scholarly journals Relative platelet reduction provides a better pathophysiologic signature of coagulopathy in sepsis than absolute platelet count: A large multicenter eICU database analysis

2020 ◽  
Author(s):  
Daisuke Kasugai ◽  
Masayuki Ozaki ◽  
Kazuki Nishida ◽  
Yukari Goto ◽  
Kunihiko Takahashi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Platelet Count ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Mortality Risk ◽  
The United States ◽  
Research Database ◽  
The Absolute ◽  
The Impact

Abstract BackgroundIn sepsis-associated coagulopathy and disseminated intravascular coagulation, the relative platelet reduction may reflect the severity of the coagulopathy. However, there is little evidence to support its clinical significance and most of the coagulopathy criteria in sepsis focus on absolute platelet count. The aim of this study was to estimate the impact of the relative platelet reduction and the absolute platelet count on outcomes in sepsis.MethodsMulticenter retrospective observational study was performed using the eICU Collaborative Research Database, which includes 335 intensive care units (ICUs) in the United States. Patients with sepsis and with an ICU stay of longer than 2 days were included. The estimated effect of the relative platelet reduction and the absolute platelet count on mortality and coagulopathy-related complications were evaluated.ResultsOf 30,114 septic patients, 26,193 were included in this study. Multivariable mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with more profound degrees of relative reduction in platelet count between day 1 and day 2, which is independent from the resultant absolute platelet count. Adjusted odds ratio (OR) for in-hospital mortality was 1.28 (95% confidence interval [CI], 1.23-1.32); 1.86 (95% CI, 1.75-1.97); 2.99 (95% CI, 2.66-3.36); and 6.05 (95% CI, 4.40 - 8.31) for 20-40%, 40-60%, 60-80%, and more than 80%, respectively, compared to less than 20% decrease in platelet. Interaction for mortality odds between relative platelet reduction and resultant absolute platelet count was not found (p=0.33). In multivariate logistic regression analysis, the estimated effects of platelet reduction ≧50% for coagulopathy-related complications were greater than that of platelet counts ≦100,000/μL on day 2 (OR for composite outcome [95%CI], 2.03 [1.68 - 2.45] and 1.18 [1.07 - 1.30], respectively).ConclusionThe magnitude of platelet reduction not only represents mortality risk but also provides a better signature of coagulopathy in sepsis than absolute platelet count, and may, therefore, be more plausible for the criteria of coagulopathy in sepsis.

scholarly journals Relative platelet reductions provide better pathophysiologic signatures of coagulopathies in sepsis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daisuke Kasugai ◽  
Masayuki Ozaki ◽  
Kazuki Nishida ◽  
Yukari Goto ◽  
Kunihiko Takahashi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Mortality Risk ◽  
The United States ◽  
Research Database ◽  
Mixed Effect ◽  
Platelet Counts ◽  
The Impact

AbstractIn sepsis-associated coagulopathies and disseminated intravascular coagulation, relative platelet reductions may reflect coagulopathy severity. However, limited evidence supports their clinical significance and most sepsis-associated coagulopathy criteria focus on the absolute platelet counts. To estimate the impact of relative platelet reductions and absolute platelet counts on sepsis outcomes. A multicenter retrospective observational study was performed using the eICU Collaborative Research Database, comprising 335 intensive care units (ICUs) in the United States. Patients with sepsis and an ICU stay > 2 days were included. Estimated effects of relative platelet reductions and absolute platelet counts on mortality and coagulopathy-related complications were evaluated. Overall, 26,176 patients were included. Multivariate mixed-effect logistic regression analysis revealed marked in-hospital mortality risk with larger platelet reductions between days one and two, independent from the resultant absolute platelet counts. The adjusted odds ratio (OR) [95% confidence intervals (CI)] for in-hospital mortality was 1.28[1.23–1.32], 1.86[1.75–1.97], 2.99[2.66–3.36], and 6.05[4.40–8.31] for 20–40%, 40–60%, 60–80%, and > 80% reductions, respectively, when compared with a < 20% decrease in platelets (P < 0.001 for each). In the multivariate logistic regression analysis, platelet reductions ≥ 11% and platelet counts ≤ 100,000/μL on day 2 were associated with high coagulopathy-related complications (OR [95%CI], 2.03 and 1.18; P < 0.001 and P < 0.001), while only platelet reduction was associated with thromboembolic complications (OR [95%CI], 1.43 [1.03–1.98], P < 0.001). The magnitude of platelet reductions represent mortality risk and provides a better signature of coagulopathies in sepsis; therefore, it is a plausible criterion for sepsis-associated coagulopathies.

