P0691LIPOPROTEIN(A) AS A POTENTIAL RISK FACTOR FOR CARDIOVASCULAR (CV) AND THROMBOTIC EVENTS IN CHRONIC KIDNEY DISEASE (CKD) AND TRANSPLANTED PATIENTS

Abstract Background and Aims Several studies suggested an independent association between elevated Lipoprotein (a) [Lp(a)] levels and the incidence of CV events in the normal population. Lp(a) levels start to rise with decreasing glomerular filtration rate. Whether high Lp(a) serum levels may contribute to the pathogenesis of atherosclerosis or thrombosis in CKD and, particularly, in transplanted (Tx) patients is largely unclear. Furthermore, it is still uncertain to which extent very high Lp(a) levels might influence CV events in this population. Aims: 1. To evaluate Lp(a) serum concentrations and lipid profile in CKD, dialysis and Tx patients. 2. To investigate the relationship between Lp(a) serum levels and atherosclerotic cardiovascular disease (ASCVD), including myocardial infarction, coronary revascularization, cerebrovascular accident, carotid endarterectomy, peripheral revascularization, gangrene, or limb amputation. 3. To assess whether Lp(a) may have a role in thrombotic events (failure of vascular access in HD or early renal allograft thrombosis after transplantation) in these patients. Method Serum Lp(a) levels and lipid profile were assessed in 295 patients (M 172, F 123; mean age 57.3, range 19-85 years): 23 with CKD stage I-III, 76 with CKD stage IV-V, 128 on dialysis (68 hemodialysis (HD), 60 peritoneal dialysis) and 68 were kidney Tx recipients (eGFR>30 ml/min). In the latter group, Lp(a) values were assayed before and after transplantation. Lp(a) levels were determined using the Macra® Lp(a) ELISA kit (Trinity Biotech, USA). Values are expressed as median and interquartile range. Logistic regression analysis was used to determine whether Lp(a) is a risk factor for CV and thrombosis disease. The cut-off value was identified according to maximum Youden index by receiver operating characteristic (ROC) curve. Results Increased mean serum levels of LDL-C (93.85 mg/d; normal values=<70 mg/dl) were observed in all groups of patients, while HDL-C and triglycerides serum levels were in the normal range. Serum Lp(a) levels (nv=14-31 mg/dl) were significantly (p<0.001) increased in advanced CKD group (stage IV-V) (45.5, 1.5-216.5 mg/dl) and, mostly, in patients on dialysis treatment (63.2, 2.0-216.6 mg/dl, p=0.001) compared to mild-moderate CKD group (stage I-III) (32, 1.3-149 mg/dl). Lp(a) serum levels correlated significantly with age (r=0.11, p<0.05) and, inversely, with eGFR only in advanced CKD group (r=-0.21 p<0.05). A significant (-56%; p<0.001) decrease of serum Lp(a) was observed after renal Tx, while staying in HD for another year resulted in an increase in serum Lp (a) levels of about 23.7% (p<0.003). No significant relationship was found between Lp(a) values and gender, inflammation (as assessed by serum C-reactive protein levels), or diabetes. By logistic regression analysis, Lp(a) values were found to be a risk factors for ASCVD in the whole population (No events 246 pts: Lp(a) 47.8 mg/dl; Yes events 49 pts: Lp(a) 53.8 mg/dl; p=0.049) and for thrombotic events in HD group (vascular access thrombosis: 4 events) and Tx patients (early acute renal vein thrombosis after Tx: 4 events) (p=0.028). The ROC curve (AUC 0.7829, 95% CI 0.5751-0.9907) allowed us to define the cut-off value for serum Lp(a) (82.45 mg/dl) (sensitivity of 87%; specificity of 73%) as a thrombotic risk factor in HD and Tx patients. Conclusion The study confirms the relevance of Lp(a) as non-traditional CV risk factor in CKD and Tx patients predicting both, the development of ASCVD and thrombosis. Serum Lp(a) levels higher than 82.45 mg/dl are potential thrombotic risk factors for vascular access failure in HD patients or early acute renal allograft thrombosis in Tx patients, suggesting more aggressive strategies to lower Lp(a) serum levels in this patient setting.

