Factors Affecting Patients with Concurrent Deep Neck Infection and Acute Epiglottitis

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.

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Factors Affecting the Necessity of Tracheostomy in Patients with Deep Neck Infection

Diagnostics ◽

10.3390/diagnostics11091536 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1536

Author(s):

Shih-Lung Chen ◽

Chi-Kuang Young ◽

Tsung-You Tsai ◽

Huei-Tzu Chien ◽

Chung-Jan Kang ◽

...

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Clinical Findings ◽

Older Age ◽

Retropharyngeal Space ◽

Deep Neck Infection ◽

Neck Infection ◽

Factors Associated ◽

Streptococcus Constellatus ◽

Common Pathogen

Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163–5.161, p = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153–9.360, p = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097–42.972, p < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). Streptococcus constellatus (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and Streptococcus constellatus was the most common pathogen in the patients with DNI that required tracheostomy.

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A dangerous cause of airway obstruction: deep neck infection

10.22514/sv.2020.16.0101 ◽

2020 ◽

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

Deep Neck Infection ◽

Jugular Vein Thrombosis ◽

Neck Infection ◽

Vein Thrombosis ◽

Lethal Complications ◽

Life Threatening ◽

Fascial Spaces ◽

Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

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Risk Factors Associated with Retinopathy of Prematurity in Very and Extremely Preterm Infants

Medicina ◽

10.3390/medicina57050420 ◽

2021 ◽

Vol 57 (5) ◽

pp. 420

Author(s):

Claudia Ioana Borțea ◽

Florina Stoica ◽

Marioara Boia ◽

Emil Radu Iacob ◽

Mihai Dinu ◽

...

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Gestational Age ◽

Retinopathy Of Prematurity ◽

Univariate Analysis ◽

Significant Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surfactant Administration ◽

Stage 1

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

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Risk factors for cholesterol polyp formation in the gallbladder are closely related to lipid metabolism

Lipids in Health and Disease ◽

10.1186/s12944-021-01452-6 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Zhihao Yu ◽

Changlin Yang ◽

Xuesong Bai ◽

Guibin Yao ◽

Xia Qian ◽

...

Keyword(s):

Risk Factors ◽

Low Density Lipoprotein ◽

Univariate Analysis ◽

Density Lipoprotein ◽

High Volume ◽

Population Characteristics ◽

Polyp Formation ◽

Logistic Analysis ◽

Cholesterol Polyp ◽

Independent Risk Factors

Abstract Background The purpose of this study was to assess the risk factors for cholesterol polyp formation in the gallbladder. Methods This was a multicenter retrospective study based on pathology. From January 2016 to December 2019, patients who underwent cholecystectomy and non-polyp participants confirmed by continuous ultrasound follow-ups were reviewed. Patients in the cholesterol polyp group were recruited from three high-volume centers with a diagnosis of pathologically confirmed cholesterol polyps larger than 10 mm. Population characteristics and medical data were collected within 24 h of admission before surgery. The non-polyp group included participants from the hospital physical examination center database. They had at least two ultrasound examinations with an interval longer than 180 days. Data from the final follow-up of the non-polyp group were analyzed. The risk factors for cholesterol polyp formation were analyzed by comparing the two groups. Results A total of 4714 participants were recruited, including 376 cholesterol polyp patients and 4338 non-polyp participants. In univariate analysis, clinical risk factors for cholesterol polyps were age, male sex, higher body mass index (BMI), higher low-density lipoprotein (LDL), lower high-density lipoprotein (HDL), and higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. In multivariate logistic analysis, independent risk factors were age > 50 years (odds ratio [OR] = 3.02, 95% confidence interval [CI] 2.33–3.91, P < 0.001], LDL > 2.89 mmol/L (OR = 1.38, 95% CI 1.08–1.78, P = 0.011), lower HDL (OR = 1.78 95% CI 1.32–2.44, P < 0.001), AST > 40 IU/L (OR = 3.55, 95% CI 2.07–6.07, P < 0.001), and BMI > 25 kg/m 2 (OR = 1.32, 95% CI 1.01–1.72, P = 0.037). Conclusions Age, LDL, HDL, AST, and BMI are strong risk factors for cholesterol polyp formation. Older overweight patients with polyps, accompanied by abnormal lipid levels, are at high risk for cholesterol polyps.

