Odds Ratios For Adverse Outcomes Research Articles

Inability to start or complete upper secondary school strongly predicts unemployment and psychosocial and psychiatric adversities - A register-based follow-up study from southwestern Sweden.

To study academic, social and psychiatric outcomes among adults in the general population in southwestern Sweden. Groups of individuals born in 1998 and ineligible, eligible but not completed, and eligible and completed upper secondary school were followed in 2020. Data were retrieved from Statistics Sweden, the Swedish National Agency for Education, the Longitudinal Integrated Database for Health Insurance and Labour Market Studies, the Swedish National Crime Register and the National Patient Register. The four adverse outcomes neither engaging in post-secondary studies nor having a regular salary, needing social benefits, having any criminal conviction, and having a psychiatric disorder at age ≥16 were examined. Of the final sample of 2706 individuals who had attended 9th grade of compulsory school in 2014, 273 (10%) were ineligible for upper secondary school. Of eligible individuals, 82 (3%) never started, 282 (10%) did not complete and 2065 (77%) completed upper secondary school. Compared with completers, the odds ratios for adverse outcomes were markedly increased for all other groups up to 22 years old. Inability to start or complete upper secondary school strongly predicted unemployment and psychosocial and psychiatric adversities. School authorities should consider offering vocational programmes post compulsory school without grade restrictions.

25, 50 and 75 years ago

25, 50 and 75 years ago

Underweight patients are the highest risk body mass index group for perioperative adverse events following stand-alone anterior lumbar interbody fusion

BACKGROUND CONTEXTPrior studies investigating the association between Body Mass Index (BMI) and patient outcomes following spine surgery have had inconsistent conclusions, likely owing to insufficient power, confounding variables, and varying definitions and cutoffs for BMI categories (eg, underweight, overweight, obese, etc.). Further, few studies have considered outcomes among low BMI cohorts. PURPOSEThe current study analyzes how anterior lumbar interbody fusion (ALIF) perioperative outcomes vary along the BMI spectrum, using World Health Organization (WHO) categories of BMI. STUDY DESIGN/SETTINGA retrospective cohort study. PATIENT SAMPLEPatients undergoing stand-alone one or two-level anterior lumbar interbody fusion (ALIF) found in the 2005–2018 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) databases. OUTCOME MEASURESThirty-day adverse events, hospital readmissions, post-operative infections, and mortality. METHODSStand-alone one or two-level ALIF surgical cases were identified and extracted from the 2005–2018 National Surgical Quality Improvement Program (NSQIP) database. Posterior cases and those primary diagnoses of trauma, tumor, infection, or emergency presentation were excluded. Patients were then binned into WHO guidelines of BMI. The incidence of adverse outcomes within 30-day post-operation was defined. Odds ratios of adverse outcomes, normalized to the average risk of normal-weight subjects (BMI 18.5–24.9 kg/m3), were calculated. Multivariate analysis was then performed controlling for patient factors. RESULTSIn total, 13,710 ALIF patients were included in the study. Incidence of adverse events was elevated in both the underweight (BMI<18.5 kg/m3) and super morbidly obese (>50 kg/m3), however, multivariate risks for adverse events and postoperative infection were elevated for underweight patients beyond those found in any other BMI category. No effect was noted in these identical variables between normal, overweight, obese class 1, or even obese class 2 patients. Multivariate analysis also found overweight patients to show a slightly protective trend against mortality while the super morbidly obese had elevated odds. CONCLUSIONSUnderweight patients are at greater odds of experiencing postoperative adverse events than normal, overweight, obese class 1, or even obese class 2 patients. The present study identifies underweight patients as an at-risk population that should be given additional consideration by health systems and physicians, as is already done for those on the other side of the BMI spectrum.

Probability and outcomes of second pregnancy after HELLP syndrome in the first: A population-based registry study.

