Multivariate Conditional Logistic Regression Analysis Research Articles

Clinical characteristics and risk factors of 267 patients having severe fever with thrombocytopenia syndrome–new epidemiological characteristics of fever with thrombocytopenia syndrome: Epidemiological characteristics of SFTS

To analyze the epidemiological distribution, clinical characteristics, and prognostic risk factors of patients having severe fever with thrombocytopenia syndrome (SFTS). We enrolled 790 patients with SFTS divided into the ordinary group and the severe group, analyzed the clinical characteristics, and screened the risk factors of severious patients by univariate logistic regression analysis. Most of the 790 patients (SFTS) are farmers (84.56%). The proportion of patients with fieldwork history was 72.41%, of which 21.27% had a clear history of a tick bite and 98.61% were sporadic cases. The annual peak season is from April to November. 16.33% patients were not accompanied by fever. The incidence of severe thrombocytopenia was 47.59%. They were statistically significant between the 2 groups in indicators such as age, hypertension, coronary heart disease, diabetes mellitus, bunyavirus nucleic acid load and mean platelet count (P < .05). Multivariate non conditional Logistic regression analysis showed that the risk factors of the mild patients deteriorating severe disease were age (OR = 1.985, P ≤ .003), diabetes mellitus (OR = 1.702, P ≤ .001), coronary heart disease (OR = 1.381, P ≤ .003), platelet count (OR = 2.592, P ≤ .001), viral nucleic acid loading (OR = 3.908, P ≤ .001). The incidence population and seasonal distribution characteristics of patients with SFTS are obvious. The risk factors for poor prognosis of severe patients are old age, multiple basic medical histories, high viral load, a serious decrease of mean platelet count, and delay of treatment time.

1010. Metronidazole-associated neurologic adverse events: risk factors analysis

Abstract Background Metronidazole is a widely used antibiotic to treat anaerobic and protozoal infections. However, neurologic adverse events associated with metronidazole have been reported in case series and case reports. Previous publications implicated that long-term usage and cumulative dose are risk factors for this adverse event. Still, little is known about the risk factor of the metronidazole-associated neurologic adverse events. Therefore, we conducted a retrospective study to investigate the risk factors for the metronidazole-associated neurologic adverse events through a matched case-control study. Methods This retrospective study enrolled patients prescribed metronidazole from January 2006 to July 2021 at Severance Hospital, a tertiary hospital in South Korea. Case patients were defined as those who developed central nervous system (CNS) adverse events or peripheral nervous system (PNS) adverse events during the study period with causality assessment. In a 1 to 3 ratio, case patients were compared to a control group of the patients without neurologic adverse events, matched on age and cumulative dose of metronidazole. Results 92838 patients were prescribed metronidazole during the study period. Among them, 52 patients showed metronidazole-associated neurologic adverse events (39 patients with CNS, 27 patients with PNS adverse events, and 14 patients with both). The proportion of chronic kidney disease (CKD), solid organ transplantation, liver cirrhosis (LC), intravenous (IV) administration of metronidazole, and concomitant use of a proton pump inhibitor was significantly higher in the case group. The body weight, hemoglobin, and serum albumin levels were lower, and Sequential Organ Failure Assessment scores were higher in the case group. Multivariate conditional logistic regression analysis demonstrated LC, CKD, IV administration, and lower body weight as risk factors for metronidazole-associated neurologic adverse events. Conclusion In this case-control study, LC, CKD, IV administration, and lower body weight were associated with the metronidazole-associated neurologic adverse events. Prolonged metronidazole treatment in patients with the risk factors requires careful examination for these adverse events. Disclosures All Authors: No reported disclosures.

Cardiovascular risk factors among patients with acute unilateral inner ear hypofunction: A case-control study.

To assess the prevalence of cardiovascular risk factors (CVRFs) and their impact on acute unilateral inner ear hypofunction (AUIEH), including acute unilateral peripheral vestibulopathy (AUPVP), sudden sensorineural hearing loss (SSNHL) and acute unilateral audiovestibular hypofunction (AUAVH). One hundred and twenty-five patients consecutively diagnosed with AUPVP, SSNHL or AUAVH and 250 sex- and age-matched controls were included. Cases presented a mean age of 58.6 ± 14.7 years and included 59 women and 66 men. The correlation between CVRFs (high blood pressure [HBP], diabetes mellitus [DM], dyslipidemia [DLP], cardiocerebrovascular disease [CCVD]) and AUIEH was assessed by multivariate conditional logistic regression analysis. A higher prevalence of CVRFs was identified in patients than in controls (30 individuals with DM, 53 with HBP, 45 with DLP and 14 with a previous history of CCVD, p < .05). A significantly elevated risk of AUIEH was found in patients with two or more CVRFs (adjusted odds ratio [OR] 5.11; 95% CI 2.23-11.70). Previous CCVD individually predicted AUIEH (OR 8.41; 95% CI 2.36-29.88). Subgroup analysis showed the same tendency for AUPVP and SSNHL. Acute unilateral inner ear hypofunction patients presented significantly more CVRFs than controls, and the presence of two or more CVRFs was associated with AUIEH. Future studies evaluating vascular risk in AUIEH may include AUPVP and SSNHL patients from the same source population to better characterize risk profiles that can indicate a vascular origin. 3b.

