Preoperative Venous Thromboembolism in Orthopedic Oncology Patients: Incidence, Risk Factors, and D-Dimer Cutoff Value

Abstract Background: Venous thromboembolism (VTE) is known as one of the major complications in patients with malignant tumors and orthopedic disorders. Patients undergoing surgery for orthopedic oncology are at an increased risk for thromboembolic events. However, there are limited studies regarding the incidence and risk factors for preoperative VTE in orthopedic oncology patients.Methods: The aim is to determine the incidence and risk factors of preoperative VTE by screening with D-dimer. We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for orthopedic oncology, had preoperative D-dimer levels measured and were subsequently screened for VTE by lower extremity venous ultrasonography and contrast-enhanced computed tomography (CT) scans if necessary. Statistical analyses were performed to examine the incidence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the cutoff value of D-dimer for the diagnosis of VTE.Results: A total of 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors and 12 with hematologic malignancies) were included. The value of D-dimer was high in 79 patients. VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that, age ≥60 years (P = 0.021), and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the cutoff value of D-dimer for the diagnosis of VTE was 1.53 µg/mL (sensitivity of 89.5% and specificity of 79.4%).Conclusions: Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in orthopedic oncology patients. D-dimer was not significantly different in the multivariate analysis because D-dimer is affected by a wide variety of conditions, such as malignancy and aging. Patients with high D-dimer levels and the abovementioned risk factors are at increased risk of preoperative VTE, and additional ultrasonography should be considered.Trial registration: Our study was approved by the institutional review board. The registration number is B200600056. The registration date was July 13, 2020.

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Incidence and risk factors of preoperative venous thromboembolism in patients with malignant musculoskeletal tumors: an analysis based on D-dimer screening and imaging

10.21203/rs.3.rs-1095414/v1 ◽

2021 ◽

Author(s):

Kenta Hayashida ◽

Yusuke Kawabata ◽

Keiju Saito ◽

Shintaro Fujita ◽

Hyonmin Choe ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Roc Analysis ◽

Tumor Location ◽

Lower Limbs ◽

Cutoff Value ◽

Increased Risk ◽

Orthopedic Oncology ◽

Independent Risk Factors ◽

D Dimer

Abstract Background: Venous thromboembolism (VTE) is a major complication in patients with malignant tumors and orthopedic disorders. Although it is known that patients undergoing surgery for orthopedic oncology are at an increased risk of thromboembolic events, only few studies have investigated this risk in detail. Therefore, the aim of this study was to determine the incidence and risk factors for preoperative VTE in orthopedic oncology patients.Methods: We retrospectively reviewed the medical records of 270 patients who underwent surgical procedures, including biopsy for orthopedic oncology, have undergone measurements of preoperative D-dimer levels, and were subsequently screened for VTE by lower extremity venous ultrasonography and/or contrast-enhanced computed tomography scans. Statistical analyses were performed to examine the incidence and risk factors for VTE. Receiver operating characteristic (ROC) analysis was performed to verify the D-dimer cutoff value for the diagnosis of VTE.Results: Overall, 199 patients (103 with primary soft tissue sarcomas, 38 with primary bone sarcomas, 46 with metastatic tumors, and 12 with hematologic malignancies) were included. D-dimer levels were high in 79 patients; VTE was detected in 19 patients (9.5%). Multivariate analysis indicated that age ≥60 years (P = 0.021) and tumor location in the lower limbs (P = 0.048) were independent risk factors for VTE. ROC analysis showed that the D-dimer cutoff value for the diagnosis of VTE was 1.53 µg/mL; the sensitivity and specificity were 89.5% and 79.4%, respectively.Conclusions: Our study indicated that age and tumor location in the lower limbs were independent risk factors for preoperative VTE in orthopedic oncology patients. D-dimer levels were not associated with VTE in the multivariate analysis, likely because they are affected by a wide variety of conditions, such as malignancy and aging. Patients with high D-dimer levels and the identified risk factors are at an increased risk of preoperative VTE, and additional ultrasonography should be considered.Trial registration: Our study was approved by the institutional review board. The registration number is B200600056. The registration date was July 13, 2020.