Some studies have suggested that women may avoid further pregnancies after experiencing a pregnancy affected by a hypertensive disorder. Large population-based studies are needed to better understand the outcomes of later pregnancies among women who have a history of hypertensive disorders of pregnancy. The aims of the study were to assess outcomes of the second pregnancy and second delivery rate among women experiencing Hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome in their first pregnancy. This population-based registry study included all women with a first delivery registered in the Medical Birth Registry of Norway from 1999 to 2014 (n = 418 897). Logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for adverse outcomes of the second delivery and the probability of no second delivery among women with HELLP syndrome in first pregnancy compared with women without HELLP syndrome. We also compared outcomes in the first and second pregnancies among women with HELLP syndrome in first. HELLP syndrome occurred in 0.24% of first pregnancies (n = 1006). Among women with HELLP syndrome in their first pregnancy, adverse outcomes were substantially less frequent in the second pregnancy: preterm deliveries declined from 56.0% to 14.2%, and small for gestational age from 6.6% to 2.8%. More than 75% had no hypertensive disorder in their second pregnancy. Still, compared with women without a history of HELLP syndrome, ORs for adverse outcomes in second pregnancies were increased: preterm birth (OR 3.7, 95% CI 2.8-4.8), small for gestational age (OR 2.7, 95% CI 1.6-4.8), perinatal death (OR 3.1, 95% CI 1.4-7.0), placental abruption (OR 4.2, 95% CI 1.8-9.4) and hypertensive complication (OR 8.3, 95% CI 6.7-10.3). HELLP syndrome did not influence the probability of a second delivery. Among women with HELLP syndrome in their first pregnancy, the occurrence of adverse pregnancy outcomes was substantially reduced in the second pregnancy. However, compared with unaffected women, they were still at greater risk of pregnancy complications.

Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery

BACKGROUND CONTEXTPast studies have focused on the association of high body mass index (BMI) on spine surgery outcomes. These investigations have reported mixed conclusions, possible due to insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (e.g. underweight, overweight, and obese). Few studies have considered outcomes of patients with low BMI. PURPOSETo analyze how anterior cervical spine surgery outcomes track with World Health Organization categories of BMI to better assess where along the BMI spectrum patients are at risk for adverse perioperative outcomes. DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEPatients undergoing elective anterior cervical spine surgery were abstracted from the 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program database. OUTCOME MEASURESThirty-day adverse events, hospital readmissions, postoperative infections, and mortality. METHODSPatients undergoing anterior cervical spine procedures (anterior cervical discectomy and fusion, anterior cervical corpectomy, cervical arthroplasty) were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Patients were then aggregated into modified World Health Organization categories of BMI. Odds ratios of adverse outcomes, normalized to average risk of normal weight subjects (BMI 18.5–24.9 kg/m2), were calculated. Multivariate analyses were then performed on aggregated adverse outcome categories controlling for demographics (age, sex, functional status) and overall health as measured by the American Society of Anesthesiologists classification. RESULTSIn total, 51,149 anterior cervical surgery patients met inclusion criteria. Multivariate analyses revealed the odds of any adverse event to be significantly elevated for underweight and super morbidly obese patients (Odds Ratios [OR] of 1.62 and 1.55, respectively). Additionally, underweight patients had elevated odds of serious adverse events (OR=1.74) and postoperative infections (OR=1.75) and super morbidly obese patients had elevated odds of minor adverse events (OR=1.72). Relative to normal BMI patients, there was no significant elevation for any adverse outcomes for any of the other overweight/obese categories, in fact some had reduced odds of various adverse outcomes. CONCLUSIONSUnderweight and super morbidly obese patients have the greatest odds of adverse outcomes after anterior cervical spine surgery. The current study identifies underweight patients as an at-risk population that has previously not received significant focus. Physicians and healthcare systems should give additional consideration to this population, as they often already do for those at the other end of the BMI spectrum.