Identification of metabolic biomarkers associated with the onset of type 2 diabetes based on a nested case-control study

Objective: To explore metabolic biomarkers associated with the onset of type 2 diabetes. Methods: Cluster random sampling method was used to select 10 867 local residents aged ≥ 20 years in Liangxi district of Wuxi City, Jiangsu Province in 2007. The baseline survey and physical examination were conducted to collect participants' information, including demographic characteristics, behavior and lifestyles, disease history, family history of diabetes, height, weight, waist circumference and blood pressure, etc. Blood samples were collected and biochemical indexes (high density lipoprotein cholesterol, total cholesterol, triglyceride, fasting blood glucose, etc.) were tested. By June 30, 2020, 220 newly diagnosed patients with type 2 diabetes during the follow-up were selected as cases, and 220 healthy individuals were matched as controls with age (±5 years) and the same sex. High performance liquid chromatography mass spectrometer was used to detect and identify metabolites in serum samples of two groups at baseline. Lasso regression and multivariate conditional logistic regression were used to explore the metabolites associated with the onset of type 2 diabetes. Results: The age of participants at baseline was (53±7) years, and 41.82% were male. 25 out of 1 579 metabolites were selected to be potentially associated with the onset of type 2 diabetes in the lasso regression model. The multivariable conditional logistic regression analysis showed that only 7-Methylxanthine had an independent effect on type 2 diabetes (P=0.019). The area under the receiver operating characteristic curve (AUC) (95%CI) of the prediction model of type 2 diabetes based on traditional risk factors was 0.80 (0.76-0.85). After the 7-methylxanthine in the model, the AUC (95%CI) increased to 0.92 (0.89-0.95) (P<0.001). From the second year, 7-methylxanthine could improve the prediction performance (P=0.007). Conclusion: The level of 7-methylxanthine is related to the onset of type 2 diabetes, and can be used as a biomarker to predict its incidence risk.

Rurality, Socioeconomic Status, and Residence in Environmental Risk Areas Associated with Increased Lyme Disease Incidence in Ontario, Canada: A Case-Control Study.

Background: Lyme disease (LD) is the most common tick-borne illness in North America. LD is acquired through exposure to the tick vector, Ixodes scapularis, known as the blacklegged tick. In Canada, LD is rapidly emerging, with the establishment of I. scapularis in many newly endemic regions posing a growing risk to local communities. In the Canadian context, many environmental and socioeconomic risk factors for human LD infection are yet to be ascertained and the degree of risk associated with residential and community exposure to ticks is not well known. Methods: We conducted a matched case-control study in southeastern Ontario, using LD patient data from provincial laboratory databases and uninfected population controls from 2014 to 2018. We aimed to identify area-level risk factors for LD and associations with residence in environmental risk areas, defined as areas with high model-predicted probability of I. scapularis occurrence, using the neighborhood dissemination area as the unit of analysis. Results: Using multivariable conditional logistic regression analysis, we identified that patients with LD had higher odds (odds ratio, OR; 95% confidence interval, CI) of living in neighborhoods with high probability of tick occurrence in the environment (OR = 2.2; 95% CI: 2.0-2.5), low walkability (OR = 1.6; 95% CI: 1.2-2.1), low material deprivation (OR = 1.4; 95% CI: 1.2-1.7), and low ethnic concentration (OR = 8.1; 95% CI: 6.7-9.9). We also found that the odds of LD infection for individuals residing in environmental risk areas was highest for those living in public health units (PHUs) with <250,000 population (OR = 3.0; 95% CI: 2.4-3.9) compared to those living in PHUs with >1,000,000 population (OR = 1.5; 95% CI: 1.1-2.1). Conclusion: This study shows that odds of human LD infection in Ontario, Canada is higher in less urbanized areas with higher socioeconomic status and indicates that exposure to ticks around the home residence or neighborhood is linked to increased odds of LD.

