湖南省湘潭县农村地区肺结核发病情况及影响因素分析

目的 了解农村地区肺结核发病情况及危险因素。 方法 采用巢式病例对照研究方法，对湖南省湘潭县农村地区人群72859名随访观察1年，队列中80例新发肺结核患者作为病例组；从该队列中采用简单随机抽样的方法抽取400名健康人作为对照。对有关暴露因素进行单因素和多因素非条件logistic回归分析。 结果 农村地区肺结核发病率为109.80/10万（80/72 859），男性、女性发病率分别为168.11/10万（63/37 476）、48.05/10万（17/35 383）。单因素分析显示不同年龄（Wald χ²=22251，P<0.001，OR=1.759）、性别（Wald χ²=16.145，P<0.001，OR=0.310）、文化程度（Wald χ²=21.937，P<0.001，OR=0.468）、婚姻状况（Wald χ²=8.320，P=0.004，OR=0.358）、职业（Wald χ²=10.297，P=0.001，OR=0.377）、结核病患者接触史（Wald χ²=7.535，P=0.006，OR=4.166）、结核病病史（Wald χ²=14.637，P<0.001，OR=57.000）、吸烟史（Wald χ²=4.525，P=0.033，OR=1.730）、可疑症状（Wald χ²=46.630，P<0.001，OR=12.758）人群的肺结核发病情况差异均有统计学意义；多因素分析有统计学意义的变量有性别（β=-1.142，Wald χ²=12.904，OR=0.319、95%CI=0.171～0.595）、文化程度（β=-0.743，Wald χ²=14.355，OR=0.476、95%CI=0.324～0.699）、婚姻状况（β=-1.138，Wald χ²=7.537，OR=0.320、95%CI=0.142～0.722）、结核病病史（β=2.852，Wald χ²=5.563，OR=17.329、95%CI=1.619～185.441）、可疑症状（β=1.728，Wald χ²=16.333，OR=5.630、95%CI=2.435～13.016）。 结论 女性、文化程度高和无配偶是肺结核发病的保护因素，有结核病病史和可疑症状是肺结核发病的危险因素。     

Risk factors for nosocomial pneumonia in the elderly.

PURPOSE: Elderly patients have a disproportionate incidence of nosocomial pneumonia (NP) and a higher mortality rate, yet few studies have focused on this high-risk population. We undertook a study to examine risk factors for NP in elderly inpatients and to describe how these patients differ from younger patients with NP. METHODS: In a public teaching hospital, all cases of NP in patients aged 65+ were ascertained by prospective surveillance during a 2-year period (n = 59). These elderly cases were compared with 59 cases of NP in patients aged 25 to 50 to describe differences in risk factors and outcomes. Elderly cases were then matched to elderly control subjects who were admitted to the same hospital service but did not develop NP. Data were collected on known risk factors and on the potential risk factors of poor nutrition, neuromuscular disease, and dementia. Significant differences in risk factors were analyzed using univariate and multivariate comparisons of cases and controls. RESULTS: Elderly patients had twice the incidence of NP (RR = 2.1) as younger patients. Onset of infection was earlier for young than for older cases (6 versus 11 days, p less than or equal to 0.02), but mortality following NP was equal for the two age groups (42% versus 44%). No significant differences in risk factors were found for old and young cases, although older cases tended to have higher rates of poor nutrition, neuromuscular disease, and aspiration preceding their pneumonias. Comparison of elderly cases and elderly controls revealed significantly increased frequencies of poor nutrition, neuromuscular disease, pharyngeal colonization, aspiration, depressed level of alertness, intubation, intensive care unit admission, nasogastric tube use, and antacid use among cases. Cases were more severely ill on admission and had more pre-existing risk factors (2.8 versus 1.3, p less than or equal to 0.001) and more in-hospital risk factors (4.7 versus 1.6, p less than or equal to 0.001). Logistic regression analysis revealed low albumin, diagnosis of neuromuscular disease, and tracheal intubation to be strong independent predictors of risk for NP among elderly inpatients. CONCLUSIONS: We conclude that the specific risk factors of poor nutrition, neuromuscular disease, and tracheal intubation may prove useful to target future clinical interventions to prevent NP in the elderly.     