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Early and Late Postoperative Seizures in Meningioma Patients and Prediction by a Recent Scoring System

Cancers ◽

10.3390/cancers13030450 ◽

2021 ◽

Vol 13 (3) ◽

pp. 450

Author(s):

Peter Baumgarten ◽

Mana Sarlak ◽

Daniel Monden ◽

Andrea Spyrantis ◽

Simon Bernatz ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Tumor Volume ◽

Total Risk ◽

Increased Risk ◽

Independent Risk Factors ◽

Temporal Location ◽

Meningioma Surgery ◽

Impaired Quality

Seizures are among the most common symptoms of meningioma. This retrospective study sought to identify risk factors for early and late seizures in meningioma patients and to evaluate a modified STAMPE2 score. In 556 patients who underwent meningioma surgery, we correlated different risk factors with the occurrence of postoperative seizures. A modified STAMPE2 score was applied. Risk factors for preoperative seizures were edema (p = 0.039) and temporal location (p = 0.038). For postoperative seizures preoperative tumor size (p < 0.001), sensomotory deficit (p = 0.004) and sphenoid wing location (p = 0.032) were independent risk factors. In terms of postoperative status epilepticus; sphenoid wing location (p = 0.022), tumor volume (p = 0.045) and preoperative seizures (p < 0.001) were independent risk factors. Postoperative seizures lead to a KPS deterioration and thus an impaired quality of life (p < 0.001). Late seizures occurred in 43% of patients with postoperative seizures. The small sub-cohort of patients (2.7%) with a STAMPE2 score of more than six points had a significantly increased risk for seizures (p < 0.001, total risk 70%). We concluded that besides distinct risk factors, high scores of the modified STAMPE2 score could estimate the risk of postoperative seizures. However, it seems not transferable to our cohort

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Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

Sleep And Breathing ◽

10.1007/s11325-020-02287-8 ◽

2021 ◽

Author(s):

Maria Värendh ◽

Christer Janson ◽

Caroline Bengtsson ◽

Johan Hellgren ◽

Mathias Holm ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Health ◽

Smoking Status ◽

Northern Europe ◽

Nasal Breathing ◽

Nasal Symptoms ◽

Increased Risk ◽

Study Population ◽

Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

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Higher D-dimer level in the early third trimester predicts the occurrence of postpartum hemorrhage

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0287 ◽

2016 ◽

Vol 44 (5) ◽

Author(s):

Naho Endo-Kawamura ◽

Mana Obata-Yasuoka ◽

Hiroya Yagi ◽

Rena Ohara ◽

Yuko Nagai ◽

...

Keyword(s):

Risk Factors ◽

Postpartum Hemorrhage ◽

Blood Parameters ◽

Demographic Characteristics ◽

Activity Level ◽

Late Gestation ◽

Antithrombin Activity ◽

Estimated Blood Loss ◽

Independent Risk Factors ◽

D Dimer

AbstractThis study aimed to determine effective predictive factors for primary postpartum hemorrhage (PPH) among clinical blood parameters associated with coagulation and fibrinolysis and demographic characteristics.We retrospectively studied 1032 women who underwent determinations of clinical blood parameters at gestational week (GW) 29–32 and GW 35–37 and gave birth to singleton infants at our hospital between January 2011 and December 2013. PPH was defined as estimated blood loss ≥700 mL. Multivariate logistic regression analyses were used to determine independent risk factors and odds ratios (OR) for PPH.PPH occurred in 104 of 1032 women (10%). Three blood variables, fibrinogen level <4.0 g/L (OR [95% CI], 1.96 [1.18–3.27]), antithrombin activity <85% of normal activity level (1.84 [1.05–3.21]), and D-dimer level >2.7 μg/mL (2.03 [1.29–3.19]) at GW 35–37, and three demographic characteristics, maternal age ≥35 years (1.75 [1.15–2.68]), BMI >28.2 kg/mAmong blood parameters, higher D-dimer levels and lower levels of antithrombin activity and fibrinogen in late gestation were independent risk factors for PPH.

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Abstract T P231: Does Intraventricular Hemorrhage Lead to a Normal Pressure Hydrocephalus-Like Syndrome?

