scholarly journals Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4647
Author(s):  
Su-Jeong Lee ◽  
Jun-Pyo Myong ◽  
Yun-Hee Lee ◽  
Eui-Jin Cho ◽  
Sung-Jong Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Endometrial Cancer ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Gynecological Cancer ◽  
Risk Groups ◽  
Developed Countries ◽  
Cox Proportional Hazards ◽  
Health Care Resources

Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer. Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes. Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40–59 years, aOR = 1.413; 95% confidence interval (CI) 1.203–1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239–1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27–2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer (p < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years. Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.

scholarly journals Title: Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

2020 ◽  
Author(s):  
Jack W Goodall ◽  
Thomas A N Reed ◽  
Maddalena Ardissino ◽  
Paul Bassett ◽  
Ashley M Whittington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Severe Disease ◽  
Cox Proportional Hazards ◽  
Hospitalized Patients ◽  
Reactive Protein ◽  
Global Pandemic ◽  
Northwick Park Hospital ◽  
Observational Cohort

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalized patients is critical as the pandemic progresses. This observational cohort study aimed to characterize the independent associations between the clinical outcomes of hospitalized patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, United Kingdom between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Score <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

scholarly journals ASSESSING RISK FOR ENDOMETRIAL CANCER AMONG HISPANIC FEMALES AGE 50 YEARS AND OLDER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S460-S460
Author(s):  
Ana Rodriguez ◽  
Yong-Fang Kuo ◽  
Enshuo Hsu
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Endometrial Cancer ◽  
Health Care Utilization ◽  
Gynecological Cancer ◽  
Signs And Symptoms ◽  
Care Utilization ◽  
Common Symptom ◽  
Hispanic Females ◽  
History Of

Abstract Endometrial cancer is the most common gynecological cancer in the US, with most women diagnosed between 55 and 64 years old. Seventy-five percent of women with endometrial cancer are postmenopausal, and the most common symptom is postmenopausal bleeding. Only a few studies have addressed the lack of knowledge and awareness of risk factors and/or health care utilization for early signs and symptoms of endometrial cancer. The objective of this study was to evaluate health care utilization among Hispanic women aged ≥50 years who are at risk for endometrial cancer. This retrospective cohort study used a combination of diagnosis and procedure codes from UTMB’s electronic health records to identify Texas Hispanic females who had a health encounter at ≥50 years of age between 2012 and 2016. Risk factors included conditions/treatments affecting hormone levels, age, body mass index, diabetes, gravidity, parity, family history of endometrial or colorectal cancer, previous diagnosis of breast or ovarian cancer or endometrial hyperplasia, smoking or alcohol use, and treatment with radiation therapy in the pelvis area. Multivariate logistic regression models evaluated for predictors of endometrial cancer. The study included 11,563 Hispanic females aged ≥50 years (median age=57). Most women were overweight. Currently, we identified 705 Hispanic females (6.1%) with possible endometrial cancer with validation underway. Females who have a history of vaginal spotting/bleeding, pelvic bleeding, and pelvic pain are at higher risk for endometrial cancer. It is important for physicians to educate patients on recognizing the signs and symptoms of endometrial cancer.

Abstract P161: Self-Management Resources in Heart Failure: A Prospective Community Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Matteo Fabbri ◽  
Sheila Manemann ◽  
Cynthia Boyd ◽  
Jennifer Wolff ◽  
Alanna Chamberlain ◽  
...  
Keyword(s):  
Heart Failure ◽  
Health Care ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Self Management ◽  
Health Care Resources ◽  
International Classification Of Disease ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Increased Risk

Introduction: Little is known about the characteristics and resources that enable patients with heart failure (HF) to engage in effective self-management. To address this gap in knowledge, we measured personal and health care resources for self-management and examined associations with mortality among patients with HF. Methods: We surveyed 5543 residents of 11 counties in Southeast Minnesota with a first-ever code for HF [International Classification of Disease, Ninth Revision code 428 or Tenth Revision code I50] between 1/1/2013 and 3/31/2016. Self-management resources were measured with the health care and personal subscales of the Chronic Illness Resources Survey (CIRS), both of which included 3 questions on a 5-point scale. The responses were averaged and participants were categorized as low if the mean score was below the median of the distribution (range from 1 to 5). The survey was returned by 2866 participants (response rate 52%) and those with complete data on the main items of interest were retained for analysis (N=2212). Cox proportional hazards regression was used to determine the association between each subscale and mortality. Results: Among 2212 participants (mean age 72.8 years, 54.1% men) the median health care score was 4, while the personal score was 3. Those with low health care resources were older and less educated than those with a higher score (p<0.05), while those with low personal resources had less comorbidities and lower education attainment compared to those with a higher score (p<0.05). After a mean (SD) follow-up of 1.3 ± 0.6 years, 207 deaths occurred. Low levels of both self-management resources were associated with an increased risk of death compared with patients with high levels (Table). Conclusions: Having limited self-management resources is associated with an increased risk of mortality among patients with HF. Thus, interventions aimed at supporting self-management among patients with HF may improve outcomes.

