Long-Term Mortality in Critically Ill Tracheostomized Patients Based on Home Mechanical Ventilation at Discharge

Data regarding the long-term outcomes for tracheostomized patients receiving home mechanical ventilation (HMV) are limited. We aimed to determine the 1-year mortality rate for critically ill tracheostomized patients with and without HMV. Data of tracheostomized patients between 1 January 2015 and 31 December 2019 were analyzed. A Kaplan-Meier analysis was performed to assess the survival curve of the patients. Among the 124 tracheostomized patients, 102 (82.3%) were weaned from mechanical ventilation (MV), and 22 (17.7%) required HMV at discharge. The overall 1-year mortality rate was 47.6%, and HMV group had a significantly higher 1-year mortality rate than those weaned from MV (41.2% vs. 77.3%, p = 0.002). In the Cox proportional hazards regression, BMI (HR 0.913 [95% CI 0.850–0.980], p = 0.012), Sequential Organ Failure Assessment (SOFA) score (HR 1.114 [95% CI 1.040–1.193], p = 0.002), transfer to a nursing facility (HR 5.055 [95% CI 1.558–16.400], p = 0.007), and HMV at discharge (HR 1.930 [95% CI 1.082–3.444], p = 0.026) were significantly associated with 1-year mortality. Critically ill tracheostomized patients with HMV at discharge had a significantly higher 1-year mortality rate than those weaned from MV. Low BMI, high SOFA score, transfer to a nursing facility, and HMV at discharge were significantly associated with 1-year mortality.

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Maternal hepatitis B or C carrier status and long-term risk for offspring neurological morbidity: a population-based cohort study

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420001397 ◽

2021 ◽

pp. 1-5

Author(s):

Israel Yoles ◽

Eyal Sheiner ◽

Naim Abu-Freha ◽

Tamar Wainstock

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Survival Curve ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Carrier Status ◽

Hazards Model ◽

Kaplan Meier

Abstract Hepatitis B and hepatitis C (HBV/HCV) are important global public health concerns. We aimed to evaluate the association between maternal HBV/HCV carrier status and long-term offspring neurological hospitalisations. A population-based cohort analysis compared the risk for long-term childhood neurological hospitalisations in offspring born to HBV/HCV carrier vs. non-carrier mothers in a large tertiary medical centre between 1991 and 2014. Childhood neurological diseases, such as cerebral palsy, movement disorders or developmental disorders, were pre-defined based on ICD-9 codes as recorded in hospital medical files. Offspring with congenital malformations and multiple gestations were excluded from the study. A Kaplan–Meier survival curve was constructed to compare cumulative neurological hospitalisations over time, and a Cox proportional hazards model was used to control for confounders. During the study period (1991–2014), 243,682 newborns met the inclusion criteria, and 777 (0.3%) newborns were born to HBV/HCV mothers. The median follow-up was 10.51 years (0–18 years). The offspring from HBV/HCV mothers had higher incidence of neurological hospitalisations (4.5 vs. 3.1%, hazard ratio (HR) = 1.91, 95% CI 1.37–2.67). Similarly, the cumulative incidence of neurological hospitalisations was higher in children born to HBV/HCV carrier mothers (Kaplan–Meier survival curve log-rank test p < 0.001). The increased risk remained significant in a Cox proportional hazards model, which adjusted for gestational age, mode of delivery and pregnancy complications (adjusted HR = 1.40, 1.01–1.95, p = 0.049). We conclude that maternal HBV or HCV carrier status is an independent risk factor for the long-term neurological hospitalisation of offspring regardless of gestational age and other adverse perinatal outcomes.

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Perinatal Outcome and Long-Term Infectious Morbidity of Offspring Born to Women with Known Tuberculosis

Journal of Clinical Medicine ◽

10.3390/jcm9092768 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2768

Author(s):

Shanny Sade ◽

Tamar Wainstock ◽

Eyal Sheiner ◽

Gali Pariente

Keyword(s):

Perinatal Outcome ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Very Low Birth Weight ◽

Survival Curve ◽

Study Groups ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Infectious Morbidity

Objective: To evaluate the perinatal outcome of women with tuberculosis and to assess a possible association between maternal tuberculosis and long-term infectious morbidity of the offspring. Study design: Perinatal outcome and long-term infectious morbidity of offspring of mothers with and without tuberculosis were assessed. The study groups were followed until 18 years of age tracking infectious-related morbidity and infectious-related hospitalizations and then compared. For perinatal outcome, generalized estimation equation models were used. A Kaplan-Meier survival curve was used to compare cumulative incidence of long-term infectious morbidity. A Cox proportional hazards model was conducted to control for confounders. Results: During the study period, 243,682 deliveries were included, of which 46 (0.018%) occurred in women with tuberculosis. Maternal tuberculosis was found to be independently associated with placental abruption, cesarean deliveries, and very low birth weight. However, offspring born to mothers with tuberculosis did not demonstrate higher rates of infectious-related morbidity. Maternal tuberculosis was not noted as an independent risk factor for long-term infectious morbidity of the offspring. Conclusion: In our study, maternal tuberculosis was found to be independently associated with adverse perinatal outcomes. However, higher risk for long-term infectious morbidity of the offspring was not demonstrated. Careful surveillance of these women is required.