P25.05: Uterine Doppler, cerebroplacental ratio and fetal growth in the late third trimester: association with adverse outcome

To determine the performance of uteroplacental Doppler plus cerebroplacental ratio and fetal growth and its association with adverse perinatal outcome (APO) and birthweight below p3 in pregnancies explored at late third trimester. A retrospective cohort of low risk singleton pregnancies scanned at 37 gestational weeks was reviewed. At inclusion, biometry for estimated fetal weight (EFW) and fetoplacental Doppler evaluation (uterine artery pulsatility index [UtA-PI], cerebroplacental ratio [CPR] normalised by EFW. Estimated fetal weight defining two groups above and below to the 10th centile. APO was defined as the occurrence of composite morbidity including emergent Caesarean section for non-reassuring fetal status, 5-min Apgar score <7 or neonatal acidosis at birth defined by ph venous below 7.1, admission at NICU and stillbirth. A total of 2272 pregnancies were included. Among these, 65.2% were nulliparous and 34.8% were multiparous , 176 cases of Adverse perinatal outcome APO, 20,6%. Using uterine Doppler above p95 th centile as the predictor of adverse outcome we found 30% of cases within the estimated fetal weight below 10 centile and 14.8% in the above 10th. Odds ratio of 2,28 (1,5-3.4). Regarding CPR within the two groups of EFW the odds ratio for adverse outcome was 2.6 (1.8-3.6) in the group of SGA and 1,52 (1.02-2-44) for the AGA group. The model combining efw plus uterine Doppler above p95 and cpr below p5 had an AUC of 0,58 (0,54-0.61) for the prediction of Adverse perinatal outcome with a sensitivity of 20.2% for a false positive of 9,5%. Using the same model including uterine Doppler and CPR according to estimated fetal weight for the prediction of FGR <P3 birthweight the Sensitivity is 16% for a false positive of 3,2%. The combination of uterine Doppler and Cerebroplacental ratio is associated with adverse perinatal outcome, although significant the predictive values are very low. The performance improves in the cases of estimated fetal weight below the 10th centile.

EP16.09: Cerebroplacental ratio at term and risk of adverse perinatal outcome

To determine the performance of cerebroplacental ratio and its association with adverse perinatal outcome (APO) in pregnancies explored at late third trimester. A retrospective cohort of low risk singleton pregnancies scanned at 37 gestational weeks was reviewed. At inclusion, biometry for estimated fetal weight (EFW) and feto-placental Doppler evaluation (uterine artery pulsatility index [UtA-PI], cerebroplacental ratio [CPR] normalised by EFW according to Baschat were measured. APO was defined as the occurrence of composite morbidity including birthweight below 5th centile, emergent Caesarean section for non-reassuring fetal status, 5-min Apgar score <7 or neonatal acidosis at birth defined by ph venous below 7.1, admission at NICU and stillbirth. A total of 2272 pregnancies were included. Among these, 65.2% were nulliparous and 34.8% were multiparous. Overall with the definition of APO including SGA 5 centile the total number of APO was 659 (29%). The cerebroplacental ratio below 5th centile according to Baschat was present in a 13.1% of cases. Out of those 47% of APO were in the group with low CPR (<5th centile) rendering an odds ratio of 2,54 (1,98-3,26). The low CPR was also a risk factor for the individual components of the adverse outcome, especially mortality and transfer to NICU. Comparing the CPR according to Estimated Fetal Weight the cpr remained significantly associated with APO, even in the cases of normal estimated fetal weight the odds ratio for adverse outcome with low CPR was 1,58 (1.02-2.44). 11.4 % of the adverse outcome is in the group of normal growth but low CPR. The low Cerebroplacental Ratio has become a proxy of abnormal perinatal outcome when determined in the late third trimester, even in cases with normal growth we have found a significant association with adverse perinatal outcome. There are clear limitations because of the retrospective review and the selection of cases, nevertheless the abnormal ratio seems to be related with an increased risk of abnormal outcome.

Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population-based study in Alberta, Canada, 2005-11.