Implications of extubation delay in brain-injured patients meeting standard weaning criteria

We hypothesized that variation in extubating brain injured patients would affect the incidence of nosocomial pneumonia, length of stay, and hospital charges. In a prospective cohort of consecutive, intubated brain-injured patients, we evaluated daily: intubation status, spontaneous ventilatory parameters, gas exchange, neurologic status, and specific outcomes listed above. Of 136 patients, 99 (73%) were extubated within 48 h of meeting defined readiness criteria. The other 37 patients (27%) remained intubated for a median 3 d (range, 2 to 19). Patients with delayed extubation developed more pneumonias (38 versus 21%, p < 0.05) and had longer intensive care unit (median, 8.6 versus 3.8 d; p < 0.001) and hospital (median, 19.9 versus 13.2 d; p = 0.009) stays. Practice variation existed after stratifying for differences in Glasgow Coma Scale scores (10 versus 7, p < 0.001) at time of meeting readiness criteria, particularly for comatose patients. There was a similar reintubation rate. Median hospital charges were $29,057.00 higher for extubation delay patients (p < 0.001). This study does not support delaying extubating patients when impaired neurologic status is the only concern prolonging intubation. A randomized trial of extubation at the time brain-injured patients fulfill standard weaning criteria is justifiable.     

Noninvasive versus conventional mechanical ventilation. An epidemiologic survey

A prospective survey was performed over a period of 3 wk among 42 intensive care units to assess the incidence of use and effectiveness of noninvasive mechanical ventilation (NIV) in clinical practice. All patients requiring ventilatory support for acute respiratory failure (ARF), either with endotracheal intubation (ETI) or NIV, were included. Ventilatory support was required in 689 patients, 581 with ETI and 108 (16%) with NIV (35% of patients not intubated on admission). Reasons for mechanical ventilation were coma (30%), cardiogenic pulmonary edema (7%), and hypoxemic (48%) and hypercapnic ARF (15%). NIV was never used for patients in coma (who were excluded from further analysis), but was used in 14% of patients with hypoxemic ARF, in 27% of those with pulmonary edema, and in 50% of those with hypercapnic ARF. NIV was followed by ETI in 40% of cases. The incidence of both nosocomial pneumonia (10% versus 19%, p = 0.03), and mortality (22% versus 41%, p < 0.001) was lower in NIV patients than in those with ETI. After adjusting for differences at baseline, Simplified Acute Physiology Score (SAPS) II (odds ratio [OR] = 1.05 per point; confidence interval [CI]: 1.04 to 1.06), McCabe/Jackson score (OR = 2.18; CI: 1.57 to 3.03), and hypoxemic ARF (OR = 2.30; CI: 1.33 to 4.01) were identified as risk factors explaining mortality; success of NIV was associated with a lower risk of pneumonia (OR = 0.06; CI: 0.01 to 0.45) and of death (OR = 0.16; CI: 0.05 to 0.54). In NIV patients, SAPS II and a poor clinical tolerance predicted secondary ETI. Failure of NIV was associated with a longer length of stay. In conclusion, NIV can be successful in selected patients, and is associated with a lower risk of pneumonia and death than is ETI.     

A predictive risk index for nosocomial pneumonia in the intensive care unit.

PURPOSE: To develop a scoring system for stratifying patients in intensive care units (ICUs) by risk of developing nosocomial pneumonia (NP) and to identify the time period associated with the highest risk. PATIENTS AND METHODS: Two hundred and three patients 18 years of age or older and residing in the ICU for 72 hours or more were followed until development of NP or death or for 48 hours after discharge from the ICU. After the identification of independent risk factors for NP, a scoring system was developed to arrive at a predictive risk index for NP. RESULTS: Twenty-six (12.8%) patients developed NP. The presence of a nasogastric (NG) tube [odds ratio (OR) = 6.48, 95% confidence intervals (CI) = 2.11 to 19.82], upper abdominal/thoracic surgery (OR = 4.34, 95% CI = 1.43 to 13.14), and bronchoscopy (OR = 2.95, 95% CI = 1.02 to 8.52), most commonly performed for respiratory toilet, were identified as independent risk factors on multivariate analysis. The risks associated with endotracheal intubation and altered consciousness, although not independently significant, were highest when these factors were present for 1 to 4 days after the 72 hours required for study entry (endotracheal intubation, OR = 2.2 to 2.5; altered consciousness, OR = 1.4 to 2.0). The risk then declined; ORs of less than 1 were observed at 7 days. The risk associated with the NG tube was highest during the first 6 days (OR = 6.0 to 19.5). Although a subsequent decrease in risk was observed, the OR was still greater than 2 at 7 days. To obtain a predictive risk index for NP, a scoring system was developed using a multivariate model. This system has a sensitivity of 85% and a specificity of 66% in predicting NP in this ICU population. CONCLUSION: ICU patients can be stratified into high- and low-risk groups for NP using a bedside scoring system. Endotracheal intubation, altered mental status, and NG tube are associated with the highest risk of NP during the first 1 to 6 days of their presence after 72 hours of stay in the ICU. After this time period, the risk associated with these factors decreases. Bronchoscopy may be an independent risk factor for NP that has not been previously recognized. This procedure, often done in the ICU for respiratory toilet, may be an avoidable risk in this group of patients.     