Modifiable factors associated with postoperative atrial fibrillation in older patients with hip fracture in an orthogeriatric care pathway: a nested case–control study

BackgroundFew data are available regarding post-operative atrial fibrillation (POAF) in non-cardiothoracic surgery, particularly orthopedic surgery. Hence, given the frequent incidence of POAF after surgery and its marked impact, we need to identify modifiable factors associated with POAF after hip fracture surgery in older patients.MethodsWe conducted a nested case–control study in the unit for perioperative geriatric care of an academic hospital in Paris from July 1, 2009 to December 31, 2019, enrolling all consecutive patients aged ≥ 70 years with hip fracture surgery and no history of permanent AF before admission (retrospective analysis of prospectively collected data). Patients with and without POAF were matched 1:5 on 5 baseline characteristics (age, hypertension, diabetes, coronary artery disease, cardiac failure).ResultsOf the 757 patients included, 384 were matched, and 64 had POAF. The incidence of POAF was 8.5%. The mean age was 86 ± 6 years, 298 (78%) patients were female, and the median Charlson Comorbidity Index was 6 (interquartile range 4–8). The median time from surgery to the occurrence of POAF was 2 days (1–4). On multivariable conditional logistic regression analysis (matched cohort), the modifiable factors present at admission associated with POAF were time to surgery > 48 h (odds ratio [OR] = 1.66, 95% confidence interval [1.01–2.81]) and > 2 units of packed red blood cells (OR = 3.94, [1.50–10.03]).ConclusionsThis study provides new information about POAF in older patients with hip fracture surgery, a surgical emergency whose complexity requires multidisciplinary care.

Risk factors for the rupture of mirror middle cerebral artery aneurysm using computer-assisted semiautomated measurement and hemodynamic analysis

ObjectivesTo identify the morphologic and hemodynamic risk factor of mirror middle cerebral artery (MCA) aneurysms. MethodsWe conducted a retrospective analysis of 40 paired mirror MCA aneurysms. Aneurysms were divided into ruptured and unruptured groups. Seventeen morphological and nine hemodynamic parameters were measured using computer-assisted semiautomated measurement (CASAM) and computer flow dynamic (CFD) simulation. We performed a paired t-test (for normally distributed data) or a paired Wilcoxon rank-sum (for non-normally distributed data) to analyze all parameters between the groups. Multivariate conditional logistic regression analysis identified independent risk factors. The receiver operating characteristic curve was analyzed to acquire the area under the curve (AUC) and the cutoff values of the independent risk factors. ResultsThere were significant differences in morphological and hemodynamic parameters between the ruptured and unruptured mirror aneurysms. The multivariate logistic analysis showed that the greater size (odds ratio [OR] = 9.807, p = 0.003), smaller neck diameter (OR = 0.285, p = 0.018) and maximum oscillatory shear index (OSI) (OR = 0.000001, p = 0.046) were independently correlated with aneurysm rupture. AUCs for size, N. and maximum OSI were 0.794, 0.695, and 0.701, respectively. The cutoff values of the size, neck diameter, and maximum OSI were 6.30, 5.07, and 0.356437, respectively. ConclusionsMorphology and hemodynamics can help predict aneurysm rupture risks. The more significant size, smaller neck diameter and maximum OSI were independent risk factors for the rupture of MCA aneurysms. The variables could aid practical risk evaluation.

Prevalence of SARS-CoV-2 infection and associated risk factors: A testing program and nested case-control study conducted at Sapienza University of Rome between March and June 2021.

To safely resume in-person activities during the COVID-19 pandemic, Sapienza University of Rome implemented rigorous infection prevention and control measures, a successful communication campaign and a free SARS-CoV-2 testing program. In this study, we describe the University's experience in carrying out such a program in the context of the COVID-19 response and identify risk factors for infection. Having identified resources, space, supplies and staff, from March to June 2021 Sapienza offered to all its enrollees a molecular test service (8.30 AM to 4 PM, Monday to Thursday). A test-negative case-control study was conducted within the program. Participants underwent structured interviews that investigated activity-related exposures in the 2 weeks before testing. Multivariable conditional logistic regression analyses were performed. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were calculated. A total of 8,959 tests were administered, of which 56 were positive. The detection trend followed regional tendencies. Among 40 cases and 80 controls, multivariable analysis showed that a known exposure to a COVID-19 case increased the likelihood of infection (aOR: 8.39, 95% CI: 2.38-29.54), while having a job decreased it (aOR: 0.23, 95% CI: 0.06-0.88). Of factors that almost reached statistical significance, participation in activities in the university tended to reduce the risk (aOR: 0.32, 95% CI: 0.09-1.06), while attendance at private gatherings showed an increasing risk trend (aOR: 3.48, 95% CI: 0.95-12.79). Age, gender, activities in the community, visiting bars or restaurants, and use of public transportation were not relevant risk factors. When those students regularly attending the university campus were excluded from the analysis, the results were comparable, except that attending activities in the community came close to having a statistically significant effect (aOR: 8.13, 95% CI: 0.91-72.84). The testing program helped create a safe university environment. Furthermore, promoting preventive behavior and implementing rigorous measures in public places, as was the case in the university setting, contributed to limit the virus transmission.