scholarly journals D-Dimer as Biomarker for Early Prediction of Clinical Outcomes in Patients With Severe Invasive Infections Due to Streptococcus Pneumoniae and Neisseria Meningitidis

2021 ◽  
Vol 8 ◽  
Author(s):  
Simone Meini ◽  
Emanuela Sozio ◽  
Giacomo Bertolino ◽  
Francesco Sbrana ◽  
Andrea Ripoli ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Streptococcus Pneumoniae ◽  
Hospital Mortality ◽  
Neisseria Meningitidis ◽  
Clinical Outcomes ◽  
Logistic Regression Analysis ◽  
Mortality Risk ◽  
Invasive Infections ◽  
D Dimer

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection; no current clinical measure adequately reflects the concept of dysregulated response. Coagulation plays a pivotal role in the normal response to pathogens (immunothrombosis), thus the evolution toward sepsis-induced coagulopathy could be individuate through coagulation/fibrinolysis-related biomarkers. We focused on the role of D-dimer assessed within 24 h after admission in predicting clinical outcomes in a cohort of 270 patients hospitalized in a 79 months period for meningitis and/or bloodstream infections due to Streptococcus pneumoniae (n = 162) or Neisseria meningitidis (n = 108). Comparisons were performed with unpaired t-test, Mann-Whitney-test or chi-squared-test with continuity correction, as appropriate, and multivariable logistic regression analysis was performed with Bayesian model averaging. In-hospital mortality was 14.8% for the overall population, significantly higher in S. pneumoniae than in N. meningitidis patients: 19.1 vs. 8.3%, respectively (p = 0.014). At univariable logistic regression analysis the following variables were significantly associated with in-hospital mortality: pneumococcal etiology, female sex, age, ICU admission, SOFA score, septic shock, MODS, and D-dimer levels. At multivariable analysis D-dimer showed an effect only in N. meningitidis subgroup: as 500 ng/mL of D-dimer increased, the probability of unfavorable outcome increased on average by 4%. Median D-dimer was significantly higher in N. meningitidis than in S. pneumoniae patients (1,314 vs. 1,055 ng/mL, p = 0.009). For N. meningitidis in-hospital mortality was 0% for D-dimer &lt;500 ng/mL, very low (3.5%) for D-dimer &lt;7,000 ng/mL, and increased to 26.1% for D-dimer &gt;7,000 ng/mL. Kaplan-Meier analysis of in-hospital mortality showed for N. meningitidis infections a statistically significant difference for D-dimer &gt;7,000 ng/mL compared to values &lt;500 ng/mL (p = 0.021) and 500–3,000 ng/mL (p = 0.002). For S. pneumoniae the mortality risk resulted always high, over 10%, irrespective by D-dimer values. In conclusion, D-dimer is rapid to be obtained, at low cost and available everywhere, and can help stratify the risk of in-hospital mortality and complications in patients with invasive infections due to N. meningitidis: D-dimer &lt;500 ng/mL excludes any further complications, and a cut-off of 7,000 ng/mL seems able to predict a significantly increased mortality risk from much &lt;10% to over 25%.

