Risk Factors for Mortality in an Older Veteran Population With infective Endocarditis

2021 ◽  
Vol 36 (5) ◽  
pp. 258-266
Author(s):  
Kari A. Mergenhagen ◽  
Kyle Polanski ◽  
Erin Conway ◽  
Alexander Tito ◽  
Fiona Cheung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Older Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Bivariate Analysis ◽  
Close Monitoring ◽  
Duke Criteria ◽  
Increased Risk ◽  
One Year ◽  
Minor Criteria

OBJECTIVE: To determine 30-day and 1-year mortality in patients treated for infective endocarditis (IE) in a VA population. The secondary objective was to identify risk factors for increased risk of mortality in veterans diagnosed with IE. DESIGN: A retrospective cohort study. SETTING: Veterans Affairs Western New York Healthcare System PARTICIPANTS: Patients who had a diagnosis of IE between the years 2005 and 2016. Patients were identified via International Classification of Diseases (ICD) codes. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Factors for death and survival were compared using a bivariate analysis. Significant factors were built into a multivariate logistic regression analysis to determine risk factors for death at 30 days and 1 year. RESULTS: Between 2005 and 2016, there were 153 patients with IE. All-cause mortality at 30 days was 14% versus 39% at 1 year. Patients were more likely to die at 1 year with higher Pitt Bacteremia Scores, older age, and lower number of minor criteria according to Duke Criteria. Comorbidities were similar between groups. CONCLUSIONS: Older patients with higher Pitt Bacteremia Scores and lower numbers of minor criteria are more likely to experience mortality at one year. Given the high rates of death at one year, close monitoring, even after completion of therapy may be necessary in older patients. Senior care pharmacists are in a unique position to monitor these patients.

Risk Factors for Umbilical Venous Catheter-Associated Thrombosis in Very Low Birth Weight Infants.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1490-1490
Author(s):  
Shalu Narang ◽  
Jason Roy ◽  
Timothy P. Stevens ◽  
Meggan Butler-O’Hara ◽  
Craig A. Mullen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Very Low Birth Weight ◽  
Multivariate Logistic Regression Analysis ◽  
Bivariate Analysis ◽  
Increased Risk ◽  
Catheter Related Thrombosis

Abstract Background: Thrombosis in neonates is a rare but serious occurrence that is usually associated with central catheterization. Among acquired risk factors, thrombocytosis has often been thought to play a role in neonatal thrombosis, but little evidence exists to support this impression. Objectives:To investigate the effects of platelet count on catheter-related thrombosis in neonates.To investigate the effects of being small for gestational age (SGA) on catheter-related thrombosis in neonates. We hypothesized that neonates with catheter-related thrombosis would have relative thrombocytosis and would be SGA. Methods: The present retrospective study was performed using data from a randomized trial of duration of umbilical venous catheters (UVC) placement among infants <1250 g birth weight (Butler-O’Hara, Pediatrics2006;118:e25–e35). In this study, all subjects had UVC that were left in place for up to 28 days. All subjects were screened biweekly for thrombi with echocardiograms. Twenty-two cases of UVC-associated thrombosis were identified in this sample. The remaining study sample (n=188) served as controls. Data on thrombosis, platelets, gestational age, birth weight, hematocrit, serum sodium (as a measure of dehydration), duration of catheter placement, study group assignment and demographic factors were collected using database and record review. Results: Among the total subjects (n=210), 112 (53%) were males and 126 (60%) were Caucasians, with mean gestational age of 27.7 ± 2.1 wks (SD) and mean birth weight of 923 ± 195g. Bivariate analysis revealed significant association of thrombosis with hematocrit >55% in the first wk (OR, 5.4; 95% CI, 2.0–14.6; p=0.0003), being small for gestational age (OR, 2.9; 95% CI, 1.2–7.4; p=0.02), lower platelet counts in the first wk (193 ± 57 x 103/uL in infants with thrombus vs. 238 ± 70 x 103/uL in infants without thrombus, p=0.005) and gestational age (27.8 ± 2.5 wks in infants with thrombus vs. 27.6 ± 2.0 wks in infants without thrombus, p=0.02). In multivariate logistic regression analysis, only higher hematocrit was independently associated with thrombus (OR, 3.9; 95% CI 1.3–12.6; p=0.02). There was a trend towards an independent negative association between platelets and thrombosis (OR, 0.93 per 10 x 103/uL platelet rise; 95% CI, 0.85–1.02; p=0.12). Conclusion: This study demonstrates a significant, independent association of elevated hematocrit and development of UVC-associated thrombosis. We did not observe an increased risk of thrombosis with increased platelet count. Careful monitoring for catheter-associated thrombosis is suggested for neonates with hematocrit >55% in the first wk of life.

