scholarly journals Associations of vascular calcification, calcium phosphate disturbances, FGF 23 and Matrix Gla protein with mortality of hemodialysis patients: one center cohort study

2018 ◽  
Vol 26 (4) ◽  
pp. 451-460
Author(s):  
Vaida Petrauskiene ◽  
Ruta Vaiciuniene ◽  
Vytautas Kuzminskis ◽  
Edita Ziginskiene ◽  
Saulius Grazulis ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Calcium Phosphate ◽  
Vascular Calcification ◽  
Odds Ratio ◽  
Negative Impact ◽  
Matrix Gla Protein ◽  
Multivariate Logistic Regression ◽  
Risk Of Death ◽  
Calcification Score ◽  
Fgf 23

Abstract Background and objectives: Vascular calcification (VC) is one of the factors associated with mortality in hemodialysis (HD) patients. The purpose of the study was to assess associations between prevalent VC and disturbances of calcium-phosphate metabolism as well as changes in vitamin D (25(OH)D), FGF 23 and MGP levels and to evaluate the possible impact of VC and changes of these biomarkers on survival in HD patients. Methods: The study population consisted of 81 prevalent patients in the hemodialysis unit of Hospital of Lithuanian University of Health Sciences Kaunas Clinics. A simple vascular calcification score (SVCS) was evaluated as it is described by Adragao et al. 25(OH)D (nmol/L), FGF 23 (ng/L) and MGP (ng/mL) were measured and analysed. Results: Patients were divided into two groups: SVCS<3 (31 patient (38.3%) and SVCS ≥3 (50 patients (61.7%)). In multivariate logistic regression, age (odds ratio 1.062, 95% CI [1.024-1.1] p=0.001) and diabetes (odds ratio 6.9, 95% CI [1.5-31], p=0.012) were associated with SVCS ≥3. The multivariate logistic regression revealed the highest negative impact of SVCS ≥3, age and 25(OH)D level for death risk. Conclusion: VC in HD patients is highly influenced by age and presence of diabetes and associated with higher risk of death. No significant association was found between MGP and FGF 23 and VC as well as between these two biomarkers and risk of death. Lower 25(OH)D levels were associated with mortality in this dialysis patients cohort.

scholarly journals Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110248
Author(s):  
Mario Sestan ◽  
Nastasia Kifer ◽  
Marijan Frkovic ◽  
Matej Sapina ◽  
Sasa Srsen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Odds Ratio ◽  
Biochemical Parameters ◽  
Upper Extremities ◽  
Iga Vasculitis ◽  
Older Children ◽  
Multivariate Logistic Regression ◽  
Gastrointestinal Involvement ◽  
Chronic Complications ◽  
Gi Symptoms

Background: We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications. Methods: A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009–2019. Results: Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09–4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43–5.34)] or face [OR 3.69 (95% CI 1.42–9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23–8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01–0.62)], fibrinogen [OR 0.45 (95% CI 0.29–0.70)] and IgM [OR 0.10 (95% I 0.03–0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04–4.39)] and recurrent rash [OR 2.61 (CI 1.27–5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67–26.06)], older children [OR 1.22 (95% CI 1.02–1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12–31.15)] were particularly high-risk for developing IgAVN. Conclusion: We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.

PENGARUH CORPORATE GOVERNANCE TERHADAP PERINGKAT DAN YIELD OBLIGASI DI BEI

2011 ◽  
Vol 6 (1) ◽  
pp. 11
Author(s):  
Sihotang Dikson Terry
Keyword(s):  
Corporate Governance ◽  
Logistic Regression ◽  
Multivariate Regression ◽  
Negative Impact ◽  
Institutional Ownership ◽  
Variable Result ◽  
Multivariate Logistic Regression ◽  
Bond Rating ◽  
Bond Yield

The purpose of this study is to examine weather corporate governance impact on bond yield and rating. This study analyses sample 27 of bonds made of Indonesian Stock Exchangelisted finance firms over the period 2004-2008. Data is analysed by using multivariate logistic regression dan multivariate regression. Multivariate logistic regres-sion is used to analyse the effect of corporate governance impact on bond rating. Meanwhile, multivariateregres-sion is used to analyse the effect of corporate governance impact on bond yield. The analyses show two main findings. First, Independent board have negative impact on bond rating. How-ever, the coefficient of the variable result is not consistent with the prediction.  Second, institutional ownership have negative impact on bond yield.Keywords: Corporate Governance, Bond Rating, Bond Yield