Abstract 1534: Diabetes Mellitus Is An Independent Predictor Of Mortality In Defibrillator Recipients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Carol Chen-Scarabelli ◽  
Tiziano M Scarabelli
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Mortality Risk ◽  
Independent Predictor ◽  
Mortality Data ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
The Impact

Background: Previous studies have shown an increased morbidity and mortality risk in patients with diabetes mellitus (DM) undergoing percutaneous coronary interventions and cardiac surgery. However, the impact of DM on mortality in patients with implantable cardioverter defibrillators (ICDs) is unknown. Aim: to investigate whether DM was associated with increased mortality risk in patients with ICDs Methods: A retrospective review of all ICD patients followed within a consecutive 2.5 year period was performed. Baseline characteristics and mortality data were compared between DM and non-DM patients. Mann Whitney test was used to analyze the differences between the means, and multivariate logistic regression analysis was performed to identify independent predictors of mortality. Results: A total of 336 patients with ICDs (including 141 patients with DM and 195 without DM) were studied. The mean age was 66.8 ± 9.6 years in the overall population, with no significant difference in baseline characteristics between the 2 groups, except for beta-blocker therapy, creatinine, and estimated glomerular infiltration rate (EGFR). Use of beta-blockers was greater in the non-DM group (92.8% vs 84.4%, p=0.02). Renal function was worse in the DM group, as documented by a higher serum creatinine (1.6 ± 0.8 mg/dl in DM vs 1.38 ± 0.74 mg/dl in non-DM, p = 0.003) and a lower EGFR (55.9 ± 22.9 ml/min/1.73m 2 vs 63.5 ± 19.9 ml/min/1.73m 2 , p=0.0005). Although the incidence of VT was not significantly different between the two groups, there was a significantly higher mortality in the DM group (27.7% vs 11.3% in non-DM, p=0.0002). On multivariate stepwise logistic regression analysis, DM was a significant independent predictor of mortality (OR 2.38, 95% CI 1.3– 4.36, p =0.005). Conclusion: DM is an independent predictor of mortality in ICD patients. Prevention of DM, as well as early diagnosis and intervention, should be emphasized in order to reduce the growing epidemic of type 2 DM and its associated complications.

scholarly journals Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 722
Author(s):  
Yusuke Ito ◽  
Hidetaka Wakabayashi ◽  
Shinta Nishioka ◽  
Shin Nomura ◽  
Ryo Momosaki
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Nutritional Status ◽  
Logistic Regression Analysis ◽  
Short Form ◽  
Mini Nutritional Assessment ◽  
Functional Independence ◽  
Rehabilitation Ward ◽  
The Impact

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

scholarly journals Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning

2021 ◽  
Vol 16 (1) ◽  
pp. 703-710
Author(s):  
Yuhang Mu ◽  
Boqi Hu ◽  
Nan Gao ◽  
Li Pang
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Poor Prognosis ◽  
Prognostic Value ◽  
Organophosphorus Pesticide ◽  
Neutrophil To Lymphocyte Ratio ◽  
Pesticide Poisoning ◽  
Lymphocyte Ratio

Abstract This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

The Impact of Extraversion and Sensation Seeking on Tourist Role

2015 ◽  
Vol 43 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Cheng-Yu Li ◽  
Shiao-Yuan Lu ◽  
Bi-Kun Tsai ◽  
Keh-Yuan Yu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Sensation Seeking ◽  
Large Scale ◽  
Personality Variables ◽  
Tourism Marketing ◽  
Large Scale Survey ◽  
And Behaviors ◽  
The Impact

In recent years, personality variables, such as extraversion and sensation seeking, have been used to investigate tourist preferences and behaviors. For this study, we classified tourist roles into three types: the familiarized mass tourist, the organized mass tourist, and the independent tourist. We investigated the impact of extraversion and sensation seeking on tourist roles in a large-scale survey of Taiwanese citizens (N = 1,249) aged 20 years and older. Using logistic regression analysis, the results indicated that sensation seeking was a significant predictor of tourist role, but extraversion was not. Compared to familiarized mass tourists, people who are sensation-seeking are more likely to become independent tourists rather than organized mass tourists. We provide suggestions for tourism marketing.