The diagnostic value of an interferon gamma release assay in new cases of active pulmonary tuberculosis and the factors influencing its negative results

ObjectiveThe aim of the study was to investigate the diagnostic value of an interferon gamma release assay (IGRA) - QuantiFERON-TB GOLD in-tube (QFT-GIT) - to identify new cases of active pulmonary tuberculosis (PTB) in Quzhou City, and to assess possible factors associated with false-negative IGRA results in bacteriologically confirmed PTB. MethodsThis study collected clinical data of suspected adult PTB patients who underwent QFT-GIT in Quzhou People's Hospital between January 1, 2020 and December 31, 2020, and calculated the total sensitivity, specificity of QFT-GIT in new case of active PTB patients were 90.9% (401/448) and 72.9%(929/1275), respectively. Univariate and multivariate logistic regression were used to analyze the influencing factors of the false-negative results of QFT-GIT. ResultsA total of 1723 patients were enrolled, including 448(448/1723,26.0%) with new case of active PTB (389 cases were bacteriologically confirmed and 59 cases were clinically diagnosed) and 1275 non-PTB patients. There were 747(747/1723,43.4%) patients with positive results of QFT-GIT, among whom 401 were new case of active PTB patients (347 cases were bacteriologically confirmed and 54 cases were clinically diagnosed) and 346 were non-PTB patients. The total sensitivity and specificity of QFT-GIT in the diagnosis of new case of active PTB patients were 90.9% and 72.8% respectively. In bacteriologically comfirmed PTB patients, multivariate conditional logistic regression analysis showed that BMI and diabetes, malignant tumors and severe infections were all independent risk factors for the false-negative results of QFT-GIT. ConclusionQFT-GIT showed high sensitivity and relatively low specificity in the diagnosis of new case of active PTB patients. In clinical practice, we should analyze the suspected PTB patients comprehensively in terms of whether they are overweight or complicated with diabetes, malignant tumors or severe infections, and avoid missing the diagnosis of PTB.

Association between levothyroxine replacement therapy and osteoporosis in Riyadh, Saudi Arabia: a matched case-control study.

Hypothyroidism is a common health problem among elder women. However, conflicting results were observed regarding the association between levothyroxine treatment and osteoporosis risk. Therefore, the current study aimed to evaluate the effect of levothyroxine replacement therapy on osteoporosis risk in the Saudi population. This study was a matched case-control study conducted from June to August 2020. Data were extracted from the electronic medical records and included sociodemographic, clinical characteristics, comorbid conditions, levothyroxine replacement therapy dose, duration, concomitant therapy, and bone mineral density. Cases were matched with controls (1:1 basis) by age; the study included 256 cases and 256 controls. In the multivariate conditional logistic regression analysis, thyroxine use was independently associated with an increased likelihood of osteoporosis. Therefore levothyroxine use in elderly females was associated with an increased risk of osteoporosis, and hence, clinicians must be aware of the levothyroxine replacement therapy outcomes in postmenopausal females at risk of osteoporosis.

Risk of complications after a non-ST segment elevation acute myocardial infarction in a Latin-American cohort: An application of the ACTION ICU score

