Analysis of the Risk Factors for the Recurrence of Ischemic Stroke with Diabetes Mellitus and Establishment of Cox’s Regression Model and the Personal Prognosis Index in Two Years of Follow-Up

2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Ya-Chen An ◽  
Yu-Xun Wang ◽  
Yan-Ru Jiang ◽  
Yan-Zheng Li ◽  
Jing-Yu Feng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
Regression Model ◽  
Recurrence Rate ◽  
Factors Associated ◽  
Recurrence Model ◽  
Cox's Regression ◽  
Independent Risk Factors

Background: Ischemic stroke is a major cause of disability and mortality in patients with type 2 diabetes mellitus (T2DM), and diabetic stroke has a high recurrence rate. Objectives: This prospective cohort study aimed at investigating the risk factors and establishing Cox’s regression model and personal prognosis index for the recurrence of ischemic stroke at a two-year follow-up in T2DM patients. Methods: T2DM patients with ischemic stroke, who were consecutively admitted to the Neurology Department of North China University of Science and Technology Affiliated Hospital between January 1, 2015, and December 31, 2015, were retrospectively reviewed. These cases were followed up since the onset of ischemic stroke for 2 years. Univariate and multivariate Cox’s proportional hazard regression model was used to analyze risk factors associated with the recurrence rate. Thus, a recurrence model and personal prognosis index were set up. Results: During the follow-up period, 44 cases relapsed. Furthermore, the 1-year recurrence rate was 16.48%, while the 2-year recurrence rate was 24.18%. The univariate and multivariate Cox proportional hazard regression model revealed that the independent risk factors associated with recurrence were TOAST criteria (X1) (RR = 1.663; 95% CI = 1.015 - 2.760, P = 0.032), hypertension grade (X2) (RR = 1.897; 95% CI = 1.097 - 3.280, P = 0.022), duration of diabetes mellitus (X3) (RR = 1.151; 95% CI = 1.009 - 1.991, P = 0.039), total cholesterol (X4) (RR = 1.13; 95% CI = 1.006 - 1.876, P = 0.035), and Essen stroke risk score (ESRS) (X5) (RR = 2.055; 95% CI = 1.357 - 3.134, P = 0.001). The personal prognosis index of the recurrence model was as follows: PI = 0.504 X1 + 0.640 X2 + 0.345 X3 + 0.759 X4 + 0.823 X5. Conclusions: TOAST criteria, hypertension grade, duration of diabetes mellitus, total cholesterol, and ESRS were the independent risk factors associated with the recurrence of ischemic stroke with diabetes mellitus. The recurrence model and personal prognosis index equation were successfully established.

scholarly journals Factors Associated with Poor Glycemic and Lipid Levels in Ambulatory Diabetes Mellitus Type 2 Patients in Asmara, Eritrea: A Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Oliver Okoth Achila ◽  
Millen Ghebretinsae ◽  
Abraham Kidane ◽  
Michael Simon ◽  
Shewit Makonen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Waist Circumference ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Specific Lipid

