scholarly journals Identification of RAGE and OSM as new prognosis biomarkers of severe pneumonia

2020 ◽  
Author(s):  
Li Wang ◽  
Yan Tan ◽  
Jiangnan Zhao ◽  
Lin Gao ◽  
Jing Lei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oxygenation Index ◽  
Severe Pneumonia ◽  
Final Analysis ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Related Risk ◽  
Diabetes Mellitus Status ◽  
Jinling Hospital ◽  
Risk Patients

Abstract BackgroundPatients with severe pneumonia complicated with hypoxic respiratory failure often associated with increased morbidity and mortality rates. It is critical to discover more sensitive and specific markers for early identification of such high risk patients thus specific and timely treatment can be adjusted.MethodsThis retrospective study was performed in the respiratory intensive care unit (RICU) of Nanjing First Hospital and Jinling Hospital, Nanjing Medical University. Clinical data of patients admitted to the RICU and diagnosed with pneumonia from January 2017 to October 2019 was retrospectively reviewed. The eligible patients were classified into hypoxemia and non hypoxemia groups according to oxygenation index of 250 mmHg. In the meantime, the same cohort was separated into survival and deceased groups after 30 days post hospital admission. The related risk factors in these two classifications were examined separately.ResultsA total of 828 patients were screened for eligibility, and eventually 130 patients with pneumonia were included in our final analysis. Among the patients, 16 passed away despite exhausting standard treatments. The comparison between hypoxemia and non hypoxemia groups suggested that gender, diabetes mellitus status, count of white blood cell(WBC), neutrophils, neutrophils/Lymphocyte, lactic acid, creatinine, D-dimer, procalcitonin (PCT), C-reactive protein (CRP), PH, Lymphocyte, albumin and RAGE were significantly different.ConclusionsPrevious studies have suggested that the APACHE II score, LIS, SOFA, Nutric scores, WBC, neutrophils, lymphocyte counts and albumin levels were independent risk factors for severe pneumonia. Our study indicated that RAGE should be a new biomarker to predict poor prognosis in pneumonia. In addition, we also showed that LIS, SOFA, lactate, lymphocyte, platelet, BUN, total bilirubin, and PCT levels before treatment were independent factors that associated with 30 days survival rate. In addition, we proposed that OSM should be considered as a new prognosis marker for pneumonia patients.

Final Analysis of MELISSE, a Large Multicentric Observational Study to Determine Risk Factors of Venous Thromboembolism in Patients with Multiple Myeloma Treated with Immunomodulator Drugs

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1235-1235 ◽  
Author(s):  
Xavier Leleu ◽  
Laurent Daley ◽  
Philippe Rodon ◽  
Cyrille Hulin ◽  
Charles Dauriac ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
High Risk ◽  
Incidence Rate ◽  
Research Funding ◽  
Final Analysis ◽  
Vte Prophylaxis ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