We assessed the prevalence and pregnancy outcomes of pre-existing diabetes mellitus (pre-DM) and gestational diabetes mellitus (GDM) in Alberta, Canada, 2005-11. 327 198 singleton and 5552 twin pregnancies resulting in live births or stillbirths were included. The odds ratios of adverse outcomes were evaluated comparing pre-DM with no diabetes and GDM with no diabetes, controlling for maternal characteristics. Diabetes complicated 6.3% of pregnancies, with 88% being GDM. In singleton pregnancies, pre-DM and GDM were associated with increased risks of pre-eclampsia (adjusted odds ratio [aOR] = 3.38 and 1.83, respectively), cesarean delivery (aOR 2.53, 1.55), spontaneous preterm (aOR 4.20, 1.71), and labor-induced preterm (aOR 3.82, 2.00) in the mother, and macrosomia (aOR 2.11, 1.30), shoulder dystocia (aOR 1.54, 1.32), congenital anomalies (aOR 1.61, 1.20), and neonatal intensive care unit (NICU) admissions (aOR 3.81, 1.60) in the infants. In addition, pre-DM was associated with an increased likelihood of stillbirth (aOR 3.73) and neonatal death (aOR 2.00) compared with non-diabetic pregnancies. In twin pregnancies, pre-DM was associated with increased risks of spontaneous (aOR 3.54) and labor-induced (aOR 3.57) preterm births, large for gestational age (LGA) infants (aOR 3.73), congenital anomalies (aOR 3.05) and NICU admissions (aOR 2.91); GDM was associated with an increased risk of pre-eclampsia (aOR 1.54), cesarean delivery (aOR 1.57), and LGA infants (aOR 1.63). Pre-existing diabetes confers higher risks than GDM. Diabetes is associated with adverse outcomes in singleton and twin pregnancies, and the increased risks are generally similar or less in twins, probably due to their higher "baseline" risks and closer clinical monitoring.

Association between a prolonged corrected QT interval and outcomes in patients in a medical Intensive Care Unit.

Introduction:Patients admitted into a medical Intensive Care Unit (ICU) have varying illnesses and risk factors. An electrocardiogram (ECG) is a useful tool to assess the cardiac status. The aim of the study was to determine the prevalence of QT prolongation of the ECG in patients admitted to a medical ICU in a tertiary hospital, to assess outcomes in terms of mortality, cardiovascular events, and duration of ICU stay.Materials and Methods:Prospective observational study, 6 months duration, assessing the prevalence of prolonged corrected QT interval (QTc) at admission into a medical ICU. A QTc calculated by Bazett's formula, of >440 ms for males and >460 ms for females was considered prolonged. Details of illness, clinical and lab parameters were monitored.Results:The total number of patients screened was 182. There was a high prevalence of prolonged QTc (30%) on admission to the ICU. This reduced to 19% on day 3 (P = 0.011). In patients with a prolonged QTc the odds ratio of adverse outcome from ICU was 3.17 (confidence interval [CI]: 1.52–6.63) (P = 0.001) and of adverse outcome for hospital stay was 2.27 (CI: 1.11–4.66) (P = 0.014). In the study, 35% of all patients received drugs with QT prolonging action. Of patients with a prolonged QTc at admission 18 (35%) received a QT prolonging drug.Conclusions:We found that prolonged QTc is common (30%) in our medical ICU at admission and a large proportion (35%) received drugs capable of prolonging QT interval. These patients with QTc prolongation have a higher odds ratio for adverse outcomes.

Perinatal outcome in relation to fetal sex in offspring to mothers with pre-gestational and gestational diabetes--a population-based study.

The objective of the present study was to investigate if perinatal outcome differs with fetal sex in pregnancies with maternal Type 1 diabetes, Type 2 diabetes or gestational diabetes. This was a population-based cohort study, with data from the Medical Birth Registry in Sweden throughout the period 1998-2007. Singleton pregnancies with maternal Type 1 diabetes (n = 4092), Type 2 diabetes (n = 412) and gestational diabetes (n = 8602) were identified based on the International Classification of Diseases, 10th edition code. For comparison, 905 565 pregnancies without diabetes were included. The primary outcome was a composite outcome, consisting of any of the following diagnoses: perinatal mortality rate, major malformation, preterm delivery, acute respiratory disorders and neonatal hypoglycaemia. Logistic regression was used to obtain odds ratios for adverse outcomes in male offspring within the diabetic and reference cohorts, respectively. In pregnancies with diabetes, maternal characteristics did not differ with fetal sex, except for a higher rate of Caesarean delivery in male offspring of women with Type 1 diabetes. Male infants to mothers with Type 1 diabetes and gestational diabetes had significantly increased odds of respiratory disorders [adjusted odds ratio (confidence interval) Type 1 diabetes: 1.50 (1.12-2.02); gestational diabetes: 1.81 (1.27-2.57)]. Male infants to mothers with gestational diabetes also had significantly increased odds of major malformations [adjusted odds ratio: 1.44 (1.07-1.93)]. In offspring of mothers with Type 2 diabetes, odds ratios of most outcomes were higher in male infants; however, not significantly different from female infants. In pregnancies without diabetes, male infants had significantly higher odds of all adverse outcomes, except perinatal mortality rate. The risk of adverse perinatal outcome in offspring of mothers with Type 1 diabetes and gestational diabetes did not differ by sex, except for a higher risk in male infants for respiratory disorders. The risk of major malformations was also significantly increased in male offspring to mothers with gestational diabetes. In offspring of mothers with Type 2 diabetes, no significant differences between sexes were found.