BackgroundEuropean Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTEMI) recommend Intensive Care Unit (ICU) surveillance during the first 24–48 h. Interestingly, the in-hospital mortality of NSTEMI patients has consistently decreased, giving some patients the option to be managed in general hospital wards. The ACTION ICU score has been proposed to identify high-risk patients with NSTEMI and guide the selective risk-based need for ICU care. ObjectiveTo evaluate the usefulness of the ACTION ICU score to predict patients’ risk of developing complications requiring ICU care in a Latin-American cohort with NSTEMI. MethodsWe applied the ACTION ICU score in a retrospective cohort. A composite primary outcome included: cardiorespiratory arrest, shock, high-grade atrio-ventricular block, respiratory failure, stroke, or death. The predictive performance of this model was estimated with a conditional multivariable logistic regression analysis. ResultsOf 1,062 patients with NSTEMI, the primary outcome was present in 75 patients (7.1%), and 1,019 (96%) were admitted to ICU. The most common event was respiratory failure (4.0%), followed by cardiogenic shock (3.7%), and cardiac arrest (1.7%). The presence of heart failure signs or symptoms had the highest association with the primary outcome (OR:2.16; 95%CI:1.61–2.92). The best cut-off point for this population was 3 (complications risk: 4.0%, SEN:96%, SP:15.4%, NPV:98.1%, PPV:7.9%). ConclusionThe ACTION ICU score may be a promising tool to identify the need for ICU care in Latin-American patients with NSTEMI. Furthermore, additional research is needed to evaluate the cost-effectiveness of this strategy.

Association between tea intake and hospitalized nephrolithiasis in Chinese adults: A case-control study.

Introduction and aimNephrolithiasis is one of the most common urological disorders worldwide. Tea is one of the most popular drinks worldwide. This study aimed to explore the association between tea intake and hospitalized nephrolithiasis in Chinese adults.MethodsThe patients and healthy participants were from the Shenyang sub-cohort of Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study. After selecting and matching by age (±1 year) and sex using the 1:2 ratio, 834 participants were included in this study. Of these, 278 patients had hospitalized nephrolithiasis and 556 were healthy controls. The tea intake was assessed using a validated self-administered food frequency questionnaire. Multivariate conditional logistic regression analysis was used to evaluate the association between tea intake and hospitalized nephrolithiasis.ResultsAfter adjustment, a higher frequency of tea intake was found to be negatively associated with the risk of hospitalized nephrolithiasis. Compared with participants who never drank tea, the odds ratio (95% confidence interval) [OR (95% CI)] for participants who drank ≥1 cup (180 mL) of tea per day was 0.418 (0.192–0.911) (P for trend = 0.013). Moreover, the adjusted OR (95% CI) for participants who drank ≥1 cup of green tea and black tea per day was 0.189 (0.069–0.520) (P for trend <0.001) and 1.248 (0.437–3.559) (P for trend = 0.654), respectively.ConclusionsIncreased tea intake was found to be associated with a lower risk of hospitalized nephrolithiasis among Chinese adults. This finding may assist in the prevention of hospitalized nephrolithiasis.

MIND diet lowers risk of open-angle glaucoma: the Rotterdam Study

PurposeTo assess the association between the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet and the incidence of open-angle glaucoma (iOAG), as well as the association between iOAG and two other well-established diets in the Netherlands, i.e., the Mediterranean diet and Dutch dietary guidelines.MethodsIn the Rotterdam Study, participants were followed for iOAG since 1991, with intervals of approximately 5 years. A total of 170 participants developed iOAG during follow-up. Participants with iOAG were matched with healthy controls on age and sex in a case:control ratio of 1:5. The associations between food frequency questionnaire-derived diet adherences (baseline) and iOAG were analyzed using multivariable conditional logistic regression analyses. The associations between the diet adherences and intraocular pressure (IOP; a risk factor for OAG) were assessed using multivariable linear regression analyses.ResultsGreater adherence to the MIND diet was associated with a decreased iOAG risk (odds ratio [95% confidence interval]: 0.80 [0.66 to 0.96], for each 10-percent increase in adherence). Food component analyses showed that, in particular a higher intake of green leafy vegetables, berries and fish tended to be protective for iOAG. No significant associations were observed between adherence to the Mediterranean diet or Dutch dietary guidelines and iOAG. Moreover, none of the three examined diets were associated with IOP.ConclusionAdherence to the MIND diet was significantly associated with a lower incidence of OAG in contrast to adherence to the Mediterranean diet or the Dutch dietary guidelines. As this association was IOP-independent, the MIND diet may be particularly relevant for the prevention of neurodegeneration in the eye.

Study on the Influencing Factors of Osteoarthritis in Southern China.