scholarly journals Risk factors for severe disease in patients admitted with COVID-19 to a hospital in London, England: a retrospective cohort study

2020 ◽  
Vol 148 ◽  
Author(s):  
J. W. Goodall ◽  
T. A. N. Reed ◽  
M. Ardissino ◽  
P. Bassett ◽  
A. M. Whittington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Severe Disease ◽  
Cox Proportional Hazards ◽  
Reactive Protein ◽  
Global Pandemic ◽  
Northwick Park Hospital ◽  
Hospitalised Patients ◽  
Observational Cohort

Abstract COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalised patients is critical as the pandemic progresses. This observational cohort study aimed to characterise the independent associations between the clinical outcomes of hospitalised patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, UK between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Scale <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

scholarly journals Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Juhyun Song ◽  
Dae Won Park ◽  
Jae-hyung Cha ◽  
Hyeri Seok ◽  
Joo Yeong Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Icu Admission ◽  
Hazards Model

AbstractWe investigated association between epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients and clinical outcomes in Korea. This nationwide retrospective cohort study included 5621 discharged patients with COVID-19, extracted from the Korea Disease Control and Prevention Agency (KDCA) database. We compared clinical data between survivors (n = 5387) and non-survivors (n = 234). We used logistic regression analysis and Cox proportional hazards model to explore risk factors of death and fatal adverse outcomes. Increased odds ratio (OR) of mortality occurred with age (≥ 60 years) [OR 11.685, 95% confidence interval (CI) 4.655–34.150, p < 0.001], isolation period, dyspnoea, altered mentality, diabetes, malignancy, dementia, and intensive care unit (ICU) admission. The multivariable regression equation including all potential variables predicted mortality (AUC = 0.979, 95% CI 0.964–0.993). Cox proportional hazards model showed increasing hazard ratio (HR) of mortality with dementia (HR 6.376, 95% CI 3.736–10.802, p < 0.001), ICU admission (HR 4.233, 95% CI 2.661–6.734, p < 0.001), age ≥ 60 years (HR 3.530, 95% CI 1.664–7.485, p = 0.001), malignancy (HR 3.054, 95% CI 1.494–6.245, p = 0.002), and dyspnoea (HR 1.823, 95% CI 1.125–2.954, p = 0.015). Presence of dementia, ICU admission, age ≥ 60 years, malignancy, and dyspnoea could help clinicians identify COVID-19 patients with poor prognosis.

scholarly journals Association Between Hormone Replacement Therapy and Development of Endometrial Cancer: Results From a Prospective US Cohort Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Ying Liang ◽  
Haoyan Jiao ◽  
Lingbo Qu ◽  
Hao Liu
Keyword(s):  
Endometrial Cancer ◽  
Cohort Study ◽  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Large Scale ◽  
Proportional Hazards ◽  
Hormone Replacement ◽  
Cox Proportional Hazards

Although hormone replacement therapy (HRT) use is associated with elevated endometrial cancer(EC) risk, little evidence assesses potential effect-modifiers on HRT-related EC in a long-term follow-up. In this large-scale longitudinal cohort study, we tried to evaluate the association between different HRT types/methods use and risk of EC, and reveal this risk within different body mass index (BMI) groups. In whole cohort, 677 EC occurred during mean 11.6 years follow-up. Cox proportional hazards regression was used to estimate multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (CIs) with HRT status (never, former, or current) for risk of EC incidence. Current HRT use was not significantly associated with EC risk (HR for current vs. never HRT use: 1.13; 95% CI: 0.92, 1.38) in the whole cohort, but presented a dose-response effect on increased EC risk (HR for &gt;10-year use vs. never HRT use: 1.73; 95% CI: 1.35, 2.21). Moreover, EC risk differed in distinct regimens or subsets (all Pinteraction &lt; 0.05). Estrogen-only use was associated with elevated EC risk (HR for current vs. never HRT use: 1.51; 95% CI: 1.12, 2.04), but women with high BMI (&gt; 30 kg/m2) who currently use estrogen-only harbored decreased EC risk (HR: 0.56; 95% CI: 0.38, 0.82) compared to counterparts without HRT use. Estrogen-only use is associated with increased EC risk, and precise monitoring of EC development for postmenopausal women with long-term HRT use are urgently needed. BMI could serve as an important surrogate to assess this risk.