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Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study

Clinical Chemistry ◽

10.1373/clinchem.2019.304600 ◽

2019 ◽

Vol 65 (9) ◽

pp. 1102-1114 ◽

Cited By ~ 3

Author(s):

Hiroaki Ikezaki ◽

Virginia A Fisher ◽

Elise Lim ◽

Masumi Ai ◽

Ching-Ti Liu ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Ldl Cholesterol ◽

Disease Risk ◽

Univariate Analysis ◽

Significant Risk ◽

C Reactive Protein ◽

Cox Regression Analysis ◽

Reactive Protein ◽

Standard Risk

AbstractBACKGROUNDIncreases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study.METHODSWe used stored frozen plasma samples (−80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods.RESULTSConsidering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death).CONCLUSIONSOur data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.

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Combining Carcinoembryonic Antigen and Platelet to Lymphocyte Ratio to Predict Brain Metastasis of Resected Lung Adenocarcinoma Patients

BioMed Research International ◽

10.1155/2017/8076384 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Wei Wang ◽

Chao Bian ◽

Di Xia ◽

Jin-Xi He ◽

Ping Hai ◽

...

Keyword(s):

Risk Factors ◽

Brain Metastasis ◽

Lung Adenocarcinoma ◽

Carcinoembryonic Antigen ◽

Roc Curve ◽

Univariate Analysis ◽

Significant Risk ◽

Platelet To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Increased Risk

We aimed to evaluate the role of pretreatment carcinoembryonic antigen (CEA) and platelet to lymphocyte ratio (PLR) in predicting brain metastasis after radical surgery for lung adenocarcinoma patients. The records of 103 patients with completely resected lung adenocarcinoma between 2013 and 2014 were reviewed. Clinicopathologic characteristics of these patients were assessed in the Cox proportional hazards regression model. Brain metastasis occurred in 12 patients (11.6%). On univariate analysis, N2 stage (P = 0.013), stage III (P = 0.016), increased CEA level (P = 0.006), and higher PLR value (P = 0.020) before treatment were associated with an increased risk of developing brain metastasis. In multivariate model analysis, CEA above 5.2 ng/mL (P = 0.014) and PLR ≥ 120 (P = 0.036) remained as the risk factors for brain metastasis. The combination of CEA and PLR was superior to CEA or PLR alone in predicting brain metastasis according to the receiver operating characteristic (ROC) curve analysis (area under ROC curve, AUC 0.872 versus 0.784 versus 0.704). Pretreatment CEA and PLR are independent and significant risk factors for occurrence of brain metastasis in resected lung adenocarcinoma patients. Combining these two factors may improve the predictability of brain metastasis.

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Prenatal and neonatal risk factors for schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.170.2.128 ◽

1997 ◽

Vol 170 (2) ◽

pp. 128-133 ◽

Cited By ~ 78

Author(s):

Christina M. Hultman ◽

Arne Öhman ◽

Sven Cnattingius ◽

Ing-Marie Wieselgren ◽

Leif H. Lindström

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Subsequent Development ◽

Summary Score ◽

Obstetric Complications ◽

Physical Size ◽

Small Head ◽

Schizophrenic Patients ◽

Independent Risk Factors ◽

Birth Records

BackgroundThe present study examines the effects of independent, single pre- and perinatal risk factors and rates of obstetric complications upon the subsequent development of schizophrenia.MethodThis study was based on prospectively recorded birth records of 107 cases (82 with schizophrenic disorders and 25 with other psychotic reactions) and 214 controls, individually matched by gender and time and place of birth. Variables univariately associated with significantly elevated risk were entered in a logistic regression model.ResultsA high non-optimality summary score (> or = 7 complications of 34 possible) was a significant risk estimate for the total index group (OR 4.58, 95% CI 1.74–12.03) and the 82 schizophrenic patients (OR 3.67, CI 1.30–10.36). Patients with 2–6 complications also had an increased, although lower, risk (OR 1.67, CI 1.02–2.75). A disproportionate birth weight for body length (OR 3.57, CI 1.77–7.19) and a small head circumference (OR 3.93, CI 1.32–11.71) were the strongest independent risk factors.ConclusionsA contribution of obstetric complications to the risk of schizophrenia was confirmed. Only aberrations in physical size remained as individual independent risk factors.

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EMA-CO chemotherapy for high-risk gestational trophoblastic neoplasia: a clinical analysis of 54 patients

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00999.x ◽

2008 ◽

Vol 18 (2) ◽

pp. 357-362 ◽

Cited By ~ 35

Author(s):

W.-G. Lu ◽

F. Ye ◽

Y.-M. Shen ◽

Y.-F. Fu ◽

H.-Z. Chen ◽

...