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Multiple Factor Analysis of Symptomatic Intracranial Arterial Stenosis

Translational Neuroscience and Clinics ◽

10.18679/cn11-6030_r.2017.011 ◽

2017 ◽

Vol 3 (2) ◽

pp. 84-89

Author(s):

Chuanqiang Qu ◽

Yuanyuan Zhao ◽

Qinjian Sun ◽

Yifeng Du

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Protective Factor ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Group A ◽

Group B

Objective To discuss the correlation among intracranial arterial stenosis and its risk factors. Methods A total of 486 patients with transient ischemic attack (TIA) or ischemic cerebral infarction were examined using color doppler flow imaging (CDFI) and transcranial doppler ultrosonography (TCD). According to the degrees of extracranial arterial stenosis, patients with mild-to-moderate extracranial stenosis were classified into group A (435 cases) while those with constant severe stenosis or occlusion were classified into group B (51 cases). The differences between the two groups of risk factors were compared, and the multi-factor logistic regression analysis of risk factors associated with moderately severe intracranial arterial stenosis was performed. Results ① The risk factors that were significantly associated with intracranial arterial stenosis included age (P = 0.034) and gender (P = 0.044). ② Intracranial artery stenosis was observed in both anterior and posterior cerebral arteries in patients with hypertension, diabetes, and coronary heart disease respectively (P < 0.05). ③ Compared with group A, patients in group B were older (P = 0.000), with a higher proportion of men (P = 0.037), and the intracranial arterial stenosis degrees were significantly higher (P = 0.013). ④ Multi-factor logistic regression analysis showed that diabetes is a risk factor for moderately severe intracranial arterial stenosis (P < 0.05), and hyperlipidemia is a protective factor (P = 0.012). Conclusions Age, gender, hypertension, diabetes, coronary heart disease, and smoking are risk factors for the distribution of intracranial arterial stenosis. The degrees of intracranial arterial stenosis are related with extracranial arterial stenosis. Diabetes is a risk factor for moderately severe intracranial arterial stenosis while hyperlipidemia is a protective factor.

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Risk Factors for Silent Cerebral Infarcts in a Pediatric Sickle Cell Anemia (SCA) Cohort

Blood ◽

10.1182/blood.v112.11.2487.2487 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2487-2487 ◽

Cited By ~ 1

Author(s):

Francoise Bernaudin ◽

Suzanne Verlhac ◽

Annie Kamdem ◽

Cécile Arnaud ◽

Lena Coïc ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

G6pd Deficiency ◽

Significant Risk ◽

Significant Risk Factor ◽

History Of ◽

Independent Risk Factors

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (< 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p<0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p<0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p<0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.

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Pre-existing interstitial lung abnormalities are risk factors for immune checkpoint inhibitor-induced interstitial lung disease in non-NSCLC cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e15171 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e15171-e15171

Author(s):

Kiyofumi Shimoji ◽

Takeshi Masuda ◽

Yu Nakanishi ◽

Kakuhiro Yamaguchi ◽

Shinjiro Sakamoto ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Logistic Regression Analysis ◽

