P12.04 Body Mass Index: a possible PICC-related complications risk factor in neuro oncological patients

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
G Simonetti ◽  
P Gaviani ◽  
A Botturi ◽  
V Redaelli ◽  
E Anghileri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Thromboembolic Event ◽  
Thrombotic Event ◽  
Central Nervous System Lymphoma ◽  
Venous Catheter ◽  
Oncological Patients ◽  
Thrombotic Complications ◽  
Independent Risk Factors ◽  
Preventable Harm

Abstract BACKGROUND The use of central venous catheter with peripheral insertion (PICC) has increased rapidly in recent years particularly in cancer patients because they represent a stable and safe vascular access to administer irritants or vesicants therapies. However, the benefit provided may occasionally be affected by severe complications. An observational study conducted at our Institute, showed a significant increase of thromboembolic risk in neuro-oncological patients compared to general cancer population (16.3% vs 6.7% respectively). For this reason, it is essential to identify independent risk factors in order to avoid preventable harm. MATERIAL AND METHODS Neuro-oncological patients with PICC that developed a thromboembolic event were retrospectively analyzed. We evaluated clinical data, BMI, KPS, steroid therapies and anticoagulants at the time of positioning of the PICC and at the onset of the thrombotic event. RESULTS A total of 90 neuro-oncological patients have been analyzed. The most common histology was represented by glioblastoma, followed by anaplastic astrocytoma, primary central nervous system lymphoma, grade II glioma. 17.6% of patients were at first diagnoses, 41.6% were at the first recurrence, and the remaining patients were at the second or third recurrence. The median KPS was 90 (range 80–100), and the median ECOG was 0 (range 0–2). Overall, 14% patients developed thromboembolic events within a median time of 34.5 days (range 5–146) after PICC implantation. Among these, 64% of patients was considered overweight. No patients were on anticoagulant therapy but all were treated with a median dose of 5.5 mg of steroids (range 3,5-12), stable between PICC insertion and onset of adverse event. CONCLUSION 64% of patients who developed a thromboembolic event had BMI >28 at the time of PICC insertion, suggesting a possible trend towards a risk of developing PICC related thrombosis in overweight/obese patients. Other independent risk factors for PICC associated complications seems to be amount of previous chemotherapies administered: 82% of patients who developed thrombotic complications had already undergone at least one line of chemotherapy before PICC placement, suggesting this condition as a possible risk factor for the onset of the event. Also failed positioning attempts could damage vascular endothelium, contributing to the onset of thrombotic complications. An accurate anamnesis and a physical evaluation with particular attention to the presence of malnutrition could help in the in the early identification of independent risk factors that could farther negatively influence the outcome of neuro-oncological patients.

Acute kidney injury as a risk factor for mortality in oncological patients receiving check-point inhibitors

2021 ◽  
Author(s):  
Clara García-Carro ◽  
Mónica Bolufer ◽  
Roxana Bury ◽  
Zaira Catañeda ◽  
Eva Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Kidney Injury ◽  
Actuarial Survival ◽  
Oncological Patients ◽  
Check Point Inhibitors ◽  
Independent Risk Factors

Abstract Background Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Methods All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving anti-PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusions 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

scholarly journals MO141ACUTE KIDNEY INJURY AS A RISK FACTOR FOR MORTALITY IN ONCOLOGICAL PATIENTS RECEIVING CHECK-POINT INHIBITORS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Clara García Carro ◽  
Mónica Bolufer ◽  
Roxana Bury ◽  
Zaira CAstañeda ◽  
Eva Muñoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Checkpoint Inhibitors ◽  
Metastatic Cancer ◽  
Kidney Injury ◽  
Actuarial Survival ◽  
Oncological Patients ◽  
Check Point Inhibitors ◽  
Independent Risk Factors

Abstract Background and Aims Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Method All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusion 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