Are silent coronary stenoses predictable in diabetic patients and predictive of cardiovascular events?

OBJECTIVES: We have previously shown that silent coronary stenoses (CS) were predictors of subsequent major cardiac events in diabetic patients with silent myocardial ischemia (SMI). The aim of this study was to determine their correlates and their prognostic value for other cardiovascular events. METHODS: 362 asymptomatic diabetic patients, without prior myocardial infarction, with > or =1 additional risk factor and a normal resting electrocardiogram underwent a myocardial scintigraphy to detect SMI. The patients with SMI subsequently underwent a coronary angiography to detect CS. A total of 345 (95.3%) patients were followed up for 41 +/- 24 months with regard to the occurrence of stroke, gangrene or a peripheral revascularization procedure, exercise occurrence of angina, and nonfatal arrhythmia. RESULTS: 121 patients had SMI and 44 had CS. The univariate correlates of CS were age > 65 years (Odds Ratio 2.1 [CI 95%: 1.1-4.0]; p=0.021), male gender (OR 3.1 [1.5-6.3]; p=0.001), smoking (OR 2.8 [1.4-5.6]; p=0.004), > or =2 risk factors (OR 2.1 [1.09-4.09]; p=0.024) and peripheral arterial disease (OR 3.2 [1.2-8.7]; p=0.018). Logistic regression showed that age > 65 years (p=0.034), male gender (p=0.001) and > or =2 risk factors (p=0.013) were independently associated with the presence of CS. The univariate predictors of the 16 minor events were peripheral arterial disease (OR 8.8 [2.7-28.5]; p<0.001), CS (OR 4.9 [1.7-14.2]; p=0.002), SMI (OR 3.7, [1.3-10.5]; p=0.009) and smoking (OR 3.2 [1.1-9.2]; p=0.024). In the multivariate analysis, arterial occlusive disease (p<0.001), smoking (p<0.036) and CS (p=0.044) were independent predictors of events. CONCLUSION: Silent CS predict major cardiac events but also other cardiovascular events and are more common in diabetic patients > 65 years-old, of male gender and with > or =2 risk factors.     

涂阳肺结核患者抗结核药物不良反应发生影响因素分析

目的 探讨涂阳肺结核患者接受抗结核药物治疗的不良反应发生情况及其影响因素,为制定结核病防治策略提供参考。方法 选择2008—2010年我国8个省(市、自治区)结核病定点医疗机构治疗诊治的涂阳肺结核患者共2 142例,根据是否发生不良反应将其分为两组,运用卡方检验单因素及logistic多因素回归对不良反应发生的危险因素进行分析。结果 2 142例涂阳肺结核患者中536例患者出现不良反应,不良反应发生率为25.0%。经单因素分析结果表明年龄(χ²=23.815, P<0.001)、吸烟情况(χ²=12.040, P=0.024)及结果差异均有统计学意义。多因素非条件logistic回归结果显示, 45~64岁和≥65岁年龄组及吸烟是不良反应发生的独立危险因素,OR(95%CI)值分别为1.524(1.159~2.422)和1.756(1.200~2.570)及1.620(1.194~2.198)。结论 涂阳肺结核患者中吸烟及中老年人是发生不良反应的危险因素,在患者诊治过程中,应及时对这类高危人群进行监测和主动干预,对发现和降低不良反应的发生率有着重要意义。     

Risk factors for pulmonary disease due to culture-positive M. tuberculosis or nontuberculous mycobacteria in South African gold miners.