scholarly journals Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3613
Author(s):  
Martin Leu ◽  
Jacqueline Possiel ◽  
Markus A. Schirmer ◽  
Andrea Hille ◽  
Stefan Rieken ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Endometrial Cancer ◽  
Side Effects ◽  
Significant Influence ◽  
Proportional Hazards ◽  
Gynecological Cancer ◽  
Treatment Strategies ◽  
The Elderly ◽  
Cox Proportional Hazards ◽  
Cancer Center

Numerous clinical trials sought to improve outcomes in endometrial cancer patients with multimodal treatment strategies. We tested the hypothesis that specific histopathological and clinical parameters are prognosticators for outcomes at our Gynecological Cancer Center. A total of 203 patients (median age, 69.5 years) was included. They were irradiated postoperatively (n = 184: Brachytherapy, n = 19: Teletherapy) between 05/2007 and 03/2020. The median follow-up was 37.2 months. As statistical methods, we used the univariable Cox proportional hazards regression, and log-rank statistics. First, we found a significant influence of grading and nodal stage on outcomes. These findings underline the recommendations of more intense treatment in these patient groups, as already reflected in current guidelines. Secondly, we found that patient age had a significant influence on survival be it due to comorbidities and/or due to too hesitant treatment regimen in the elderly. Thus, it should be aimed at particular strategies in treatment of these patients. Lastly, we found very low rates of treatment-related side effects in patients treated with brachytherapy and moderate rates of side effects in patients treated with teletherapy. Overall, our study serves as basis for further improvement of treatment strategies and for conceptualization of clinical trials.

scholarly journals Plasma enterolactone and incidence of endometrial cancer in a case–cohort study of Danish women

2012 ◽  
Vol 109 (12) ◽  
pp. 2269-2275 ◽  
Author(s):  
Julie Aarestrup ◽  
Cecilie Kyrø ◽  
Knud E. B. Knudsen ◽  
Elisabete Weiderpass ◽  
Jane Christensen ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Hormone Replacement ◽  
Menopausal Status ◽  
Antibiotic Use ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Inverse Association

The phyto-oestrogen enterolactone has been hypothesised to protect against hormone-dependent cancers, probably through its anti-oestrogenic potential. We investigated whether a higher level of plasma enterolactone was associated with a lower incidence of endometrial cancer in a case–cohort study in the ‘Diet, Cancer and Health’ cohort. The cohort study included 29 875 women aged 50–64 years enrolled between 1993 and 1997. Information on diet and lifestyle was provided by self-administrated questionnaires and blood was drawn from each participant. Time-resolved fluoroimmunoassay was used for biochemical determination of plasma enterolactone. A total of 173 cases and 149 randomly selected cohort members were included. We estimated incidence rate ratio (IRR) and 95 % CI by a Cox proportional hazards model. A 20 nmol/l higher plasma concentration of enterolactone was associated with a non-significant lower risk of endometrial cancer (IRR 0·93, 95 % CI 0·84, 1·04). When excluding women with low enterolactone concentrations (quartile 1) due to potential recent antibiotic use, the association became slightly stronger, but remained non-significant (IRR 0·90, 95 % CI 0·79, 1·02). Menopausal status, hormone replacement therapy or BMI did not modify the association. In conclusion, we found some support for a possible inverse association between plasma enterolactone concentration and endometrial cancer incidence.

scholarly journals Risk Factors and Blood Pressure Control Targets Associated With the Clinical Outcome of Elderly COVID-19 Patients With Hypertension: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Ting Li ◽  
Maomao Wang ◽  
Yifei Wang ◽  
Pei Zhang ◽  
Yang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Retrospective Cohort ◽  
Proportional Hazards ◽  
Pressure Control ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Blood Pressures

