Status epilepticus after intracranial neurosurgery: incidence and risk stratification by perioperative clinical features

OBJECTIVE Status epilepticus (SE) is associated with significant mortality, cost, and risk of future seizures. In one of the first studies of SE after neurosurgery, the authors assess the incidence, risk factors, and outcome of postneurosurgical SE (PNSE). METHODS Neurosurgical admissions from the MarketScan Claims and Encounters database (2007 through 2015) were assessed in a longitudinal cross-sectional sample of privately insured patients who underwent qualifying cranial procedures in the US and were older than 18 years of age. The incidence of early (in-hospital) and late (postdischarge readmission) SE and associated mortality was assessed. Procedural, pathological, demographic, and anatomical covariates parameterized multivariable logistic regression and Cox models. Multivariable logistic regression and Cox proportional hazards models were used to study the incidence of early and late PNSE. A risk-stratification simulation was performed, combining individual predictors into singular risk estimates. RESULTS A total of 197,218 admissions (218,217 procedures) were identified. Early PNSE occurred during 637 (0.32%) of 197,218 admissions for cranial neurosurgical procedures. A total of 1045 (0.56%) cases of late PNSE were identified after 187,771 procedure admissions with nonhospice postdischarge follow-up. After correction for comorbidities, craniotomy for trauma, hematoma, or elevated intracranial pressure was associated with increased risk of early PNSE (adjusted OR [aOR] 1.538, 95% CI 1.183–1.999). Craniotomy for meningioma resection was associated with an increased risk of early PNSE compared with resection of metastases and parenchymal primary brain tumors (aOR 2.701, 95% CI 1.388–5.255). Craniotomies for infection or abscess (aHR 1.447, 95% CI 1.016–2.061) and CSF diversion (aHR 1.307, 95% CI 1.076–1.587) were associated with highest risk of late PNSE. Use of continuous electroencephalography in patients with early (p < 0.005) and late (p < 0.001) PNSE rose significantly over the study time period. The simulation regression model predicted that patients at high risk for early PNSE experienced a 1.10% event rate compared with those at low risk (0.07%). Similarly, patients predicted to be at highest risk for late PNSE were significantly more likely to eventually develop late PNSE than those at lowest risk (HR 54.16, 95% CI 24.99–104.80). CONCLUSIONS Occurrence of early and late PNSE was associated with discrete neurosurgical pathologies and increased mortality. These data provide a framework for prospective validation of clinical and perioperative risk factors and indicate patients for heightened diagnostic suspicion of PNSE.

Download Full-text

Air Pollution Is Associated with Cognitive Deterioration of Alzheimer’s Disease

Gerontology ◽

10.1159/000515162 ◽

2021 ◽

pp. 1-9

Author(s):

Feng Cheng Lin ◽

Chih Yin Chen ◽

Chung Wei Lin ◽

Ming Tsang Wu ◽

Hsuan Yu Chen ◽

...

Keyword(s):

Risk Factors ◽

Air Pollution ◽

Social Engagement ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Rank Test ◽

Cognitive Deterioration ◽

Clinical Dementia Rating ◽

Severe Stage ◽

Increased Risk

Introduction: Dementia is one of the major causes of disability and dependency among older people worldwide. Alzheimer’s disease (AD), the most common cause of dementia among the elderly, has great impact on the health-care system of developed nations. Several risk factors are suggestive of an increased risk of AD, including APOE-ε4, male, age, diabetes mellitus, hypertension, and low social engagement. However, data on risk factors of AD progression are limited. Air pollution is revealed to be associated with increasing dementia incidence, but the relationship between air pollution and clinical AD cognitive deterioration is unclear. Methods: We conducted a case-control and city-to-city study to compare the progression of AD patients in different level of air-polluted cities. Clinical data of a total of 704 AD patients were retrospectively collected, 584 residences in Kaohsiung and 120 residences in Pingtung between 2002 and 2018. An annual interview was performed with each patient, and the Clinical Dementia Rating score (0 [normal] to 3 [severe stage]) was used to evaluate their cognitive deterioration. Air pollution data of Kaohsiung and Pingtung city for 2002–2018 were retrieved from Taiwan Environmental Protection Administration. Annual Pollutant Standards Index (PSI) and concentrations of particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO) were obtained. Results: The PSI was higher in Kaohsiung and compared with Pingtung patients, Kaohsiung patients were exposed to higher average annual concentrations of CO, NO2, PM10, and SO2. AD patients living in Kaohsiung suffered from faster cognitive deterioration in comparison with Pingtung patients (log-rank test: p = 0.016). When using multivariate Cox proportional hazards regression analysis, higher levels of CO, NO2, PM10, and SO2 exposure were associated with increased risk of AD cognitive deterioration. Among all these air pollutants, high SO2 exposure has the greatest impact while O3 has a neutral effect on AD cognitive deterioration. Conclusions: Air pollution is an environment-related risk factor that can be controlled and is associated with cognitive deterioration of AD. This finding could contribute to the implementation of public intervention strategies of AD.