Background Osteoarthritis (OA) is a common chronic disease with numerous and interacting influencing factors, and current inadequate patient perceptions and behaviors in access to care contribute to the difficulties in the diagnosis, treatment, and management of osteoarthritis. Objective The purpose of this study was to investigate the influencing factors of osteoarthritis (OA) in a southern Chinese population and to provide a scientific basis for the prevention and treatment of OA. Methods A 1 : 2 matched case-control study was used to select 160 patients with OA from three hospitals in southern China as a case group. Three hundred and twenty cases of the same sex and similar age (within ± 2 years) were selected as the control group, and relevant data were collected for univariate and multivariate conditional logistic regression analysis. Results There were no significant differences between the two groups of participants in terms of age, sex, and education (P > 0.05). Logistic regression statistical analysis showed that genetic factors (OR = 4.52, 95% CI = 1.56–7.83), body mass index (OR = 2.57, 95% CI = 1.16–5.84), alcohol consumption (OR = 3.81, 95% CI = 1.53–5.87), and a history of external joint limb injury (OR = 3.37, 95% CI = 1.67–5.24) would increase the risk of OA. In contrast, eating more fresh vegetables (OR = 0.08, 95% CI = 0.03–0.31), more fresh fruits (OR = 0.34, 95% CI = 0.12–0.96), more soy products (OR = 0.11, 95% CI = 0.04–0.45), and exposure to sunlight (OR = 0.31, 95% CI = 0.14–0.71) would reduce the OA risk of OA. Conclusion Obesity, alcohol consumption, and a history of joint trauma all increase the risk of OA in a southern Chinese population, whereas a diet rich in fresh vegetables, fresh fruit, soy products, and sun exposure would reduce the risk of OA. In the future, we should focus on improving patients' awareness of medical care and developing their self-management skills, improving GPs' treatment skills, improving negative attitudes of both doctors and patients, and promoting positive patient care.

A predictive hemodynamic model based on risk factors for ruptured mirror aneurysms.

ObjectivesTo identify hemodynamic risk factors for intracranial aneurysm rupture and establish a predictive model to aid evaluation.MethodsWe analyzed the hemodynamic parameters of 91 pairs of ruptured mirror aneurysms. A conditional univariate analysis was used for the continuous variables. A conditional multivariate logistic regression analysis was performed to identify the independent risk factors. Differences where p < 0.05 were statistically significant. A predictive model was established based on independent risk factors. Odds ratios (ORs) were used to score points. The validation cohort consisted of 189 aneurysms. Receiver operating characteristic curves were generated to determine the cutoff values and area under the curves (AUCs) of the predictive model and independent risk factors.ResultsThe conditional multivariate logistic analysis showed that the low shear area (LSA) (OR = 70.322, p = 0.044, CI = 1.112–4,445.256), mean combined hemodynamic parameter (CHP) (>0.087) (OR = 3.171, p = 0.034, CI = 1.089–9.236), and wall shear stress gradient (WSSG) ratio (>893.180) (OR = 5.740, p = 0.003, CI = 1.950–16.898) were independent risk factors. A prediction model was established: 23*LSA + 1*CHP mean (>0.087: yes = 1, no = 0) + 2 * WSSG ratio (>893.180: yes = 1, no = 0). The AUC values of the predictive model, LSA, mean CHP (>0.087), and WSSG ratio (>893.180) were 0.748, 0.700, 0.654, and 0.703, respectively. The predictive model and LSA cutoff values were 1.283 and 0.016, respectively. In the validation cohort, the predictive model, LSA, CHP (>0.087), and WSSG ratio (>893.180) were 0.736, 0.702, 0.689, and 0.706, respectively.ConclusionsLSA, CHP (>0.087), and WSSG ratio (>893.180) were independent risk factors for aneurysm rupture. Our predictive model could aid practical evaluation.

Lower preoperative serum uric acid level may be a risk factor for postoperative delirium in older patients undergoing hip fracture surgery: a matched retrospective case-control study

BackgroundPostoperative delirium (POD) is a common complication after hip fracture surgery that is associated with various short- and long-term outcomes. The mechanism of POD may be associated with the oxidative stress process. Uric acid has been shown to provide a neuroprotective effect in various neurodegenerative diseases through its antioxidant properties. However, it is unclear whether lower preoperative serum uric acid levels are associated with the development of POD after hip fracture surgery. Therefore, this study assessed the association of lower preoperative uric acid levels in patients with POD during hospitalization.MethodsThis is a matched retrospective case-control study that included 96 older patients (≥65 y) who underwent hip fracture surgery. POD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Patients diagnosed with POD (cases) were matched 1:1 with patients without POD (controls) on the basis of age, sex, and anesthesia type. The relationship between preoperative uric acid and POD was analyzed by multivariable analysis.ResultsThe POD and non-POD groups each had 48 patients. In the univariate analysis, lower log preoperative serum uric acid value, higher neutrophil-to-lymphocyte ratio, and cerebrovascular disease were more likely in patients with POD than in those with no POD. Multivariable conditional logistic regression analysis showed that lower log preoperative serum uric acid (adjusted odds ratio [aOR], 0.028; confidence interval [CI], 0.001–0.844; p = 0.040), higher neutrophil-to-lymphocyte ratio (aOR, 1.314; 95% CI, 1.053–1.638; p = 0.015), and increased surgery duration (aOR, 1.034; 95% CI, 1.004–1.065; p = 0.024) were associated with increased risk of POD.ConclusionsLower preoperative serum uric acid levels may be an independent risk factor for POD after adjustment for possible confounding factors. However, large prospective studies are needed to confirm this finding.

