scholarly journals Covid -19, An Acute on Chronic Metabolic Syndrome? HbA1c-A Marker of Severe Infection.

2021 ◽  
Author(s):  
Susanne Rysz ◽  
Malin Jonsson Fagerlund ◽  
Claire Rimes-Stigare ◽  
Emma Larsson ◽  
Francesca Campoccia Jalde ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Respiratory Failure ◽  
Logistic Regression Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
The Metabolic Syndrome ◽  
Multivariable Logistic Regression ◽  
Uncontrolled Diabetes ◽  
Increased Risk

Abstract Background: The comorbidities commonly observed in severe Covid-19 are diagnoses that comprise the metabolic syndrome. The metabolic status of patients when infected with SARS-Cov-2 and its significance for the severity of the disease is not yet fully understood. We investigated the association between respiratory symptoms and the levels of HbA1c in hospitalized patients infected with SARS-CoV-2. Methods: In this retrospective observational study, we included all inpatients at the Karolinska University Hospital, Sweden who had both a positive SARS-CoV-2 test and who had a HbA1c test obtained within 3 months of admission. The primary reasons for hospitalization included trauma, stroke, myocardial infarction, acute or elective surgery as well as infection. Based on HbA1c level and diabetes history, we classified patients into the following dysglycemia categories: prediabetes, unknown diabetes, controlled diabetes or uncontrolled diabetes. We used multivariable logistic regression analysis adjusted for age, sex and body mass index, to assess the association between dysglycemia categories and development of respiratory failure when infected with SARS-CoV-2. Primary outcome was respiratory failure associated with SARS-CoV-2.Results: Of the 385 study patients, 88 (22.9%) had prediabetes, 68 (17.7%) had unknown diabetes, 36 (9.4%) had controlled diabetes, and 83 (21.6%) had uncontrolled diabetes. Overall, 299 (77.7%) patients were admitted with or developed SARS-CoV-2-assoociated respiratory failure during hospitalization. The proportion of patients in need of intensive care (62.5% vs 26.7%, p<0.001), mechanical ventilation (60.9% vs. 26.7%, p<0.001) and renal replacement therapy (14% vs. 1.2%, p<0.001) were all higher in patients with SARS-CoV-2 associated respiratory failure vs. patients without. In addition, 83% of the ICU patients with SARS-CoV-2 associated respiratory failure had a HbA1c > 42 mmol/mol. In multivariable logistic regression analysis compared with no chronic dysglycemia, prediabetes (OR 14.41, 95% CI 5.27-39.43), unknown diabetes (OR 15.86, 95% CI 4.55-55.36), and uncontrolled diabetes (OR 17.61, 95% CI 5.77-53.74) was independently associated with increased risk of SARS-CoV-2-induced respiratory failure.Conclusion: Metabolic imbalance, reflected by elevated HbA1c with or without previous diagnosed diabetes mellitus, was associated with a more severe course of SARS-CoV-2-respratory infection. We suggest that HbA1c could be used as a marker of risk for severe Covid-19.

scholarly journals Impact of histologic chorioamnionitis on pulmonary hypertension and respiratory outcomes in preterm infants

2018 ◽  
Vol 8 (2) ◽  
pp. 204589401876016 ◽  
Author(s):  
Sook Kyung Yum ◽  
Min-Sung Kim ◽  
Yoojin Kwun ◽  
Cheong-Jun Moon ◽  
Young-Ah Youn ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Preterm Infants ◽  
Logistic Regression Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression ◽  
Histologic Chorioamnionitis ◽  
Respiratory Outcomes ◽  
Lower Birthweight

