Obesity as a risk factor of contrast-induced acute kidney injury in patients with arterial hypertension and stable coronary artery disease

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance. Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH. Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI. Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model. Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.

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Heart failure and contrast-induced acute kidney injury in patients with coronary artery disease

Consilium Medicum ◽

10.26442/20751753.2020.10.200352 ◽

2020 ◽

Vol 22 (10) ◽

pp. 61-63

Author(s):

Olga Iu. Mironova ◽

◽

Olga A. Sivakova ◽

Aleksandr D. Deev ◽

Viktor V. Fomin ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Coronary Artery ◽

Serum Creatinine ◽

Contrast Media ◽

Kidney Injury ◽

Baseline Serum ◽

Artery Disease ◽

Contrast Media Administration

Aim. To assess the influence of heart failure on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) with indications to diagnostic procedures requiring intra-arterial administration of contrast media. Materials and methods. 1023 patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angio-plasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. CI-AKI was defined as 25% or more increase of baseline serum creatinine, or more than 0.5 mg/dl and was assessed 48 hours after contrast media administration. The primary endpoint was the CI-AKI development according to KDIGO criteria. Most of the patients, included in the study, were males aged 66.3±10 years with arterial hypertension and overweight (BMI 29.14±5 kg/m2). Results. The study included 1023 patients, 76 suffered from heart failure. The rate of CI-AKI in this group was 13.2% (10 patients). The rate of CI-AKI using the absolute creatinine rise definition was 4% cases (3 cases). Conclusion. Female patients suffering from heart failure with higher levels of serum creatinine and low glomerular filtration rate need more attention, less amount of contrast and adequate preventive measures before contrast media administration in order to lower the risk of CI-AKI development.

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Contrast-associated acute kidney injury in patients with arterial hypertension and stable coronary artery disease

Systemic Hypertension ◽

10.26442/2075082x.2020.3.200337 ◽

2020 ◽

Vol 17 (3) ◽

pp. 48-52

Author(s):

Olga Iu. Mironova ◽

Viktor V. Fomin

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Coronary Artery ◽

Arterial Hypertension ◽

Contrast Media ◽

Stable Coronary Artery Disease ◽

Kidney Injury ◽

Baseline Creatinine ◽

Artery Disease

Relevance.The combination of stable coronary artery disease (CAD) and arterial hypertension (AH) is one of the most common seen by cardiologists. The administration of contrast media might increase the risk of development of acute kidney injury, especially in patients with comorbidities. The influence of iodine contrast media administration on the risk of development of contrast-associated acute kidney injury (CA-AKI) in patients with stable CAD and AH was studied in our work. Materials and methods.863 patients with stable CAD and AH and indications for interventions requiring intraarterial administration of contrast media were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). CA-AKI was defined according to KDIGO criteria as the elevation of serum creatinine 25% and more above baseline or 0.5 mg/dl (44 mkmol/l) and more in 48 hours after intraarterial administration of contrast media. The primary endpoint was the development of CA-AKI. Results.Diabetes mellitus, obesity and hyperuricemia were not statistically significant risk factors of CA-AKI development according to the contingency tables analyses, unlike proteinuria. A logistic regression model was built (area under the curve 0.7638,p0.0001, 95% confidence interval 0.7130.815) and included the following risk factors: age, weight, body mass index, female gender, heart failure, proteinuria, AH, anemia, baseline creatinine. Proteinuria, baseline creatinine and contrast volume were statistically significant ones. Conclusion.The rate of CA-AKI was 12.6%. Proteinuria, baseline creatinine and contrast volume were statistically significant risk factors of CA-AKI in logistic regression model. Key words:contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, arterial hypertension, stable coronary artery disease, prognosis.