An Overview of the Pathophysiology of Vascular Calcification in Chronic Kidney Disease

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 215-222 ◽  
Author(s):  
Tomasz Stompór
Keyword(s):  
Chronic Kidney Disease ◽  
Calcium Phosphate ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Vessel Wall ◽  
Matrix Gla Protein ◽  
Soft Tissue Calcification ◽  
Poor Control ◽  
Bone Morphogenetic Protein 7 ◽  
Morphogenetic Protein

Abnormalities of calcium–phosphate balance, with subsequent bone metabolism disorders, are among the key and earliest features of chronic kidney disease (CKD). Recently, another consequence of these abnormalities was brought to light—namely, vascular calcification. Most studies performed in patients on dialysis suggest that their vascular calcification is more advanced than that seen in the general population. Furthermore, the progression of vessel wall mineralization is much more dynamic in patients with CKD. Apart from the commonly assessed factors that promote vascular calcification, such as age, duration of dialysis, or poor control of calcium–phosphate status, several other factors have recently been identified. In the spectrum of substances involved in the regulation of the process of soft-tissue calcification, the most extensively studied in the nephrology literature are bone morphogenetic protein 7, osteoprotegerin, matrix Gla protein, fetuin-A, and the phosphatonins. Better understanding of the mechanisms underlying excess vascular mineralization have led to the development of promising new therapies.

Risk Factors of Changes in Hepatitis B Antibody Status after Allogeneic Hematopoietic Stem Cell Transplantation in Chinese Children with Thalassemia Major

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5809-5809
Author(s):  
Xiaoqin Feng ◽  
Lina Long ◽  
Chunfu Li
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Odds Ratio ◽  
Thalassemia Major ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hbv Reactivation ◽  
Type I ◽  
Multivariate Logistic Regression ◽  
Post Transplant

Abstract Objective: This retrospective study evaluated the risk factors involved in the changes in HBsAb status in patients with thalassemia major at a single center in China. Methods: A total of 104 children who underwent allo-HSCT, using NF-08-TM transplant protocol in our center, between January 2010 and June 2012 were recruited.Hepatitis B markers, including HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc were examined by TRFIA (time-resolved fluoroimmunoassay) or ELISA (Enzyme-Linked Immunosorbent Assay) for recipients before and after allo-HSCT (at least up to 6 months) and for donors prior to transplantation. HBsAg positive recipients and donors received lamivudine antiviral therapy before allo-HSCT and the treatment was continued in recipients up to 6 months post transplantation. The demographic and clinical characteristics of the patients and their donors were summarized by descriptive statistics. For identification of risk factors that influenced the post-transplant anti-HBs loss and HBV reactivation, both univariate and multivariate logistic regression was used, and odds ratio (OR) and 95% confidence interval (CI) were determined for the covariates that were shown to be statistically significant. All tests were 2-sided, with the type I error rate fixed at 0.05. Statistical analyses were performed using IBM SPSS 20 (SPSS Statistics V20, IBM Corporation, Somers, New York). Results: Of the 104 patients, 2（1.9%） recipients were positive for HBsAg and 102（98.1%） recipients were negative for HBsAg. Of the 102 patients negative for HBsAg before transplantation, the proportion of positive anti-HBs was 69.6% (71 of 102 patients). Of the 104 donors, 99 (95.2%)were negative for HBsAg and 5 (4.8%)were positive for HBsAg. Of the 99 donors negative for HBsAg before transplantation, 72 donors (72.7%) had anti-HBs. After transplantation, of the 69 patients, 27 (39.1%) patients lost their HBV immunity in a median follow-up period of 30 months (range: 21–45); the remaining 42 (60.9 %) patients maintained the immunity against HBV after a median follow-up period of 28.5 months (range: 19–46). 33 patients were anti-HBs negative before the allo-HSCT. The 33 patients included 11 patients with donors who had no anti-HBs and 22 patients with donors who had anti-HBs. After the allo-HSCT, 15 of the 33 patients were found to have newly gained HBV immunity, as represented by the presence of anti-HBs. While 14 of them who developed adoptive immunity had immunized donors (63.6%; 14 out of 22), 1 of them (9.1%; 1 out of 11) with a non-immunized donor (donors without anti-HBs) also had developed HBV immunity. Multivariate logistic regression analysis of 104 patients who underwent allo-HSCT revealed that, patients with pre-HSCT titer of HBsAb < 257.47mIU/mL (adjusted odds ratio, 10.5, 95% CI, 2.1–53.3) and HBsAb-immunized donors (51.3, 2.8–938.6) were significant risk factors for post allo-HSCT HBV loss and acquisition, respectively. In addition, the post-transplant HBV reactivation rate was 11.1%. Conclusions: Current results indicate that pre-transplant HBsAb titer is a key determinant in the loss of HBV immunity after allo-HSCT and HBsAb negative patients with immunized donors are more likely to gain HBV immunity after allo-HSCT than those with non-immunized donors. Further, preemptive antiviral treatment with lamivudine significantly reduces HBV reactivation. This is the first study to have indicated the significant predictors of changes in HBsAg status in children with thalassemia major. Disclosures No relevant conflicts of interest to declare.