What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry

Nephron ◽  
2018 ◽  
Vol 141 (2) ◽  
pp. 98-104 ◽  
Author(s):  
Fahad Saeed ◽  
Susana Arrigain ◽  
Jesse D. Schold ◽  
Joseph V. Nally Jr ◽  
Sankar Dass Navaneethan
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Older Patients ◽  
Cleveland Clinic ◽  
One Year

scholarly journals Factors associated with COVID-19 related hospitalisation, critical care admission and mortality using linked primary and secondary care data

2021 ◽  
Author(s):  
Lisa Cummins ◽  
Irene Ebyarimpa ◽  
Nathan Cheetham ◽  
Victoria Tzortziou Brown ◽  
Katie Brennan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Learning Disabilities ◽  
Secondary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Additional Patient ◽  
Factors Associated ◽  
Icu Admission ◽  
Risk Of Death ◽  
North East ◽  
Increased Risk

AbstractBackgroundTo identify risk factors associated with increased risk of hospitalisation, intensive care unit (ICU) admission and mortality in inner North East London (NEL) during the first UK COVID-19 wave.MethodsMultivariate logistic regression analysis on linked primary and secondary care data from people aged 16 or older with confirmed COVID-19 infection between 01/02/2020-30/06/2020 determined odds ratios (OR), 95% confidence intervals (CI) and p-values for the association between demographic, deprivation and clinical factors with COVID-19 hospitalisation, ICU admission and mortality.ResultsOver the study period 1,781 people were diagnosed with COVID-19, of whom 1,195 (67%) were hospitalised, 152 (9%) admitted to ICU and 400 (23%) died. Results confirm previously identified risk factors: being male, or of Black or Asian ethnicity, or aged over 50. Obesity, type 2 diabetes and chronic kidney disease (CKD) increased the risk of hospitalisation. Obesity increased the risk of being admitted to ICU. Underlying CKD, stroke and dementia in-creased the risk of death. Having learning disabilities was strongly associated with increased risk of death (OR=4.75, 95%CI=(1.91,11.84), p=0.001). Having three or four co-morbidities increased the risk of hospitalisation (OR=2.34,95%CI=(1.55,3.54),p<0.001;OR=2.40, 95%CI=(1.55,3.73), p<0.001 respectively) and death (OR=2.61, 95%CI=(1.59,4.28), p<0.001;OR=4.07, 95% CI= (2.48,6.69), p<0.001 respectively).ConclusionsWe confirm that age, sex, ethnicity, obesity, CKD and diabetes are important determinants of risk of COVID-19 hospitalisation or death. For the first time, we also identify people with learning disabilities and multi-morbidity as additional patient cohorts that need to be actively protected during COVID-19 waves.

scholarly journals 701. Blood Stream Infection And Risk Of Endocarditis Following Cardiac Valve Repair: A Population-Based Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Jack McHugh ◽  
Talha Khawaja ◽  
Larry M Baddour ◽  
Larry M Baddour ◽  
Juan Crestanello ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Stream Infection ◽  
Subsequent Development ◽  
Bloodstream Infections ◽  
Population Based ◽  
Cardiac Valve ◽  
Valve Repair ◽  
Population Based Study ◽  
Increased Risk ◽  
One Year

