High Disease Activity Influences the Presence of Vertebral Fractures in Rheumatoid Arthritis

Abstract Background: To investigate the prevalence and risk factors for vertebral fractures in patients with rheumatoid arthritis (RA) during an era of tight management.Methods: We retrospectively reviewed 426 RA patients who had visited our outpatient RA clinic between July 2017 and June 2020. Among them, we included 107 patients (19 males and 88 females) who had undergone lateral X-ray of the thoracolumbar spine and dual-energy X-ray absorption spectroscopy for the assessment of osteoporosis. We assessed the disease activity score for 28 joints (DAS28), the history of medication for RA and osteoporosis, the number and location of vertebral fractures, and the bone mineral density (BMD). Two board-certified specialists determined osteoporotic vertebral fractures on a lateral X-ray of the thoracolumbar spine.Results: The mean age, average disease duration, and average DAS28 of the analyzed patients were 67.9 years, 14.9 years, and 2.8, respectively. Vertebral fractures were found in 33 patients (30.8%). In this population, 84.8% of patients with vertebral fractures and 59.5% of those without vertebral fractures were treated for osteoporosis with active vitamin D3, bisphosphonate, and/or denosumab. RA patients with vertebral fractures had significantly higher DAS28 values, a higher rate of patients with a history of glucocorticoid use, and lower BMD in comparison to those than without vertebral fractures (p = 0.009, p = 0.004, and p = 0.01, respectively). Logistic regression analysis showed DAS28 (p = 0.038) and BMD (p = 0.004) were independent factors associated with the presence of vertebral fractures. The ordered logistic regression analysis also showed DAS28 (p = 0.043) and BMD (p = 0.024) were independent factors that explained the number of vertebral fractures.Conclusions: Vertebral fractures were frequently observed in RA patients, even when patients were treated the recommended anti-osteoporotic agents. A high disease activity score and low BMD were associated with the presence and number of vertebral fractures in patients with RA.

Download Full-text

POS0455 EFFECT OF ANTI-Ro/SSA ANTIBODIES FOR TREATMENT RESPONSE TO METHOTREXATE IN RHEUMATOID ARTHRITIS: A RETROSPECTIVE MULTICENTER OBSERVATIONAL STUDY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1485 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 458.1-458

Author(s):

R. Yokochi ◽

H. Tamai ◽

T. Kido ◽

Y. Yagyu ◽

D. Waki ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Regression Analysis ◽

Disease Activity ◽

Clinical Response ◽

Logistic Regression Analysis ◽

Age At Onset ◽

Treat To Target ◽

Low Disease Activity ◽

Target Strategy

Background:Several previous observational studies have suggested that patients with anti-Ro/SSA antibody-positive rheumatoid arthritis (RA) may respond poorly to treatment, including tumor necrosis factor inhibitors1. However, its influence on methotrexate (MTX) treatment, which is the anchor drug of treat-to-target strategy in RA treatment, remains unclear.Objectives:We compared the clinical response to MTX in both anti-Ro/SSA antibody-positive and -negative patients with MTX-naiive RA and investigated the reasons for the difference in response.Methods:We recruited 210 consecutive patients with RA who were newly started on MTX in this retrospective cohort study. The effect of the presence of anti-Ro/SSA antibodies on achieving low disease activity (LDA) of DAS28-CRP at six months after initiating MTX was investigated by using logistic regression analysis. CDAI, SDAI, concomitant using DMARDs and painkillers, patient’s and evaluator’s VAS, tender joint counts, and swollen joint counts at six months were also compared between the anti-Ro/SSA-positive patients and -negative patients. Missing data were imputed by using multiple imputations before multivariate analysis.Results:32 anti-Ro/SSA antibody-positive patients and 178 anti-Ro/SSA antibody-negative patients were included. The rate of achieving DAS28-LDA at six months was significantly lower in the anti-Ro/SSA antibody-positive patients than those in the anti-Ro/SSA antibody-negative patients (56.2% versus 75.8%, P=0.03). in the logistic regression analysis, the presence of anti-Ro/SSA antibodies was an independent negative predictor for achieving DAS-28-LDA at six months (OR:0.431, 95%CI: 0.190-0.978, P=0.044) (Table1). Anti-Ro/SSA antibody-positive patients had significantly higher patient’s VAS at six months (median [IQR]: 22 [15-41] vs 19 [5-30], P=0.038), and prescribed NSAIDs (37.5% vs 18.0%, P=0.018). CDAI and SDAI after six months were not significantly different between the group.Conclusion:The presence of anti-Ro/SSA antibodies might be one of the predictive factors for the insufficient response to treat to target strategy in RA treatment. Residual pain was suspected as one of the mechanisms contributing to the lesser clinical response of MTX in anti-Ro antibody-positive RA.References:[1]Ran Matsudaira wt al. J Rheumatol 2011;38(11):2346-54Table 1.Logistic regression analysis for the rate of achieving DAS28 low disease activity at six months.Risk factor Odds ratio95%CIP valueAge at onset0.9930.968-1.0180.586Sex (woman)0.6430.300-1.3840.258RF-positive1.9620.853-4.5110.112ACPA-positive0.5520.225-1.3510.192Anti-Ro/SSA antibody-positive0.4310.190-0.9780.044Disclosure of Interests:None declared