Independent Risk Factor ◽

Patient Characteristics ◽

Significant Difference

e15171 Background: Immune check point inhibitor (ICI) induced interstitial lung disease (ICI-ILD) is a clinically serious and life-threatening toxicity. Pre-existing ILD has been reported to be a risk factor for ICI-ILD in patients with non-small cell lung cancer (NSCLC). In addition, we have previously reported that interstitial lung abnormality (ILA) is also a risk factor for the ICI-ILD. Therefore, we investigated whether any patient characteristics, including ILA, were risk factors for ICI-ILD in patients with non-NSCLC cancers. Methods: Head and neck cancer, malignant melanoma, oral cavity cancer, renal cell carcinoma or gastric cancer patients who received anti PD-1 antibody (Nivolumab or Pembrolizumab) at Hiroshima University Hospital from December 2015 to May 2019 were enrolled. Information on patient characteristics before anti-PD-1 antibody administration, including chest CT findings and laboratory data, were obtained. Results: Two hundred patients were enrolled, and 20 (10%) developed ICI-ILD. Grade1 was observed in 15 patients, grade2 in 3, and grade3 and 5 in 1. There was no significant difference in the background factors between patients with and without ICI-ILD. On the other hand, the proportion of patients with ILA was significantly higher in the patients with ICI-ILD than those without (P < 0.01). Furthermore, univariate logistic regression analysis revealed ILA was the risk factor for ICI-ILD (p < 0.01), and multivariate logistic regression analysis showed that GGA or reticulation in ILA was an independent risk factor for ICI-ILD (p = 0.016, 0.011). Conclusions: Pre-existing ILA is a risk factor for ICI-ILD, and GGA or reticulation in ILA is an independent risk factor for ICI-ILD in patients with non-NSCLC cancers. Therefore, we should pay more attention to the development of ICI-ILD in patients with ILA, especially GGA or reticulation.

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Abdominal obesity as a risk factor for stroke in Abuja, Nigeria

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20213394 ◽

2021 ◽

Vol 9 (9) ◽

pp. 2573

Author(s):

Gerald A. Onwuegbuzie ◽

Peter Alabi ◽

Fatima Abdulai

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Abdominal Obesity ◽

Logistic Regression Analysis ◽

Statistical Significance ◽

Lifestyle Changes ◽

Health Concern ◽

Increased Risk

Background: Obesity in Africa has remained a public health concern, which is been fueled by urbanization and its attendant lifestyle changes which includes less energy demanding jobs, sedentary lifestyle and adopting detrimental western eating habits. There are well established risk factors for stroke, however the association of obesity with that of stroke is less clear.Methods: This study was designed to determine whether abdominal obesity is independently associated with an increased risk of ischaemic stroke. It is a case control study of 113 patients in which structured questionnaire was administered to consecutive patients admitted into the medical wards. The controls were matched for age and sex from a database with participants of the population-based cohort study. Statistical analysis of data was performed using SAS software (SAS Institute) 9.4.Results: In the study 85% of the patients had hypertension, 50.5% had hypercholesterolemia and 33.6% had diabetes. The BMI was normal for most of the cases (23.3% vs. 76.7% p<0.0001) while the WHR was increased for most of the cases (70.9% vs. 29.1% p<0.0001). The statistical significance shows that WHR was more sensitive in assessing obesity than BMI. The logistic regression analysis, in model 1 unadjusted and model 2 adjusted for sex and age, BMI showed a positive association with risk of stroke (OR 1.10; 95% CI, 1.04-1.17; p=0.002) this association lost its significance in model 3 after adjusting for diabetes, hypertension and hypercholesterolemia (OR 1.04; 95% CI, 0.96-1.13; p=0.3751). The results of logistic regression analysis for WHR for model 1, model 2 and model 3 did not show any significance before and after adjustment.Conclusions: Abdominal obesity may increase the risk of ischemic stroke through conventional vascular risk factors, but not as an independent risk factor.