Abstract 1847: Prognostic Impact Of Previous Percutaneous Coronary Interventions On Coronary Artery Bypass Graft Surgery: A Multicentric Analysis FromThe German Federal State North-Rhine-Westphalia

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Parwis Massoudy ◽  
Matthias Thielmann ◽  
Nils Lehmann ◽  
Anja Marr ◽  
Georg Kleikamp ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Artery Bypass ◽  
Federal State ◽  
Multivariable Logistic Regression Analysis ◽  
Percutaneous Coronary ◽  
German Federal State

Background: We have previously shown that multiple prior percutaneous coronary intervention (PCI) procedures adversely affect outcome after subsequent coronary artery bypass grafting (CABG). We were now interested to investigate this effect on a multicentric basis. Methods: Eight cardiac surgical centers from the German Federal State of North-Rhine-Westphalia provided outcome data of 37140 consecutive patients having undergone isolated first-time CABG between 01/2000 and 12/2005. Twenty-two patient characteristics and outcome variables, which are part of a collection of data claimed by the national medical quality-control commission, were retrieved from the individual databases. Three groups of patients were analyzed for overall in-hospital mortality and major adverse cardiac events (MACE): Patients without a previous PCI procedure, patients with 1 previous PCI procedure and patients with ≥2 previous PCI procedures before surgery. Unadjusted univariable and risk-adjusted multivariable logistic regression analysis were applied. Computed propensity-score matching was performed based on 15 patient major risk factors to correct for and minimize selection bias. Results: A total of 10.3% of patients had 1 previous PCI procedure, and 3.7% of patients had ≥2 previous PCI procedures. Risk-adjusted multivariable logistic regression analysis of ≥2 previous PCI significantly correlated with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4–3.0; P <0.0005) and MACE (OR, 1.5; CI, 1.2–1.9; P <0.0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of ≥2 previous PCI procedures was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3–2.7; P =0.0016) and MACE (OR, 1.5; CI, 1.2–1.9; P =0.0019). Conclusions: This large multicentric trial supports earlier results of our single-center analysis, multiple previous PCI procedures significantly increased the event of in-hospital mortality and MACE after subsequent CABG.

Abstract TP21: Is Presence of Diabetes Mellitus a Key Prognostic Factor among Patients Receiving Endovascular Treatment for Acute Ischemic Stroke?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Seong-Joon Lee ◽  
Yang-Ha Hwang ◽  
Ji Man Hong ◽  
Jin Wook Choi ◽  
Dong-Hun Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Intravenous Thrombolysis ◽  
The Impact