Keyword(s):

Risk Factors ◽

Survival Rate ◽

High Risk ◽

Complete Remission ◽

Univariate Analysis ◽

Significant Risk ◽

Clinical Analysis ◽

Secondary Malignancy ◽

Primary Therapy ◽

Gestational Trophoblastic Neoplasia

This study was designed to analyze the outcomes of chemotherapy for high-risk gestational trophoblastic neoplasia (GTN) with EMA-CO regimen as primary and secondary protocol in China. Fifty-four patients with high-risk GTN received 292 EMA/CO treatment cycles between 1996 and 2005. Forty-five patients were primarily treated with EMA-CO, and nine were secondarily treated after failure to other combination chemotherapy. Adjuvant surgery and radiotherapy were used in the selected patients. Response, survival and related risk factors, as well as chemotherapy complications, were retrospectively analyzed. Thirty-five of forty-five patients (77.8%) receiving EMA-CO as first-line treatment achieved complete remission, and 77.8% (7/9) as secondary treatment. The overall survival rate was 87.0% in all high-risk GTN patients, with 93.3% (42/45) as primary therapy and 55.6% (5/9) as secondary therapy. The survival rates were significantly different between two groups (χ2= 6.434, P = 0.011). Univariate analysis showed that the metastatic site and the number of metastatic organs were significant risk factors, but binomial distribution logistic regression analysis revealed that only the number of metastatic organs was an independent risk factor for the survival rate. No life-threatening toxicity and secondary malignancy were found. EMA-EP regimen was used for ten patients who were resistant to EMA-CO and three who relapsed after EMA-CO. Of those, 11 patients (84.6%) achieved complete remission. We conclude that EMA-CO regimen is an effective and safe primary therapy for high-risk GTN, but not an appropriate second-line protocol. The number of metastatic organs is an independent prognostic factor for the patient with high-risk GTN. EMA-EP regimen is a highly effective salvage therapy for those failing to EMA-CO.

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Development of Predictive Nomograms for Clinical Use to Quantify the Risk of Amputation in Patients with Diabetic Foot Ulcer

Journal of Diabetes Research ◽

10.1155/2021/6621035 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Bocheng Peng ◽

Rui Min ◽

Yiqin Liao ◽

Aixi Yu

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Prediction Model ◽

Predictive Factors ◽

Diabetic Foot ◽

Univariate Analysis ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Single Factor ◽

Independent Risk Factors

Objective. To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). Methods and Materials. In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. Results. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Conclusion. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.

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Improving Quality of Surgical Care and Outcomes: Factors Impacting Surgical Site Infection after Colorectal Resection

The American Surgeon ◽

10.1177/000313481408000823 ◽

2014 ◽

Vol 80 (8) ◽

pp. 759-763 ◽

Cited By ~ 5

Author(s):

Virginia Oliva Shaffer ◽

Caitlin D. Baptiste ◽

Yuan Liu ◽

Jahnavi K. Srinivasan ◽

John R. Galloway ◽

...

Keyword(s):

Risk Factors ◽

Glucose Level ◽

Univariate Analysis ◽

Significant Risk ◽

Surgical Care ◽

Surgical Site Infections ◽

Case Volume ◽

Improvement Project ◽

Combining Data

Surgical site infections (SSIs) result in patient morbidity and increased costs. The purpose of this study was to determine reasons underlying SSI to enable interventions addressing identified factors. Combining data from the American College of Surgeons National Surgical Quality Improvement Project with medical record extraction, we evaluated 365 patients who underwent colon resection from January 2009 to December 2012 at a single institution. Of the 365 patients, 84 (23%) developed SSI. On univariate analysis, significant risk factors included disseminated cancer, ileostomy, patient temperature less than 36°C for greater than 60 minutes, and higher glucose level. The median number of cases per surgeon was 36, and a case volume below the median was associated with a higher risk of SSI. On multivariate analysis, significant risks associated with SSI included disseminated cancer (odds ratio [OR], 4.31; P < .001); surgery performed by a surgeon with less than 36 cases (OR, 2.19; P = .008); higher glucose level (OR, 1.06; P 5.017); and transfusion of five units or more of blood (OR, 3.26; P 5.029). In this study we found both modifiable and unmodifiable factors associated with increased SSI. Identifying modifiable risk factors enables targeting specific areas to improve the quality of care and patient outcomes.

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