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Development and validation of nomogram to predict long-term prognosis of critically ill patients with acute myocardial infarction

10.1101/2020.08.14.20174953 ◽

2020 ◽

Author(s):

yiyang tang ◽

lihuang zha ◽

xiaofang zeng ◽

yilu feng ◽

wenchao lin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Discriminative Ability ◽

Term Survival ◽

Long Term Survival

Background: Acute myocardial infarction (AMI) is a common critical illness in the cardiovascular field, with poor prognosis. This study aimed to construct a nomogram to predict long-term survival of critically ill patients with AMI, which helps to assess severity, guide treatment, and improve prognosis. Methods and results: The clinical data of patients with AMI was extracted from the database MIMIC-III v1.4. The Cox proportional hazards models were performed to identify the independently prognostic factors, and a nomogram for predicting long-term survival of AMI patients was developed based on the multifactor analysis, of which discriminative ability and accuracy was evaluated by concordance index (C-index) and calibration curve. Results: A total of 1202 patients were included in the analysis, of which 841 were divided into the training set and 361 were the validation. Multivariate analysis shown that age, blood urea nitrogen, respiratory rate, SAPSII score, cardiogenic shock, cardiac arrhythmias, and respiratory failure served as the independently predictive factors, which were incorporated into the nomogram. Moreover, the nomogram shown favorable performance for predicting 4-year survival of AMI patients with the C- index of 0.788 [95% confidence interval (CI): 0.763 to 0.813] and 0.783 (95% CI: 0.748 to 0.818) in the training and validation set, respectively. Conclusion: The nomogram we constructed here can accurately predict the long-term survival of patients with AMI.

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Comparison of clinical course and outcomes of critically ill patients with SARS-CoV2 infection managed in traditional ICU and “Flex” ICU during the surge of the pandemic in the Bronx

10.1101/2021.03.03.21252868 ◽

2021 ◽

Author(s):

Victor Perez Gutierrez ◽

Alex Carlos ◽

Jessica Nino ◽

Julieta Osella ◽

Vihren Dimitrov ◽

...

Keyword(s):

Mechanical Ventilation ◽

Critical Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Proportional Hazards ◽

Risk Model ◽

Cox Proportional Hazards ◽

Adjusted Risk ◽

Hospital Systems ◽

Care Capacity

ABSTRACTBACKGROUNDAs part of the response to increase critical care capacity during the unprecedented surge of COVID-19 infections, NYC Health + Hospital systems identified and resourced areas in the hospital that could deliver critical care as “Flex” ICUs to complement the traditional ICUs to manage the rapid influx of critically ill patients.OBJECTIVEComparison of clinical features and outcomes of mechanically ventilated COVID-19 patients admitted to the traditional and “Flex” ICUs during the surge of the pandemicMETHODSRetrospective comparative cohort study of patients with confirmed SARS-CoV-2 infection on mechanical ventilation admitted to traditional ICU and ‘Flex’ ICU. Univariate and multivariate analysis to detect factors associated with death from COVID-19 patients in mechanical ventilation were performed with the Cox proportional hazards regression modelRESULTSOut of the 312 patients on mechanical ventilation, 111 were admitted to the traditional ICU and 201 to the ‘Flex’ ICU. The mortality rate was higher in the ‘Flex’ ICU compared with the traditional ICU, but the adjusted risk model was not significantly associated with increased mortalityCONCLUSION“Flex” ICUs played a crucial role in the management of critically ill patients during the pandemic. Mortality risk of patients in the “Flex” ICUs were comparable to traditional ICUs in the adjusted analysis. While there is enough evidence for Intensivist managed ICUs to have better outcomes, our study demonstrates the feasibility of non-intensivist led Flex” ICUs during a crisis.