Stroke ◽

10.1161/str.45.suppl_1.tp231 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Andrew J Kruger ◽

Matthew Flaherty ◽

Padmini Sekar ◽

Mary Haverbusch ◽

Charles J Moomaw ◽

...

Keyword(s):

Risk Factors ◽

Normal Pressure Hydrocephalus ◽

Barthel Index ◽

Intraventricular Hemorrhage ◽

Normal Pressure ◽

Stroke Study ◽

Increased Risk ◽

Independent Risk Factors ◽

Poor Outcomes

Background: Intracerebral hemorrhage (ICH) has the highest short and long-term morbidity and mortality rates of stroke subtypes. While increased intracranial pressure due to the presence of intraventricular hemorrhage (IVH) may relate to early poor outcomes, the mechanism of reduced 3-month outcome with IVH is unclear. We hypothesized that IVH may cause symptoms similar to normal pressure hydrocephalus (NPH), specifically urinary incontinence and gait disturbance. Methods: We used interviewed cases from the Genetic and Environmental Risk Factors for Hemorrhagic Stroke Study (7/1/08-12/31/12) that had 3-month follow-ups available. CT images were analyzed for ICH volume and location, and IVH presence and volume. Incontinence and dysmobility were defined by Barthel Index at 3 months. We chose a Barthel Index score of bladder less than 10 and mobility less than 15 to define incontinence and dysmobility, respectively. Multivariate analysis was used to assess independent risk factors for incontinence and dysmobility. ICH and IVH volumes were log transformed because of non-normal distributions. Results: Barthel Index was recorded for 308 ICH subjects, of whom 106 (34.4%) had IVH. Presence of IVH was independently associated with both incontinence (OR 2.7; 95% CI 1.4-5.2; p=.003) and dysmobility (OR 2.5; 95% CI 1.4-4.8; p=.003). The Table shows that increasing IVH volume was also independently associated with both incontinence and dysmobility after controlling for ICH location, ICH volume, age, baseline mRS, and admission GCS. Conclusion: Our data show that patients with IVH after ICH are at an increased risk for developing the NPH-like symptoms of incontinence and dysmobility. This may explain the worse long-term outcomes of patients who survive ICH with IVH than those who had ICH alone. Future studies are needed to confirm this finding, and to determine the effect of IVH interventions such as shunt or intraventricular thrombolysis.

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Positive Signs on Physical Examination Are Not Always Indications for Endotracheal Tube Intubation in Patients with Facial Burn

10.21203/rs.3.rs-128508/v1 ◽

2020 ◽

Author(s):

Ruo-Yi Huang ◽

Szu-Jen Chen ◽

Yen-Chang Hsiao ◽

Ling-Wei Kuo ◽

Chien-Hung Liao ◽

...

Keyword(s):

Risk Factors ◽

Endotracheal Tube ◽

Odds Ratio ◽

Inhalation Injury ◽

Burn Patients ◽

Shortness Of Breath ◽

Airway Protection ◽

Increased Risk ◽

Independent Risk Factors ◽

Facial Burn

Abstract BackgroundAfter clinical evaluation in the emergency department (ED), facial burn patients are usually intubated to protect their airways. However, the possibility of unnecessary intubation or delayed intubation after admission exists. Objective criteria for the evaluation of inhalation injury and the need for airway protection in facial burn patients are needed.MethodsFacial burn patients between January 2013 and May 2016 were reviewed. Patients who were and were not intubated in the ED were compared. All intubated patients received routine bronchoscopy to evaluate whether they had inhalation injuries. Patients with and without confirmed inhalation injuries were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for inhalation injuries in facial burn patients. The reasons for intubation in patients without inhalation injuries were also investigated.ResultsDuring the study period, 121 patients were intubated in the ED among a total of 335 facial burn patients. Only 73 (60.3%) patients were later confirmed to have inhalation injuries on bronchoscopy. The comparison between patients with and without inhalation injuries showed that shortness of breath (odds ratio=3.376, p=0.027) and high total body surface area (TBSA) (odds ratio=1.038, p=0.001) were independent risk factors for inhalation injury. Other physical signs (e.g., hoarseness, burned nostril hair, etc.), laboratory examinations and chest X-ray findings were not predictive of inhalation injury in facial burn patients. All patients with a TBSA over 60% were intubated in the ED even if they did not have inhalation injuries.ConclusionIn the management of facial burn patients, positive signs on conventional physical examinations may not always be predictive of inhalation injury and the need for endotracheal tube intubation in the ED. More attention should be paid to facial burn patients with shortness of breath and a high TBSA because they have an increased risk of inhalation injuries. Airway protection is needed in facial burn patients without inhalation injuries because of their associated injuries and treatment.