Download Full-text

Serum chemerin levels: A potential biomarker of joint inflammation in women with rheumatoid arthritis

PLoS ONE ◽

10.1371/journal.pone.0255854 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0255854

Author(s):

Fabiola Gonzalez-Ponce ◽

Jorge I. Gamez-Nava ◽

Emilio E. Perez-Guerrero ◽

Ana M. Saldaña-Cruz ◽

Maria L. Vazquez-Villegas ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Regression Analysis ◽

Disease Activity ◽

Multiple Regression Analysis ◽

Multiple Regression ◽

Logistic Regression Analysis ◽

Fat Mass ◽

Severe Disease ◽

Potential Biomarker

Background Chemerin has a potential role in perpetuating inflammation in autoimmune diseases. Nevertheless, to date, there is no conclusive information on whether high chemerin levels increase the severity of rheumatoid arthritis (RA). Therefore, this study evaluated whether serum chemerin is a biomarker of disease activity in RA patients. Methods Study design: cross-sectional. The assessment included clinical and laboratory characteristics, body mass index (BMI) and fat mass. The severity of the disease activity was identified according to the DAS28-CRP index as follows: A) RA with a DAS28-CRP≤2.9 (remission/mild activity) and B) RA with a DAS28-CRP>2.9 (moderate/severe activity). Serum chemerin concentrations were measured by ELISA, and ≥103 ng/mL was considered a high level. Logistic regression analysis was applied to determine whether high chemerin levels were associated with disease activity in RA after adjusting for confounders. Multiple regression analysis was performed to identify variables associated with chemerin levels. Results Of 210 RA patients, 89 (42%) subjects had moderate/severe disease activity and had higher serum chemerin levels than patients with low disease activity or remission (86 ± 34 vs 73± 27; p = 0.003). Serum chemerin correlated with the number of swollen joints (r = 0.15; p = 0.03), DAS28-CRP (r = 0.22; p = 0.002), and C-reactive protein levels (r = 0.14; p = 0.04), but no correlation was observed with BMI and fat mass. In the adjusted logistic regression analysis, high chemerin levels (≥103 ng/mL) were associated with an increased risk of moderate/severe disease activity (OR: 2.76, 95% CI 1.35–5.62; p = 0.005). In the multiple regression analysis, after adjusting for potential confounders, serum chemerin levels were associated with higher DAS28-CRP (p = 0.002). Conclusions Higher chemerin levels increased the risk of moderate and severe disease activity in RA. These results support the role of chemerin as a marker of inflammation in RA. Follow-up studies will identify if maintaining low chemerin levels can be used as a therapeutic target.