Objective. There is a dearth of relevant research on the rapidly evolving epidemic of diabetes mellitus (particularly Type 2 diabetes mellitus) in sub-Saharan Africa. To address some of these issues in the Eritrean context, we conducted a cross-sectional study on glycemic and lipid profiles and associated risk factors. Methods. A total of 309 patients with diabetes mellitus on regular follow-up at the Diabetic and Hypertensive Department at Halibet Regional Referral Hospital, Asmara, were enrolled for the study. Data on specific clinical chemistry and anthropomorphic parameters was collected. Chi-squared (χ2) test or Fischer’s exact test was used to evaluate the relationship between specific variables. Multivariate logistic regression (backward: conditional) was undertaken to identify the factors associated with increased odds of suboptimal values in glucose and specific lipid panel subfractions. Results. High proportions of patients (76.7%) had suboptimal levels of HbA1c with a mean±SD of 8.6%±1.36, respectively. In multivariate regression analysis, the likelihood of HbA1c≥7% was higher in patients with abnormal WHR (AOR=3.01, 95% CI, 3.01 (1.15–7.92=0.024)) and in patients without hypertension (AOR=1.97, 95% CI (1.06–3.56), p=0.021). A unit reduction in eGFR was also associated with HbA1c≥7% (AOR=0.99, 95% CI (0.98–1=0.031)). In a separate analysis, the data shows that 80.9% of the patients had dyslipidemia. In particular, 62.1% of the patients had TC≥200 mg/dL (risk factors: sex, hypertension, and HbA1c concentration), 81.6% had LDL‐C≥100 mg/dL (risk factors: sex and hypertension), 56.3% had TG≥150 (risk factors: sex, HbA1c, and waist circumference), 62.8% had abnormal HDL-C (risk factors: waist circumference), 78.3% had non‐HDL<130 mg/dL (risk factors: duration of disease, reduced estimated glomerular filtration rate, and HbA1c), and 45.3% had abnormal TG/HDL (risk factors: sex, age of patient, FPG, and waist circumference). Conclusions. The quality of care, as measured by glycemic and specific lipid targets, in this setting is suboptimal. Therefore, there is an urgent need for simultaneous improvements in both indicators. This will require evidence-based optimization of pharmacological and lifestyle interventions. Therefore, additional studies, preferably longitudinal studies with long follow-up, are required on multiple aspects of DM.

scholarly journals Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Rui He ◽  
Guoyou Wang ◽  
Ting Li ◽  
Huarui Shen ◽  
LijuanZhang
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Ischemic Stroke ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Older Age ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

scholarly journals Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

2021 ◽  
Vol 10 (19) ◽  
pp. 4372
Author(s):  
Ioanna Sfakianaki ◽  
Paris Binos ◽  
Petros Karkos ◽  
Grigorios G. Dimas ◽  
George Psillas
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Recurrence Rate ◽  
Benign Paroxysmal Positional Vertigo ◽  
Female Gender ◽  
Recurrence Rates ◽  
Positional Vertigo ◽  
Risk Factors For Recurrence ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

scholarly journals Predictors of dementia after first ischemic stroke

2021 ◽  
Vol 15 (2) ◽  
pp. 216-222
Author(s):  
Wafik Mahmoud El-Sheik ◽  
Aktham Ismail El-Emam ◽  
Ahmed Abd El-Galil Abd El-Rahman ◽  
Gelan Mahmoud Salim
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
Binary Logistic Regression ◽  
Ischemic Heart ◽  
Stroke Severity ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Stroke Subtypes ◽  
Independent Risk Factors

ABSTRACT. Various mechanisms contribute to dementia after first ischemic stroke as lesions on strategic areas of cognition and stroke premorbidity. Objectives: Assessing clinical and neuroimaging predictors of dementia after first ischemic stroke and its relation to stroke location, subtypes and severity. Methods: Eighty first ischemic stroke patients were included. Forty patients with dementia after first stroke and forty patients without dementia according to DSM-IV diagnostic criteria of vascular dementia. All patients were subjected to general and neurological assessment, National Institute Health Stroke Scale (NIHSS) for stroke severity, Montreal Cognitive Assessment (MoCA) scale for cognition assessment, MRI brain and Trial of Org 10172 in acute stroke treatment (TOAST) classification for stroke subtypes. Results: Left hemispheric ischemic stroke, strategic infarctions, diabetes mellitus and stroke of anterior circulation were found to be independent risk factors for dementia after first ischemic stroke (OR=3.09, 95%CI 1.67-10.3, OR=2.33, 95%CI 1.87-8.77, OR=1.88, 95%CI 1.44-4.55, OR=1.86, 95%CI 1.45-6.54, respectively). Hypertension, dyslipidemia, smoking, ischemic heart disease, high NIHSS score and large vessel infarction were significantly higher among post stroke dementia patients. However, on binary logistic regression, they did not reach to be independent risk factors. Conclusion: Stroke location (left stroke, strategic infarction, anterior circulation stroke) and diabetes mellitus could be predictors of dementia after first ischemic stroke, but stroke severity, stroke subtypes, hypertension, dyslipidemia, smoking and ischemic heart could not.