Download Full-text

Nephrectomy Delay of More than 10 Weeks from Diagnosis Is Associated with Decreased Overall Survival in pT3 RCC

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.v8i2.125 ◽

2021 ◽

Vol 8 (2) ◽

pp. 27-33

Author(s):

Jiping Zeng ◽

Ken Batai ◽

Benjamin Lee

Keyword(s):

Risk Factors ◽

Overall Survival ◽

Logistic Regression ◽

Proportional Hazards ◽

Surgical Margin ◽

Cox Proportional Hazards ◽

Cancer Center ◽

Integrated Network ◽

Factors Associated ◽

The Impact

In this study, we aimed to evaluate the impact of surgical wait time (SWT) on outcomes of patients with renal cell carcinoma (RCC), and to investigate risk factors associated with prolonged SWT. Using the National Cancer Database, we retrospectively reviewed the records of patients with pT3 RCC treated with radical or partial nephrectomy between 2004 and 2014. The cohort was divided based on SWT. The primary out-come was 5-year overall survival (OS). Logistic regression analysis was used to investigate the risk factors associated with delayed surgery. Cox proportional hazards models were fitted to assess relations between SWT and 5-year OS after adjusting for confounding factors. A total of 22,653 patients were included in the analysis. Patients with SWT > 10 weeks had higher occurrence of upstaging. Using logistic regression, we found that female patients, African-American or Spanish origin patients, treatment in academic or integrated network cancer center, lack of insurance, median household income of <$38,000, and the Charlson–Deyo score of ≥1 were more likely to have prolonged SWT. SWT > 10 weeks was associated with decreased 5-year OS (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.15–1.33). This risk was not markedly attenuated after adjusting for confounding variables, including age, gender, race, insurance status, Charlson–Deyo score, tumor size, and surgical margin status (adjusted HR, 1.13; 95% CI, 1.04–1.24). In conclusion, the vast majority of patients underwent surgery within 10 weeks. There is a statistically significant trend of increasing SWT over the study period. SWT > 10 weeks is associated with decreased 5-year OS.

Download Full-text

Improvement of Abandonment of Therapy in Pediatric Patients with Cancer in Guatemala

Journal of Global Oncology ◽

10.1200/jgo.2016.004648 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 76s-76s ◽

Cited By ~ 2

Author(s):

Elysia Alvarez ◽

Midori Seppa ◽

Kevin Messacar ◽

John Kurap ◽

E. Alejandro Sweet-Cordero ◽

...

Keyword(s):

Risk Factors ◽

Psychosocial Intervention ◽

Intervention Program ◽

Proportional Hazards ◽

Conflicts Of Interest ◽

Population Based ◽

Cox Proportional Hazards ◽

Middle Income ◽

Targeted Interventions ◽

Increased Risk

Abstract 59 Background: Abandonment of therapy is a major cause of therapeutic failure in the treatment of childhood cancer in Low and Middle Income Countries (LMIC). This study examines factors associated with increased risk of therapy abandonment in Guatemalan children with cancer and the rates of therapy abandonment before and after implementation of a multidisciplinary psychosocial intervention program. Methods: A retrospective population-based study was performed to identify risk factors for abandonment of therapy in Guatemalan children, ages 0-18, with cancer who were seen at UNOP from 2001-2008. Patient data was collected from the Pediatric Oncology Networked Database (POND4Kids). Abandonment was defined as a lapse of 4 weeks in planned treatment or failure to begin treatment for a potentially curable cancer. Cox proportional hazards analysis identified the effect of age, sex, year of diagnosis, distance travelled to UNOP, ethnicity, and principal diagnosis on abandonment of therapy. Kaplan Meier analysis was used to evaluate survival. Results: A retrospective analysis of 1,789 charts was performed and 367 patients abandoned therapy. The rate of abandonment decreased from 27% in 2001 to 7% in 2008 following a multidisciplinary psychosocial intervention program. Greater distance to UNOP (p = 0.00), younger age (p = 0.02) and earlier year of diagnosis (p = 0.00) were associated with increased risk of abandonment. Abandonment of therapy correlated with decreased survival. The cumulative survival at 8.3 years was 0.57 ± 0.02 (survival±SE) for those who completed therapy vs 0.06 ± 0.02 for those who abandoned and refused therapy (p=0.000) in an abandonment sensitive analysis. Conclusion: This study identified distance, age, and year of diagnosis as risk factors for abandonment of therapy for pediatric cancer in Guatemala. This study highlights risk factors for abandonment of therapy and the role of targeted interventions in altering rates of abandonment that could be replicated in other LMIC countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Download Full-text