Abstract Background Bloodstream infections (BSIs) confer an increased risk of infective endocarditis (IE) in patients with a prosthetic cardiac valve. This relationship is less well established in patients undergoing valve repair. We conducted a retrospective population-based study to determine the incidence of BSIs following valve repair and identify risk factors associated with the development of IE. Methods The Rochester Epidemiology Project (REP) data linkage system was used to identify all persons who underwent valve repair in a 7-county region in Southeastern Minnesota between January 1, 2010 and December 31, 2018. Medical records were screened for the development of a BSI from time of procedure until May 15, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. IE at outset was defined as cases where IE was diagnosed at the time of initial positive blood culture. Results A total of 387 patients underwent valve repair surgery. A total of 31 (8%) patients subsequently developed a BSI, 4% within one year of surgery. Seventeen patients underwent mitral repair with annuloplasty, 9 underwent tricuspid annuloplasty, and 5 had concurrent repairs. Median time to the development of BSI was 338 days. Of the 31 patients with BSI, 4 (13%) had BSI with IE at outset. No patients developed IE subsequent to BSI, Enterococcus spp. was responsible for 3 cases of IE, and MSSA for 1. All cases occurred within one year of surgery. Given the low incidence, statistical analysis of associated risk factors for IE was not feasible. All patients with BSI and IE at outset, however, died by the end of the study period, versus 11/27 in the BSI only group. Conclusion Incidence of BSIs was higher in patients undergoing cardiac valve repair than in the general population. The incidence of IE with a BSI was 13%, which is lower than what has been previously published. It is notable that all cases of IE occurred within one year of surgery. Recognizing that endothelialization of device surfaces occurs, it is tempting to speculate that the risk of IE may be time dependent and may decline over time. Subsequent investigation of this theory is underway. Disclosures Larry M. Baddour, MD, Boston Scientific (Consultant)

Incidence and risk factors for severe tardive dyskinesia in older patients

1997 ◽  
Vol 171 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Michael P. Caligiuri ◽  
Jonathan P. Lacro ◽  
Enid Rockwell ◽  
Lou Ann McAdams ◽  
Dilip V. Jeste
Keyword(s):  
Risk Factors ◽  
Tardive Dyskinesia ◽  
Movement Disorder ◽  
Cumulative Incidence ◽  
Older Patients ◽  
Negative Symptoms ◽  
Cox Regression ◽  
Effective Dosage ◽  
Regression Analyses ◽  
One Year

BackgroundSevere tardive dyskinesia (TD) represents a serious and potentially disabling movement disorder, yet relatively little is known about the incidence of and risk factors for severeTD.MethodWe report the results of a longitudinal prospective incidence study of severeTD in 378 middle-aged and elderly neuropsychiatric patients. Psychiatric, neuropsychological, pharmacological and motor variables were obtained at intake and at regular intervals for 36 months.ResultsThe cumulative incidence of severeTD was 2.5% after one year, 12.1% after two years, and 22.9% after three years. Individual univariable Cox regression analyses were conducted to identify demographic, psychiatric, motor and pharmacological predictors of severeTD. Results indicated that higher daily doses of neuroleptics at study entry, greater cumulative amounts of prescribed neuroleptic, and greater severity of worsening negative symptoms were predictive of severeTD Conclusions These findings suggest that conventional neuroleptics may be prescribed to older patients only when necessary and at the lowest effective dosage. Additional caution is recommended in patients exhibiting negative symptoms.

scholarly journals Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

2020 ◽  
Vol 21 (16) ◽  
pp. 5613
Author(s):  
Ryuta Nakae ◽  
Yu Fujiki ◽  
Yasuhiro Takayama ◽  
Takahiro Kanaya ◽  
Yutaka Igarashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Propensity Score ◽  
Older Patients ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Elderly Group ◽  
Post Injury ◽  
D Dimer

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

scholarly journals Decreased eGFR Is Associated With Ischemic Stroke in Patients With Dilated Cardiomyopathy

2019 ◽  
Vol 25 ◽  
pp. 107602961986690 ◽  
Author(s):  
Yuqing Deng ◽  
Zhiqing Chen ◽  
Lili Hu ◽  
Zhenyan Xu ◽  
Jinzhu Hu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Dilated Cardiomyopathy ◽  
Logistic Regression Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Analysis Model ◽  
Multivariate Logistic Regression ◽  
Increased Risk