Download Full-text

AB0212 FLARE RISK AFTER DISCONTINUING LONG-TERM METHOTREXATE TREATMENT IN PATIENTS HAVING RHEUMATOID ARTHRITIS WITH LOW DISEASE ACTIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3612 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1406.1-1407

Author(s):

S. H. Nam ◽

J. S. Lee ◽

S. J. Choi ◽

W. J. Seo ◽

J. S. Oh ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Regression Analysis ◽

Disease Activity ◽

Logistic Regression Analysis ◽

Weekly Dose ◽

Low Disease Activity ◽

Disease Flare ◽

The Mean

Background:Several recent studies have reported that MTX could be discontinued in patients with low disease activity who are taking biologic DMARDs or tofacitinib. However, there are limited studies on whether MTX could be discontinued in patients with low disease activity who have taken MTX for a long term.Objectives:We investigated the disease flare rate in patients with rheumatoid arthritis (RA) who achieved low disease activity following long-term methotrexate (MTX) treatment and the factors related to flare.Methods:This retrospective longitudinal cohort study included patients with RA and low disease activity who were exposed to MTX for >10 years. Disease flare was defined as an increase in DAS28 of >1.2 within 6 months of discontinuation of MTX. Logistic regression analysis was performed to identify the factors associated with flare.Results:In total, 97 patients with RA were included in the study. The mean baseline DAS28 was 1.96 ± 0.56. The median cumulative MTX dose was 11.7g; the median duration of exposure to MTX was 19 years. Following MTX discontinuation, flare occurred in 43 (44.3%) patients; the mean time to flare was 98 ± 37.7 days. According to univariable logistic regression analysis, C-reactive protein, erythrocyte sedimentation rate (ESR) at discontinuation, the average ESR in the 6 months before discontinuation of MTX, a weekly dose of MTX before discontinuation, and use of other conventional synthetic DMARDs were associated with a higher risk of disease flare. In multivariable analysis, a weekly dose of MTX before discontinuation (OR, 1.014; 95% CI, 1.014–1.342; p = 0.031) was significantly associated with flare risk.Conclusion:Among patients with RA who achieved low disease activity with long-term treatment with MTX, more than half of the patients remained flare free after MTX discontinuation. A higher MTX dose before discontinuation was associated with a high flare risk.Disclosure of Interests:None declared

Download Full-text

Performance of cytokine models in predicting SLE activity

Arthritis Research & Therapy ◽

10.1186/s13075-019-2029-1 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Nopparat Ruchakorn ◽

Pintip Ngamjanyaporn ◽

Thanitta Suangtamai ◽

Thanuchporn Kafaksom ◽

Charin Polpanumas ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Disease Activity ◽

Sensitivity And Specificity ◽

Logistic Regression Analysis ◽

Lupus Erythematosus ◽

Activity Index ◽

Multiple Logistic Regression Analysis ◽

Negative Relationship ◽

Complement C3

Abstract Background Identification of universal biomarkers to predict systemic lupus erythematosus (SLE) flares is challenging due to the heterogeneity of the disease. Several biomarkers have been reported. However, the data of validated biomarkers to use as a predictor for lupus flares show variation. This study aimed to identify the biomarkers that are sensitive and specific to predict lupus flares. Methods One hundred and twenty-four SLE patients enrolled in this study and were prospectively followed up. The evaluation of disease activity achieved by the SLE disease activity index (SLEDAI-2K) and clinical SLEDAI (modified SLEDAI). Patients with active SLE were categorized into renal or non-renal flares. Serum cytokines were measured by multiplex bead-based flow cytometry. The correlation and logistic regression analysis were performed. Results Levels of IFN-α, MCP-1, IL-6, IL-8, and IL-18 significantly increased in active SLE and correlated with clinical SLEDAI. Complement C3 showed a weakly negative relationship with IFN-α and IL-18. IL-18 showed the highest positive likelihood ratios for active SLE. Multiple logistic regression analysis showed that IL-6, IL-8, and IL-18 significantly increased odds ratio (OR) for active SLE at baseline while complement C3 and IL-18 increased OR for active SLE at 12 weeks. IL-18 and IL-6 yielded higher sensitivity and specificity than anti-dsDNA and C3 to predict active renal and active non-renal, respectively. Conclusion The heterogeneity of SLE pathogenesis leads to different signaling mechanisms and mediates through several cytokines. The monitoring of cytokines increases the sensitivity and specificity to determine SLE disease activity. IL-18 predicts the risk of active renal SLE while IL-6 and IL-8 predict the risk of active non-renal. The sensitivity and specificity of these cytokines are higher than the anti-dsDNA or C3. We propose to use the serum level of IL-18, IL-6, and IL-8 to monitor SLE disease activity in clinical practice.