Clinical characteristics and prognosis in patients with premature coronary artery disease of different genders after intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
X.F Tang ◽  
Y Yao ◽  
S.D Jia ◽  
Y Liu ◽  
B Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Coronary Intervention ◽  
Premature Coronary Artery Disease ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Cerebrovascular Events ◽  
Independent Risk Factors ◽  
Artery Disease

Abstract Objective To investigate the clinical characteristics and long-term prognosis of coronary intervention in patients with premature coronary artery disease (PCAD) between different genders. Methods From January 2013 to December 2013, 4 744 patients diagnosed as PCAD with percutaneous coronary intervention (PCI) in our hospital were enrolled. The general clinical data, laboratory results and interventional treatment data of all patients were collected, and the occurrence of major adverse cardio-cerebrovascular events (MACCE) within 2 years after PCI was followed up. Results Of the 4 744 patients undergoing PCI, 3 390 (71.5%) were males and 1 354 (28.5%) were females. The 2-year follow-up results showed that the incidence of BARC grade 1 hemorrhage in female patients was significantly higher than that in male patients (6.9% vs. 3.7%; P<0.001); however, there was no significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause death, cardiac death, recurrent myocardial infarction, revascularization (target vessel revascularization and target lesion revascularization), stent thrombosis, stroke and BARC grade 2–5 hemorrhage between the two groups (P>0.05). Multivariate COX regression analysis showed that gender was an independent risk factor for BARC grade 1 bleeding events in PCAD patients (HR=2.180, 95% CI: 1.392–3.416, P<0.001), but it was not an independent risk factor for MACCE and BARC grade 2–5 bleeding. Hyperlipidemia, preoperative SYNTAX score, multivessel lesions and NSTE-ACS were the independent risk factors for MACCE in PCAD patients with PCI (HR=1.289, 95% CI: 1.052–1.580, P=0.014; HR=1.030, 95% CI: 1.019–1.042, P<0.001; HR=1.758, 95% CI: 1.365–2.264, P<0.001; HR=1.264, 95% CI: 1.040–1.537, P=0.019); gender, hyperlipidemia, anticoagulant drugs like low molecular weight heparin or sulfonate were the independent risk factors for bleeding events (HR=1.579,95% CI 1.085–2. 297, P=0.017; HR=1.305, 95% CI 1.005–1.695, P=0.046; HR=1.321, 95% CI 1.002–1.741, P=0.048; HR=1.659, 95% CI 1.198–2.298, P=0.002). Conclusion The incidence of minor bleeding in women with PCAD is significantly higher than that in men; After adjusting for various risk factors, gender is an independent risk factor for minor bleeding events, but not an independent risk factor for MACCE in patients with PCAD. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science and Technology Support Program of China

scholarly journals Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients

2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Goodness Of Fit ◽  
Insertion Site ◽  
Healthcare Providers ◽  
Venous Catheter ◽  
Goodness Of Fit Test ◽  
Peripheral Venous Catheter ◽  
Independent Risk Factors

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.

scholarly journals Risk Factors for Failure of Direct Current Cardioversion in Patients with Type 2 Diabetes Mellitus and Atrial Fibrillation

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Handrean Soran ◽  
Moulinath Banerjee ◽  
Jamal B. Mohamad ◽  
Safwaan Adam ◽  
Jan Hoong Ho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Left Atrial ◽  
Control Group ◽  
Left Atrial Size ◽  
Direct Current Cardioversion ◽  
Atrial Size ◽  
Independent Risk Factors ◽  
Lv Ejection Fraction