73Hemoglobin a1c levels and the risk of ischemic stroke and mortality in individuals with diabetes mellitus and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Kezerle ◽  
M A Tsadok ◽  
A Akriv ◽  
B Feldman ◽  
M Leventer-Roberts ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Dependent Manner ◽  
Historical Cohort ◽  
Increased Risk ◽  
Dose Dependent ◽  
Hba1c Levels

Abstract Funding Acknowledgements Pfizer Israel Background Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Whether the risk of stroke in AF patients remains the same among the wide spectrum of disease is yet to be determined. Aim Among individuals with AF and DM, to assess the incidence rates and risk of ischemic stroke and mortality by baseline HbA1C levels. Methods We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to HBA1C levels at the time of AF diagnosis: &lt;7.0%, between 7-9% and ≥ 9%. Results A total of 44,451 cases were identified. The median age was 75 years (IQR 65-83) and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.9 in patients with HBA1C &lt;7%, 2.37 in the intermediary group and 2.72 in those with HBA1C &gt;9%. In both univariate and multivariate analyses, higher levels of HBA1C were associated with an increased risk of stroke compared with a dose-dependent response when compared to individuals with HBA1C &lt;7% (Adjusted Hazard Ratio (AHR) = 1.32 {95% CI 1.12-1.55}for levels between 7-9% and AHR 1.64 {95% CI 1.28-2.09}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants. The risk for overall mortality did not differ significantly between groups, with a slight elevation in the HBA1C &gt;9% group after adjusted analysis {aHR = 1.17 (1.07- 1.28)} Conclusion: In this observational cohort of patients with incident newly diagnosed nonvalvular atrial fibrillation, HBA1C levels were associated with an increased risk of stroke in a dose-dependent manner even after accounting for other recognized risk factors for stroke in this population. Abstract Figure. Kaplan-Meier for stroke-free survival

Abstract 1122‐000011: Risk Factors Associated with Various Subtypes of Ischemic Stroke: A Prospective Study

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Mohammad Shahidullah ◽  
Subash K Dey ◽  
Nahid Sultana
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
Smoking Habit ◽  
Smoking History ◽  
Large Artery ◽  
Middle Income ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Risks Factors

Introduction : Stroke is the main cause of adult disability and the second most leading cause of death worldwide. The number of deaths due to stroke is 5·54 million worldwide. Stroke is also a major cause of long‐term disability. Globally, 70% of strokes and 87% of both stroke‐related deaths and disability‐adjusted life years occur in low and middle‐income countries. The incidence of stroke varies among various countries. Over the last four decades, the stroke incidence in low and middle‐income countries has become more than doubled. . However, there are limited data and very few studies on various subtypes of ischemic stroke and their risks factors in our country. So, we purposively designed this study. The aim of this study was to investigate the risks factors associated with the various subtypes of ischemic stroke according to TOAST criteria. Methods : This was a prospective observational cross sectional study conducted during June‐2019 to May‐2020. A total of 220 ischemic stroke patients aged above 30 years confirmed by CT Scan/MRI of brain were included in this study. A complete history was taken regarding hypertension, diabetes, dyslipidemia, ischemic heart disease, current smoking history of previous stroke, positive familial history, coronary artery diseases, alcohol consumption and demographic characteristics were noted in the questionnaire. Hypertension was defined as systolic blood pressure (SBP) > 140 mmHg, diastolic blood pressure > 90 mmHg or both on two separate occasions, or the use of anti‐hypertensive medication at any time before the onset of stroke. Diabetes was defined if fasting plasma glucose levels are 126 mg/dl or higher after an overnight fast on more than one occasion or as random blood glucose level 200 mg/dl or higher on more than one occasion. Ischemic stroke was classified according to TOAST criteria. Data were collected with a pre structured questionnaire from the patients’ investigations reports and face to face interview with the researcher (an expert neurologist). Results : Among the 220 stroke patients, Large‐artery atherosclerosis (LAA), Cardio‐embolism (CE), Small‐vessel occlusion (SVO, Stroke of other determined etiology (SODE) and Stroke of undetermined etiology (SUDE) were being observed 84(38.18%), 14(6.36%), 63(28.64%), 12(5.45%) and 47(18.18%). The highest prevalence of subtypes 70(31.82%) was found in the age group (51‐60). The prevalence of subtypes was found 150(68.18%) in male and 70(31.82%) in female. 86(39.09%) prevalence of subtypes was found who were from rural areas whereas 134(60.91%) was observed in urban areas. The significant risk factors associated with the prevalence of various subtypes of ischemic stroke were observed Hypertension, Diabetes Mellitus, Smoking history, Dyslipidemia, Heart disease, H/O Previous Stroke, Positive Familial History, Coronary Artery Disease and Alcohol Consumption (p <0.05). Conclusions : The higher prevalence of Large‐artery atherosclerosis (LAA) was found in this study. It suggests the influence of uncontrolled hypertension, diabetes mellitus, smoking habit and dyslipidemia. So, importance should be given on various subtypes of ischemic stroke and collective preventive measures and strategies are to be taken to control the associated risk factors especially hypertension, diabetes mellitus, smoking habit and dyslipidemia to decrease the stroke mortality rate.