Neonatal Outcomes and Birth Weight in Pregnancies Complicated by Maternal Thyroid Disease

Maternal hypothyroidism has previously been shown to increase risk for neonatal intensive care treatment, but otherwise the association between thyroid diseases and neonatal morbidity is understudied. The Consortium on Safe Labor, a retrospective cohort (2002-2008), included 223,512 singleton deliveries of which 0.2% had hyperthyroidism, 1.4% primary and 0.1% iatrogenic hypothyroidism, and 1.3% other/unspecified thyroid disease. Logistic regression with generalized estimating equations estimated adjusted odds ratios of adverse outcomes. Intensive care treatment was more common for neonates of women with thyroid disease. Hyperthyroidism and primary hypothyroidism were associated with sepsis, respiratory distress syndrome, transient tachypnea, and apnea. Iatrogenic hypothyroidism was associated with sepsis and neonatal anemia. Hyperthyroidism was also associated with rare outcomes (prevalence, <1%) including cardiomyopathy, retinopathy of prematurity, and neonatal thyroid diseases. Hyperthyroid non-Hispanic black women had higher odds of term infants that weighed <2,500 g, and hypothyroid non-Hispanic white women had higher odds of large-for-gestational-age infants. These analyses were stratified by race/ethnicity due to interaction. Associations were similar in analyses restricted to term infants. In conclusion, thyroid diseases were associated with increased neonatal morbidity. Although we lacked data on treatment during pregnancy, these nationwide data suggest a need for better thyroid disease management to reduce neonatal morbidity.

Factors influencing the clinical outcome of methicillin-resistant Staphylococcus aureus bacteraemia

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with high mortality due to a combination of host, pathogen and therapy related factors. This was a retrospective exploratory study to evaluate host, pathogen and therapy related factors influencing the clinical outcome of MRSA bacteraemia in a UK teaching hospital setting. Of the 38 consecutive episodes of MRSA bacteraemia over a 1-year period, 16 of 38 (40%) patients died at 1 month and 21/38 (55%) died at 6 months. Univariate analysis revealed age (p < 0.006), mean serum vancomycin level (p < 0.035), agr group I (p < 0.036) and set4-var2_11 gene (p < 0.036) at 1 month; and age (p < 0.004) and set4-var2_11 gene (p < 0.002) at 6 months as significant factors. However, there was no association between first trough vancomycin concentration and outcome at 1 month. Multivariate survival analysis from time of admission showed, for each one year increase in age, a patient is 1.121 (95% CI 1.006-1.250, p < 0.007) times more likely to die at any particular point in time, and patients with a mean serum vancomycin level of <10mg/L, the odds ratio of adverse outcome is 16.129 (95% CI 2.398-111.111) compared to patients with a mean serum level >10mg/L. A variety of host, pathogen, and therapy related factors influence the clinical outcome of MRSA bacteraemia.

Cesarean Section in Term Breech Presentations: Do Rates of Adverse Neonatal Outcomes Differ by Hospital Birth Volume?