Introduction. Type 2 diabetes mellitus (T2DM) is a well-recognised risk factor for cardiovascular disease and the prevalence of atrial fibrillation (AF) is higher among patients with T2DM. Direct current cardioversion (DCCV) is an important management option in persistent AF. We sought to determine independent risk factors for immediate and short-term outcomes of DCCV for treatment of AF in patients with T2DM. Methods. Retrospective outcome analysis of DCCV for persistent AF in 102 T2DM patients compared with 102 controls. Results. DCCV was successful in 68 (66.6%) people with T2DM compared to 86 (84.3%) in the control group (P=0.003). After initial successful cardioversion, only 38 (37.2%) T2DM patients remained in sinus rhythm compared to 63 (61.8%) in the control group (P=0.007) at a median follow-up of 74.5 days (IQR 69.4–77.4). Multiple logistic regression analysis showed that the presence of T2DM (P=0.014), digoxin use (P=0.01), statin use (P=0.005), left-atrial size (P=0.01), and LV ejection fraction (P=0.008) were independent risk factors for immediate DCCV failure. T2DM (P=0.034) was an independent risk factor for AF relapse. Among patients with T2DM, previous DCCV (P=0.033), digoxin use (P=0.035), left-atrial size (P=0.01), LV ejection fraction (P=0.036), and HbA1c (P=0.011) predicted immediate failure of DCCV whilst digoxin use (P=0.026) was an independent risk factor for relapse of AF. Conclusion. T2DM, higher HbA1c, digoxin treatment, and structural and functional cardiac abnormalities are independent risk factors for immediate DCCV failure and AF relapse.

scholarly journals Risk factors for methicillin-resistantStaphylococcus aureusbacteraemia differ depending on the control group chosen

2013 ◽  
Vol 141 (11) ◽  
pp. 2376-2383 ◽  
Author(s):  
M. POGORZELSKA-MAZIARZ ◽  
E. Y. FURUYA ◽  
E. L. LARSON
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Organ Transplant ◽  
Severity Of Illness ◽  
Venous Catheter ◽  
Case Control ◽  
Control Group ◽  
Major Organ ◽  
Independent Risk Factors ◽  
Nested Case Control

SUMMARYMethicillin-resistantStaphylococcus aureus(MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptibleStaphylococcus aureus(MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.

scholarly journals Venous anomalies as potentially lethal risk factors during ordinary catheterization

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
Savino Occhionorelli ◽  
Sergio Gianesini ◽  
Lorenzo Marinelli ◽  
Marianna Daniele ◽  
Sara Chierici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Central Venous Catheter ◽  
Literature Review ◽  
Venous Catheter ◽  
Clinical Implications ◽  
Venous Malformations ◽  
Central Venous ◽  
Venous Anomalies ◽  
Technology Advancement

Venous malformations are rare but possible findings too, constituting a further risk factor for central venous catheter procedures. Herein we describe a case of death because of an innominate vein perforation by a catheter that incidentally was tucked into a sacciform malformation. Even if the technology advancement is constantly offering us new investigation tools, up to now diagnostic options are limited in the detection of those malformations that could potentially lead to dramatic complications as the described one. The present work raises the awareness about rare venous anomalies and their potential clinical implications. A proper literature review and diagnostic implementation proposal are reported.

Implications of cytogenetics for venous thromboembolism in acute myeloid leukaemia

2015 ◽  
Vol 113 (01) ◽  
pp. 201-208 ◽  
Author(s):  
Ji-hyun Kwon ◽  
Sung Yoon ◽  
Leo Song ◽  
Jae-Ho Yoon ◽  
Seung-Hwan Shin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Advanced Age ◽  
Leukemia Diagnosis ◽  
Incidence Risk ◽  
Thrombotic Complications ◽  
Predictive Role ◽  
Independent Risk Factors ◽  
One Year ◽  
Acute Myeloid