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Serum markers change for intraocular metastasis in renal cell carcinoma

Bioscience Reports ◽

10.1042/bsr20203116 ◽

2021 ◽

Author(s):

Tie Sun ◽

Jing Tang ◽

Yi-Cong Pan ◽

Chen-Yu Yu ◽

Biao Li ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Cell Carcinoma ◽

Renal Cell ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Intraocular Metastasis

Objective: Intraocular metastasis(IOM) of renal cell carcinoma is rare. In this study, we studied the relationship between different biochemical indicators and the occurrence of IOM in renal cancer patients, and identified the potential risk factors. Methods: A retrospective analysis of the clinical data of 214 patients with renal cell carcinoma from October 2001 to August 2016. Analyze the difference and correlation of various indicators between the two groups with or without IOM, and use binary logistic regression analysis to explore the risk factors of IOM in renal cancer patients. Calculate the diagnostic value of each independent related factor according to the receiver operating curve (ROC). Results: The level of neuron specific enolase （NSE） in renal cell carcinoma patients with IOM was significantly higher than that in patients without IOM (P < 0.05). There was no significant difference in ALP, Hb, serum calcium concentration, AFP, CEA, CA-125 etc. between IOM group and non-intraocular metastasis (NIOM) group (P > 0.05). Binary logistic regression analysis showed that NSE was an independent risk factor for IOM in renal cell carcinoma patients (P < 0.05). ROC curve shows that the factor has high accuracy in predicting IOM, and the area under the curve is 0.774. The cut-off value of NSE was 49.5U/L, the sensitivity was 72.2%, and the specificity was 80.1%. Conclusion：NSE concentration is a risk factor for IOM in patients with renal cell cancer. If the concentration of NSE in the patient's body is ≥49.5U/L, disease monitoring and eye scans should be strengthened.

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Delayed diagnosis of critical congenital heart defects predicting risk factors and survival rate in newborns in Beijing: a retrospective study

Journal of International Medical Research ◽

10.1177/03000605211028028 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110280

Author(s):

Wen Zhang ◽

Hong-Yan Xu ◽

Yan-Chun Zhang ◽

Kai-Bo Liu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Retrospective Study ◽

Congenital Heart ◽

Heart Defects ◽

Delayed Diagnosis ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression

Objective To assess the prevalence and survival rate of newborns with a delayed diagnosis of critical congenital heart defects (CCHD) in Beijing. Methods This retrospective study analysed data from births between 2010 and 2017 from the Birth Defects Monitoring Network in Beijing. Newborns with CCHD were analysed according to seven categories. Statistical analyses were used to calculate the mortality rate within the first week (days 0–6) after live birth. Multivariate logistic regression analysis of survival was performed to analyse the potential risk factors for newborn mortality. Results A total of 1 773 935 perinatal newborns were screened in Beijing and 1851 newborns were diagnosed with CCHD, showing a prevalence of 10.43 per 10 000. Among the total 1851 CCHD patients, the majority (1692 of 1851; 91.41%) were identified through prenatal diagnosis, 104 of 1851 (5.62%) were diagnosed before obstetric discharge/transfer and 55 of 1851 (2.97%) were identified through delayed diagnosis. The prevalence of CCHD in newborns was 1.96 per 10 000 births. Multivariate logistic regression analysis of survival demonstrated that gestational age at delivery was the only risk factor for death within the first week after birth. Conclusions Within the first week after birth, gestational age was the only risk factor for death in newborns with CCHD.

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Caution for liver injury after bariatric surgery: logistic regression of risk factors for early elevation of liver enzymes after surgery

10.21203/rs.3.rs-148114/v1 ◽

2021 ◽

Author(s):

Yu Zhang ◽

Huawu Yang ◽

Dafang Zhan ◽

Xiaoxiao Liu ◽

Chenxin Xu ◽

...

