the criteria were not setting-specific.Methods: The study was a descriptive cross-sectional survey conducted through an emailed self-administered semi-structured questionnaire amongst malaria researchers who met the set selection criteria and signed informed consent.Results: Most (92.3%) participants knew about SA’s malaria elimination policy, but only 45.8% had fully read it. The majority held a strong view that SA’s 2018 elimination target was not realistic, citing that the policy had neither been properly adapted to the country’s operational setting nor sufficiently disseminated to all relevant healthcare workers. Key concerns raised were lack of new tools, resources, and capacity to fight malaria; poor cross-border collaborations; overreliance on partners to implement; poor community involvement; and poor surveillance.Conclusion: Malaria elimination is a noble idea, with sharp divisions. However, there is a general agreement that elimination requires: (a) strong cross-border initiatives; (b) deployment of adequate resources; (c) sustainable multistakeholder support and collaboration; (d) good surveillance systems; and (e) availability and use of all effective intervention tools.

scholarly journals Risk factors for symptomatic Avascular Necrosis (AVN) in a multi-ethnic Systemic Lupus Erythematosus (SLE) cohort

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248845
Author(s):  
Syahrul Sazliyana Shaharir ◽  
Siew Huoy Chua ◽  
Rozita Mohd ◽  
Ruslinda Mustafar ◽  
Malehah Mohd Noh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Avascular Necrosis ◽  
Lupus Erythematosus ◽  
Osteoporotic Fractures ◽  
Protective Effects ◽  
Regression Analyses ◽  
Mobility Limitations ◽  
Factors Associated ◽  
Multivariable Logistic Regression

Avascular necrosis of bone (AVN) is increasingly being recognized as a complication of SLE and causes significant disability due to pain and mobility limitations. We studied the prevalence and factors associated with avascular necrosis (AVN) in a multiethnic SLE cohort. SLE patients who visited the outpatient clinic from October 2017 to April 2019 were considered eligible. Their medical records were reviewed to identify patients who developed symptomatic AVN, as confirmed by either magnetic resonance imaging or plain radiography. Subsequently, their SLE disease characteristics and treatment were compared with the characteristics of patients who did not have AVN. Multivariable logistic regression analyses were performed to determine the independent factors associated with AVN among the multiethnic SLE cohort. A total of 390 patients were recruited, and the majority of them were females (92.6%); the patients were predominantly of Malay ethnicity (59.5%), followed by Chinese (35.9%) and Indian (4.6%). The prevalence of symptomatic AVN was 14.1%, and the mean age of AVN diagnosis was 37.6 ± 14.4 years. Both univariate and multivariable logistic regression analyses revealed that a longer disease duration, high LDL-C (low density lipoprotein cholesterol), positive anti-cardiolipin (aCL) IgG and anti-dsDNA results, a history of an oral prednisolone dose of more than 30 mg daily for at least 4 weeks and osteoporotic fractures were significantly associated with AVN. On the other hand, hydroxychloroquin (HCQ), mycophenolate mofetil (MMF) and bisphosphonate use were associated with a lower risk of AVN. No associations with ethnicity were found. In conclusion, several modifiable risk factors were found to be associated with AVN, and these factors may be used to identify patients who are at high risk of developing such complications. The potential protective effects of HCQ, MMF and bisphosphonates warrant additional studies.

scholarly journals Characteristics and Outcomes of COVID-19 Patients with Mature B-Cell Non-Hodgkin Lymphomas (mB-Cell NHL): A US Nationwide Electronic Health Record (EHR) Database Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2418-2418
Author(s):  
Xiaomeng Yue ◽  
David Hallett ◽  
Yangyang Liu ◽  
Reethi Iyengar ◽  
Elisa Basa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
B Cell ◽  
Clinical Characteristics ◽  
Index Date ◽  
B Cell Lymphoma ◽  
Male Gender ◽  
Older Age ◽  
Multivariable Logistic Regression ◽  
The Impact