SummaryDue to the high risk of thrombocytopenia and haemorrhage, thrombotic complications have received little attention in patients with acute myeloid leukemia (AML). Furthermore, the predictive role of cytogenetics on venous thromboembolism (VTE) has largely been ignored. This study aimed to evaluate the incidence, risk factors, and prognostic aspects of VTE in AML. A total of 811 consecutive patients with AML were enrolled and analysed retrospectively. Cox time-dependent covariate regression analysis was used to identify the significant predictors of VTE development. To minimise potential confounding factors, we used propensity-score matching to compare overall survival between patients with and without VTE. The six-month and one-year cumulative incidences of VTE were 3.1 % (95 % confidence interval [CI], 2.0–4.7) and 3.9 % (95 % CI, 2.6–5.7), respectively. Of the 26 cases of VTE, 22 (85 %) developed within 6 months of leukemia diagnosis and 13 (50 %) were catheter-related. In multivariate analysis, advanced age (≥ 65 years) (hazard ratio [HR], 2.70; p = 0.03) and increasing cytogenetic risk (common HR, 1.84; p = 0.05) were independent predictors of VTE. There was no significant association between VTE development and decreased survival (p = 0.32 for matched analysis). Advanced age and increasing cytogenetic risk, well-known predictors for clinical outcome in AML, were also independent risk factors of VTE development. Our results suggest that VTE does not hold prognostic implications for AML.

scholarly journals Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Ischaemic Attack ◽  
Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study

Gerontology ◽  
2020 ◽  
Vol 66 (6) ◽  
pp. 532-541
Author(s):  
Marta Zatta ◽  
Stefano Di Bella ◽  
Daniele Roberto Giacobbe ◽  
Filippo Del Puente ◽  
Maria Merelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Catheter ◽  
Prognostic Impact ◽  
Old Patients ◽  
Very Old ◽  
Probability Of Survival ◽  
Independent Risk Factors ◽  
Nosocomial Candidemia ◽  
Medical Wards ◽  
Few Data

<b><i>Introduction:</i></b> Being elderly is a well-known risk factor for candidemia, but few data are available on the prognostic impact of candidemia in the very old (VO) subjects, as defined as people aged ≥75 years. <b><i>Objective:</i></b> The aim of this study was to assess risk factors for nosocomial candidemia in two groups of candidemia patients, consisting of VO patients (≥75 years) and adult and old (AO) patients (18–74 years). In addition, risk factors for death (30-day mortality) were analysed separately in the two groups. <b><i>Methods:</i></b> We included all consecutive candidemia episodes from January 2011 to December 2013 occurring in six referral hospitals in north-eastern Italy. <b><i>Results:</i></b> A total of 683 nosocomial candidemia episodes occurred. Of those, 293 (42.9%) episodes were in VO and 390 (57.1%) in AO patients. Hospitalization in medical wards, chronic renal failure, urinary catheter, and peripheral parenteral nutrition (PPN) were more common in VO than in AO patients. In the former patient group, adequate antifungal therapy (73.2%) and central venous catheter (CVC) removal (67.6%) occurred less frequently than in AO patients (82.5 and 80%, <i>p</i> &#x3c; 0.002 and <i>p</i> &#x3c; 0.004, respectively). Thirty-day mortality was higher in VO compared to AO patients (47.8 vs. 23.6%, <i>p</i> &#x3c; 0.0001). In AO patients, independent risk factors for death were age (OR 1.04, 95% CI 1.00–1.09, <i>p</i> = 0.038), recent history of chemotherapy (OR 22.01, 95% CI 3.12–155.20, <i>p</i> = 0.002), and severity of sepsis (OR 40.68, 95% CI 7.42–223.10, <i>p</i> &#x3c; 0.001); CVC removal was associated with higher probability of survival (OR 0.10, 95% CI 0.03–0.33, <i>p</i> &#x3c; 0.001). In VO patients, independent risk factors for death were PPN (OR 3.5, 95% CI 1.17–10.47, <i>p</i> = 0.025) and hospitalization in medical wards (OR 2.58, 95% CI 1.02–6.53, <i>p</i> = 0.046), while CVC removal was associated with improved survival (OR 0.40, 95% CI 0.16–1.00, <i>p</i> = 0.050). <b><i>Conclusion:</i></b> Thirty-day mortality was high among VO patients and was associated with inadequate management of candidemia, especially in medical wards.

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