Introduction: Given the recent positive endovascular therapy trials for acute ischemic stroke (AIS), this therapeutic strategy is now being increasingly incorporated into routine clinical practice. Identifying prognostic factors among AIS patients receiving endovascular revascularization treatments (ERT) in the real world could be important for clinicians and patients. While the impact of diabetes mellitus (DM) on IV thrombolytic outcomes after AIS has been extensively investigated, there is a paucity of data assessing effects of DM on ERT outcomes after AIS. We evaluated the impact of comorbid DM on ERT for AIS. Methods: From Jan 2011 to Feb 2016, patients with AIS who underwent ERT for cervicocephalic occlusions were consecutively enrolled into the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention - Korean Retrospective (ASIAN KR) registry from 3 hospitals. Patients were excluded if onset to puncture time over 8 hours, in-hospital stroke, or unavailable 3-month mRS. DM was diagnosed if a patient had the history, or hemoglobin A1c on admission was over 6.5. Univariate analysis was performed to compare the characteristics between DM and non-DM population. Multiple logistic regression analysis was used to validate the effect of comorbid DM on 3 month outcomes. Results: Of 721 patients, 667 (93%) were finally included, with 233 DM patients and 434 non-DM patients. In the univariate analysis, comorbidity with hypertension (71.2% vs. 58.3%, p=0.001) and dyslipidemia (36.7% vs. 26.7%, p=0.012) were more frequent in the DM population. Periprocedural factors such as target vessels, intravenous thrombolysis, and final reperfusion grades did not differ. Good outcomes with mRS 0-2 were less frequent in the DM population (43.3% vs. 53.7%, p=0.011). In the logistic regression analysis adjusting age, male sex, initial NIHSS, premorbid mRS, hypertension history, atrial fibrillation, intravenous thrombolysis, onset to puncture time and successful reperfusion, DM was an independent predictor of poor outcomes (mRS 3-6; 1.933, 1.274-2.933, p=0.002). Conclusion: In patients receiving ERT for AIS due to cervicocephalic artery occlusions, the presence of DM as a comorbidity confers greater odds of a poor functional outcome.

Trust in police as an influencing factor on trust in government: 2SLS analysis using perception of safety

2020 ◽  
Vol 43 (4) ◽  
pp. 541-558
Author(s):  
Jisu Jeong ◽  
Seunghui Han
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Trust In Government ◽  
Content Type ◽  
Perception Of Safety ◽  
Ordered Logistic Regression ◽  
The Impact ◽  
The Relationship ◽  
Trust In Police

PurposeCitizen trust in police is important in terms of citizen consent to government policies and of police achieving their organizational goals. In the previous study, improvements in police policy, organizational operation and policing activities were developed to clarify which factors influence trust in police and how trust can be improved. This research raises the question, would changes in trust in police have an impact on trust in government? In this paper, this research question is discussed theoretically and the causal relationship analyzed empirically by applying OLS, ordered logistic, 2SLS and logistic regressions.Design/methodology/approachThe basic analysis methods are to apply the OLS and the ordered logistic regression. OLS regression analysis is an analytical method that minimizes an error range of a regression line. The assumptions for OLS are: linearity, independence, equilibrium, extrapolation and multicollinearity issues. These problems were statistically verified and analyzed, in order to confirm the robustness of the analysis results by comparing the results of the ordered logistic regression because of the sequence characteristic of the dependent variable. The data to be used in this study is the Asia Barometer Survey in 2013.FindingsTrust in police and citizen perception of safety are analyzed as important factors to increase trust in the government. The effects of trust in police are more significant than the effects of control variables, and the direction and strength of the results are stable. The effect of trust in police on trust in government is strengthened by the perception of safety (IV). In addition, OLS, ordered logistic regression analysis, which analyzed trust in central government and local government, and logistic regression analysis categorized by trust and distrust show the stability.Research limitations/implicationsThis paper has implications in terms of theoretical and empirical analysis of the relationship between trust in police and trust in government. In addition, the impact of perception of safety on trust in police can be provided to police officers, policymakers and governors who are seeking to increase trust in government. This paper is also meaningful in that it is the microscopic research based on the citizens' survey. One of the limitations of macroscopic research is that it does not consider the individual perceptions of citizens.Practical implicationsThe results of this paper can confirm the relationship of the virtuous cycle, which is perception of safety – trust in police – trust in government. The police will need to provide security services to improve citizens' perception of safety and make great efforts to create safer communities and society. Trust in police formed through this process can be an important component of trust in government. By making citizens feel safer and achieving trust in police, ultimately, trust in government will be improved.Originality/valueThe police perform one of the essential roles of government and are one of the major components of trust in government, but the police sector has been neglected compared to the roles of the economic and political sectors. These influences of macro factors are too abstract to allow specific policy directions to be suggested. If we consider trust in police, and factors that can improve trust in government, we can suggest practical policy alternatives.

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