Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study

Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ≥ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.

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Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011–2014

BMJ Open ◽

10.1136/bmjopen-2017-019090 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019090

Author(s):

Yoshifumi Kido ◽

Norito Kawakami ◽

Mami Kayama

Keyword(s):

Cohort Study ◽

Hospital Admission ◽

Social Functioning ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Problem Behaviours ◽

Model Project

ObjectiveThis study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours.Design and settingThis study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011–2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care.ParticipantsA total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis.Outcome measuresThe primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared.ResultsThe clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups.ConclusionThis is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.

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Creatinine-to-body weight ratio is a predictor of incident diabetes: a population-based retrospective cohort study

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-021-00776-8 ◽

2022 ◽

Vol 14 (1) ◽

Author(s):

Jiacheng He

Keyword(s):

Body Weight ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Weight Ratio ◽

Threshold Effect ◽

Population Based ◽

Cox Proportional Hazards ◽

Incident Type

Abstract Purpose Creatinine to body weight (Cre/BW) ratio is considered the independent risk factor for incident type 2 diabetes mellitus (T2DM), but research on this relationship is limited. The relationship between the Cre/BW ratio and T2DM among Chinse individuals is still ambiguous. This study aimed to evaluate the correlation between the Cre/BW ratio and the risk of T2DM in the Chinese population. Methods This is a retrospective cohort study from a prospectively collected database. We included a total of 200,658 adults free of T2DM at baseline. The risk of incident T2DM according to Cre/BW ratio was estimated using multivariable Cox proportional hazards models, and a two-piece wise linear regression model was developed to find out the threshold effect. Results With a median follow-up of 3.13 ± 0.94 years, a total of 4001 (1.99%) participants developed T2DM. Overall, there was an L-shaped relation of Cre/BW ratio with the risk of incident T2DM (P for non-linearity < 0.001). When the Cre/BW ratio (× 100) was less than 0.86, the risk of T2DM decreased significantly as the Cre/BW ratio increased [0.01 (0.00, 0.10), P < 0.001]. When the Cre/BW ratio (× 100) was between 0.86 and 1.36, the reduction in the risk of developing T2DM was not as significant as before [0.22 (0.12, 0.38), P < 0.001]. In contrast, when the Cre/BW ratio (× 100) was greater than 1.36, the reduction in T2DM incidence became significantly flatter than before [0.73 (0.29,1.8), P = 0.49]. Conclusion There was an L-shaped relation of Cre/BW ratio with incidence of T2DM in general Chinese adults. A negative curvilinear association between Cre/BW ratio and incident T2DM was present, with a saturation effect predicted at 0.86 and 1.36 of Cre/BW ratio (× 100).

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Associations between SARS-CoV-2 variants and risk of COVID-19 hospitalization among confirmed cases in Washington State: a retrospective cohort study

10.1101/2021.09.29.21264272 ◽

2021 ◽

Author(s):

Miguel I. Paredes ◽

Stephanie Lunn ◽

Michael Famulare ◽

Lauren A. Frisbie ◽

Ian Painter ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Sentinel Surveillance ◽

Cox Proportional Hazards Model ◽

Ancestral Lineage ◽

Significant Difference

Background: The COVID–19 pandemic is now dominated by variant lineages; the resulting impact on disease severity remains unclear. Using a retrospective cohort study, we assessed the risk of hospitalization following infection with nine variants of concern or interest (VOC/VOI). Methods: Our study includes individuals with positive SARS–CoV–2 RT PCR in the Washington Disease Reporting System and with available viral genome data, from December 1, 2020 to July 30, 2021. The main analysis was restricted to cases with specimens collected through sentinel surveillance. Using a Cox proportional hazards model with mixed effects, we estimated hazard ratios (HR) for the risk of hospitalization following infection with a VOC/VOI, adjusting for age, sex, and vaccination status. Findings: Of the 27,814 cases, 23,170 (83.3%) were sequenced through sentinel surveillance, of which 726 (3.1%) were hospitalized due to COVID–19. Higher hospitalization risk was found for infections with Gamma (HR 3.17, 95% CI 2.15–4.67), Beta (HR: 2.97, 95% CI 1.65–5.35), Delta (HR: 2.30, 95% CI 1.69–3.15), and Alpha (HR 1.59, 95% CI 1.26–1.99) compared to infections with an ancestral lineage. Following VOC infection, unvaccinated patients show a similar higher hospitalization risk, while vaccinated patients show no significant difference in risk, both when compared to unvaccinated, ancestral lineage cases. Interpretation: Infection with a VOC results in a higher hospitalization risk, with an active vaccination attenuating that risk. Our findings support promoting hospital preparedness, vaccination, and robust genomic surveillance.