We aimed to evaluate the association between the presence of histologic chorioamnionitis (HC) and development of pulmonary hypertension (PH) during neonatal intensive care unit (NICU) stay. Data of preterm infants born at 32 weeks of gestation or less were reviewed. The development of PH and other respiratory outcomes were compared according to the presence of HC. Potential risk factors associated with the development of PH during NICU stay were used for multivariable logistic regression analysis. A total of 188 infants were enrolled: 72 in the HC group and 116 in the no HC group. The HC group infants were born at a significantly shorter gestational age and lower birthweight, with a greater proportion presenting preterm premature rupture of membrane (pPROM) > 18 h before delivery. More infants in the HC group developed pneumothorax ( P = 0.008), and moderate and severe bronchopulmonary dysplasia (BPD; P = 0.001 and P = 0.006, respectively). PH in the HC group was significantly more frequent compared to the no HC group (25.0% versus 8.6%, P = 0.002). Based on a multivariable logistic regression analysis, birthweight ( P = 0.009, odds ratio [OR] = 0.997, 95% confidence interval [CI] = 0.995–0.999), the presence of HC ( P = 0.047, OR = 2.799, 95% CI = 1.014–7.731), and duration of invasive mechanical ventilation (MV) > 14 days ( P = 0.015, OR = 8.036, 95% CI = 1.051–43.030) were significant factors. The presence of HC and prolonged invasive MV in infants with lower birthweight possibly synergistically act against preterm pulmonary outcomes and leads to the development of PH. Verification of this result and further investigation to establish effective strategies to prevent or ameliorate these adverse outcomes are needed.

scholarly journals Hounsfield unit attenuation value can differentiate pyonephrosis from hydronephrosis and predict septic complications in patients with obstructive uropathy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Luca Boeri ◽  
Irene Fulgheri ◽  
Franco Palmisano ◽  
Elena Lievore ◽  
Vito Lorusso ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Obstructive Uropathy ◽  
Hounsfield Unit ◽  
Infectious Complications ◽  
Multivariable Logistic Regression Analysis ◽  
Ureteral Catheter ◽  
Septic Complications ◽  
Multivariable Logistic Regression

Abstract We aimed to assess the role of computerized tomography attenuation values (Hounsfield unit—HU) for differentiating pyonephrosis from hydronephrosis and for predicting postoperative infectious complications in patients with obstructive uropathy. We analysed data from 122 patients who underwent nephrostomy tube or ureteral catheter placement for obstructive uropathy. A radiologist drew the region of interest for quantitative measurement of the HU values in the hydronephrotic region of the affected kidney. Descriptive statistics and logistic regression models tested the predictive value of HU determination in differentiating pyonephrosis from hydronephrosis and in predicting postoperative sepsis. A HU cut-off value of 6.3 could diagnose the presence of pyonephrosis with 71.6% sensitivity and 71.5% specificity (AUC 0.76; 95%CI: 0.66–0.85). At multivariable logistic regression analysis HU ≥ 6.3 (p ≤ 0.001) was independently associated with pyonephrosis. Patients who developed sepsis had higher HU values (p ≤ 0.001) than those without sepsis. A HU cut-off value of 7.3 could diagnose the presence of sepsis with 76.5% sensitivity and 74.3% specificity (AUC 0.79; 95%CI: 0.71–0.90). At multivariable logistic regression analysis, HU ≥ 7.3 (p ≤ 0.001) was independently associated with sepsis, after accounting for clinical and laboratory parameters. Measuring HU values of the fluid of the dilated collecting system may be useful to differentiate pyonephrosis from hydronephrosis and to predict septic complications in patients with obstructive uropathy.

Is rising BMI associated with an increased rate of clinically relevant pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma?

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 360-360
Author(s):  
Evan Scott Glazer ◽  
Yixuan Zhou ◽  
Justin Drake ◽  
Jeremiah Lee Deneve ◽  
Stephen W Behrman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Logistic Regression Analysis ◽  
Older Age ◽  
Ductal Adenocarcinoma ◽  
Multivariable Logistic Regression Analysis ◽  
Term Survival ◽  
Increased Risk