In the United States, the majority (86%) of infants in breech presentation is delivered by cesarean, but some still have adverse neonatal outcomes. This study asked whether adverse outcomes after cesarean delivery at term differ according to the volume of such births at a given hospital. This population-based cohort study used Missouri birth certificate data from 10,106 singleton term infants (37 or more weeks gestation) born from 1993 to 1999 who had birth weights from 2500 to 3999 g and were in breech presentation. Infants with congenital abnormalities, growth restriction, or macrosomia, and all multiple gestations and preterm births were excluded. Participating hospitals were divided into low-, medium-, and high-volume terciles based on the median number of yearly deliveries over the period of study (<1034, 1035-2236, and 2237-6474 deliveries per year, respectively). The proportions of study infants born at low-, medium-, and high-volume hospitals were 38%, 28%, and 33%, respectively. The rates of any adverse outcome during the period under review were, respectively, 18, 15, and 6 cases per 1000 deliveries at low-, medium-, and high-volume hospitals. Neonatal deaths were relatively rare in all groups. After adjusting for maternal educational level, adverse outcomes were collectively more frequent in low- and medium-volume hospitals that at high-volume institutions. The respective odds ratios for low- and medium-volume hospitals compared with high-volume centers were 2.7 (95% confidence interval [CI], 1.6-4.5) and 2.4 (95% CI, 1.4-4.1). The odds ratios for adverse outcomes were significantly higher for parous women having a repeat cesarean section at a medium-volume hospital and for nulliparous mothers having primary cesareans at low- and medium-volume hospitals. These findings suggest that parturients whose fetuses are in breech presentation incur an increased risk of an adverse outcome after cesarean delivery at hospitals where there are fewer than 2200 births per year. Not enough is known about the factors affecting this finding to recommend transferring prospective mothers to large-volume hospitals.

The effect of pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes in urban care settings in Urmia-Iran

BackgroundNutritional status of women has been considered an important prognostic indicator of pregnancy outcomes. Few studies have evaluated patterns of weight gain and pre-pregnancy body mass index in developing regions where malnutrition and poor weight gain as well as maternal obesity have significant influences on the pregnancy outcome. This study aims to show effect of pregnancy body mass index and the corresponding gestational weight gain on the outcome of pregnancy.MethodsOn a prospective cross sectional study, two hundred and seventy women from urban areas of Northwest Iran were recruited for participation during their first eight weeks of pregnancy. Body mass index (BMI) was categorized and gestational weight gain was divided into two groups of normal and abnormal based on recommendations of Institute of Medicine (IOM) published in 1990. Chi square and one way ANOVA were used in the univariate analysis of the association between weight gain and corresponding adverse outcomes including cesarean, preterm labor and low neonatal birth weight. Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models, while controlling for the following factors: maternal age, parity, and education.ResultsBoth pre-pregnancy BMI < 19 and abnormal weight gain during pregnancy were found to be associated with low neonatal birth weight defined as < 2500 g. Abnormal weight gain, during pregnancy was not related to an increased risk of preterm labor or cesarean delivery but it was highly associated with low birth weight (LBW)(P < 0.05).ConclusionLow pre-pregnancy BMI is an established risk factor for LBW. Abnormal gestational weight gain may further complicate the pregnancy as an additional risk factor for neonatal LBW. All women, regardless of their pre-pregnancy BMI may be at risk for abnormal weight gain and hence low birth weight. Pre-pregnancy and gestation nutritional assessments remain significant part of all prenatal visits.

Early Enhanced Expression of Interferon-Inducible Protein-10 (CXCL-10) and Other Chemokines Predicts Adverse Outcome in Severe Acute Respiratory Syndrome

Background: Exaggerated activation of cytokines/chemokines has been proposed as a factor in adverse outcome of severe acute respiratory syndrome (SARS). Previous studies on chemokines have included only small numbers of patients, and the utility of plasma chemokines as prognostic indicators is unclear. Methods: We studied 255 archival plasma samples collected during the first or second week after disease onset. The chemokines interferon-inducible protein-10 (IP-10), monokine induced by interferon-γ (MIG), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), and regulated upon activation normal T cell expressed and secreted (RANTES) were measured by cytometric bead array with a 4-color FACSCalibur flow cytometer. Reverse transcription and real-time quantitative PCR and immunohistochemical staining were performed to analyze the production of IP-10 in lung tissue at autopsy. Conditional logistic regression was used to identify independent predictors for adverse disease outcome. Results: Increases in IP-10, MIG, and IL-8 during the first week after onset of fever were associated with adverse outcome (intensive care unit admission or death) in the univariate analysis. During the second week, only MIG concentration was associated with prognosis. After adjusting for other risk factors, plasma IP-10 concentration at the first week remained as an independent prognostic factor, with an odds ratio for adverse outcome of 1.52 (95% confidence interval, 1.05–2.55) per fold increase in plasma IP-10 concentration above the median. During the second week, chemokines provided little independent prognostic information. IP-10 was increased in lung tissue from patients who died of SARS. Conclusions: Increased plasma IP-10 during the first week of SARS symptoms is an independent predictor of outcome. Chemokine activation may be an early event in SARS, and an exaggerated host response may produce complications.