Determinants of neonatal mortality in the neonatal intensive care unit of Dilla University Referral Hospital, Southern Ethiopia; 2019–2020; A matched, case–control study

BackgroundNeonatal mortality rate (NMR) refers to the number of deaths occurring from birth to 28 days of life per-1000 Live Births (LB). The global NMR declined from 37 deaths per- 1,000 LB in 1990 to 18 in 2017, whereas it was 27 deaths per 1000 LB in the Sub-Saharan region. Ethiopia plans to reduce the NMR from 28 deaths to 11 deaths per 1,000 LB by 2020 and to end all preventable child deaths by 2035. The aim of this study was to identify the determinants of neonatal mortality in the neonatal intensive care unit (NICU) of Dilla University Referral Hospital (DURH). MethodsAn age-matched case control study was conducted at DURH's NICU. Two controls having age 2 days before or after the case were used for matching. One hundred eighteen cases (died) and 236 controls (survived) neonates admitted to the NICU from January 11, 2018, to February 25, 2020, were studied. Missed data were filled by multiple imputations. Multicollinearity was checked by the variance inflation factor. For variables with a P-value <0.2 on bivariable conditional logistic regression, multivariable conditional logistic regression analysis was performed to control for confounders using clogit command in a survival package to identify the risk factors for neonatal mortality using R version 3.6.3. ResultGestational age <37 weeks (Adjusted matched odds ratio (AmOR): 14.02; 95% confidence interval (CI): 3.68–53.46), first-minute APGAR score <7 (AmOR: 5.68; 95% CI: 1.76–18.31), perinatal asphyxia (PNA) (AmOR: 4.62; 95% CI: 1.15–18.53) and being twins (AmOR: 6.84; 95% CI: 1.34–34.96) were significantly associated with neonatal deaths in our study. Furthermore, antenatal care and follow-up during pregnancy (AmOR: 0.15; 95% CI: 0.04–0.53) and having a normal random blood sugar level at admission (AmOR: 0.1; 95% CI: (0.02–0.66) were found to be determinant of neonatal mortalities in our study. ConclusionGestational age less than 37 weeks, first-minute APGAR scores <7, being twins, diagnosis of PNA, antenatal care and follow-up of mothers during pregnancy and normoglycemia in neonates at admission were significant determinant of neonatal death in the NICU of DURH.

Risk Factors for Development of Pneumatosis Intestinalis after Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Case-Control Study

The significance of pneumatosis intestinalis (PI) in pediatric patients following hematopoietic stem cell transplantation (HSCT) is poorly understood. A knowledge gap remains with respect to the etiology, risk factors, and evidence-based treatment of these patients. As a result, management is frequently based on each center's clinical practice, without standardization across treatment centers. In this single-center trial, we aimed to validate both previously proposed and additional risk factors for the development of PI and to examine our management and outcomes for these patients. We performed a retrospective case-control study examining risk factors for the development of PI in pediatric HSCT patients at a single tertiary referral children's hospital. We used univariate and multivariable conditional logistic regression analysis to explore differences in pharmacologic and other transplantation-specific risk factors. Between 2012 and 2019, PI was diagnosed in 212 patients at our pediatric hospital, of whom 42 were HSCT recipients. The majority of patients (88%; n=37 of 42) with PI were diagnosed by X-ray. Eighteen patients (43%) were asymptomatic and diagnosed incidentally after imaging was obtained for standard post-transplantation surveillance or other nonrelated indications. All patients with PI were hospitalized and placed on strict bowel rest while receiving parenteral nutrition and antibiotics. Recurrence of PI occurred in 4 patients (10%) following their initial diagnosis. Increased doses of steroid exposure within 30 days of PI diagnosis (odds ratio [OR], 5.7; 95% confidence interval [CI], 2.1 to 15.3; P=.0006), presence of grade II-IV gastrointestinal acute graft-versus-host disease (GVHD) (OR, 5.3; 95% CI, 1.0 to 28.1; P=.05), and receipt of >50% of total daily nutrition by nasogastric (NG) tube feeds (OR, 22.0; 95% CI, 1.3 to 370.2; P=.03) were identified as independent risk factors for the development of PI. Intensity of the conditioning regimen, exposure to total body irradiation, stem cell source, donor type, HLA matching, use of mycophenolate mofetil, and presence of bacterial or viral infection at the time of PI diagnosis were not demonstrably associated with the development of PI in our study. We conclude that development of asymptomatic PI is a benign condition following HSCT, and that the risk for PI is increased in patients with gastrointestinal GVHD, patients receiving steroid therapy, and patients relying on supplemental NG tube feeds for at least one-half of their total daily nutrition.