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes

10.21203/rs.2.18517/v3 ◽

2020 ◽

Author(s):

Hayley Martin ◽

Kelly Thevenet-Morrison ◽

Ann Dozier

Keyword(s):

Weight Gain ◽

Exclusive Breastfeeding ◽

Proportional Hazards ◽

Directed Acyclic Graphs ◽

Cox Proportional Hazards ◽

Cross Sectional ◽

Increased Risk ◽

Causal Pathway ◽

Breastfeeding Cessation ◽

The Impact

Abstract Background: It is well established that mothers with above-normal pre-pregnancy BMI are at increased risk of breastfeeding cessation; however, the impact of pregnancy weight-gain (PWG) is less well-defined. Excess PWG may alter the hormonal preparation of breast tissue for lactation, increase the risk of complications that negatively impact breastfeeding (e.g. Cesarean-section, gestational diabetes), and may make effective latch more difficult to achieve. Methods: Our objective was to determine the impact of PWG and pre-pregnancy BMI on the risk of breastfeeding cessation utilizing the Institute of Medicine’s 2009 recommendations. Cox proportional hazards models were utilized to estimate the risk of cessation of exclusive breastfeeding, and cessation of any breastfeeding among women who initiated exclusive and any breastfeeding, respectively, in a cross sectional sample of survey respondents from a New York county (N=1207). PWG category was interacted with pre-pregnancy BMI (3 levels of pre-pregnancy BMI, 3 levels of PWG). Confounders of the relationship of interest were evaluated using directed acyclic graphs and bivariate analyses; variables not on the proposed causal pathway and associated with the exposure and outcome were included in multivariate models. Results: After adjustment, women of normal and obese pre-pregnancy BMI with greater-than-recommended PWG had 1.39 (1.03-1.86) and 1.48 (1.06-2.07) times the risk of any breastfeeding cessation within the first 3 months postpartum compared to women with normal pre-pregnancy BMI who gained within PWG recommendations. Overweight women with greater-than-recommended PWG were at increased risk of cessation, although not significantly (aHR[95% CI]: 1.29 [0.95 – 1.75]). No significant relationship was observed for exclusive breastfeeding cessation. Conclusions: Pre-pregnancy BMI and PWG may be modifiable risk factors for early breastfeeding cessation. Understanding the mechanism behind this risk should be ascertained by additional studies aimed at understanding the physiological, social, logistical (positioning) and other issues that may lead to early breastfeeding cessation.

Download Full-text

Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes

10.21203/rs.2.18517/v4 ◽

2020 ◽

Author(s):

Hayley Martin ◽

Kelly Thevenet-Morrison ◽

Ann Dozier

Keyword(s):

Weight Gain ◽

Exclusive Breastfeeding ◽

Proportional Hazards ◽

Directed Acyclic Graphs ◽

Cox Proportional Hazards ◽

Cross Sectional ◽

Increased Risk ◽

Causal Pathway ◽

Breastfeeding Cessation ◽

The Impact

Download Full-text

Abstract 140: Association Between Epilepsy and the Risk of Ischemic Stroke or Myocardial Infarction

Stroke ◽

10.1161/str.48.suppl_1.140 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Matthew A Mercuri ◽

Alexander E Merkler ◽

Neal S Parikh ◽

Michael E Reznik ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Ischemic Stroke ◽

Elderly Patients ◽

Proportional Hazards ◽

Predictor Variable ◽

Cox Proportional Hazards ◽

Vascular Events ◽

Increased Risk ◽

Acute Mi

Background: Vascular brain injury can result in epilepsy. It is posited that seizures in elderly patients might reflect subclinical vascular disease and thus herald future clinical vascular events. Hypothesis: Seizures in elderly patients are associated with an increased risk of ischemic stroke or myocardial infarction (MI). Methods: We obtained inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries ≥66 years of age. The predictor variable was epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure. The primary outcome was a composite of ischemic stroke or acute MI. The predictors and outcomes were all ascertained with previously validated ICD-9-CM code algorithms. Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors. Patients were censored at the first occurrence of a stroke or MI, at the time of death, or on December 31, 2014. Results: Among 1,548,556 beneficiaries with a mean follow-up of 4.4 (±1.8) years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI. Patients with seizures were older (76.1 versus 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort. The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10-3.47%) in those with seizures versus 1.79% (95% CI, 1.78-1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78-2.00). After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29-1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65-1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86-1.04). Conclusions: We found an association between epilepsy in elderly patients and future ischemic stroke but not acute MI. Therefore, seizures might signify occult cerebrovascular disease but not necessarily occult disease in other vascular beds.