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Contrast-induced acute kidney injury in patients with stable coronary artery disease: the most important risk factors and prevalence

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.09.000751 ◽

2020 ◽

Vol 92 (9) ◽

pp. 44-48

Author(s):

O. I. Mironova ◽

I. I. Staroverov ◽

O. A. Sivakova ◽

V. V. Fomin

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Logistic Regression Model ◽

Stable Coronary Artery Disease ◽

Kidney Injury ◽

Multiple Logistic Regression ◽

Artery Disease ◽

Stable Cad

Aim.The aim of our study was to assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) receiving optimal medical treatment with indications to coronary angiography and intraarterial administration of contrast agents. Materials and methods.1023 patients with stable CAD were included in the open prospective observational cohort study. The CI-AKI was defined as a rise in serum creatinine 25% from baseline. The mean age of the study group was 61.710.1 years; 72.4% were males and 84.4% had arterial hypertension. A multiple logistic regression model of prediction of CI-AKI was created. Results.CI-AKI developed in 132 (12.9%) of the patients. The multiple logistic regression model included gender, BMI, weight, age, heart failure, diabetes mellitus, arterial hypertension, anemia, hyperuricemia, proteinuria and baseline serum creatinine. Area under the curve for the model was 0.749 (95% confidence interval 0.7030,795;p0.0001). When trying to build a prognostic model, including baseline GFR and contrast volume, the model lost significance and the AUC diminished. Conclusion.The CI-AKI remains quite a common kidney injury developing in patients with stable CAD undergoing percutaneous interventions. Several risk factors need to be assessed very carefully before any intervention requiring intraarterial contrast media administration especially in patients with comorbidities.

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Serum creatinine level changes and contrast-induced acute kidney injury in patients with stable coronary artery disease

Consilium Medicum ◽

10.26442/20751753.2020.10.200358 ◽

2020 ◽

Vol 22 (10) ◽

pp. 72-75

Author(s):

Olga Iu. Mironova ◽

◽

Viktor V. Fomin ◽

Keyword(s):

Risk Factors ◽

Creatinine Level ◽

Filtration Rate ◽

Logistic Regression Model ◽

Stable Coronary Artery Disease ◽

Significant Risk ◽

Kidney Injury ◽

Baseline Creatinine ◽

Artery Disease ◽

Contrast Media Administration

Aim. The aim of our study was to assess the influence of different risk factors on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD). Materials and methods. Patients, who were receiving optimal medical therapy and had indications to coronary angiography and possible coronary angioplasty, with stable CAD were included in the study. We conducted an observational open prospective cohort study, which was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. Most of the patients, included in the study, were males aged 61.7±10.1 years with arterial hypertension and overweight. The rate of CI-AKI in this group was 12.9% (132 patients). The rate of CI-AKI using the absolute creatinine rise definition was 1.8% cases (18 cases). A logistic regression model was created, where baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors. The AUC was 0.984 (95% CI 0.969–0.999; p<0.0001). Conclusion. The most significant risk factors in the logistic regression model created were baseline creatinine, baseline glomerular filtration rate and delta between baseline creatinine and creatinine level after contrast media administration were the most statistically significant risk factors.

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Contrast-associated acute kidney injury in patients with arterial hypertension and coronary artery disease and its long-term prognosis

Systemic Hypertension ◽

10.26442/2075082x.2020.4.200528 ◽

2021 ◽

Vol 17 (4) ◽

pp. 32-36

Author(s):

Olga Iu. Mironova ◽

Viktor V. Fomin

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Coronary Artery ◽

Contrast Media ◽

Kidney Injury ◽

Percutaneous Coronary ◽

Acute Decompensation ◽

Artery Disease ◽

Stable Cad ◽

Long Term Prognosis

Background. Arterial hypertension (AH) is frequently associated with coronary artery disease (CAD), especially in older patients and patients with comorbidities. Kidneys eliminate the contrast media after percutaneous coronary interventions and are considered target organs of AH, what makes the research of contrast-associated acute kidney injury (CA-AKI) and its long-term prognosis important topics for the researchers nowadays. Aim. To assess the incidence of CA-AKI in patients with CAD and AH and its prognostic significance. Materials and methods. 435 patients with stable CAD and AH and indications for studies with intraarterial iodine contrast media administration were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153) with a follow-up period more than 5 years. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was CI-AKI according to KDIGO criteria. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention. Results. Most of the patients, included in the study, were overweight (BMI 29.14.8 kg/m2) males. 88 (20.2%) patients suffered from diabetes mellitus and 3.9% had heart failure. The mean volume of contrast media administered was 236.690.2 ml. The rate of CA-AKI was 82 (18.9%) cases. The cardiovascular mortality rate was 3.9%, myocardial infarction 9.4%, stroke 2.5%, acute decompensation of heart failure 9.7%. Conclusion. The rate of CA-AKI in patients with stable CAD and AH is slightly higher than in patients without such a combination of diseases. There is a trend towards better survival free of myocardial infarction, stroke or acute decompensation of heart failure in patients without CA-AKI.