Abstract Introduction COVID-19 poses a serious concern for mB-cell NHL patients given their advanced age, high burden of comorbidities, and immune dysfunction. Limited by smaller sample sizes during the early period of the COVID-19 pandemic, previous studies were unable to thoroughly evaluate the impact of COVID-19 on patients with mB-cell NHL 1,2. We aim to describe demographics and clinical characteristics, outcomes, and risk factors associated with death and other severe outcomes among COVID-19 patients with mB-cell NHL in a large US nationwide database. Methods This retrospective cohort study was conducted using the Optum EHR database, comprising data from an integrated network of ambulatory and hospital care providers across the US. Patients with COVID-19 (diagnosis code of U07.1, U07.2, or a positive result of SARS-Cov-2 virus PCR or antigen tests) between Feb. 1, 2020 and Jan 7, 2021 (index date) and mB-cell NHL diagnosis prior to the COVID-19 diagnosis were included. Patients were excluded if they were under 18 years of age, had missing age or sex, or had &lt;1year continuous eligibility prior to their index date (pre-index period). All baseline characteristics, including demographics and comorbidities, were determined during the one-year pre-index period. Severe outcomes, including death, hospitalization, ICU admission, and acute respiratory insufficiency (ARI), were evaluated within 30 days post-index date. Multivariable logistic regression was conducted to identify variables independently associated with severe outcomes. Results Among 2,767 patients with mB-cell NHL who were infected with SARS-CoV-2 between Feb. 1, 2020 and Jan. 7, 2021 (mean age±SD: 67.9 years±14.7, 53.9% male), majority were white (73.9%), followed by African American (10.9%), Hispanic (6.9%), and Asian (1.2%). The most common subtypes of mB-cell NHL were chronic lymphocytic leukemia/small lymphocytic lymphoma (26.9%), multiple myeloma (22.4%), diffuse large B-cell lymphoma (13.2%), and follicular lymphoma (7.3%). Of these patients, 93.4% have at least one comorbidity. The most common comorbidities were hypertension (58.5%), neurological disease (49.4%), diabetes (28.2%), ischemic heart disease (25.5%), cardiac arrhythmia/conduction disorders (24.4%), chronic kidney disease (CKD, 19.2%), heart failure/cardiomyopathy (18.1%), and COPD (12.3%). Overall, 960 patients (34.7%) developed severe outcomes, among which, 847 patients (30.6%) were hospitalized, 214 patients (7.7%) were admitted to the ICU, 201 patients (7.3%) experienced ARI, and 220 patients (8.0%) died. Multivariable logistic regression showed that increased odds of severe outcomes were independently associated with older age (85+ years vs. &lt;65 years; adjusted odds ratio [OR], 2.0; 95% CI, 1.4-2.7), male gender (OR, 1.4; 95% CI, 1.1-1.6), insurance coverage with Medicaid (OR, 1.8; 95% CI, 1.1-2.9) and/or Medicare (vs. commercial only; OR, 1.9; 95% CI, 1.5-2.5), infected during the first quarter (OR, 5.6; 95% CI, 3.4-9.4) or second quarter of 2020 (vs. fourth quarter of 2020; OR, 1.7; 95% CI, 1.4-2.1), having CKD (OR, 1.3; 95% CI, 1.0-1.6), COPD (OR, 1.4; 95% CI, 1.0-1.8), diabetes (OR, 1.3; 95% CI, 1.1-1.6), and receiving active treatment for NHL (OR, 1.4; 95% CI, 1.0-2.0) within 30 days prior to COVID-19 diagnosis (Figure). Conclusions This study demonstrated key demographic and clinical characteristics associated with severe outcomes among COVID-19 patients with mB-cell NHL using one of the largest nationwide databases. Risk factors for severe outcomes identified in the general population, such as older age, male gender, and having certain underlying medical conditions were also identified in this study. In addition, COVID-19 infection occurring earlier in the pandemic and receiving active NHL treatments were associated with severe outcomes. These latter two observations might reflect the improvement in patient management during the latter period of the pandemic and that active mB-cell NHL disease and treatment rendered an increased risk of severe outcomes in COVID-19 patients with mB-cell NHL. These insights highlight the importance of utilizing demographic, clinical and treatment information to estimate the risk for severe outcomes, whereas prospective studies focusing on optimal COVID-19 management are required to identify specific actions that can be taken to improve outcomes of COVID-19 in patients with mB-cell NHL. Figure 1 Figure 1. Disclosures Yue: Joule: Current Employment. Hallett: AbbVie: Current Employment. Liu: AbbVie: Current Employment. Iyengar: AbbVie: Current Employment. Basa: AbbVie: Current Employment. Yang: AbbVie: Current Employment.

scholarly journals Factors Associated with Prolonged Hospital Stay: a Retrospective Study for Imported Malaria Cases

2021 ◽  
Author(s):  
Liang Huang ◽  
Hong Jin ◽  
Hong Zhang ◽  
Yang Liu ◽  
Xinxing Shi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Infection ◽  
Hospital Stay ◽  
Predictive Factors ◽  
Imported Malaria ◽  
Health Concern ◽  
P Value ◽  
Prolonged Hospital Stay ◽  
Imported Cases ◽  
Prolonged Hospital