scholarly journals Mitral valve thickening in acute rheumatic fever as a predictor of late valvar dysfunction

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259737
Author(s):  
Telêmaco Luis da Silva ◽  
Antonio Pazin-Filho ◽  
Minna M. D. Romano ◽  
Virgínia P. L. Ferriani ◽  
José A. Marin-Neto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mitral Valve ◽  
Rheumatic Fever ◽  
Odds Ratio ◽  
Acute Rheumatic Fever ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression ◽  
Valve Dysfunction ◽  
Logistic Regression Models ◽  
Important Health

Background Rheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established. Objective To investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction. Methods Prospectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant. Results We evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction. Conclusions Mitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.

scholarly journals Establishment of Routine Clinical Indicators-Based Nomograms for Predicting the Mortality in Patients with COVID-19

2020 ◽  
Author(s):  
Jialin He ◽  
Caiping Song ◽  
En Liu ◽  
Xi Liu ◽  
Hao Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Clinical Manifestations ◽  
Vital Signs ◽  
Multivariate Logistic Regression Analysis ◽  
Hospital Death ◽  
Multivariate Logistic Regression ◽  
Clinical Indicators ◽  
Risk Of Death ◽  
Laboratory Test Results ◽  
Better Than

Abstract Background: The aim of the study was to establish and validate nomograms to predict the mortality risk of patients with COVID-19 using routine clinical indicators. Method: This retrospective study included a development cohort enrolled 2119 hospitalized COVID-19 patients and a validation cohort included 1504 COVID-19 patients. The demographics, clinical manifestations, vital signs and laboratory test results of the patients at admission and outcome of in-hospital death were recorded. The independent factors associated with death were identified by a forward stepwise multivariate logistic regression analysis and used to construct two prognostic nomograms. The models were then tested in an external dataset. Results: Nomogram 1 is a full model included nine factors identified in the multivariate logistic regression and nomogram 2 is built by selecting four factors from nine to perform as a reduced model. Nomogram 1 and nomogram 2 established showed better performance in discrimination and calibration than the MuLBSTA score in training. In validation, Nomogram 1 performed better than nomogram 2 for calibration. Conclusion: Nomograms we established performed better than the MuLBSTA score. We recommend the application of nomogram 1 in general hospital which provide robust prognostic performance but more cumbersome; nomogram 2 in mobile cabin hospitals which depend on less laboratory examinations and more convenient. Both nomograms can help clinicians in identifying patients at risk of death with routine clinical indicators at admission, which may reduce the overall mortality of COVID-19.

scholarly journals Low psoas muscle index is a poor prognostic factor for lower gastrointestinal perforation: a single-center retrospective cohort study

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hajime Kayano ◽  
Eiji Nomura ◽  
Rin Abe ◽  
Yasuhiko Ueda ◽  
Takashi Machida ◽  
...  
Keyword(s):  
Body Composition ◽  
Logistic Regression ◽  
Adipose Tissue ◽  
Prognostic Factors ◽  
Emergency Surgery ◽  
Odds Ratio ◽  
Psoas Muscle ◽  
Lower Gastrointestinal Tract ◽  
Multivariate Logistic Regression ◽  
Tract Perforation