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P0585ANEMIA AS A PROGNOSTIC FACTOR IN CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0585 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Olga Mironova ◽

Olga Perekosova ◽

Alina Ushanova ◽

Georgy Isaev ◽

Alexander Ermolaev ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Primary Outcome ◽

Stable Coronary Artery Disease ◽

Kidney Injury ◽

Number Of Patients ◽

Artery Disease ◽

Stable Cad ◽

Heart Failure Decompensation

Abstract Background and Aims Contrast-induced acute kidney injury (CI-AKI) remains one of the major obstacles to perform percutaneous coronary interventions (PCI), especially in older patients and in patients with comorbidities. The number of cases of stable coronary artery disease (CAD) requiring such kind of interventions, in spite of optimal medical treatment received, remains high. Diabetes, hyperuricemia and other components of metabolic syndrome, as well as heart failure, are well known risk factors predisposing to the development of CI-AKI after contrast exposure. Anaemia is diagnosed in a number of patients without underlying chronic kidney disease (CKD), when they seek for medical help due to CAD. The aim of our study was to assess the prevalence of CI-AKI (primary outcome) and the prognostic significance of anaemia as a its possible risk factor (secondary outcome) in different groups of patients with stable CAD requiring PCI using the contrast media. Method We conducted a single-centre prospective observational cohort study. 561 patients aged 18-89 with stable CAD undergoing PCI were enrolled from June 2012 until October 2013. The CI-AKI was defined as a rise in serum creatinine of ≥0,5 mg/dl (≥44μmol/l) or a 25% increase from baseline value, assessed at 48-72 hours after PCI. Anaemia was defined according to the WHO definition – haemoglobin level <12,0 g/dl in women and <13,0 g/dl in men. The contrast media used was either iodixanol (iso-osmolar contrast) or iopromide (low-osmolar contrast), which are both known to cause less adverse events than high-osmolar types of contrast. Nephrotoxic drugs were stopped 48 hours before PCI. The 5-year prognosis including all-cause and cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, decompensation of chronic heart failure, repeat revascularizations (PCI and coronary artery bypass grafting), end-stage renal disease (ESRD) development, was assessed via phone calls and appointments according to the clinical situation and severity of the condition. Results The prevalence of CI-AKI in this group of patients was 104 cases (18,5%) (primary outcome). The number of patients with anaemia was higher in the group of patients who developed CI-AKI after PCI (6% [7/104] vs 4,4% [20/457]). The female patients with anaemia were more likely to develop CI-AKI (71% [5/7] vs 35% [7/20]). The number of patients who suffered from MI having anaemia at the inclusion date was 2 (28,6%) vs 6 (30%) in patients with and without CI-AKI respectively. Acute heart failure decompensation in patients with anaemia was significantly higher in patients with CI-AKI (43% [3/7] vs 10% [2/20]). This fact needs further evaluation in larger studies but anaemia may be one of the prognostic factors, worsening the kidney damage and leading to worse cardiorenal outcomes. Conclusion Patients with stable CAD suffering from anaemia are more likely to develop CI-AKI even without underlying CKD or ESRD. Female patients with anaemia and stable CAD have higher risk of development of CI-AKI. The combination of CI-AKI and anaemia may lead to a higher 5-year risk of acute heart failure decompensation.