Abstract Background China had entered post-elimination era for malaria, however, the imported cases are continuously are a public health concern as the increasing number of cases. In this study we studied the potential predictive factors for prolonged hospital stay for imported malaria patients. Material and Methods We retrospectively collected patients of imported malaria cases data from 2017–2020 in our hospital. we analyzed the data from clinical, epidemiological, geographical, and seasonal points of view, and used cox proportional hazard model to find the predictive factors for prolonged hospital stay. Results We found most of imported cases were from Democratic Republic of the Congo(23%, 34/150) and most cases 74%(26/34) were infected by P. falciparum. Through Edwards Test, no significant seasonality of imported cases were found(χ2 = 2.51 p-value = 0.28). We found bacterial infection(HR = 0.58, p-value = 0.01) and thrombocytopenia(HR = 0.66, p-value = 0.02) were protective factors for discharge, that were, the risk factors for prolonged hospital stay. Conclusions The imported cases are the major risk of malaria in post-elimination era of China. The bacterial infection and thrombocytopenia were the risk factors for prolonged hospital stay.

scholarly journals 1244. Evaluation of Intraoperative Topical Vancomycin and the Incidence of Acute Kidney Injury

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S448-S448
Author(s):  
Alison L Blackman ◽  
Sabeen Ali ◽  
Xin Gao ◽  
Rosina Mesumbe ◽  
Carly Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Serum Creatinine ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Kidney Injury ◽  
Topical Formulation ◽  
Multivariable Logistic Regression Model ◽  
Multivariable Logistic Regression

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.

scholarly journals Infective endocarditis at a tertiary care hospital in South Korea

Heart ◽  
2020 ◽  
Vol 107 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Jung Ho Kim ◽  
Hi Jae Lee ◽  
Nam Su Ku ◽  
Seung Hyun Lee ◽  
Sak Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
South Korea ◽  
Hospital Mortality ◽  
Care Hospital ◽  
Multivariable Logistic Regression ◽  
Long Term Prognosis

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).ConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

A Risk-Prediction Model For Identifying Venous Thromboembolism In Hospitalized Pediatric Patients: A Single Institution Retrospective Case-Control Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2957-2957
Author(s):  
Ruchika Goel ◽  
Jessy Dhillon ◽  
Craig Malli ◽  
Kishen Sahota ◽  
Prabhjot Seehra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Venous Thromboembolism ◽  
Risk Prediction ◽  
Research Funding ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Case Control ◽  
Control Analysis ◽  
Multivariable Logistic Regression

Abstract Introduction Venous thromboembolism (VTE) is increasing in children, especially in the tertiary care setting. Hospital-associated VTE (HA-VTE) is a potentially preventable cause of major morbidity and mortality. However, the incidence of HA-VTE VTE is low in children Risk stratification tools may aid in identification of hospitalized high risk pediatric patients who may benefit from VTE prophylaxis. Methods We conducted a case-control study of pediatric patients with HA-VTE (21 years or younger at the time of diagnosis) admitted to the Johns Hopkins Hospital from 2008-2010. Cases were identified using ICD-9 codes for DVT and PE and verified by reviewing hospital records and radiologic imaging reports. HA-VTE was defined as: 1) VTE was diagnosed ≥48 hours after hospital admission without signs/symptoms of VTE on admission, or 2) VTE was diagnosed within 90 days of hospital discharge. Two contemporaneous controls matched for age, sex and admission unit were selected for each case. Records of cases and controls were reviewed for presence of a priori identified putative VTE risk factors at admission. Univariate and conditional multivariable logistic regression analyses with backward elimination were used to develop risk-prediction models. Based on results of univariate analysis, we sought to evaluate two multivariable models, one without length of stay (LOS) with relevance to assessment at admission, and one in which LOS was included with relevance to re-assessment after several days of hospitalization. All variables selected for the multivariable model were tested for interaction with a significance threshold level of p<0.2. Except for this, all hypothesis testing was two tailed and a p value of <0.05 was considered significant. Receiver operator curves (ROC) were constructed using risk factors on multivariate analysis. Results Table 1 lists the results putative risk factors by univariate analysis with a) significantly higher odds of VTE and b) higher odds of VTE but not statistically significant. In multivariable logistic regression analysis, central venous catheter (CVC), VTE predisposition and immobility or LOS >5 days were independently associated with HA-VTE. The combination of CVC and VTE predisposition with either immobility or LOS was predictive of HA-VTE (area under the curve for ROC of 76.6% and 80.6%, Table 2). Conclusion We found independently associated risk factors with that may potentially be used in a predictive model of HA-VTE in children. Further prospective validation studies of these and other risk factors may serve as the basis of future risk-stratified randomized control trials of primary prevention of pediatric HA-VTE. Disclosures: Streiff: Bristol Myers Squibb: Research Funding; Sanofi: Consultancy, Honoraria; Eisai, Daiichi-Sankyo, Boehringer-Ingelheim, Janssen HealthCare: Consultancy. Strouse:NIH: Research Funding; Doris Duke Charitable Foundation: Research Funding; Masimo Corporation: Membership on an entity's Board of Directors or advisory committees, Research Funding. Takemoto:Novonordisk: Research Funding.

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