360 Background: Clinically relevant pancreatic fistula (CR-POPF), following distal pancreatectomy (DP) remains a clinical challenge. Prior studies investigating the relationship between body mass index (BMI) and CR-POPF have yielded conflicting results. We examined this relationship utilizing our institutional database and hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who underwent DP for PDAC at a single institution from 2007 to 2018 were retrospectively reviewed. A CR-POPF was defined as ISGPS grade B or C fistula. Uni- and multi-variable logistic regression analysis to assess factors associated with CR-POPF following DP was performed, controlling for factors such as gland texture, operative drain placement, gender, and smoking status. Results: 78 patients met the inclusion criteria. 51% were female, 51% were Caucasian, and the average age was 59 ± 15 years. The median BMI was 26 (interquartile range 24 to 29). Overall, 19% (n = 15) of patients had a CR-POPF. With a mean follow up 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with long-term survival (P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (OR = 0.95, P = 0.015) while increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). After controlling for multiple factors on multivariable logistic regression analysis, BMI (OR = 1.12, P = 0.035) was the only factor associated with development of a CR-POPF while older age (OR = 0.94, P < 0.001) was slightly protective of CR-POPF development. Conclusions: For patients undergoing DP for PDAC, increasing BMI is associated with an increased risk of CR-POPF, independent of other factors. These findings should be considered during preoperative counseling. Although there is no specific cut-off for the association between BMI and CR-POPF, efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI based on this data.

scholarly journals Weight Loss in Parkinson’s Disease: The Relationship with Motor Symptoms and Disease Progression

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Maria G. Cersosimo ◽  
Gabriela B. Raina ◽  
Luis A. Pellene ◽  
Federico E. Micheli ◽  
Cristian R. Calandra ◽  
...  
Keyword(s):  
Weight Loss ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Disease Progression ◽  
Logistic Regression Analysis ◽  
Disease Duration ◽  
Multivariable Logistic Regression Analysis ◽  
Single Session ◽  
Multivariable Logistic Regression ◽  
The Relationship

Objectives.To determine the prevalence of weight loss (WL) in PD patients, its relationship to the severity of motor manifestations and appetite changes.Methods.144 PD patients and 120 controls were evaluated in a single session. All subjects were asked about changes in body weight and appetite. PD patients were examined with the UPDRS-III and the Hoehn and Yahr (HY) scales. Subscores of tremor, bradykinesia /rigidity, and non-dopaminergic symptoms (NDS) were analyzed individually. Multivariable logistic regression analysis was used to determine an association between WL and PD motor manifestations.Results.48.6 % of PD patients presented WL compared to 20.8 % of controls (p < 0.001). Weight losers were significantly older and had longer disease duration, higher scores in HY stages, UPDRS-III, and NDS-subscore. Multivariable logistic regression analysis demonstrated that WL was associated with NDS-subscore (p= 0.002; OR: 1.33) and older age (p= 0.037; OR: 1.05). Appetite in PD cases losing weight was unchanged (35.7 %), decreased (31.4 %), or even increased (32.9).Conclusions.Our results showed that WL occurs in almost half of PD patients and it is largely the consequence of disease progression rather than involuntary movements or a decrease in food intake.

scholarly journals Treatment Strategy of Oxaliplatin-induced Peripheral Neuropathy: A Retrospective, Nationwide Study

2021 ◽  
Author(s):  
Satoshi Yokoyama ◽  
Chihiro Nakagawa ◽  
Kouichi Hosomi
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Peripheral Neuropathy ◽  
Logistic Regression Analysis ◽  
Multivariable Logistic Regression Analysis ◽  
Prescription Patterns ◽  
Nationwide Study ◽  
Multivariable Logistic Regression ◽  
Oxaliplatin Treatment ◽  
Prolonged Duration

Abstract PurposeChemotherapy-induced peripheral neuropathy (CIPN) is a common adverse events of cancer treatment; however, no drug is recommended for the prevention of CIPN. In Japan, several drugs such as Gosha-Jinki-Gan and duloxetine have been frequently administered for the treatment of CIPN. The aim of this study was to elucidate prescription patterns of drugs administered for the treatment of CIPN caused by oxaliplatin and the association between these drugs and the duration of oxaliplatin treatment.MethodsWe conducted a retrospective nationwide study using the JMDC administrative claims database (January 2005–June 2020). Patients newly treated with oxaliplatin were identified, and prescription patterns of CIPN medication including Gosha-Jinki-Gan, pregabalin, duloxetine, mecobalamin, and mirogabalin were investigated. The primary outcome was the duration of oxaliplatin treatment. Multivariable logistic regression analysis was performed to examine the association between CIPN medication and duration of oxaliplatin treatment.ResultsA total of 4,739 patients who newly received oxaliplatin were identified. Of these, 759 (16.0%) had received CIPN medication. Duloxetine was administered in 99 (2.1%) patients. Multivariable logistic regression analysis revealed that CIPN medication was significantly associated with the prolonged duration of oxaliplatin treatment (odds ratio: 2.35, [95% confidence interval: 1.99-2.77]).ConclusionReal-world data demonstrated that the administration rate of CIPN medication was higher in patients who underwent oxaliplatin treatment for over 6 months. Increasing administration preference of duloxetine and conducting prospective studies to verify the causal relationship between CIPN medication and prolonged duration of oxaliplatin treatment are needed.