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Serum neutrophil-gelatinase associated lipocalin as a predictor of post-contrast acute kidney injury in children

QJM ◽

10.1093/qjmed/hcab113.057 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Alyaa A Kotby ◽

Marwa W Nasef ◽

Walaa A Kabiel ◽

Yasser H Mohammad ◽

Rana M Elmaghrabi

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Contrast Media ◽

Cardiac Catheterization ◽

Congenital Heart ◽

Kidney Injury ◽

Significant Rise ◽

Contrast Injection ◽

Post Contrast ◽

Contrast Media Administration

Abstract Background Diagnosis of post-contrast acute kidney injury (PC-AKI) by serum creatinine can be delayed because of various factors. A new biomarker neutrophilgelatinase associated lipocalin (NGAL) is postulated to be more sensitive for recognizing patients prone to PC-AKI. Objective To assess serum NGAL changes as an early biomarker of PC-AKI in children with congenital heart disease undergoing cardiac catheterization. Methods This observational study included 30 children with congenital heart disease who underwent cardiac catheterization at the Pediatric Cardiac Catheterization Unit, New Children’s Hospital, Ain Shams University. They had a median age of 30 months and 63% were females. Serum NGAL was measured just before the catheterization, 6hrs and 24hrs after contrast media administration while serum creatinine was measured before and after 24hrs of contrast media administration. Results Significant rise of serum NGAL was noted within 24hrs after contrast administration (p < 0.05) while serum creatinine showed a non-significant rise (p > 0.05). Serum NGAL was positively correlated with age, weight, height, body surface area and rate of contrast injection (p < 0.01). Higher levels of serum NGAL were found among patients who underwent diagnostic cardiac catheterization and those who received Midazolam for initial sedation during induction of anesthesia (p < 0.05). Conclusions Serum NGAL was elevated as early as 6 hours post contrast injection, however its serum level is affected by many factors. It’s important to be aware of other possible risk factors of PC-AKI rather than contrast media as type of cardiac catheterization and the anaesthetic Midazolam.

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Relationship between the D-dimer and von Willebrand factor levels and the development of gastrointestinal bleeding in patients with stable coronary artery disease: data from the registry of long-term antithrombotic therapy REGATTA-1

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-3022 ◽

2021 ◽

Vol 20 (7) ◽

pp. 3022

Author(s):

O. O. Shakhmatova ◽

A. L. Komarov ◽

V. V. Korobkova ◽

E. V. Titaeva ◽

A. B. Dobrovolskiy ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Independent Predictor ◽

Stable Coronary Artery Disease ◽

Artery Disease ◽

Stable Cad ◽

Von Willebrand ◽

Willebrand Factor ◽

D Dimer

Aim. To study the role of von Willebrand factor (VWF) and D-dimer (DD) as predictors of upper gastrointestinal bleeding (GIB) in patients with stable coronary artery disease (CAD).Material and methods. The study included patients with stable CAD who are members of the prospective registry of long-term antithrombotic therapy (REGATTA-1) (ClinicalTrials.gov Identifier: NCT04347200). The primary endpoints were actionable GIBs (Bleeding Academic Research Consortium type 2-5). Cut-off points for DD and VWF were determined by ROC analysis. The predictive significance of an increase in VWF and DD was assessed by the logistic regression.Results. The study included 408 patients (men, 77,5%; mean age, 61,3±10,8 years). The median follow-up period was 2,5 [1,1-14,7] years. DD was determined in all patients, including 36 patients with GIB, while VWF — in 169 patients (28 patients with GIB). An increase in DD >928 ng/ml was an independent predictor of GIB, including taking into account clinical risk factors (odds ratio (OR), 3,26 [95% confidence interval (CI), 1,43-7,42] (p=0,0047), or the previously developed REGATTA scale score (OR, 3,73, 95% CI: 1,65-8,43 (p=0,0015)). VWF >105% was also an independent predictor of GIB (OR, 14,02; 95% CI: 1,41-139,42 (p=0,023)); in the REGATTA scale model — OR 11,3, 95% CI: 1,43-88,83 (p=0,021). The increase in both markers was most unfavorable, since the proportion of those with GIB was 41,4%, while among patients with normal DD and increased VWF — 14,9%, and with low values of both markers — 0%. OR of GIB in patients with an increase in both markers was 4,1 (95% CI: 1,6-10,3 (p=0,003)).Conclusion. In patients with stable CAD, an increase in VWF and DD was associated with an increase in GIB risk regardless of the presence of clinical risk factors.