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Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

BMC Geriatrics ◽

10.1186/s12877-021-02728-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Rui He ◽

Guoyou Wang ◽

Ting Li ◽

Huarui Shen ◽

LijuanZhang

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Ischemic Stroke ◽

Hip Fracture ◽

Total Hip Arthroplasty ◽

Older Age ◽

Factors Associated ◽

Independent Risk Factors ◽

D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

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Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

Korean Journal of Anesthesiology ◽

10.4097/kja.20035 ◽

2020 ◽

Vol 73 (6) ◽

pp. 542-549

Author(s):

Taeha Ryu ◽

Baek Jin Kim ◽

Seong Jun Woo ◽

So Young Lee ◽

Jung A Lim ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Odds Ratio ◽

Arthroscopic Surgery ◽

Sitting Position ◽

Past Medical History ◽

Frequent Adverse Event ◽

Increased Risk ◽

Potential Risk Factors ◽

Independent Risk Factors

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

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Risk for Cardiovascular Disease and One-Year Mortality in Patients With Chronic Obstructive Pulmonary Disease and Obstructive Sleep Apnea Syndrome Overlap Syndrome

Frontiers in Pharmacology ◽

10.3389/fphar.2021.767982 ◽

2021 ◽

Vol 12 ◽

Author(s):

Manyun Tang ◽

Yidan Wang ◽

Mengjie Wang ◽

Rui Tong ◽

Tao Shi

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cardiovascular Diseases ◽

Overlap Syndrome ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Obstructive Sleep ◽

Increased Risk ◽

All Cause Mortality ◽

Independent Risk Factors

Background: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSAS) overlap syndrome (OS) are thought to be at increased risk for cardiovascular diseases.Objective: To evaluate the burden of cardiovascular diseases and long-term outcomes in patients with OS.Methods: This was a retrospective cohort study. The prevalence of cardiovascular diseases and 1-year mortality were compared among patients diagnosed with OS (OS group), COPD alone (COPD group) and OSAS alone (OSAS group), and Cox proportional hazards models were used to assess independent risk factors for all-cause mortality.Results: Overall, patients with OS were at higher risk for pulmonary hypertension (PH), heart failure and all-cause mortality than patients with COPD or OSAS (all p < 0.05). In multivariate Cox regression analysis, the Charlson comorbidity index (CCI) score [adjusted hazard ratio (aHR): 1.273 (1.050–1.543); p = 0.014], hypertension [aHR: 2.006 (1.005–4.004); p = 0.048], pulmonary thromboembolism (PTE) [aHR: 4.774 (1.335–17.079); p = 0.016] and heart failure [aHR: 3.067 (1.521–6.185); p = 0.002] were found to be independent risk factors for 1-year all-cause mortality.Conclusion: Patients with OS had an increased risk for cardiovascular diseases and 1-year mortality. More efforts are needed to identify the causal relationship between OS and cardiovascular diseases, promoting risk stratification and the management of these patients.

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Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

Epidemiology and Infection ◽

10.1017/s0950268819001638 ◽

2019 ◽

Vol 147 ◽

Cited By ~ 2

Author(s):

Wei Zhang ◽

Xingpeng Song ◽

Hao Wu ◽

Rui Zheng

Keyword(s):

Risk Factors ◽

Antifungal Agents ◽

Multivariate Analyses ◽

Urinary Catheter ◽

Bloodstream Infections ◽

Tertiary Hospital ◽

Adult Patients ◽

Increased Risk ◽

Independent Risk Factors ◽

Isolated Species

Abstract This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.

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