Abstract Abstract 1235 Background. Immunomodulator drugs (IMiDs) are associated with an increased risk of thromboembolic events (TE). Multiple Myeloma patients (MM) that can not benefit from novel agents, including IMiDs, only have 9 months survival. IMiDs must be stopped when TE occurs with the consequence of potential shortened life expectancy. MELISSE was designed to prospectively evaluate the incidence and risk factors of venous TE (VTE) associated with IMiDs in MM. We have presented the interim analysis of MELISSE at ASH 2010. A reduced incidence rate of early VTE was observed when a prophylaxis for VTE was started as compared to patients that had no prophylaxis. Interestingly, we also reported that most of the patients had received aspirin, while aspirin is not considered to exert any venous prophylactic effect. LMWH was primarily proposed to patients with high risk of TE according to physician's evaluation. We present the final analysis of MELISSE with updated results at 1 year. Method. A total of 524 MM treated with IMiDs-based therapy were included in 52 IFM centers. VTE prophylaxis was recommended prior to start IMiDs, the choice of which was left at the discretion of the investigator. Patients gave written informed consent according to the declaration of Helsinki. The physicians were to record the risk of VTE occurrence, categorized as low, moderate and high, based on guidelines and their own appreciation of the risk. Occurrence of any VTE was to be recorded along with the management of the event and the patient's outcome. The data were collected at entry in the study, and then after 4 and 12 months. Results. The median age was 70 years old, with 64.67% of patients >65 years old. Overall 36.0% had thalidomide-based and 64.0% had lenalidomide-based therapy, with 180 patients in first line and the remaining patients in 2nd and 3rd lines of therapy. The observed repartition of TE risk factors was as expected in a European population with myeloma. The risk of VTE was assessed as high in 14.2% patient and small or intermediate otherwise. Interestingly, approximately 70% of patients rated as low and intermediate risk received aspirin as a routine prophylaxis for VTE as compared to 20% in high risk patients. LMWH was primarily given to high risk patients, 45.8%. Surprisingly, 16.0% of patients had no VTE prophylaxis. Investigators recorded 29 (5.5% annual incidence rate) TE at 12 months, including 12 associated with PE. The incidence rate of TE was similar within the first 4 months (early occurrence, 3.5%) versus after 4 months (late, 2.5%). We have not identified any risk factor that would explain early versus late occurrence of VTE. Interestingly, the incidence of VTE was higher in patients that had no prophylaxis treatment, 8.5%, as compared to 4.4% and 5.9% in the LMWH and aspirin groups, respectively. There was no PE recorded in patients that were on LMWH prophylaxis. The VTE was equally breakdown across the 3 groups of risk factors. The bleeding adverse events were reported for 27 patients, mainly patients with aspirin. We isolated a model with 3 variables that independently predicted a higher risk to develop VTE in the multivariate model, and that comprised the male gender [OR 4.31 (95% CI 1.60 – 13.90)], the smoking habit [6.76 (1.73–22.42)] and the association to EPO [2.66 (1.04–6.58)]. Aspirin showed no significance, but with a p value at 0.55. The multivariate analysis is limited as certain subgroups with high risk factors might have received the optimal VTE prophylaxis, such as patients with bed rest and patients with prior history of VTE. These 2 groups rarely had aspirin. Survival data will be updated and presented at ASH 2011. Conclusion. This study further demonstrates that TE prophylaxis is required for MM treated with IMiDs-based therapy. There is a slight increase risk of VTE/PE with the use of aspirin as compared to LMWH, but a significant increase in bleeding events. Although we have identified risk factors of VTE in MM treated with IMiDs, for the first time, we could not identified VTE risk factors to guide investigators between LMWH and aspirin-based prophylaxis. The optimal dose and duration of LMWH remains to be determined. Disclosures: Leleu: LeoPharma: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Janssen Cilag: Honoraria, Research Funding; Roche: Research Funding; Amgen: Honoraria; Novartis: Research Funding. Daley:LeoPharma: Employment. Hulin:Janssen: Honoraria; Celgene: Honoraria. Lamblin:LeoPharma: Employment. Natta:LeoPharma: Employment.

scholarly journals Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Begüm Ergan ◽  
Recai Ergün ◽  
Taner Çalışkan ◽  
Kutlay Aydın ◽  
Murat Emre Tokur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Invasive Mechanical Ventilation ◽  
Apache Ii Score ◽  
Risk Patients ◽  
Group 2 ◽  
Group 1

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission.Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients.Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%;p<0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%;p=0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n=13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality.Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

scholarly journals Value of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio, and Red Blood Cell Distribution Width in Evaluating the Prognosis of Children with Severe Pneumonia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Xuejiao Qi ◽  
Yihui Dong ◽  
Xiaojie Lin ◽  
Wencheng Xin
Keyword(s):  
Risk Factors ◽  
Severe Pneumonia ◽  
Apache Ii Score ◽  
Cell Distribution ◽  
Platelet To Lymphocyte Ratio ◽  
Survival Group ◽  
Distribution Width ◽  
Lymphocyte Ratio ◽  
Death Group ◽  
Red Blood Cell Distribution

Objective. To investigate the value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and red blood cell distribution width (RDW) in evaluating the prognosis of children with severe pneumonia (SP). Methods. A retrospective analysis of the data of 91 children with SP admitted to our hospital from March 2018 to March 2021. According to the survival status after 28 days of treatment, all children were divided into the survival group (n = 59) and the death group (n = 32). The clinical data and laboratory indicators of the patients were recorded. Multivariate logistic regression was used to analyze the risk factors of prognosis, and the ROC curve was used to analyze the predictive value of each index. Results. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and CURB-65 score of the death group were higher than those of the survival group ( P < 0.05 ). The RDW, NLR, PLR, and high-sensitivity C-reactive protein, procalcitonin blood lactic acid (Lac) of the death group, were higher than those of the survival group, and LYM was lower than the survival group ( P < 0.05 ). Multivariate regression analysis showed that APACHE II score, RDW, NLR, PLR, and Lac were all independent risk factors for poor prognosis in children with SP ( P < 0.05 ). The AUC of NLR, PLR, and RDW for evaluating the prognosis of children with SP were 0.798, 0.781, and 0.777, respectively. The sensitivity was 56.25%, 90.63%, and 56.25%, respectively, and the specificity was 89.83%, 55.93%, and 91.53%, respectively. The AUC of NLR, PLR, and RDW combined to evaluate the prognosis of children with SP was 0.943. When the best cut-off value was 0.8528, the sensitivity was 93.75%, and the specificity was 91.53%. Conclusion. NLR, PLR, and RDW have certain predictive value for the prognosis of children with SP; the combination of the three indicators has a higher value in evaluating the prognosis of children with SP, which can better guide the prognostic treatment.