scholarly journals P827 Left atrial contractile function is the main correlate of atrial fibrillation in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Rosca ◽  
L Mandes ◽  
D Ciuperca ◽  
A Calin ◽  
C C Beladan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Hypertrophic Cardiomyopathy ◽  
Logistic Regression Analysis ◽  
Left Atrial ◽  
Contractile Function ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression ◽  
And Function

Abstract Background Given the negative impact of atrial fibrillation (AF) in patients (pts) with hypertrophic cardiomyopathy (HCM), finding new and better predictors of AF is clinically important, especially for patients considered at low or intermediate risk based on current recommendations (i.e. left atrial diameter, LAD &lt;45 mm). Purpose To assess the relationship between left atrial (LA) remodelling (size and function) and the presence of paroxysmal AF in HCM patients with and without increased LAD. Methods A comprehensive echocardiogram was performed in 110 consecutive pts (52 ± 17 years, 50 men) with HCM, in sinus rhythm. Indexed LA volume (LAVi), maximum left ventricular wall thickness (LVWT), LV ejection fraction, E/e’ ratio were determined. Global longitudinal LV strain (GLS) and LA strain parameters (LAɛ, SSr, ASr) were assessed by speckle tracking echocardiography. Patients were divided into two groups according to the presence (30 pts) or absence (80 pts) of documented paroxysmal AF (24/48 h ambulatory ECG recordings) Results Patients with AF were older than pts without AF (p &lt; 0.001). LAD, LAVi, E/e’ were significantly higher, while LAɛ, ESr, ASr were significantly lower in pts with AF compared to pts without AF (p &lt; 0.05 for all). There were no significant differences between pts with and without AF regarding: gender, LVWT, GLS, the presence and severity of LV outflow tract obstruction (p &gt; 0.05 for all). The correlates of AF in the whole HCM study population were: age (OR = 1.05, p = 0.001), ASr (OR = 10.1, p &lt; 0.001), LAVi (OR = 1.03, p = 0.004), LAD (OR = 1.2, p = 0.001), E/e’(OR = 1.05, p = 0.02) and mitral regurgitation degree (OR = 1.6, p = 0.04). ASr had the best area under the curve (AUC: 0.74) with a cutoff of -0.88 s-1 for identifying HCM patients with AF (sensitivity: 80%, specificity: 65%). At multivariable logistic regression analysis, age, LAVi and ASr emerged as the only independent correlates of AF. 14 of the 71 patients with a LAD &lt; 45 mm had paroxysmal AF. In this selected population, pts with AF were older (p = 0.001), had higher values for E/e’ (p = 0.04) and lower values for ASr (p = 0.02) than pts without AF. Moreover, in this subgroup of pts, at multivariable logistic regression analysis, ASr correlated with AF independently of age, LA dimensions, LV hypertrophy or E/e’ (OR = 10.008, 95% CI 1.297-77.219, p = 0.02). Conclusions In pts with HCM, age, LAVi and ASr, were independently related to the presence of AF, while LAD was not. Moreover, in the subgroup of HCM pts with LAD &lt; 45 mm, ASr (reflecting LA contractile function) was the only LA remodelling parameter correlated with the presence of AF. The assessment of LA volume and function can provide further insights into the risk stratification of pts with HCM, especially in pts considered at lower risk for AF based on the assessment of classical risk parameters, such as LAD.