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Double Filtration Plasmapheresis in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Kidney Dysfunction

Blood Purification ◽

10.1159/000507615 ◽

2020 ◽

Vol 49 (6) ◽

pp. 713-722 ◽

Cited By ~ 1

Author(s):

Lu Cheng ◽

Yue-Qiu Tang ◽

Jing Yi ◽

Qian Ren ◽

Xiao-Yan Yang ◽

...

Keyword(s):

Adverse Events ◽

Serum Creatinine ◽

Kidney Injury ◽

Kidney Dysfunction ◽

Double Filtration Plasmapheresis ◽

Significant Difference ◽

Before And After ◽

The Difference ◽

Double Filtration

Background: Therapeutic plasma exchange (TPE) has been recommended by guidelines for the treatment of anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV) with severe kidney dysfunction. In recent years, some researchers have proposed that double-filtration plasmapheresis (DFPP) can also be used effectively in the treatment of these patients, but the difference between the 2 modalities of plasmapheresis is not clear. Methods: In this retrospective cohort study of AAV patients with serum creatinine ≥500 μmol/L from March 2013 to July 2018 who received TPE or DFPP treatment, we compared TPE and DFPP in terms of the changes of clinical parameters before and after plasmapheresis, the rates of adverse events during plasmapheresis, and kidney and patient survival during follow-up. Results: Forty-two AAV patients with kidney injury were included in this study. Twenty patients were treated with TPE and 22 patients were treated with DFPP. All patients were followed up for a median of 22 months. In each group, there were 10 deaths, and 6 patients developed end-stage kidney disease (ESKD). There were no significant differences between TPE and DFPP in terms of the changes of renal function or other laboratory results after treatment. During the plasmapheresis treatment, there was no significant difference in the rate of adverse events (p = 0.67). During the follow-up, there was no difference between the groups regarding the level of serum creatinine for patients with kidney recovery. The hazard ratio (HR) for TPE compared to DFPP for the outcome of ESKD was 0.92 (95% CI 0.45–1.9; p = 0.79) and the HR for death was 1.11 (95% CI 0.45–2.76; p = 0.82). Conclusion: There were no differences in short-term effectiveness, safety, or long-term outcomes between the 2 modalities of plasmapheresis. Our study suggests that DFPP may be a choice of plasmapheresis for AAV patients with severe kidney injury especially in countries and regions with limited blood resources.

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Hyperuricemia in patients with stable coronary artery disease and arterial hypertension and percutaneous coronary interventions

Consilium Medicum ◽

10.26442/20751753.2020.12.200555 ◽

2020 ◽

Vol 22 (12) ◽

pp. 20-22

Author(s):

Olga Iu. Mironova ◽

◽

Viktor V. Fomin ◽

Keyword(s):

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Coronary Artery ◽

Linear Regression ◽

Arterial Hypertension ◽

Stable Coronary Artery Disease ◽

Kidney Injury ◽

Multiple Linear Regression Model ◽

Artery Disease ◽

Stable Cad

Aim. To assess the influence of hyperuricemia on the risk of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and arterial hypertension. Materials and methods. Patients receiving optimal medical therapy and with indications for coronary angiography and possible coronary angioplasty, with stable CAD and arterial hypertension were included in the study. We conducted an observational open prospective cohort study, that was registered in clinicaltrials.gov with ID NCT04014153. Results. We included 1023 patients with chronic CAD. 863 had arterial hypertension. Hyperuricemia was diagnosed in 31 patients, 832 had normal levels of uric acid on admission. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. In patients with stable CAD, AH and no hyperuricemia the rate of CI-AKI was 107 (12.9%) patients. The difference between groups was not statistically significant (95% CI -0.056–0.183, р=0.292). We built a multiple linear regression model that included age, weight, female gender, heart failure, diabetes mellitus, kidney diseases in past medical history, protei-nuria, anemia, baseline glomerular filtration rate, contrast volume and difference between baseline creatinine and creatinine after contrast administration. No risk factor showed any statistical significance in the model. Conclusion. Contrast-induced acute kidney injury developed in 2 (6.5%) patients suffering from hyperuricemia. The rate of CI-AKI in patients without hyperuricemia was twice higher but the results were not statistically significant. Among the risk factors included in the multiple linear regression model none was statistically significant.

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