Abstract Background: COVID-19 is a global pandemic, especially among the elderly. Our study aimed to explore the risk factors and identify the blood pressure control targets associated with the clinical outcome of elderly COVID-19 patients with hypertension. Methods: In this retrospective cohort study, elderly COVID-19 patients who were admitted to Wuhan Huoshenshan Hospital from February 8 to 17, 2020 was included. Demographic, medical history, clinical data, and laboratory test data were collected from medical records. The adverse clinical outcomes were intensive care unit (ICU) admission and death. Difference between hypertension and non-hypertension groups were compared. Hypertension group were further divided into 3 subgroups according to their maximum blood pressures. Kaplan–Meier (K–M) method was used to find the differences both between hyperntesion and non-hypertension groups, and among the 3 hypertension subgroups. Univariable and multivariable Cox proportional hazards regression model were used to find risk factors.Results: All 133 elderly COVID-19 patients (79 patients with hypertension) were included. (1) Univariate analysis between hypertension and non-hypertension patients showed most laboratory tests were significantly (P < 0.05, or P < 0.01), particularly in adverse clinical outcomes (32.91% vs 7.41% at 30 days, P < 0.05). (2) Multivariate Cox proportional hazards models confirmed hypertension (HR 3.202, 95% CI:1.164 - 8.807) were the most important independent risk factors of outcomes in elderly patients, as well as low lymphocyte count, while the statistical difference of other values diminished. (3) Hypertension group were further divided into 3 subgroups according to their maximum blood pressures. K-M analysis showed maximum systolic blood pressure (SBP) ≥160mmHg subgroup (P < 0.01) and maximum blood pressure (DBP) ≥90mmHg subgroup (P < 0.05) experienced more adverse outcomes than others. (4) Multivariate Cox-proportional hazard model confirmed that maximum SBP≥160mmHg and maximum DBP ≥90mmHg were risk factors (HR 8.279, 95% CI: 1.346, 50.914; HR 5.080, 95% CI: 1.606,16.071; respectively). Conclusions: Hypertension is the most important independent risk factor of adverse outcomes in elderly COVID-19 patients, controlling the maximum blood pressure levels under 160/90 mmHg will decrease large part risks of adverse outcomes, the first week are key treatment period for patient prognosis.

scholarly journals Fibrosis-4 index as a predictor for mortality in hospitalised patients with COVID-19: a retrospective multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041989
Author(s):  
Jung Gil Park ◽  
Min Kyu Kang ◽  
Yu Rim Lee ◽  
Jeong Eun Song ◽  
Na Young Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Proportional Hazards ◽  
Severe Infection ◽  
Cox Proportional Hazards ◽  
Respiratory Support ◽  
Hospitalised Patients ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

ObjectiveThe reliable risk factors for mortality of COVID-19 has not evaluated in well-characterised cohort. This study aimed to identify risk factors for in-hospital mortality within 56 days in patients with severe infection of COVID-19.DesignRetrospective multicentre cohort study.SettingFive tertiary hospitals of Daegu, South Korea.Participants1005 participants over 19 years old confirmed COVID-19 using real-time PCR from nasopharyngeal and oropharyngeal swabs.MethodsThe clinical and laboratory features of patients with COVID-19 receiving respiratory support were analysed to ascertain the risk factors for mortality using the Cox proportional hazards regression model. The relationship between overall survival and risk factors was analysed using the Kaplan-Meier method.OutcomeIn-hospital mortality for any reason within 56 days.ResultsOf the 1005 patients, 289 (28.8%) received respiratory support, and of these, 70 patients (24.2%) died. In multivariate analysis, high fibrosis-4 index (FIB-4; HR 2.784), low lymphocyte count (HR 0.480), diabetes (HR 1.917) and systemic inflammatory response syndrome (HR 1.714) were found to be independent risk factors for mortality in patients with COVID-19 receiving respiratory support (all p<0.05). Regardless of respiratory support, survival in the high FIB-4 group was significantly lower than in the low FIB-4 group (28.8 days vs 44.0 days, respectively, p<0.001). A number of risk factors were also significantly related to survival in patients with COVID-19 regardless of respiratory support (0–4 risk factors, 50.2 days; 49.7 days; 44.4 days; 32.0 days; 25.0 days, respectively, p<0.001).ConclusionFIB-4 index is a useful predictive marker for mortality in patients with COVID-19 regardless of its severity.

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