Dilated cardiomyopathy (DCM) is increasingly indicated as a cause of cardioembolic syndrome, in particular, cardioembolic ischemia stroke. However, the potential risk factors for stroke among DCM patients remain under investigated. DCM patients hospitalized from June 2011 to June 2016 were included. The cases were defined as the group of DCM patients with stroke compared with those without stroke. Clinical characteristic data were collected and compared between the two groups including demographic data, complicated diseases, echocardiography index, and laboratory parameters and estimated glomerular filtration rate (eGFR). A multivariate logistic regression analysis model adjusted by sex and age was used to explore the related risk factors for stroke in DCM patients. A total of 779 hospitalized patients with DCM were included. Of these, 55 (7.1%) had experienced a stroke. Significantly lower eGFR levels (68.03 ± 26.22 vs 79.88 ± 24.25 mL/min/1.73 m2, P = .001) and larger left atrial diameters (45.32 ± 7.79 vs 43.25 ± 7.11 mm, P = .04) were found in the group of patients having DCM with stroke compared to those without stroke. When the eGFR was categorized as eGFR >60, 30<eGFR≤ 60 and eGFR ≤ 30, there were more patients with 30<eGFR≤ 60 (30.9% vs 17.7%) and eGFR≤ 30 (9.1% vs 3.3%) in the ischemic stroke group ( P = 0.003). A multivariate logistic regression analysis model adjusted by sex and age showed that 30 <eGFR≤60 (odds ratio [OR]: 2.07, 95% confidence interval [CI]: [1.05-4.07], P = .035) and eGFR≤30 (OR: 4.04, 95% CI: [1.41-11.62], P = .009) were statistically associated with ischemic stroke in patients with DCM. It is concluded that decreased eGFR is significantly associated with an increased risk of ischemic stroke in patients with DCM.

P1802Management and outcomes of infective endocarditis in adults with congenital heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Ly ◽  
D Lebeaux ◽  
F Pontnau ◽  
F Compain ◽  
B Gaye ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Congenital Heart ◽  
Hospital Death ◽  
Oral Streptococci ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Duke Criteria ◽  
Increased Risk

Abstract Background Causes, epidemiology and microbiology of infective endocarditis (IE) have evolved in recent decades. Although novel tools for the diagnosis and therapeutic strategies have emerged, mortality and morbidity remain high. These trends may particularly concern the growing population of adults with congenital heart disease (CHD) who are at increased risk for IE. Purpose We aimed to characterize IE in CHD patients and describe management and outcome in this setting. We also sought to determine the risk factors associated with in-hospital death in CHD patients. Methods From January 2000 to June 2018, 666 consecutive episodes of IE in adults were recorded in our center. Among them, 143 concerned CHD, including 5 implantable cardiac electronic devices-lead infections, all managed by an IE team including CHD specialists. Cases were classified according to modified Duke criteria. Results CHD patients were significantly younger (37 years IQR [26–52]), with a more common history of cardiac reoperations (numbers of sternotomies≥2 in 35.7%) and infective endocarditis (19.7%, p<0.01) compared to non-CHD patients. There were more infections of valve-containing prosthetics (44% vs. 30%, p<0.04), and the right heart side (41.5%, p<0.01) in CHD patients. Forty-nine percent of them had a simple CHD, 12.7% a moderate, and 36.4% a complex. A predisposing event could be identified in only 34% of cases. Oral streptococci/Streptococci bovis and Staphylococcus aureus were the most frequently microorganisms isolated (32.4% and 20.4%, respectively). Surgery was performed in 90 episodes (62%), and was selected in emergency (<24h) in 61% (figure 1). In-hospital mortality was 12.7% and was directly related to IE in 10/18 cases. CHD patients had a significant lower risk of death compared to non-CHD patients (OR=0.47, p=0.026, p<0.01), even after adjustment for age, and the infected heart side. On multivariate analysis the complexity of CHD (if simple CHD: OR=0.07 IQR [0.01 to 0.44], p<0.01) and the white blood cell count (OR=1.18 IQR [1.04 to 1.33], p=0.01) were the strongest predictive factors of in-hospital death in the CHD group. Conclusions Mortality associated with IE in CHD patients is lower than in acquired heart disease. The multidisciplinary approach by IE team and CHD specialists may have improved management and outcome in this setting. However, risk for death remains high in complex lesions. Larger prospective studies on IE in adults with CHD are needed to develop guidelines in these complex patients.

Retrospective analysis of risk factors for fatigue in clinical trial patients (pts) with metastatic renal cell carcinoma (mRCC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15624-e15624
Author(s):  
Martin Eric Gore ◽  
Viktor Gruenwald ◽  
Robert John Motzer ◽  
David I. Quinn ◽  
Brian I. Rini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Analysis ◽  
Kinase Inhibitors ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Female Gender ◽  
Phase Iii ◽  
Phase Ii Trials ◽  
Increased Risk ◽  
Ecog Ps