Risk Factors for Developing Inflammatory Bowel Disease Within and Across Families with a Family History of IBD.

A family history of inflammatory bowel disease [IBD] is the strongest risk factor for disease. However, some first-degree relatives (FDRs) will develop disease, while others will not. Using the nationwide Danish National Patient Register, we examined risk factors in families with two or more affected FDRs. First, we compared exposures between siblings with and without IBD within the same family [within-family analysis]. Second, we compared exposures between individuals with and without IBD across all families [across-family analysis]. Exposures included sex, birth order, mode of delivery, antibiotics, personal and family history of immune-mediated diseases, gastrointestinal infections, and surgical history preceding diagnosis. Uni- and multivariable conditional logistic regression analyses were conducted. In the 'within-family analysis', 1669 families were included [1732 cases, 2447 controls]. Female sex (adjusted odds ratio [aOR]: 1.40, 95% confidence interval [CI] 1.23, 1.59), history of ankylosing spondylitis [aOR: 2.88, 95% CI 1.05, 7.91] and exposure to antibiotics [aOR: 1.28, 95% CI 1.02, 1.61] increased the risk for IBD. In the 'across-family analysis', 1254 cases and 37 584 controls were included, confirming an association with prior ankylosing spondylitis [aOR: 3.92, 95% CI 1.38, 11.12] and exposure to antibiotics [aOR: 1.29, 95% CI 1.04, 1.60]. Having two or more relatives [aOR: 6.26, 95% CI 1.34, 29.29] or a sibling with IBD [aOR: 1.36, 95% CI 1.18, 1.57] increased the risk of IBD. Appendectomy reduced the risk of ulcerative colitis [aOR: 0.32, 95% CI 0.14, 0.72]. In families with IBD, we identified risk factors for the unaffected FDR to develop disease. These findings provide an opportunity for counselling IBD relatives.

Risk factors of non-specific low back pain in a rural community of Bangladesh: A case-control study

Background: Data pertaining to risk factors of nonspecific low back pain (NSLBP) among rural Bangladeshi is scarce. This study explored the risk factors associated with NSLBP among rural Bangladeshi adults. Methods: A community-based study was done in Sonargaon Upazila of Narayanganj district of Bangladesh. A total of 343 NSLBP patients were recruited as cases, based on the Bangla version of Community oriented program for control of rheumatic diseases (COPCORD) questionnaire. An equal number of age and sex matched subjects without any rheumatic disease were recruited from the same community. A total of 15 probable factors were analyzed. Age-sex adjusted univariate and age-sex with 13 risk factors adjusted multivariate conditional logistic regression analyses were done. Results: The mean age of the participants was 33.1 years old (standard deviation: 9.5). Out of 13 risk factors, history of chronic disease (OR 2.0, 95% CI 1.2 – 3.4), prolonged sitting (OR 4.6, 95% CI 2.0 – 11.0), squatting (OR 7.2, 95% CI 3.2 – 16.0), bending of the waist (OR 3.7, 95% CI 1.8 – 7.6), regular lifting or carrying a heavy load (OR 9.2, 95% CI 2.2 – 39.7), prolonged standing (OR 5.8, 95% CI 1.9 – 17.7), occupation related to strenuous physical activity (OR 0.2, 95% CI 0.1 – 0.8), overweight (body mass index &gt;=25 kg/m2) (OR 3.1, 95% CI 1.8 – 5.2) and depression (OR 2.2, 95% CI 1.4 – 3.6) were found to be significantly associated with NSLBP. Conclusions: The study generated knowledge on associated risk factors for NSLBP in rural people of Bangladesh that may facilitate an evidence-based intervention for the target group.