scholarly journals Predicting lung fibrosis in post-COVID-19 patients after discharge with follow-up chest CT findings

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Rabab Yasin ◽  
Ahmed Abdelhakim Kamel Gomaa ◽  
Tamer Ghazy ◽  
Shaimaa Abdelhamid Hassanein ◽  
Reda Abdel latif Ibrahem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severity Score ◽  
Lung Fibrosis ◽  
Chest Ct ◽  
High Resolution Computed Tomography ◽  
Factors Associated ◽  
Icu Admission ◽  
Significant Difference ◽  
Independent Risk Factors

Abstract Background Coronavirus disease has spread widely all over the world since the beginning of 2020, and this required rapid adequate management. High-resolution computed tomography (HRCT) has become an initial valuable tool for screening, diagnosis, and assessment of disease severity. This study aimed to assess the clinical, radiographic, and laboratory findings of COVID-19 with HRCT follow-up in discharged patients to predict lung fibrosis after COVID-19 infection in survived patients. Results This study included two-hundred and ten patients who were tested positive for the novel coronavirus by nasopharyngeal swap, admitted to the hospital, and discharged after recovery. Patients with at least a one-time chest CT scan after discharge were enrolled. According to the presence of fibrosis on follow-up CT after discharge, patients were classified into two groups and assigned as the “non-fibrotic group” (without evident fibrosis) and “fibrotic group” (with evident fibrosis). We compared between these two groups based on the recorded clinical data, patient demographic information (i.e., sex and age), length of stay (LOS) in the hospital, admission to the ICU, laboratory results (peak C-reactive protein [CRP] level, lowest lymphocyte level, serum ferritin, high-sensitivity troponin, d-dimer, administration of steroid), and CT features (CT severity score and CT consolidation/crazy-paving score). CT score includes the CT during the hospital stay with peak opacification and follow-up CT after discharge. The average CT follow-up time after discharge is 41.5 days (range, 20 to 65 days). There was a statistically significant difference between both groups (p ˂0.001). Further, a multivariate analysis was performed and found that the age of the patients, initial CT severity score, consolidation/crazy-paving score, and ICU admission were independent risk factors associated with the presence of post-COVID-19 fibrosis (p<0.05). Chest CT severity score shows a sensitivity of 86.1%, a specificity of 78%, and an accuracy of 81.9% at a cutoff point of 10.5. Conclusion The residual pulmonary fibrosis in COVID-19 survivors after discharge depends on many factors with the patient’s age, CT severity, consolidation/crazy-paving scores, and ICU admission as independent risk factors associated with the presence of post-COVID-19 fibrosis.