e15624 Background: Fatigue is a common toxicity in pts with mRCC, often associated with therapy, particularly with tyrosine kinase inhibitors (TKI). We performed a pooled retrospective analysis of pts with mRCC treated in clinical studies in order to explore predictors for fatigue. Methods: Data from pts treated in Pfizer mRCC trials (2003-2011) from phase III (NCT00083899, NCT00065468, NCT00678392) and phase II trials (NCT00054886, NCT00077974, NCT00083889, NCT00338884, NCT00137423) were included. Adverse event (CTCAE v3.0) terms of “fatigue” and “asthenia” were used. Hypothyroidism was defined as TSH>ULN or T4<LLN. A multivariate logistic regression analysis was performed to identify significant risk factors for grade (G) 2 (moderate or causing difficulty performing some ADL) or higher fatigue. Results: 2749 pts (71% male) with a median age 60 (33% ≥65) were treated (median 162 days) with axitinib (n=359), sunitinib (n=1059), temsirolimus (TEM) (n=208), interferon-alfa (IFN) (n=560), sorafenib (n=335), or TEM + IFN (n=208). Most pts had baseline ECOG PS of 0 (47%) or 1 (51%), clear cell histology (91%), and nephrectomy (84%). 553 (20%) pts reported fatigue prior to starting study therapy. During study, fatigue was reported in 1794 (65%) pts (21% G1, 26% G2, 17% G3, 1% G4); in 61% pts worst grade was reported within the first 2 months of therapy. Fatigue led to discontinuation in 2%, and dose interruption or adjustment in 8%. Of 1773 pts treated with TKIs, 42% had ≥G2 fatigue. Of pts treated with TEM, IFN or both, 39%, 50% and 50%, respectively, had ≥G2 fatigue. Baseline factors [Odds Ratio] associated (p < 0.05) with ≥G2 fatigue were pretreatment fatigue [1.7] or hypothyroidism [1.6], age ≥65 [1.6], time from diagnosis ≥1 yr [1.4], female gender [1.3], ECOG PS 0 [0.7], and Asian vs Caucasian race [0.5]. Baseline LDH, calcium, and anemia were not significant. Conclusions: Pt attributes and comorbidities at baseline, independent of therapy, are associated with increased risk of clinically significant fatigue in pts treated for mRCC, and can be used to generate a predictive model. Appropriate counseling and control of co-morbid conditions may be important in managing fatigue in pts on TKI therapy.

scholarly journals Risk Factors for Postpartum Thyroid Dysfunction in Euthyroid Women Prior to Pregnancy

Folia Medica ◽  
2017 ◽  
Vol 59 (2) ◽  
pp. 190-196
Author(s):  
Boyan I. Nonchev ◽  
Antoaneta V. Argatska ◽  
Blagovest K. Pehlivanov ◽  
Maria M. Orbetzova
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Early Pregnancy ◽  
Thyroid Disease ◽  
Thyroid Dysfunction ◽  
Multivariate Logistic Regression Analysis ◽  
Postpartum Women ◽  
Increased Risk ◽  
History Of ◽  
Postpartum Thyroid Dysfunction

AbstractBackground:Thyroid dysfunction is common during the postpartum and the predisposing factors for its development are considered specific for the population studied. The aim of this study was to evaluate the risk factors for the occurrence of postpartum thyroid dysfunction (PPTD) in euthyroid women prior to pregnancy.Materials and methods:Forty-five women with PPTD and 55 age-matched euthyroid postpartum women from Plovdiv, Bulgaria were included in the study. TSH, FT4, FT3, TPOAb, TgAb, TRAb were measured and ultrasound evaluation of the thyroid was performed in the first trimester of pregnancy and during the postpartum.Results:The study found higher risk of developing PPTD in women with family history of thyroid disease (OR 4.42; 95% CI 1.87,10.43), smokers (OR 4.01; 95% CI 1.72,9.35), personal history of autoimmune thyroid disease (OR 5.37; 95% CI 1.15,28.53), positive TPOAb (OR 18.12; 95% CI 4.93,66.65) and thyroid US hypoechogenicity during early pregnancy (OR 6.39; 95% CI 2.53,16.12) and those who needed levothyroxine during pregnancy (OR 3.69; 95% CI 1.28,10.61). BMI before pregnancy was significantly lower in women with PPTD than in euthyroid postpartum women (22.80±0.55 vs 26.25±0.97, p=0.013). The multivariate logistic regression analysis identified as most important independent risk factors for PPTD occurrence the TPOAb positivity during early pregnancy, family history of thyroid disease, smoking and lower BMI before pregnancy.Conclusion:Our data suggest that in the population studied several factors are associated with an increased risk of PPTD and screening for thyroid disorders among those women can be beneficial.

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