Keyword(s):

Risk Factors ◽

Bariatric Surgery ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Liver Injury ◽

Independent Risk Factor ◽

Liver Enzymes ◽

Early Elevation

Abstract The reasons for the influence of bariatric surgery (BS) on the early abnormal increase of liver enzymes and liver injury remain unclear. We found abnormal elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in liver chemistry early after BS. To investigate the risk factors for early elevation of ALT and AST after BS, we performed a regression analysis of 177 patients who underwent BS at our center. Follow-up data before and after BS were collected and divided into two groups according to whether ALT and/or AST increased and exceeded the clinical threshold one month after BS. Logistic regression analysis was used, and independent risk factors were screened. Waist circumference (WC) before BS was an independent risk factor (P < 0.05) for increased ALT and AST after BS, but other factors (P > 0.05), such as sex, type of BS, or body mass index (BMI), were not. The cutoff of WC to predict abnormal elevation of ALT and AST after BS was 117.35 cm (sensitivity, 0.75; specificity, 0.62) and 113.65 cm (sensitivity, 0.88; specificity, 0.48), respectively. WC is an independent risk factor for early liver injury after BS. Long-term liver-related follow-up is necessary.

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The Risk Factors For The Failure of Hook Wire Localization of Ground Glass Nodules Prior To Thoracoscopic Surgery

10.21203/rs.3.rs-842171/v1 ◽

2021 ◽

Author(s):

Musu Ala ◽

Junzhong Liu ◽

Jieli Kou ◽

Xinhua Wang ◽

Minfeng Sun ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

Thoracoscopic Surgery ◽

Wire Localization ◽

Ct Guided ◽

Hook Wire ◽

Ground Glass Nodules

Abstract Objectives: To retrospectively analyse the potential influencing factors of CT-guided hook wire localization failure prior to thoracoscopic resection surgery of ground glass nodules (GGNs), and determine the main risk elements for localization failure.Methods: In all, 372 patients were included in this study, with 21 patients showing localization failure. The related parameters of patients, GGNs, and localization were analysed through univariate and multiple logistic regression analysis to determine the risk factors of localization failure.Results: Univariate logistic regression analysis indicated that trans-fissure (odds ratio [OR]: 4.896, 95% confidence interval [CI]: 1.489–13.939); trans-emphysema (OR: 3.538, 95%CI: 1.343–8.827); localization time (OR: 0.956, 95%CI: 0.898–1.019); multi-nodule localization (OR: 2.597, 95%CI: 1.050–6.361); and pneumothorax (OR: 10.326, 95%CI: 3.414–44.684) were risk factors for localization failure, and the p-values of these factors were <0.05. However, according to the results of multivariate analysis, pneumothorax (OR: 5.998, 95%CI: 1.680–28.342) was an exclusive risk factor for the failure of preoperative localization of GGNs.Conclusion: CT-guided hook wire localization of GGNs prior to thoracoscopic surgery is often known to fail; however, the incidence is low. Pneumothorax is an independent risk factor for failure in the localization process.

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Clinical risk predictors for bradycardia, supraventricular tachycardia and epilepsy necessitating therapy in patients with unexplained syncope monitored by insertable cardiac monitor

European Heart Journal ◽

10.1093/ehjci/ehaa946.0709 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Onuki ◽

M Shoji ◽

M Kikuchi ◽

T Asano ◽

H Suzuki ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Independent Risk Factor ◽