Download Full-text

MO375EPIDEMIOLOGY AND PREDICTORS OF CARDIAC BYPASS ASSOCIATED AKI IN A MIDDLE-INCOME CARIBBEAN COUNTRY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0029 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Lori-Ann Fisher ◽

Sunil Stephenson ◽

Marshall Tulloch-Reid ◽

Simon Anderson

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Fold Increase ◽

University Hospital ◽

Small Island ◽

Multivariable Logistic Regression Model ◽

Middle Income ◽

Neutrophil Lymphocyte Ratio ◽

Multivariable Logistic Regression ◽

Increased Risk

Abstract Background and Aims AKI is a common and resource intensive complication of cardiopulmonary bypass surgery (CPB) in high income-countries occurring in up to one third of surgeries performed. However, little is known of its incidence and impact in the small island developing states of the Caribbean. We describe the incidence, risk factors and outcomes of AKI following CPB at a referral cardiac centre in Jamaica. Method A review of the Medical Records of adult patients (aged ≥ 18 years) with no prior ESRD or dialysis requirement undergoing CPB at the University Hospital of the West Indies, Mona between January 1, 2016 to June 30, 2019 inclusive was undertaken. Demographics, pre-operative status, intraoperative and post-operative data were abstracted. The primary outcome was all-cause 30-day mortality. AKI was defined as meeting the KDIGO criteria based on the peak serum creatinine measurement obtained within 72 hours post-operatively. Multivariable logistic regression was used to examine the risk factors for and impact of AKI on all-cause mortality. Results Of the 259 persons who underwent CPB in the study period, 211 (58% men, mean age 58.1±12.9 years, median± IQR Euro-score II of 1.4 ± 1.4) met inclusion criteria. AKI occurred in 37.3 % (80) of patients with 43.8% (35) KDIGO I, 32.5% (26) KDIGO II and (19) 23.7% KDIGO III. Renal replacement therapy was required in 3.2% (7) of patients. In a multivariable logistic regression model, baseline CKD (eGFR<60mL/min/1.732m2; odds ratio, 95%CI: 5.32,1.72-15.90), Prolonged bypass time (1.73,1.21-2.48; per hour), intraoperative PRBC transfusion (2.33,1.08-5.03) and elevated 24-hour post-operative Neutrophil/Lymphocyte ratio>18 (3.00, 1.07-8.35) were associated with an increased risk of AKI. AKI after CPB resulted in greater hospital (23.6 versus 14.6 days, p<0.001) and ICU stay (8.1 versus 3.3 days, p<0.001) and a 6-fold increase in 30-day mortality after adjusting for age and sex (HR, 95 CI: 6.40, 2.38-17.25). (see Figure 1 Kaplan Meier survival estimates for AKI) Conclusion The occurrence of AKI following CPB is comparable to that reported in the literature and is associated with poor short-term outcomes. Larger multicentre prospective studies to predict risk, identify interventions to reduce mortality and assess long term complications of AKI following CPB in Caribbean countries are needed.

Download Full-text

Loneliness and Risk of Dementia

The Journals of Gerontology Series B ◽

10.1093/geronb/gby112 ◽

2018 ◽

Vol 75 (7) ◽

pp. 1414-1422 ◽

Cited By ~ 15

Author(s):

Angelina R Sutin ◽

Yannick Stephan ◽

Martina Luchetti ◽

Antonio Terracciano

Keyword(s):

Risk Factors ◽

Social Isolation ◽

Genetic Risk ◽

Proportional Hazards ◽

Genetic Risk Factors ◽

Cognitive Status ◽

Cox Proportional Hazards ◽

Dementia Risk ◽

Increased Risk ◽

Modifiable Factor

Abstract Objective The present study tests whether loneliness is associated with risk of dementia in the largest sample to date and further examines whether the association is independent of social isolation, a related but independent component of social integration, and whether it varies by demographic factors and genetic vulnerability. Method Participants from the Health and Retirement Study (N = 12,030) reported on their loneliness, social isolation, and had information on clinical, behavioral, and genetic risk factors. Cognitive status was assessed at baseline and every 2 years over a 10-year follow-up with the modified Telephone Interview for Cognitive Status (TICSm). A TICSm score of 6 or less was indicative of dementia. Results Cox proportional hazards regression indicated that loneliness was associated with a 40% increased risk of dementia. This association held controlling for social isolation, and clinical, behavioral, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk. Discussion Loneliness is associated with increased risk of dementia. It is one modifiable factor that can be intervened on to reduce dementia risk.