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A Nomogram Prediction of Length of Hospital Stay in Patients with COVID-19 Pneumonia: A Retrospective Cohort Study

Disease Markers ◽

10.1155/2021/5598824 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Kang Li ◽

Chi Zhang ◽

Ling Qin ◽

Chaoran Zang ◽

Ang Li ◽

...

Keyword(s):

Cohort Study ◽

Hospital Stay ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Characteristic Curve ◽

Length Of Hospital Stay ◽

Cox Proportional Hazards ◽

Brier Score ◽

Rank Test

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You’An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan–Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10–18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 ( 95 % confidence interval CI = 0.69 – 0.83 ), and the AUC was 0.88 ( 95 % CI = 0.82 – 0.95 ). The adjusted C-index was 0.75 ( 95 % CI = 0.67 – 0.82 ) and adjusted AUC 0.86 ( 95 % CI = 0.73 – 0.95 ), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 ( 95 % CI = 0.07 – 0.15 ) and adjusted Brier score of 0.130 ( 95 % CI = 0.07 – 0.20 ) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 ( 95 % CI = 0.69 – 0.89 ), 0.89 ( 95 % CI = 0.83 – 0.96 ), and 0.96 ( 95 % CI = 0.92 – 1.00 ), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.

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Outcomes in Critically Ill Patients Sedated with Intravenous Lormetazepam or Midazolam: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10184091 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4091

Author(s):

Björn Weiss ◽

David Hilfrich ◽

Gerald Vorderwülbecke ◽

Maria Heinrich ◽

Julius J. Grunow ◽

...

Keyword(s):

Cohort Study ◽

Critically Ill ◽

Retrospective Cohort Study ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Medical Center ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model

The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.

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Body-Mass Index and Progression of Hepatitis B: A Population-Based Cohort Study in Men

Journal of Clinical Oncology ◽

10.1200/jco.2008.16.1075 ◽

2008 ◽

Vol 26 (34) ◽

pp. 5576-5582 ◽

Cited By ~ 71

Author(s):

Ming-Whei Yu ◽

Wei-Liang Shih ◽

Chih-Lin Lin ◽

Chun-Jen Liu ◽

Jhih-Wei Jian ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Hepatitis B ◽

Body Mass ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Excess Body Weight ◽

Biochemical Tests ◽

Hazard Ratios

Purpose To determine prospectively whether body-mass index (BMI) is associated with liver-related morbidity and mortality among male hepatitis B virus (HBV) carriers. Patients and Methods We performed a prospective study of 2,903 male HBV surface antigen–positive government employees who were free of cancer at enrollment between 1989 and 1992. Main outcome measures included ultrasonography, biochemical tests, incident hepatocellular carcinoma (HCC), and liver-related death. Results During mean follow-up of 14.7 years, 134 developed HCC and 92 died as a result of liver-related causes. In Cox proportional hazards models adjusting for age, number of visits, diabetes, and use of alcohol and tobacco, the hazard ratios for incident HCC were 1.48 (95% CI, 1.04 to 2.12) in overweight men (BMI between 25.0 and 29.9 kg/m2) and 1.96 (95% CI, 0.72 to 5.38) in obese men (BMI ≥ 30.0 kg/m2), compared with normal-weight men (BMI between 18.5 and 24.9 kg/m2). Liver-related mortality had adjusted hazard ratios of 1.74 (95% CI, 1.15 to 2.65) in overweight men and 1.50 (95% CI, 0.36 to 6.19) in obese men. Excess BMI was also associated with the occurrence of fatty liver and cirrhosis detected by ultrasonography, as well as elevated ALT and γ-glutamyltransferase (GGT) activity during follow-up. The association of BMI with GGT was stronger than with ALT, and elevated GGT activity and cirrhosis were the strongest predictors for incident HCC and liver-related death. Conclusion This longitudinal cohort study indicates that excess body weight is involved in the transition from healthy HBV carrier state to HCC and liver-related death among men.