scholarly journals Risk factors and prognosis of hypoalbuminemia in surgical septic patients

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1267 ◽  
Author(s):  
Jia-Kui Sun ◽  
Fang Sun ◽  
Xiang Wang ◽  
Shou-Tao Yuan ◽  
Shu-Yun Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Lactate ◽  
Early Stage ◽  
Albumin Level ◽  
Multiple Organ ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Reactive Protein ◽  
Retrospective Clinical Study ◽  
Independent Risk Factors

The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II) score (OR 1.786, 95% CI [1.379–2.314],P< 0.001), C-reactive protein (CRP) (OR 1.016, 95% CI [1.005–1.027],P= 0.005), and blood lactate (OR 1.764, 95% CI [1.141–2.726],P= 0.011) were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ≤20 g/L were significantly worse than that of 21–25 g/L and ≥26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L) was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (≥14.5), CRP (≥34.25 mg/L), and blood lactate (≥.35 mmol/L) were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ≤20 g/L had worse prognosis than that of albumin level ≥21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L.

Abstract P193: Infection Type and Severity are Risk Factors for Hospital-Acquired Venous Thromboembolism in Medical Inpatients

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Samuel Merrill ◽  
Michael Desarno ◽  
Damon Houghton ◽  
Christopher Huston ◽  
Peter Callas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Infection Type ◽  
Organ System ◽  
Related Risk ◽  
Medical Inpatients ◽  
Risk Patients ◽  
Culture Isolate ◽  
Hospital Acquired ◽  
The Relationship

Introduction: Hospital-acquired venous thromboembolism (HAVTE) leads to increased length of stay, cost, morbidity, and is a target of government quality measures. How infection relates to HAVTE risk is unknown. We wished to identify infection-related risk factors for HAVTE to help identify at-risk patients and to guide prevention efforts. Hypothesis: We hypothesized that increased infection severity, affected organ system, and positive microbiology culture results were associated with HAVTE in medical inpatients. Methods: HAVTE between 2009-2012 were identified by ICD-9 codes with confirmatory imaging at a 500 bed teaching hospital. ICD-9 codes, microbiology results, lab and vital sign data, and medication records were used to classify infections as presented in the Table. Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) for HAVTE adjusting for known HAVTE risk factors in the MITH score, a previously developed HAVTE risk score for medical inpatients. Models incorporated known HAVTE risk factors and assessed each variable from the Table individually. Results: In 20,327 medical admissions there were 113 hospital-acquired HAVTE (incidence: 0.56%). The table presents the association between infection-related risk factors and HAVTE. Septic shock (OR 7.48), sepsis (OR 5.9), and MSSA culture isolate (OR 6.39) had the greatest point-estimates of HAVTE after adjusting for known HAVTE risk factors. Conclusions: Infection severity, affected organ system, and microbiologic etiology were risk factors for HAVTE after adjusting for known risk factors. The relationship between these risk factors and thrombosis is likely complex, but these risk factors are easily measureable using the electronic health record. These results may help facilitate HAVTE prevention by further identifying high risk patients.

scholarly journals Check-up and cardiovascular risk progression: is there a room for innovation?

2015 ◽  
Vol 13 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Raquel Dilguerian de Oliveira Conceição ◽  
Antonio Gabriele Laurinavicius ◽  
Nea Miwa Kashiwagi ◽  
José Antonio Maluf de Carvalho ◽  
Carlos Alberto Garcia Oliva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Alcohol Consumption ◽  
Smoking Habit ◽  
Final Analysis ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
The Impact ◽  
Number Of Individuals

ABSTRACT Objective: To evaluate the impact of traditional check-up appointment on the progression of the cardiovascular risk throughout time. Methods: This retrospective cohort study included 11,126 medical records of asymptomatic executives who were evaluated between January, 2005 and October, 2008. Variables included participants’ demographics characteristics, smoking habit, history of cardiovascular diseases, diabetes, dyslipidemia, total cholesterol, HDL, triglycerides, glucose, c-reactive protein, waist circumference, hepatic steatosis, Framingham score, metabolic syndrome, level of physical activity, stress, alcohol consumption, and body mass index. Results: A total of 3,150 patients was included in the final analysis. A worsening was observed in all risk factors, excepting in smoking habit, incidence of myocardial infarction or stroke and in the number of individuals classified as medium or high risk for cardiovascular events. In addition, a decrease in stress level and alcohol consumption was also seen. Conclusion: The adoption of consistent health policies by companies is imperative in order to reduce the risk factors and the future costs associated with illness and absenteeism.