The aim of this study was to determine risk factors for disease due to nontuberculous mycobacteria (NTM) compared to those due to Mycobacterium tuberculosis in South African gold miners with pulmonary mycobacterial disease. A case/control study comparing tuberculosis and NTM cases amongst all patients with a positive sputum mycobacterial culture in 1995 was carried out. The 51 cases of disease due to NTM and 425 tuberculosis cases were similar with regard to age, education, home region, smoking habits and percentage of CD4 cells. After adjustment for confounders, those with NTM were more likely to have had previous tuberculosis treatment (odds ratio (OR) 3.61; 95% confidence interval (CI) 1.9-6.9), have worked longer underground (p-value for trend=0.05) or have evidence of silicosis (OR 12.6; 95% CI 2.2-71) and were less likely to drink regularly (OR 0.12; 95% CI 0.02-0.93) than patients with tuberculosis. In patients with disease due to NTM, 35.3% were human immunodeficiency virus-positive compared with 48.8% of tuberculosis patients (p=0.2) and an estimated 21% overall in the mines at the time of the study. Previous tuberculosis treatment, silicosis and duration of underground work are even more strongly associated with disease due to nontuberculous mycobacteria than with tuberculosis. Attempts to reduce the incidence of all pulmonary mycobacterial disease in this community should address recognized risk factors and ensure that those with tuberculosis are diagnosed, treated and cured.     

A study of cardiovascular risk factors in Delhi, India

Acute myocardial infarction (AMI) is a leading cause of mortality and disability of adults in urban and rural India, and occurs at younger age than in western populations. In this paper an attempt has been made to determine the risk factors for non- fatal AMI among Indian men and women and to study the difference in proportion of risk factors by taking non- AMI group along with healthy group as controls. Mantel Haenzel test showed that while comparing AMI with non-AMI group, diabetes mellitus (p < 0.05), family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with AMI after adjusting the effects of hypertension. The same test was carried out in comparing AMI with healthy group which showed that diabetes mellitus (p < 0.05), family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with AMI after adjusting the effects of hypertension. Similarly, while comparing CVD group with healthy group, family history of MI (p < 0.0001) and smoking (p < 0.0001) are significantly associated with CVD after adjusting the effects of hypertension. Stepwise logistic regression showed that while comparing AMI cases with non- AMI controls, arrhythmias (odds ratio (OR) = 5.196, p < 0.0001), angina (OR = 3.599, p < 0.0001), CHF (OR = 3.121, p < 0.0001), hypertension (OR = 2.717, p < 0.0001), smoking (OR = 1.993, p < 0.0001) and family history of MI (OR = 1.819, p < 0.01) were important risk factors for a first myocardial infarction. Moreover, while comparing AMI cases with healthy controls, family history of AMI (OR = 15.925, p < 0.0001), smoking (OR = 2.806, p < 0.001), hypertension (OR = 2.718, p < 0.0001), gender (OR = 2.410, p < 0.01) and age (OR = 2.410, p < 0.05) were important predictors of AMI; and while comparing CVD cases (AMI and non-AMI) with healthy group, family history of MI (OR = 10.377, p < 0.01), hypertension (OR = 8.237, p < 0.01) and smoking (OR = 4.454, p < 0.01), were important predictors of cardiovascular disease.     

Predictive factors of septic shock and mortality in neutropenic patients

Neutropenia is a major risk factor for developing a serious infection. Bacteremia still causes significant mortality among neutropenic patients with cancer. The purpose of this study was to identify risk factors for septic shock and for mortality in neutropenic patients with leukemia and bacteremia. Consecutive samples from 20 patients with acute myeloid leukemia and bacteremia were studied during a 1 year period (January-December 2003). All patients received empirical antibiotic therapies for febrile episodes using ceftazidime plus amikacin. About 110 neutropenic febrile episodes were noted: clinically documented 14.54%, microbiologically documented 16.36% and fever of unknown origin 69.09%. Gram-negative organism caused eight febrile episodes: Pseudomonas (5), Klebsiella (3). Gram-positive organism caused 10 episodes: Staphylococcus (6), Streptococci (2), Enterococci (2). Pulmonary infection accounted for 25% of clinically documented infections. About 14 of the 110 febrile episodes were associated with septic shock causing mortality in 7 patients. In a univariate analysis variables associated with septic shock were: pulmonary infection (OR = 17, p = 0.001), serum bicarbonate < 17 mmol/l (OR = 68, p < 0.001) and serum lactate >3 mmol/l (OR = 62, p < 0.001). Variables associated with mortality were: pulmonary infection (OR = 83, p < 0.001) and serum bicarbonate < 17 mmol/l (OR = 61, p < 0.001). In a multivariate analysis two variables were associated with septic shock: pulmonary infection (OR = 5, p = 0.043) and serum lactate >3 mmol/l (OR = 10, p = 0.003). An elevated serum lactate (>3 mmol/l) and low serum bicarbonate ( < 17 mmol/l) at the onset of bacteremia are useful biomarkers in predicting septic shock and mortality in neutropenic patients.     