The Effect Of Pre-Pregnancy Body Mass Index, Gestational Weight Gain On Pregnancy Outcomes

Background: Nutritional status of women has been considered an important prognostic indicator of pregnancy outcomes. The study aims to show the effect of various pregnancy body mass index categories and corresponding gestational weight gain on pregnancy outcomes. Materials and Methods: 270 women were included in the study. BMI was categorized and weight gain was divided into two groups normal and abnormal based on IOM's recommendation. Chi square and one way ANOVA were used in the univarate analysis of the association between weight gain and corresponding adverse outcome (cesarean, preterm labor, low birth weight). Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models, while controlling for the following factors: maternal, age, parity, education. Results: For women with pre-pregnancy BMI<19, mean birth weight of newborn was significant low. (P<0.05) The abnormal weight gain during pregnancy wasn't related to an increased risk of preterm labor or cesarean delivery but it was highly associated with LBW. (P<0.05) Conclusion: Efforts should be made to attain appropriate weight gain to reduce the likelihood of low birth weight. Hence, special attention should be paid to women with low pre-pregnancy BMI.

Comparison of pregnancy outcome of euploid fetuses with increased nuchal translucency (NT) expressed in NT MoM or delta-NT.

To evaluate the outcome of euploid fetuses with increased nuchal translucency thickness (NT) expressed in multiples of the median (MoM) or delta-NT. Included in the study were euploid fetuses with increased NT >or= 95(th) centile, for which information about pregnancy outcome was available. The following parameters were defined as an adverse outcome: miscarriage, structural anomalies justifying termination of pregnancy, and structural anomalies, genetic syndromes and neurodevelopmental problems diagnosed postnatally. Fetal outcome according to NT MoM and delta-NT was calculated using different cut-off values. Calculations of the odds ratio for adverse outcome were performed using either NT MoM or delta-NT as a predictor in logistic regression models. The study comprised 168 euploid fetuses. Of these, 38 (23%) had an adverse outcome: 11 (6%) had miscarriages, 14 (8%) were terminated because of fetal abnormalities detected on the prenatal scan and 13 (7%) were found postnatally to have abnormalities. The incidence of cases exhibiting an adverse outcome was 5.3%, 19.2% and 58.5% for NT values of 1.6-1.9, 2.0-3.0 and >3.0 MoM, respectively (P < 0.0001, chi(2) test), and 3.9%, 16.7% and 62.8% for delta-NT values of 1.0-1.4, 1.5-2.5 and >2.5 mm, respectively (P < 0.0001, chi(2) test). Using cut-offs of 2.0 MoM and delta-NT of 1.5 mm, the odds ratios for adverse outcome were 10.2 (95% CI, 3.4-30.4) and 15.4 (95% CI, 4.2-43.6), respectively. Both the NT MoM and delta-NT approaches may be used to determine cases which require additional antenatal investigation as well as fetal karyotyping. For this purpose we suggest using a cut-off of either 2.0 MoM or a delta-NT of 1.5 mm.