scholarly journals Incidence and prognostic factors for the development of symptomatic and asymptomatic marginal ulcers after Roux-en-Y gastric bypass procedures

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
J Süsstrunk ◽  
L Wartmann ◽  
D Mattiello ◽  
T Köstler ◽  
U Zingg
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Gastric Bypass ◽  
Type 2 Diabetes Mellitus ◽  
Median Time ◽  
Upper Endoscopy ◽  
Independent Risk Factors

Abstract Objective Marginal ulcer (MU) is a serious complication after Roux-en-Y gastric bypass (RYGB) procedures. This study reports the incidence, risk factors and treatment outcomes of symptomatic and incidentally, at routine endoscopy diagnosed, MU. Methods All patients undergoing RYGB procedures between 2013 and 2018 at a single center were included. Upper endoscopy was performed in case of symptoms and/or routinely 2 and 5 years postoperatively. Results 568 patients (83.3% female) underwent RYGB procedure with a median age of 40 years and median initial body mass index of 41 kg/m2. Median time to follow-up was 2.99 years. Routine 2- and 5-year upper endoscopy was performed in 256 (55.3%) and 65 (38.0%) eligible patients, respectively. In 86 (15.1%) patients, MU was diagnosed at a median time of 14.2 months (4.58 – 26.2) postoperatively and 24.4% of patients with MU were asymptomatic. 76.7% of MUs were located on the side of the Roux-limb. 88.4% of MUs were treated conservatively; re-operation was necessary in 10 (11.6%) patients. Smoking and type 2 diabetes mellitus were the only independent risk factors for MU development in multivariate analysis with a hazard ratio of 2.65 and 1.18 (HbA1c per unit &gt;6.0), respectively. Conclusion MU is a common complication after gastric bypass surgery with 25% of patients being asymptomatic. Follow-up routine endoscopy is recommended for early MU detection and subsequent accurate therapy, especially in patients with the independent risk factors smoking and type 2 diabetes mellitus.

scholarly journals Effects of tobacco smoking on recurrent hospitalisation with pneumonia: a population-based cohort study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-216494
Author(s):  
Vadsala Baskaran ◽  
Wei Shen Lim ◽  
Tricia M McKeever
Keyword(s):  
Risk Factors ◽  
Smoking Status ◽  
Population Based ◽  
Recurrent Pneumonia ◽  
Factors Associated ◽  
Independent Risk Factors ◽  
Never Smokers ◽  
Using Data ◽  
Care Database

The incidence of and risk factors for recurrent hospitalisation for pneumonia were investigated using data from Hospital Episode Statistics, linked to a UK primary care database. Within 90 days and 1 year of follow-up, 1733 (3.1%) and 5064 (9.0%), developed recurrent pneumonia respectively. Smoking status at the time of hospitalisation with index pneumonia was associated with the risk of readmission with recurrent pneumonia within a year of discharge: current versus never smokers: adjusted subhazard ratio (sHR) 1.42, 95% CI 1.32 to 1.53, p<0.001, and ex smokers versus never smokers: adjusted sHR 1.24, 95% CI 1.15 to 1.34, p<0.001. Other independent risk factors associated with recurrent pneumonia were age, gender, deprivation and underlying comorbidities.

scholarly journals Long‐Term Fate of the Truncal Valve

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Laura Gellis ◽  
Geoffrey Binney ◽  
Laith Alshawabkeh ◽  
Minmin Lu ◽  
Michael J. Landzberg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Truncus Arteriosus ◽  
Valve Regurgitation ◽  
Term Survival ◽  
Factors Associated ◽  
Patients At Risk ◽  
Independent Risk Factors

Background Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P <0.001) or stenosis (HR, 4.12; P <0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P <0.001). During follow‐up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z ‐score before truncus arteriosus full repair and during follow‐up was associated with worsening truncal valve regurgitation. Conclusions Long‐term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z ‐score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.

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