scholarly journals Risk Factors for Fatal Pulmonary Hemorrhage following Concurrent Chemoradiotherapy in Stage 3B/C Squamous-Cell Lung Carcinoma Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Erkan Topkan ◽  
Ugur Selek ◽  
Yurday Ozdemir ◽  
Ali A. Besen ◽  
Ozan C. Guler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell ◽  
Lung Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Pulmonary Hemorrhage ◽  
Concurrent Chemotherapy ◽  
Squamous Cell Lung Carcinoma ◽  
Cell Lung Carcinoma ◽  
Related Risk ◽  
Risk Patients

We aimed to identify the fatal pulmonary hemorrhage- (FPH-) related risk factors in stage 3B/C squamous-cell lung carcinoma (SqCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT). Medical records of 505 stage 3B/C SqCLC patients who underwent 66 Gy radiotherapy plus 1-3 cycles of concurrent chemotherapy with available pretreatment thoracic computerized tomography scans were retrospectively analyzed. Primary end-point was the identification of FPH-related risk factors. Examined factors included the basal patient and tumor characteristics with specific emphasis on the tumor cavitation (TC) status, tumor size (TS) and cavitation size (CS), tumor volume and cavitation volume (TV and CV), relative cavitation size (RCS = CS/TS), and relative cavitation volume (RCV=CV/TV). FPH emerged in 13 (2.6%) patients, with 12 (92.3%) of them being diagnosed ≤12 months of C-CRT. All FPHs were diagnosed in patients with TC (N=60): group-specific FPH incidence: 21.6%. TC (P<0.001) was the unique independent factor associated with higher FPH risk in multivariate analysis. Further analysis limited to TC patients exhibited the RCV>0.14 (37.5% versus 11.1% for RCV≤0.14; P<0.001), major RCS group [31.0% versus 19.0% for minor versus 0% for minimum RCS; P=0.008), and baseline hemoptysis (26.3% versus 13.6% for no hemoptysis; P=0.009) as the independent risk factors for higher FPH incidence. FPH was an infrequent (2.6%) complication of C-CRT in stage 3B/C SqCLC patients, but its incidence increased to 37.5% in patients presenting with TC and RCV>0.14. Diagnosis of >90% FPHs ≤12 months of C-CRT stresses the importance of close and careful follow-up of high-risk patients after C-CRT for multidisciplinary discussion of possible invasive preventive measures.

The Effects of Tai Chi Practice With Asynchronous Music on Compliance and Fall-Related Risk Factors in Middle-Aged and Older Women: A Pilot Study

2016 ◽  
Vol 35 (2) ◽  
pp. 142-150 ◽  
Author(s):  
Yan Du ◽  
Penny Roberts ◽  
Qingwen Xu
Keyword(s):  
Risk Factors ◽  
Older Women ◽  
Tai Chi ◽  
Fear Of Falling ◽  
Compliance Rate ◽  
Final Analysis ◽  
Analysis Of Covariance ◽  
Middle Aged ◽  
Related Risk ◽  
Dynamic Gait Index

Purpose: This study examined whether practicing Tai Chi (TC) along with music can maximize the effects of TC on compliance and fall-related risk factors (Dynamic Gait Index and fear of falling). Design: A convenient sample was recruited in a community senior center. Eighteen women aged 50 to 84 years (9 White, 9 Black) were block randomly assigned to a TC in silence (TC + S; n = 6) or a TC with music (TC + M; n = 12) class. Method: Thirteen participants (4 in TC + S group, 9 in TC + M group) with completed pre- and posttests were included in the final analysis. Paired t tests were conducted to examine changes within groups over time and analysis of covariance was used to assess group differences. Findings: After 15 weeks of intervention, balance increased in both groups with significantly higher benefits in the TC + M group ( p < .05). Fear of falling scores improved in TC + M group and compliance rate was higher in this group. Conclusions: Practicing TC + M may help increase adherence in White and Black middle-aged and older women, and maximize the effects of TC on fall-related risk factors. Studies with more rigorous study design, including musical considerations, are warranted.

scholarly journals Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

2012 ◽  
Vol 03 (S 05) ◽  
pp. 068-070 ◽  
Author(s):  
Nalini M. Guda
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pancreatic Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Invasive Procedures ◽  
Endoscopic Retrograde ◽  
Non Invasive ◽  
Related Risk ◽  
Pancreatic Duct Stenting ◽  
Risk Patients

AbstractPost ERCP pancreatitis (PEP) is a common problem. Knowledge of patient and procedure related risk factors along with appropriate measures aimed at reduction of risk have been successful in reducing both the incidence and the severity. Prophylactic pancreatic duct stenting has definitely reduced the incidence and the severity of PEP in high risk patients. There are some emerging data on the use of non steroidal anti inflammatory agents though this is not widely adapted in practice. Key is to avoid procedures with marginal indications and use of non invasive/less invasive procedures.

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