Download Full-text

14-3-3η Protein in Rheumatoid Arthritis: Promising Diagnostic Marker and Independent Risk Factor for Osteoporosis

Laboratory Medicine ◽

10.1093/labmed/lmaa001 ◽

2020 ◽

Vol 51 (5) ◽

pp. 529-539

Author(s):

Tingting Zeng ◽

Liming Tan ◽

Yang Wu ◽

Jianlin Yu

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

Independent Risk Factor ◽

Multiple Logistic Regression Analysis ◽

Area Under The Curve ◽

Enzyme Linked Immunosorbent Assay ◽

Disease Monitoring

Abstract Background Early identification and disease monitoring are challenges facing rheumatologists in the management of rheumatoid arthritis (RA). Methods We utilized enzyme-linked immunosorbent assay (ELISA) to determine 14-3-3η and anticyclic citrullinated peptide antibody (anti-CCP) levels, with rheumatoid factor (RF) level detected by rate nephelometry. The diagnostic value of each index was determined via receiver operating characteristic (ROC) curve, and the association between 14-3-3η and osteoporosis was assessed using multiple logistic regression analysis. Results Serum levels of 14-3-3η were 3.26 ng per mL in patients with RA. These levels were helpful in identifying patients with the disease, with the area under the curve (AUC) being 0.879 and 0.853, respectively, from all healthy control individuals and patients with RA. Combining 14-3-3η with RF or anti-CCP increased the diagnostic rate. Logistic regression analysis identified 14-3-3η as an independent risk factor for RA-related osteoporosis (odds ratio [OR], 1.503; 95% confidence interval [CI], 1.116–2.025; P <.01). Conclusions Serum 14-3-3η detection by itself or combined with other serum indices was helpful in differentiating patients with RA. Also, it was a promising biomarker for disease monitoring in RA.

Download Full-text

Risk Factors for Silent Cerebral Infarcts in a Pediatric Sickle Cell Anemia (SCA) Cohort

Blood ◽

10.1182/blood.v112.11.2487.2487 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2487-2487 ◽

Cited By ~ 1

Author(s):

Francoise Bernaudin ◽

Suzanne Verlhac ◽

Annie Kamdem ◽

Cécile Arnaud ◽

Lena Coïc ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

G6pd Deficiency ◽

Significant Risk ◽

Significant Risk Factor ◽

History Of ◽

Independent Risk Factors

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (< 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p<0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p<0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p<0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.

Download Full-text

Clinical Value of Patlak Ki Images Extracted From Dynamic 18F-FDG PET/CT For Evaluation of The Relationships Between Disease Activity and Clinical Events in Cardiac Sarcoidosis

10.21203/rs.3.rs-49013/v1 ◽

2020 ◽

Author(s):

Masatoyo Nakajo ◽

Satoko Ojima ◽

Hirofumi Kawakami ◽

Atsushi Tani ◽

Akira Hirayama ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Disease Activity ◽