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Clinical Outcomes of Bariatric Surgery Among Military Retirees and Beneficiaries: A Retrospective Cohort Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa063_075 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1677-1677

Author(s):

Joshua Roe ◽

Brenda Bustillos ◽

Adam Kieffer

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Cohort Study ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Military Retirees ◽

Student’S T ◽

One Year

Abstract Objectives Obesity prevalence is estimated at 34% in U.S. military retirees and 28% in beneficiaries of military healthcare, with common comorbidities being type 2 diabetes (T2D), hypertension, and hyperlipidemia. Stressors experienced during active duty service result in higher risk for disabling musculoskeletal injuries, psychological trauma, and alcohol abuse; all of which debilitate healthy weight loss efforts. No literature exists on the demographics and clinical outcomes of military retirees who elect bariatric surgery. The purpose of this study was to assess demographics and determine clinical outcomes of retirees and beneficiaries following bariatric surgery. It was hypothesized that pre-operative weights and comorbidity remission would be higher in the military retiree group. Methods A retrospective cohort study assessed military retirees and beneficiaries who underwent sleeve gastrectomy or gastric bypass surgery at a military treatment facility in 2014. Percent total weight loss (%TWL) and remission of pre-existing comorbidities (T2D, hypertension, and hyperlipidemia) at one year follow-up were primary outcomes and compared using Student's T tests and chi-squared contingency analysis. Additional statistical analyses included a Wilcoxon-Mann-Whitney test and backwards stepwise regression. Results Ninety-eight patients (64 beneficiaries and 34 retirees) were included with mean ages of 48 and 52 years, respectively. Student's T test and Wilcoxon-Mann-Whitney test confirmed that beneficiaries achieved greater %TWL at one year follow-up, 30.2% vs. 25.8% (p < 0.05) and 55.5 vs. 38.2 mean rank (p < 0.01), respectively. Beneficiaries and retirees achieved similar remission of T2D, hypertension, and hyperlipidemia. Patient's sex and surgery type were significant predictors of %TWL variation between groups at one year follow-up. These variables accounted for 9% of the %TWL variance. Conclusions Retirees who elect bariatric surgery lose less weight than their beneficiary counterparts. Etiology of this poorer outcome remains unclear, but further research may demonstrate need for improving healthcare resources provided to military retirees. Funding Sources No funding was received to support this study.

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Midday Nap Duration and Hypertension among Middle-Aged and Older Chinese Adults: A Nationwide Retrospective Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073680 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3680

Author(s):

Jialin Fu ◽

Xinge Zhang ◽

Justin B. Moore ◽

Bowen Wang ◽

Rui Li

Keyword(s):

Retrospective Cohort ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Middle Aged ◽

Chinese Adults ◽

Hazard Ratios ◽

Older Chinese ◽

Objectively Measured ◽

Older Chinese Adults

The goal of this study was to investigate the associations of midday nap duration and change in midday nap duration with hypertension in a retrospective cohort using a nationwide representative sample of middle-aged and older Chinese adults. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) database during 2011–2015. Information on midday nap duration was collected via a self-reported questionnaire and blood pressure was objectively measured. Hazard ratios (HR) with 95% confidence interval (CI) were estimated using Cox proportional hazards regression models to quantify the associations. A sample of 5729 Chinese adults (≥45 years old) were included in the longitudinal analysis. Relative to non-nappers, participants who napping for ≥90 min/day was associated with significantly larger HR for hypertension at four-year follow-up (HR = 1.18, 95% CI = 1.01–1.40, p = 0.048). Compared with people who napped ≥90 min/day both at baseline (2011) and follow-up (2013), hypertension risk at four-year follow-up declined in individuals whose midday nap durations decreased in the 2-year study period from ≥ 90 min/day to 1–59 min/day (HR = 0.59, 95% CI = 0.36–0.97, p = 0.037) and 60–89 min/day (HR = 0.68, 95% CI = 0.47–0.99, p = 0.044). Among middle-aged and older Chinese adults, relative to non-nappers, people who had longer midday nap duration (≥90 min/day) were associated with significantly larger HR for hypertension and decreased napping duration may confer benefit for hypertension prevention.