Sick Sinus Syndrome ◽

Unexplained Syncope ◽

Independent Risk Factors

Abstract Background Insertable cardiac monitors (ICMs) allow for lengthy monitoring of cardiac rhythm and improve diagnostic yield in patients with unexplained syncope. In most cardiac syncope cases, sick sinus syndrome, atrioventricular block, and paroxysmal supraventricular tachycardia (SVT) are detected using ICMs. On the other hand, epileptic seizures are sometimes diagnosed as unexplained syncope because in these situations, the loss of consciousness is a similar manifestation. Thus, the population of patients with unexplained syncope monitored by ICMs includes epileptic patients. Clinical risk factors for bradycardia, SVT and epilepsy that necessitate therapy in patients with unexplained syncope are not well known. If these risks can be clarified, clinicians could provide more specific targeted monitoring. Purpose We aimed to identify these predictors. Methods We retrospectively reviewed medical records of consecutive patients who received ICMs to monitor unexplained syncope in three medical facilities. We performed Cox's stepwise logistic regression analysis to identify significant independent risk factors for bradycardia, SVT, and epilepsy. Results One hundred thirty-two patients received ICMs to monitor unexplained syncope. During the 17-month follow-up period, 19 patients (10 patients had sick sinus syndrome and 9 had atrioventricular block) needed pacemaker for bradycardia; 8 patients (3 had atrial flutter, 4 had atrial tachycardia, and 1 had paroxysmal atrial fibrillation) needed catheter ablation for SVT; and 9 patients needed antiepileptic agents from the neurologist.Stepwise logistic regression analysis indicated that syncope during effort (odds ratio [OR] = 3.41; 95% confidence interval [CI], 1.21 to 9.6; p=0.02) was an independent risk factor for bradycardia. Palpitation before syncope (OR = 9.46; 95% CI, 1.78 to 50.10; p=0.008) and history of atrial fibrillation (OR = 10.1; 95% CI, 1.96 to 52.45; p=0.006) were identified as significant independent prognostic factors for SVT. Syncope while supine (OR = 11.7; 95% CI, 1.72 to 79.7; p=0.01) or driving (OR = 15.6; 95% CI, 2.10 to 115.3; p=0.007) was an independent factor for epileptic seizure. Conclusions ICMs are useful devices for diagnosing unexplained syncope. Palpitation, atrial fibrillation and syncope during effort were independent risk factors for bradycardia and for SVT. Syncope while supine or driving was an independent risk factor for epilepsy. We should carefully follow up of patients with these risk factors. Funding Acknowledgement Type of funding source: None

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Central Hypoventilation Is a Key Risk Factor for Mechanical Ventilation During the Acute Phase of Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Frontiers in Neurology ◽

10.3389/fneur.2021.728594 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qianhui Xu ◽

Qian Wang ◽

Jing Han ◽

Fengju Mao ◽

Silin Zeng ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Clinical Characteristics ◽

Test Results ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Central Hypoventilation

Objective: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an acute form of encephalitis of autoimmune etiology. We aimed to evaluate the risk factors that predicted the need for mechanical ventilation during the acute phase of anti-NMDAR encephalitis through an analysis of the clinical characteristics and biochemical test results of the patients with anti-NMDAR encephalitis.Methods: In this retrospective study, patients who primarily presented with anti-NMDAR encephalitis and exhibited anti-NMDAR antibody positivity in the cerebrospinal fluid (CSF) between November 2015 and February 2020 were included. Data on the clinical characteristics, biochemical test results, and treatment methods selected for the patients were collected for the analysis of factors predicting the need for mechanical ventilation.Results: Thirty-one patients with a median age of onset of 31 years (inter-quartile range: 21–48 years) were included in this study, of which 15 were male (48.4%). Psychosis (23, 74.2%), seizures (20, 64.5%), and memory deficit (20, 64.5%) were the most common clinical manifestations. At admission, 17 patients (54.8%) presented with pyrexia, of which 12 (38.7%) had a body temperature ≥38°C, and six patients (19.4%) presented with central hypoventilation. All patients received first-line therapy (glucocorticoids, intravenous immunoglobulin, or plasmapheresis alone or combined), whereas two patients (6.5%) received rituximab, a second-line agent, as well. Seven patents required mechanical ventilation. Results of univariate logistic regression analysis revealed that body temperature ≥38°C [odds ratio (OR) = 18, 95% confidence interval (CI): 1.79–181.31, P < 0.05] and central hypoventilation at admission (OR = 57.50, 95% CI: 4.32–764.89, P < 0.05) were the risk factors for mechanical ventilation. Multivariate logistic regression analysis showed that central hypoventilation at admission was the only risk factor predicting the need for mechanical ventilation.Conclusion: Central hypoventilation at admission is a key risk factor for mechanical ventilation during hospitalization in patients with anti-NMDAR encephalitis.

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