Logistic Regression Analysis ◽

Cardiac Dysfunction ◽

Fdg Pet ◽

Cardiac Sarcoidosis ◽

Clinical Events ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background: Cardiac sarcoidosis (CS) has a poor prognosis because of frequent complication of atrioventricular block, ventricular tachycardia and congestive heart failure. Qualitative or quantitative 18F-FDG PET/CT has been used for diagnosing or assessing the disease activity of CS. However, the association between 18F-FDG myocardial uptake and clinical presentations in CS has not yet been clarified, and it is unknown if Patlak Ki images (Ki images) extracted from dynamic 18F-FDG-PET/CT are useful for evaluating the disease activity or clinical events in CS patients. In this context, this study was performed to investigate the usefulness of SUV and Patlak Ki images extracted from dynamic 18F-FDG-PET/CT for evaluating the risk of severe clinical events (SCEs) in CS. Methods: The SUV and Ki myocardial images were generated from 30 dynamic 18F-FDG-PET/CT scans of 21 CS patients including those with cardiac dysfunction and arrhythmic events. SUV parameters and Ki parameters (Ki max, Ki mean, Ki volume) were measured for positive myocardial lesions. The Mann–Whitney U-test or Fisher’s exact test was used appropriately to assess differences between quantitative variables or compare categorical data. The association between each quantitative parameter and presence of SCEs was analyzed by logistic regression analysis.Results: The SUV and Ki mages both were rated as positive in 19 scans and negative in 11 scans with the same incidence of SCEs which were significantly higher in positive than negative scans [cardiac dysfunction: 78.9% (15/19) vs. 27.2% (3/11), p=0.009; arrhythmic events: 65.5% (10/19) vs. 0% (0/11), p=0.004]. In 19 positive scans, neither SUV nor Ki parameters were significantly different between scans of patients with cardiac dysfunction (n=15) and those without (n=4) (p>0.05, each), whereas the three Ki parameters were significantly higher in scans for patients with arrhythmic events (n=10) than in those without (n=9) (p<0.05, each). Logistic regression analysis showed that the Ki volume alone was significantly associated with the risk of arrhythmic events (Odds ratio: 1.11, p=0.047).Conclusion: Patlak Ki images may add value to SUV images for evaluating the risk of SCEs in CS patients.

Download Full-text

Platelet-To-Lymphocyte Ratio Can Be Used As Marker To Predict Activity And Severity In Moderate And High Disease Activity of Rheumatoid Arthritis: A Retrospective Study

10.21203/rs.3.rs-1077543/v2 ◽

2021 ◽

Author(s):

Bilin Chen ◽

Qing Zhu ◽

Shu Li ◽

Yan Ge ◽

Peijun Wu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Logistic Regression ◽

Disease Activity ◽

Roc Analysis ◽

High Disease Activity ◽

Regression Analyses ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Activity Group ◽

Ultrasound Score

Abstract Objective: This study aimed to study and evaluate the value of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) as markers to predict the disease activity and severity in patients with rheumatoid arthritis (RA).Methods: A total of 139 inpatients with RA were divided into two groups: moderate activity group (3.2<DAS28-CRP score<5.1) and high activity group (≥5.1). The correlation of routine hematological indices with DAS28 and joint ultrasound score (gray-scale ultrasound score, GS-US; power Doppler ultrasound score, PD-US; total ultrasound score, T-US) were analyzed by Pearson's correlation and logistic regression analyses. Receiver operating characteristics (ROC) analysis was performed to compare the efficacy of blood indices, ESR, or CRP in reflecting the disease activity and severity of RA.Results: The values of PLR, NLR, PD-US, and T-US were significantly different between moderate and high disease activity groups (p<0.001), and PLR was significantly correlated with PD-US and DAS28. Logistic regression analyses showed that PLR was an independent risk factor for disease activity by DAS 28 and joint damage severity by PD-US and T-US. ROC analysis showed that the efficacy of using PLR alone to evaluate the disease activity and joint severity of RA was similar to that of using combined CRP and ESR. The best cut-off value of PLR for predicting high disease activity and high joint severity was determined as 236.6.Conclusions: PLR can be used as a marker to predict activity and severity in patients with moderate and high RA disease activity.