A New Recommendation for Maternal Weight Gain in Chinese Women

Objective To characterize the distribution of maternal weight gain in Chinese women living in a well-nourished community, to recommend target weight gains from quartile values derived from women with good pregnancy outcomes, and to quantify the risk for adverse pregnancy outcomes encountered among subjects with weight gain outside these recommendations. Design A retrospective study on maternal anthropometry and pregnancy outcomes was conducted among Chinese women who delivered a singleton pregnancy in a university hospital in Hong Kong. Subjects Nine hundred eight women who delivered during the study period were identified. Among them, 754 (83%) had complete anthropometry data. The normative distribution of maternal weight gain was derived from 504 women who had a good pregnancy outcome. Statistics Analysis of variance was used to compare total weight gain among women of different prepregnancy weight. Fisher exact test was used in the univariate analysis of the association between risk factors and corresponding adverse pregnancy outcomes. Adjusted odds ratios for adverse outcomes were determined by multiple logistic regression models controlling for the following factors: maternal age, duration of gestation, prepregnancy body mass index (BMI), height, parity, and smoking. Results A maternal weight-gain chart and recommendations for total weight gains in Chinese women were derived from the distribution of weight gain in subjects with good pregnancy outcomes. The recommended total weight gain was 13 to 16.7 kg, 11 to 16.4 kg, and 7.1 to 14.4 kg respectively for women of low (BMI<19), moderate (BMI: 19 to 23.5), and high (BMI>23.5) prepregnancy BMI. Women who did not achieve the lower quartile value had more than twice the risk of having low-birth-weight infants. Those with excessive weight gain were at risk for needing assisted delivery. Applications As maternal anthropometry differs across ethnic groups, different recommendations should be made for specific populations. J Am Diet Assoc. 2000:100;791-796.

Infrarenal aortic aneurysm surgery in a rural surgical service: risk factors for mortality.

An audit of both the emergency and elective abdominal aortic surgery that was performed in a rural surgical service, was carried out. Retrospective data analysis was performed on 41 patients who were treated for abdominal aortic aneurysms (AAA) during an 8-year period from 1989 to 1996. Postoperative outcomes were analysed with respect to patient age, mode of presentation (elective or emergency), transfusion requirements and pre-existing cardiac and respiratory disease. Univariate analysis was performed using Fisher's exact test, and the odds ratio for adverse outcome was calculated. A postoperative mortality rate of 5.8% in elective repairs and 68% in cases of rupture was noted. Pre-existing respiratory disease, transfusion requirements of more than six units and presentation with retroperitoneal leak or rupture correlated with postoperative mortality, while age and pre-existing cardiac disease were shown not to be predictive of adverse outcome following surgery. An overall improvement in operative outcomes in the institution (Wimmera Base Hospital) that was audited would be affected by earlier referral for elective repair in selected patients. Like others, the authors believe that age on its own is not a contraindication to elective AAA repair.

Pregnancy outcome and anti-cardiolipin antibody in women with systemic lupus erythematosus.

Pregnancies in women with systemic lupus erythematosus are recognized to result in excessive fetal morbidity and mortality. Maternal autoantibody status may explain some of these problems. Anti-cardiolipin antibody has been associated with recurrent pregnancy losses in some women with lupus, but the risk of these losses has not been defined. At the University of Pittsburgh between January 1, 1979, and December 31, 1989, an unmatched case-control study design was used to determine whether patients with lupus and anti-cardiolipin antibody (81 cases) were at increased risk for adverse pregnancy outcomes in comparison with lupus patients without the antibody (174 controls). Cases had 98 of 192 (51%) pregnancies with an adverse outcome, while controls had 212 of 494 (43%). The odds ratio for having any adverse pregnancy outcome was 1.40 (95% confidence interval (CI) 0.98-1.98). When pregnancies were classified according to specific adverse outcome types, the frequency of late miscarriages (14-20 weeks gestation) in cases and controls was 8% and 3%, respectively. The odds ratio for late miscarriage was 2.94 (95% CI 1.31-6.60). When pregnancies were stratified by birth number and by occurrence of pregnancy before or after diagnosis, the increased frequency of late miscarriages in cases was noted only in the first pregnancy when the pregnancy occurred before recognized disease. Preterm births (before 38 weeks gestation) were increased in cases compared with controls in pregnancies that occurred after diagnosis for second and third pregnancies. If a case had one previous adverse outcome, the odds ratio for another adverse outcome was 3.00 (95% CI 1.62-5.57). If a case had two previous adverse outcomes, the odds ratio for a third adverse pregnancy outcome was 4.14 (95% CI 1.62-10.58). Thus, a previous adverse pregnancy outcome was the most important risk factor for an adverse outcome in a subsequent pregnancy.