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Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study

10.21203/rs.3.rs-74553/v1 ◽

2020 ◽

Author(s):

Jeong-Hoon Lim ◽

Jang-Hee Cho ◽

Yena Jeon ◽

Ji Hye Kim ◽

Ga Young Lee ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Enzyme Inhibitor ◽

Renin Angiotensin System ◽

Cox Proportional Hazards ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor

Abstract We investigated the association between angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB) and the risk of mortality in hospitalized severe COVID-19 patients. A retrospective cohort study was performed on all hospitalized COVID-19 patients in tertiary hospitals in Daegu, Korea. Patients were classified based on whether they received ACE-I or ARB before COVID-19 diagnosis. The Cox proportional hazards regression model was used for the analysis of survival. Of 130 COVID-19 patients, 30 (23.1%) who received ACE-I or ARB showed an increased the risk of in-hospital mortality (adjusted HR, 2.15; 95% CI, 1.04 to 4.44; P = 0.038). ACE-I or ARB were also associated with acute respiratory distress syndrome or mechanical ventilation (adjusted OR, 3.38; 95% CI, 1.18 to 9.69; P = 0.024), and acute kidney injury or shock (adjusted OR, 2.81; 95% CI, 1.04 to 7.56; P = 0.042). Among the patients with ACE-I or ARB, 14 (46.7%) discontinued the therapy and the cessation was associated with a higher mortality rate. ACE-I or ARB therapy in severe COVID-19 patients was associated with occurrence of severe complications and increased in-hospital mortality. Discontinuation of ACE-I or ARB in patients with more severe COVID-19 was not associated with improvement of mortality.

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Metformin Is Associated with a Lower Incidence of Benign Brain Tumors: A Retrospective Cohort Study in Patients with Type 2 Diabetes Mellitus

Biomolecules ◽

10.3390/biom11101405 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1405

Author(s):

Chin-Hsiao Tseng

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cohort Study ◽

Brain Tumors ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hazard Ratios

Background: The risk of benign brain tumors (BBT) associated with metformin use has not received much attention. Therefore, a retrospective cohort study was designed to investigate such an association in patients with type 2 diabetes mellitus (T2DM). Methods: We used the database of Taiwan’s National Health Insurance to enroll 152,176 ever users and 16,120 never users of metformin for the follow-up of incidence of BBT and a more specific outcome of cerebral meningioma. The patients were newly diagnosed with T2DM between 1999 and 2005; and they were followed up from 1 January 2006 until 31 December 2011. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using propensity score. Results: During follow-up, 111 never users and 557 ever users were diagnosed with BBT. For BBT, the respective incidence rates for never users and ever users were 153.95 per 100,000 person-years and 77.61 per 100,000 person-years. While ever users were compared to never users, the hazard ratio was 0.502 (95% confidence interval: 0.409–0.615). A dose-response pattern was seen when ever users were categorized into tertiles of cumulative duration of metformin therapy (cutoffs: <27.10 months, 27.10–58.27 months and >58.27 months) with respective hazard ratios of 0.910 (0.728–1.138), 0.475 (0.375–0.602) and 0.243 (0.187–0.315). For cerebral meningioma, the overall hazard ratio was 0.506 (0.317–0.808); and the hazard ratios comparing the respective tertiles to never users were 0.895 (0.531–1.508), 0.585 (0.346–0.988) and 0.196 (0.104–0.369). Conclusions: A reduced risk of BBT and cerebral meningioma is observed in metformin users in patients with T2DM.

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