Download Full-text

Factors Leading to Cesarean Section Delivery at Tarakan Hospital, North Kalimantan

Journal of Maternal and Child Health ◽

10.26911/thejmch.2021.06.01.08 ◽

2021 ◽

Vol 6 (1) ◽

pp. 77-83

Author(s):

Rahmi Padlilah ◽

◽

Ika Yulianti ◽

Ririn Ariyanti ◽

◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cesarean Section ◽

Logistic Regression Analysis ◽

Multiple Logistic Regression Analysis ◽

Mortality And Morbidity ◽

Factors Affecting ◽

Cesarean Section Delivery ◽

History Of ◽

Medical Indications

Background: The increase in cesarean section delivery requires attention. Mortality and morbidity rates for mother and fetus increase in line with the increase in cesarean section delivery. This study aimed to analyze the factors affecting the delivery of cesarean section. Subjects and Method: This was an analytical observational study with a case-control design. The study was conducted at Tarakan Hospital, North Kalimantan, from 2018 to 2020. There were 200 study subjects as the sample of this study that was selected by purposive sampling. The dependent variable was cesarean section delivery. The independent variables were parity, age, history of the disease, medical indications, and ANC history. This study used medical records to collect the data with multiple logistic regression analysis. Results: Cesarean section delivery increased with multiparous (OR= 1.26; 95% CI= 1.67 to 7.45; p= 0.001), age <20 and ≥ 35 years (OR= 1.51; 95% CI= 2.12 to 9.66; p <0.001), high-risk pregnancies such as diabetes mellitus, anemia, hypertension and preeclampsia (OR = 1.50; 95% CI = 2.12 to 9.52; p <0.001), medical indications (OR= 1.37; 95% CI = 1.82 to 8.57; p = 0.001) and complete ANC history (OR = 0.26; 95% CI = 0.13 to 0.56; p = 0.001). Conclusion: Caesarean section delivery increases with multiparous, age <20 and ≥35 years, had a history of the disease, medical indications, and a complete ANC history. Keywords: cesarean section, influencing factors, logistic regression analysis Correspondence: Rahmi Padlilah. University of Borneo Tarakan. Jl. Amal Lama No.1 Tarakan, North Kalimantan. Email: [email protected]. Mobile: +628- 11538073.

Download Full-text

Diabetes and Younger Age Are Vital and Independent Risk Factors for Acute Pancreatitis in Patients with Severe Hypertriglyceridemia

BioMed Research International ◽

10.1155/2019/2620750 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Qiang Li ◽

Chaoqun Hou ◽

Yunpeng Peng ◽

Xiaole Zhu ◽

Chenyuan Shi ◽

...

Keyword(s):

Risk Factors ◽

Acute Pancreatitis ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Severe Hypertriglyceridemia ◽

Younger Age ◽

History Of ◽

Independent Risk Factors

Background. The incidence of hypertriglyceridemia-induced acute pancreatitis (HIAP) is increasing worldwide, and now it is the third leading cause of acute pancreatitis in the United States. But, there are only 5% of patients with severe hypertriglyceridemia (>1000 mg/dl) which might generate acute pancreatitis. In order to explore which part of the patients is easy to develop into pancreatitis, a case-control study was performed by us to consider which patient population tend to develop acute pancreatitis in patients with severe hypertriglyceridemia. To perform a retrospective case-control study, we identified severe hypertriglyceridemia patients without AP (HNAP) and with HIAP with a fasting triglyceride level of >1000 mg/dl from The First Affiliated Hospital of Nanjing Medical University during January 1, 2014, to December 31, 2016. Baseline patient characteristics, comorbidities, and risk factors were recorded and evaluated by the univariate and multivariate logistic regression analysis for HIAP and HNAP patients. A total of 124 patients with severe hypertriglyceridemia were included in this study; of which, 62 patients were in the HIAP group and 62 were in the HNAP group. Univariate logistic regression analysis showed that there was no gender difference in both groups; however, there were more younger patients in the HIAP group than in the HNAP group (P value < 0.001), and the HIAP group had low level of high-density lipoprotein compared to the HNAP group (P<0.05). Meanwhile, the presence of pancreatitis was associated with higher level of glycemia and a history of diabetes (P<0.05). Multivariate logistic regression analysis indicated that a history of diabetes and younger age were independent risk factors for acute pancreatitis in patients with severe hypertriglyceridemia. Uncontrolled diabetes and younger age are potential risk factors in patients with severe hypertriglyceridemia to develop acute pancreatitis.

Download Full-text