Download Full-text

Mild behavioral impairment is related to frailty in non-dementia older adults: a cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-020-01903-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shaoyi Fan ◽

Ximin Liang ◽

Tianchan Yun ◽

Zhong Pei ◽

Bin Hu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Cross Sectional Study ◽

Consecutive Series ◽

Sectional Study ◽

Behavioral Impairment ◽

Cross Sectional ◽

Multivariable Logistic Regression ◽

Increased Risk ◽

The Relationship

Abstract Background Frailty and cognitive decline are highly prevalent among older adults. However, the relationship between frailty and mild behavioral impairment (MBI), a dementia risk syndrome characterized by later-life emergence of persistent neuropsychiatric symptoms, has yet to be elucidated. We aimed to evaluate the associations between MBI and frailty in older adults without dementia. Methods In this cross-sectional study, a consecutive series of 137 older adults without dementia in the Anti-Aging Study, recruited from primary care clinics, were enrolled. Frailty was estimated using the Fried phenotype. MBI was evaluated by the Mild Behavioral Impairment Checklist (MBI-C) at a cut-off point of > 8. Cognition was assessed with the Chinese versions of the Montreal Cognitive Assessment (MoCA-BC) and Mini-mental State Examination (MMSE). Multivariable logistic regression was performed to estimate the relationship between MBI and objective cognition with frailty status. Results At baseline, 30.7% of the older adults had frailty and 18.2% had MBI (MBI+ status). Multivariable logistic regression analysis demonstrated that compared to those without MBI (MBI- status), MBI+ was more likely to have frailty (odds ratio [OR] = 7.44, 95% CI = 1.49–37.21, p = 0.02). Frailty and MBI were both significantly associated with both MMSE and MoCA-BC score (p < 0.05). Conclusions Both frailty and MBI status were associated with higher odds of cognitive impairment. MBI was significantly associated with an increased risk of having frailty in the absence of dementia. This association merits further study to identify potential strategies for the early detection, prevention and therapeutic intervention of frailty.

Download Full-text

Informant-based hearing difficulties and the risk for mild cognitive impairment and dementia

Age and Ageing ◽

10.1093/ageing/afz099 ◽

2019 ◽

Vol 48 (6) ◽

pp. 888-894 ◽

Cited By ~ 1

Author(s):

Maria Vassilaki ◽

Jeremiah A Aakre ◽

David S Knopman ◽

Walter K Kremers ◽

Michelle M Mielke ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Daily Activities ◽

Cross Sectional ◽

Cox Proportional Hazards Models ◽

Increased Risk ◽

Hearing Difficulties

Abstract Background: hearing loss has been associated with mild cognitive impairment (MCI) and dementia. Studies have not assessed whether hearing difficulties (HD) that interfere with daily activities as reported by partners can be a marker for increased risk for cognitive decline and impairment. Objective: to assess the cross-sectional and longitudinal associations between informant-based HD, which interfere with daily activities and the risk for MCI and dementia. Methods: the study included 4812 participants without dementia, enrolled in the Mayo Clinic Study of Aging (mean age (SD) 73.7 (9.6) years) with cognitive evaluation and informant-based report on participant’s HD that interfere significantly with daily activities at baseline and for every 15 months. Cox proportional hazards models (utilising time-dependent HD status and age as the time scale) were used to examine HD and the risk for MCI or dementia, and mixed-effects models (allowing for random subject-specific intercepts and slopes) were used to examine the relationship between HD and cognitive decline. Results: about, 981 participants had HD and 612 (12.7%) had prevalent MCI at baseline; 759 participants developed incident MCI and 273 developed incident dementia. In cognitively unimpaired participants at baseline, those with HD had higher risk for MCI (hazard ratio [HR] = 1.29, 95% confidence interval [CI] (1.10, 1.51), P = 0.002; adjusting for sex, years of education). In participants without dementia, those with HD had higher risk for dementia (HR: 1.39, 95% CI, (1.08–1.79), P = 0.011; adjusting sex and education). In individuals with MCI, HD was associated with modestly greater cognitive decline. Conclusions: informant-based HD was associated with increased risk for MCI and dementia.

Download Full-text