Correlates of hospice use in elders with cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9579-9579
Author(s):  
C. Owusu ◽  
S. Koroukian ◽  
E. Madigan
Keyword(s):  
Colorectal Cancer ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Clinical Data ◽  
Logistic Regression Analysis ◽  
Functional Limitations ◽  
Multivariable Logistic Regression Analysis ◽  
Geriatric Syndromes ◽  
Multivariable Logistic Regression ◽  
Hospice Use

9579 Background: Use of hospice has remained relatively low. We aim to identify correlates of hospice in elders with cancer, hypothesizing that the presence of functional limitations and geriatric syndromes are associated with hospice use, independently of age and comorbidities. Methods: The study population included Ohio residents age 65 years or older, diagnosed with breast (n=774), prostate (n=271), or colorectal cancer (n=1,011) during the period 07/1999–12/2001, receiving care through the Medicare fee-for-service system, and first receiving home health care (HHC) in the 30 days before or after cancer diagnosis. This strategy was aimed at obtaining clinical data at baseline, as documented in the HHC Outcome Assessment Information Set (OASIS). Our data source consisted of records from the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare data, and the OASIS. In addition to descriptive analyses, multivariable logistic regression analysis was conducted to evaluate the association between hospice use, comorbidity, functional limitations, and geriatric syndromes, after adjusting for patient and tumor attributes. Results: Respectively across the anatomic cancer sites, hospice was used by 9.8%, 22.5%, and 25.1%, of patients. Hospice use increased significantly with age, and was higher among men than women. No differences in hospice use were observed by race, Medicaid status, or the presence of comorbidities. Conversely, hospice use was significantly higher (p < 0.001) among patients with functional limitations (24.0% vs. 16.5% in all others), and those with geriatric syndromes (23.8% vs. 15.3% in all others). Results from the multivariable logistic regression analysis indicated that comorbidities and functional limitations were not associated with hospice use, whereas patients with geriatric syndromes were 1.5 times as likely as those without geriatric syndromes to use hospice (adjusted odds ratio (AOR): 1.5, 95% confidence interval (1.2–1.9). Conclusions: The findings highlight the importance of clinical data that extend beyond comorbidities, when analyzing hospice use. Given marked differences in the disease trajectory across the anatomical cancer sites, future studies should analyze these associations separately in breast, prostate, and colorectal cancer patients. No significant financial relationships to disclose.

Outcomes of cancer patients with takotsubo cardiomyopathy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18101-e18101
Author(s):  
Achuta Kumar Guddati ◽  
Gagan Kumar ◽  
Iuliana Shapira ◽  
Parijat Saurav Joy
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Logistic Regression Analysis ◽  
Takotsubo Cardiomyopathy ◽  
Primary Diagnosis ◽  
Multivariable Logistic Regression Analysis ◽  
Solid Organ ◽  
Multivariable Logistic Regression

e18101 Background: Chemotherapy induced cardiomyopathy is an important complication of some chemotherapeutic agents. The stress of a cancer diagnosis and ongoing chemotherapy may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCP) in cancer patients is unknown. The incidence of TCP and related outcomes in cancer patients was investigated in this study. Methods: The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCP with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis. Results: From 2007 through 2013, an estimated 122,750 adults were admitted with a diagnosis of TCP. In 2013, the incidence of admissions in US of patients with coexisting TCP and malignancy was 1.13%. Admissions in 34,957 patients were for a primary diagnosis of TCP with 91.7% females; overall, 665 (2.1%) had solid organ cancer, 237 (0.74%) had hematological malignancy and 354 (1.11%) had metastatic cancer. Patients admitted for TCP with coexisting malignancy had a significantly higher mortality (13.8% vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29291 vs. $ 36231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCP and without any underlying malignancy, males had a higher mortality (4.02% vs. 1.03%, p < 0.0001) whereas there was no gender difference in mortality in those with coexisting malignancy (6.25% vs 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001), venous thromboembolic disease (OR 4.52, p = 0.004), malnutrition (OR 2.41, p = 0.006) and heart failure (OR 1.918, p = 0.004). Conclusions: Outcomes are significantly worse in patients with TCP and solid malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCP is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.

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