Abstract Background Various body composition indices have been reported as prognostic factors for different cancers. However, whether body composition affects prognosis after lower gastrointestinal tract perforation requiring emergency surgery and multidisciplinary treatment has not been clarified. This study examined whether body composition evaluations that can be measured easily and quickly from computed tomography (CT) are useful for predicting prognosis. Methods Subjects comprised 64 patients diagnosed with perforation at final diagnosis after emergency surgery for a preoperative diagnosis of lower gastrointestinal tract perforation and penetration. They were divided into a survival group and a non-survival (in-hospital mortality) group and compared. Body composition indices (psoas muscle index (PMI); psoas muscle attenuation (PMA); subcutaneous adipose tissue index (SATI); visceral adipose tissue index (VATI); visceral-to-subcutaneous fat area ratio (VSR)) were measured from preoperative CT. Cross-sectional psoas muscle area at the level of the 3rd lumbar vertebra was quantified. Optimal cut-off values were calculated using receiver operating characteristic curve analysis. Poor prognostic factors were investigated from multivariate logistic regression analyses that included patient factors, perioperative factors, intraoperative factors, and body composition indices as explanatory variables. Results The cause of perforation was malignant disease in 12 cases (18.7%), and benign disease in 52 cases (81.2%). The most common cause was diverticulum of the large intestine. Emergency surgery for the 64 patients led to survival in 52 patients and death in 12 patients. On multivariate logistic regression analysis, independent predictors of poor prognosis were Sequential Organ Failure Assessment score (odds ratio 1.908; 95% confidence interval (CI) 1.235–3.681; P = 0.0020) and PMI (odds ratio 13.478; 95%CI 1.342–332.690; P = 0.0252). The cut-off PMI was 4.75 cm2/m2 for males and 2.89 cm2/m2 for females. Among survivors, duration of hospitalization was significantly longer in the low PMI group (29 days) than in the high PMI group (22 days, p = 0.0257). Conclusions PMI is easily determined from CT and allows rapid evaluation of prognosis following lower gastrointestinal perforation.

Impact of patient and hospital-level risk factors on extended length of stay following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (4) ◽  
pp. 469-475
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Adam J. Kundishora ◽  
Fouad Chouairi ◽  
Megan Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Transfusion ◽  
Spinal Fusion ◽  
Odds Ratio ◽  
Hospital Level ◽  
Multivariate Logistic Regression ◽  
Total Cost

OBJECTIVEHealth policy changes have led to increased emphasis on value-based care to improve resource utilization and reduce inpatient hospital length of stay (LOS). Recently, LOS has become a major determinant of quality of care and resource utilization. For adolescent idiopathic scoliosis (AIS), the determinants of extended LOS after elective posterior spinal fusion (PSF) remain relatively unknown. In the present study, the authors investigated the impact of patient and hospital-level risk factors on extended LOS following elective PSF surgery (≥ 4 levels) for AIS.METHODSThe Kids’ Inpatient Database (KID) was queried for the year 2012. Adolescent patients (age range 10–17 years) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Extended hospital LOS was defined as greater than the 75th percentile for the entire cohort (> 6 days), and patients were dichotomized as having normal LOS or extended LOS. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were recorded. A multivariate logistic regression model was used to determine the odds ratio for risk-adjusted LOS. The primary outcome was the degree to which patient comorbidities or postoperative complications correlated with extended LOS.RESULTSComorbidities were overall significantly higher in the extended-LOS cohort than the normal-LOS cohort. Patients with extended LOS had a significantly greater proportion of blood transfusion (p < 0.001) and ≥ 9 vertebral levels fused (p < 0.001). The overall complication rates were greater in the extended-LOS cohort (20.3% [normal-LOS group] vs 43.5% [extended-LOS group]; p < 0.001). On average, the extended-LOS cohort incurred $18,916 more in total cost than the normal-LOS group ($54,697 ± $24,217 vs $73,613 ± $38,689, respectively; p < 0.001) and had more patients discharged to locations other than home (p < 0.001) than did patients in the normal-LOS cohort. On multivariate logistic regression, several risk factors were associated with extended LOS, including female sex, obesity, hypertension, fluid electrolyte disorder, paralysis, blood transfusion, ≥ 9 vertebrae fused, dural injury, and nerve cord injury. The odds ratio for extended LOS was 1.95 (95% CI 1.50–2.52) for patients with 1 complication and 5.43 (95% CI 3.35–8.71) for patients with > 1 complication.CONCLUSIONSThe authors’ study using the KID demonstrates that patient comorbidities and intra- and postoperative complications all contribute to extended LOS after spinal fusion for AIS. Identifying multimodality interventions focused on reducing LOS, bettering patient outcomes, and lowering healthcare costs are necessary to improve the overall value of care for patients undergoing spinal fusion for AIS.