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Assisted reproductive technology and long-term ophthalmic morbidity of the offspring

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420000938 ◽

2020 ◽

pp. 1-5

Author(s):

Erez Tsumi ◽

Yotam Lavy ◽

Eyal Sheiner ◽

Chiya Barrett ◽

Avi Harlev ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Survival Curve ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Fertility Treatments ◽

Hazards Model ◽

Kaplan Meier ◽

Meier Survival Curve

Abstract In this study, we investigate if children born following assisted reproduction technologies (ARTs) are at an increased risk for long-term ophthalmic complications. For this purpose, a population-based cohort analysis was conducted which included all deliveries between 1991 and 2014 at a single tertiary medical center. Offspring were classified relative to conception method as ART or spontaneous pregnancies. Offspring hospitalizations up to the age of 18 years involving ophthalmic morbidities were evaluated according to a predefined set of ICD-9 codes. A Kaplan–Meier survival curve was used to compare cumulative hospitalization rates in exposed (ART) and unexposed offspring (spontaneous), and a Cox proportional hazards model was used to control for potential confounders. A total of 243,682 deliveries were included in the study. In that, 1.8% of the deliveries (4364) were of mothers who underwent fertility treatments and 98.2% (239,318) were conceived spontaneously. Offspring born to mothers who underwent fertility treatments had a significantly higher hospitalization rate involving ophthalmic morbidity, as compared to spontaneously conceived offspring (1.2% vs. 1.0%, p = 0.04). The Kaplan–Meier survival curve pointed to a significantly higher cumulative incidence of ophthalmic morbidity following ART (log rank p = 0.02). Cox proportional hazards model was adjusted for maternal age, preterm delivery, maternal hypertensive disorders, diabetes, and mode of delivery which demonstrated ART as an independent risk factor for long-term pediatric ophthalmic morbidity (adjusted hazard ratio = 1.37, CI 1.04–1.80, p-value = 0.02). We concluded that ART is an independent risk factor for long-term ophthalmic morbidity of the offspring.

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Adapting the Default Weighted Survival Analysis Modelling Approach to Model IFRS 9 LGD

Risks ◽

10.3390/risks9060103 ◽

2021 ◽

Vol 9 (6) ◽

pp. 103

Author(s):

Morne Joubert ◽

Tanja Verster ◽

Helgard Raubenheimer ◽

Willem D. Schutte

Keyword(s):

Survival Analysis ◽

Financial Reporting ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Survival Curve ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Reporting Standard ◽

International Financial Reporting Standard ◽

Ifrs 9

Survival analysis is one of the techniques that could be used to predict loss given default (LGD) for regulatory capital (Basel) purposes. When using survival analysis to model LGD, a proposed methodology is the default weighted survival analysis (DWSA) method. This paper is aimed at adapting the DWSA method (used to model Basel LGD) to estimate the LGD for International Financial Reporting Standard (IFRS) 9 impairment requirements. The DWSA methodology allows for over recoveries, default weighting and negative cashflows. For IFRS 9, this methodology should be adapted, as the estimated LGD is a function of in the expected credit losses (ECL). Our proposed IFRS 9 LGD methodology makes use of survival analysis to estimate the LGD. The Cox proportional hazards model allows for a baseline survival curve to be adjusted to produce survival curves for different segments of the portfolio. The forward-looking LGD values are adjusted for different macro-economic scenarios and the ECL is calculated for each scenario. These ECL values are probability weighted to produce a final ECL estimate. We illustrate our proposed IFRS 9 LGD methodology and ECL estimation on a dataset from a retail portfolio of a South African bank.

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Perioperative Geriatric Assessment as A Predictor of Long-Term Hepatectomy Outcomes in Elderly Patients with Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers13040842 ◽

2021 ◽

Vol 13 (4) ◽

pp. 842

Author(s):

Masaki Kaibori ◽

Hideyuki Matsushima ◽

Morihiko Ishizaki ◽

Hisashi Kosaka ◽

Kosuke Matsui ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Geriatric Assessment ◽

Proportional Hazards ◽

Prognostic Indicator ◽

Cox Proportional Hazards ◽

Rate Of Change ◽

Score Change ◽

Comorbidity Burden ◽

Reduction Group

This retrospective study recorded pertinent baseline geriatric assessment variables to identify risk factors for recurrence-free survival (RFS) and overall survival (OS) after hepatectomy in 100 consecutive patients aged ≥70 years with hepatocellular carcinoma. Patients had geriatric assessments of cognition, nutritional and functional statuses, and comorbidity burden, both preoperatively and at six months postoperatively. The rate of change in each score between preoperative and postoperative assessments was calculated by subtracting the preoperative score from the score at six months postoperatively, then dividing by the score at six months postoperatively. Patients with score change ≥0 comprised the maintenance group, while patients with score change <0 comprised the reduction group. The change in Geriatric 8 (G8) score at six months postoperatively was the most significant predictive factor for RFS and OS among the tested geriatric assessments. Five-year RFS rates were 43.4% vs. 6.7% (maintenance vs. reduction group; HR, 0.19; 95%CI, 0.11–0.31; p < 0.001). Five-year OS rates were 73.8% vs. 17.8% (HR, 0.12; 95%CI, 0.06–0.25; p < 0.001). Multivariate Cox proportional hazards analysis showed that perioperative maintenance of G8 score was an independent prognostic indicator for both RFS and OS. Perioperative changes in G8 scores can help forecast postoperative long-term outcomes in these patients.

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Reduction in Short- and Long-term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis

Otolaryngology ◽

10.1177/01945998211015174 ◽

2021 ◽

pp. 019459982110151

Author(s):

Cheng-Ming Hsu ◽

Yao-Te Tsai ◽

Geng-He Chang ◽

Yao-Hsu Yang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Lower Incidence ◽

Vocal Fold ◽

Proportional Hazards ◽

Vocal Fold Paralysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Voice Therapy ◽

Unilateral Vocal Fold Paralysis ◽

Short And Long Term

Objective To examine the association of laryngoplasty, voice therapy, and pneumonia rate in patients with unilateral vocal fold paralysis (UVFP). Study Design Population-based retrospective cohort study. Setting Data were collected from the LHID2000 (Longitudinal Health Insurance Database 2000), containing the information of 1 million randomly selected patients in Taiwan. Methods In the LHID2000, we identified 439 patients having new diagnoses of UVFP from 1997 to 2013. We grouped the aforementioned patients according to UVFP treatment and probed the occurrence of pneumonia: 305 patients underwent laryngoplasty or voice therapy, and 134 patients did not undergo treatment. Follow-up procedures were executed for the enrollees until death or December 31, 2013, representing the end of the study period. We assessed the association of UVFP treatment and pneumonia by executing Cox proportional hazards regression. Results The pneumonia cumulative incidence was significantly higher among enrolled patients without treatment than in those receiving treatment ( P < .001). The pneumonia incidence was significantly lower in patients receiving UVFP treatment (hazard ratio, 0.49; 95% CI, 0.27-0.88; P = .018), as validated by the Cox proportional hazards model after adjustment. Patients undergoing laryngoplasty with or without voice therapy had a significantly lower incidence of pneumonia at 6 months and 1, 3, and 5 years, whereas those undergoing voice therapy alone did not. Conclusion Laryngoplasty was associated with a lower incidence of short- and long-term pneumonia in patients with UVFP. Physicians should encourage patients with UVFP at risk of aspiration to receive prompt evaluation as well as treatment.

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Inter-pregnancy interval and later pediatric cardiovascular health of the offspring – a population-based cohort study

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174420001130 ◽

2020 ◽

pp. 1-5

Author(s):

Majdi Imterat ◽

Tamar Wainstock ◽

Eyal Sheiner ◽

Gali Pariente

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards ◽

Cardiovascular Morbidity ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Kaplan Meier ◽

Inter Pregnancy Interval

Abstract Recent evidence suggests that a long inter-pregnancy interval (IPI: time interval between live birth and estimated time of conception of subsequent pregnancy) poses a risk for adverse short-term perinatal outcome. We aimed to study the effect of short (<6 months) and long (>60 months) IPI on long-term cardiovascular morbidity of the offspring. A population-based cohort study was performed in which all singleton live births in parturients with at least one previous birth were included. Hospitalizations of the offspring up to the age of 18 years involving cardiovascular diseases and according to IPI length were evaluated. Intermediate interval, between 6 and 60 months, was considered the reference. Kaplan–Meier survival curves were used to compare the cumulative morbidity incidence between the groups. Cox proportional hazards model was used to control for confounders. During the study period, 161,793 deliveries met the inclusion criteria. Of them, 14.1% (n = 22,851) occurred in parturient following a short IPI, 78.6% (n = 127,146) following an intermediate IPI, and 7.3% (n = 11,796) following a long IPI. Total hospitalizations of the offspring, involving cardiovascular morbidity, were comparable between the groups. The Kaplan–Meier survival curves demonstrated similar cumulative incidences of cardiovascular morbidity in all groups. In a Cox proportional hazards model, short and long IPI did not appear as independent risk factors for later pediatric cardiovascular morbidity of the offspring (adjusted HR 0.97, 95% CI 0.80–1.18; adjusted HR 1.01, 95% CI 0.83–1.37, for short and long IPI, respectively). In our population, extreme IPIs do not appear to impact long-term cardiovascular hospitalizations of offspring.

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