Abstract TP176: Risk Factors and Clinical Significances of the Quantitative CTA Vascular Calcification in Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takashi Shimoyama ◽  
Sibaji Gaj ◽  
Kunio Nakamura ◽  
Shivakrishna Kovi ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Vascular Calcification ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Stroke Patients ◽  
Age Category

Background and Purpose: Intracranial arterial calcification is a marker of atherosclerosis burden in the general population. The aim of the study is to investigate risk factor profiles of vascular calcification in ischemic stroke patients. Methods: We identified ischemic stroke patients who underwent complete CTA from a prospective single-hospital stroke registry in 2018. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Severe vascular calcification was defined as patients in the upper quartile calcification volume. The prevalence of severe vascular calcification and mean calcification volume were investigated by age category (<60 years, 60-70 years, 70-80 years, 80 years ≥). The relation between each potential risk factors and severe vascular calcification was assessed using the multivariate logistic regression analysis adjusted for age, sex, NIHSS score, and TOAST stroke subtypes. Results: Of the 558 consecutive acute ischemic stroke patients, 388 patients (212 males; mean age 66.6±14.2 years) met inclusion and with quantitative CTA calcification. The prevalence of severe vascular calcification (CTA calcification volume> 812 mm 3 ) increased with increasing age category (<60 years: 6.8% (7/103), 60-70 years: 15.7% (18/115), 70-80 years: 39.6% (38/105), 80 years ≥: 45.9% (34/74), P<0.001 for χ 2 test). Over age 80 years subsets had significantly higher mean calcification volume with 1213 mm 3 than other age category (<60 years: 225 mm 3 , P<0.001; 60-70 years: 462 mm 3 , P<0.001; 70-79 years: 817 mm 3 , P=0.020 for t-test). In the multivariate logistic regression analysis, age (OR 1.096, 95% CI 1.066-1.128, P<0.001), smoking (OR 3.430, 95% CI 1.833-6.419, P<0.001), and large artery atherosclerosis (LAA) (OR 4.260, 95% CI 1.963-9.247, P<0.001) were independently associated with severe vascular calcification. Conclusion: In the quantitative CTA analysis of calcification volume, older age and smoking were high risk for severe atherosclerotic calcium burden in ischemic stroke patients. Moreover, severe vascular calcification may differentiate LAA from other stroke etiology.

Natural Course of Cerebral Cavernous Malformations in Children: A Five-Year Follow-Up Study

Stroke ◽  
2021 ◽  
Author(s):  
Alejandro N. Santos ◽  
Laurèl Rauschenbach ◽  
Dino Saban ◽  
Bixia Chen ◽  
Annika Herten ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Brain Stem ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Cerebral Cavernous Malformations ◽  
Multivariate Logistic Regression ◽  
Cavernous Malformations ◽  
History Of

Background and Purpose: The purpose of this study was to investigate the natural course of cerebral cavernous malformations (CCM) in the pediatric population, with special emphasis on the risk of first and recurrent bleeding over a 5-year period. Methods: Our institutional database was screened for patients with CCM treated between 2003 and 2020. Patients ≤18 years of age with complete magnetic resonance imaging data set, clinical baseline characteristics, and ≥1 follow-up examination were included. Surgically treated individuals were censored after CCM removal. We assessed the impact of various parameters on first or recurrent intracerebral hemorrhage (ICH) at diagnosis using univariate and multivariate logistic regression adjusted for age and sex. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for (re)hemorrhage. Results: One hundred twenty-nine pediatric patients with CCM were analyzed. Univariate logistic regression identified brain stem CCM (odds ratio, 3.15 [95% CI, 1.15−8.63], P =0.026) and familial history of CCM (odds ratio, 2.47 [95% CI, 1.04−5.86], P= 0.041) as statistically significant predictors of ICH at diagnosis. Multivariate logistic regression confirmed this correlation (odds ratio, 3.62 [95% CI, 1.18−8.99], P= 0.022 and odds ratio, 2.53 [95% CI, 1.07−5.98], P =0.035, respectively). Cox regression analysis identified ICH as mode of presentation (hazard ratio, 14.01 [95% CI, 1.80−110.39], P= 0.012) as an independent predictor for rehemorrhage during the 5-year follow-up. The cumulative 5-year risk of (re)bleeding was 15.9% (95% CI, 10.2%−23.6%) for the entire cohort, 30.2% (20.2%−42.3%) for pediatric patients with ICH at diagnosis, and 29.5% (95% CI, 13.9%−51.1%) for children with brain stem CCM. Conclusions: Pediatric patients with brain stem CCM and familial history of CCM have a higher risk of ICH as mode of presentation. During untreated 5-year follow-up, they revealed a similar risk of (re)hemorrhage compared to adult patients. The probability of (re)bleeding increases over time, especially in cases with ICH at presentation or brain stem localization.

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