Is there a role for mask continuous positive airway pressure in acute respiratory failure due to COPD? Lessons from a retrospective audit of 3 different cohorts

Exacerbations of COPD that result in acute respiratory failure requiring intubation and mechanical ventilation have high morbidity and mortality. This study is a retrospective observational study that compared the outcomes of 237 patients with COPD and acute respiratory failure requiring intensive care unit (ICU) admission according to modality of initial therapy: mask continuous positive airway pressure (CPAP), medical therapy, or intubation. Of the patients treated with CPAP initially, only 16% failed and required intubation compared with 62% of those treated medically (p=0.001). The median length of ICU stay was 5 days in those treated with CPAP, compared with 7 days for those medically treated, and 8.5 days for intubated patients (p=0.001). When compared with mask CPAP, and after adjusting for potentially confounding differences, mortality was significantly higher if patients were initially intubated (adjusted odds ratios [OR] 15.7; 95% confidence interval [CI] 4.2, 59) or given medical therapy (OR 5.1; CI 1.2, 20.8). In COPD patients with acute respiratory failure, initial treatment with mask CPAP was associated with significantly better outcomes than other treatment modalities, even after adjusting for potentially confounding differences in disease severity.     

Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients

Seventy-eight (24%) episodes of nosocomial pneumonia (NP) were detected in 322 consecutive mechanically ventilated patients admitted to a 1,000-bed teaching hospital from April 1987 through May 1988 to assess the incidence, risk, and prognosis factors of NP acquired during mechanical ventilation (MV). The risk and prognosis factors for developing NP during MV were studied using both univariate and multivariate statistical techniques. Multivariate analysis selected the following variables significantly associated with a higher risk for developing ventilator-associated pneumonia: more than one intubation during MV (p = 0.000012), a prior episode of aspiration of gastric content (p = 0.00018), a MV period longer than 3 days (p = 0.015), the presence of chronic obstructive pulmonary disease (COPD) (p = 0.048), and the use of positive end-expiratory pressure (PEEP) during MV (p = 0.092). The presence of an ultimately or rapidly fatal underlying disease (p = 0.0018), worsening of acute respiratory failure caused by pneumonia (p = 0.0096), the presence of septic shock (p = 0.016), an inappropriate antibiotic treatment (p = 0.02), and the type of intensive care unit (ICU) hospitalization (noncardiac surgery and nonsurgical ICU compared with post-cardiac surgery ICU) (p = 0.08) were those factors selected by a stepwise logistic regression analysis as independently worsening the prognosis. The overall fatality rate was 23% (73 of 322). The mortality of patients with NP was higher (33%; 26 of 78; p less than 0.01) when compared with fatality rates of patients without NP (19%; 47 of 244).(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk factors for developing pneumonia within 48 hours of intubation.

Two hundred fifty intubated patients were followed during the first 48 h after intubation in order to identify potential risk factors for developing pneumonia within this period. Thirty-two developed pneumonia during this time. Univariate analysis established that large volume aspiration, presence of sedation, intubation caused by respiratory/cardiac arrest or decrease in the level of consciousness, emergency procedure, cardiopulmonary resuscitation (CPR), and Glasgow coma score < 9 were significantly associated with pneumonia. In contrast, prior infection and prior antimicrobial use were associated with a protective effect. Presence of subglottic secretion drainage and 15 other variables had no significant effect. Multivariate analysis selected CPR (odds ratio [OR] = 5.13, 95% confidence intervals [CI] = 2.14, 12.26) and continuous sedation (OR = 4.40, 95% CI = 1.83, 10.59) as significant risk factors for pneumonia, while antibiotic use (OR = 0.29, 95% CI = 0.12, 0.69) showed a protective effect. Our findings emphasize that risk factors for pneumonia change during the intubation period, and preventing pneumonia requires a combined approach.     

Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?

OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish and Surinam-Asian migrants with type 2 diabetes mellitus in the Netherlands as compared with Europeans. METHODS: In a consecutive case-control study, 59 Turkish and 62 Surinam-Asian patients were compared with 185 Europeans referred to a diabetes clinic for treatment of type 2 diabetes in the period 1992 to 1998. Main outcome measures were ischaemic heart disease and its associated risk factors. RESULTS: The prevalence of ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher (29%) in the Surinam-Asians compared with the Europeans (23%). The Turks (52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5 (p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29 +/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of the Europeans. In univariate analysis ischaemic heart disease was related to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin, OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01. Other variables were not related to ischaemic heart disease. Multivariate analysis in a model with ethnicity and smoking showed significant relations between ischaemic heart disease and Turkish ethnicity, OR 0.19 (0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p = 0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2 diabetes mellitus in different ethnic groups results in a significant difference in incidence of ischaemic heart disease. The most remarkable finding is a low incidence of ischaemic heart disease in the Turkish patients with type 2 diabetes, independent of smoking. The high prevalence of ischaemic heart disease in young migrant Asians with diabetes is confirmed.     

Risk factors for coronary heart disease in Indians: a case-control study from Eastern India

We conducted a hospital-based case-control investigation (150 cases and 176 controls) to examine the putative role of conventional risk factors in subjects with and without coronary heart disease from Eastern India. Multivariate binary logistic regression revealed the following as significant risk factors for coronary heart disease: male sex (OR = 4.6, p = 0.001), elevated total cholesterol/high-density lipoprotein ratio (OR = 4.0, p = 0.001), systolic blood pressure (OR = 3.0, p = 0.004), diastolic blood pressure (OR = 3.6, p = 0.002), fasting plasma glucose (OR = 3.0, p = 0.05), post-pondrial plasma glucose (OR = 3.2, p = 0.005), Impaired fasting glucose (OR = 3.7, p = 0.002), elevated triglyceride (OR = 3.1, p = 0.018), increased total cholesterol (OR = 3.0, p = 0.029), low-density lipoprotein (OR = 3.1, p = 0.001), low-density lipoprotein/high-density lipoprotein ratio (OR = 3.4, p = 0.004), central obesity (OR = 3.0, p = 0.006), smoking (OR = 3.7, p = 0.001) and urban residence (OR = 3.1, p = 0.003). In this study, the discriminant analysis showed that 77.2% of all entry for cases and 72.6% of all entry for controls were correctly classified using conventional risk factors and warrant early intervention for conventional risk factors.     

Multivariate analysis of the risk for pulmonary complication after gastrointestinal surgery

AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery. METHODS: A total of 1 002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied. RESULTS: The overall incidence of PPC was 22.8% (228/ 1 002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR = 1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) =q/[1+e-(-3.488+0.039×+1.090×Rd+0.001×Rbc-0.0047×Alb+0.002×Lii+ 0.049×Lni+0.630×Lmv+0.070×Dat+1.168×a)].     

Smoking and tuberculosis in Hong Kong.

OBJECTIVE: To study the relationship between smoking and tuberculosis in Hong Kong. METHOD: Indirect sex and age adjustment was used to compare the prevalence of ever smokers between a sample of 851 patients from the 1996 tuberculosis notification registry and the general population. The clinical characteristics of smokers and non-smokers were compared by stratified univariate analysis and multiple logistic regression. RESULTS: Tuberculosis patients were more likely to have smoked than population controls. The respective odds ratios for ever smoking between tuberculosis patients and population controls were 2.44 and 2.08 for males and females aged 16-64 (Mantel-Haenszel weighted OR = 2.40, P < 0.001), and 2.09 and 2.83 for males and females aged > or = 65 (Mantel-Haenszel weighted odds ratio = 2.19, P < 0.001). Male sex, age > or = 65, working at onset of illness, regular alcohol use, drug abuse and absence of contact history were associated with ever smokers (all P < 0.05). Ever smokers were more likely to have cough (OR 1.69), dyspnoea (OR 1.84), upper zone involvement (OR 1.67), cavity (OR 1.76), miliary lung involvement (OR 2.77), positive sputum culture (OR 1.43), but less isolated extrathoracic involvement (OR 0.31), even after controlling for the confounding background variables (all P < 0.05). CONCLUSION: There was a consistent association between smoking and tuberculosis. More aggressive lung involvement was also found among ever smokers.     

Development of a postoperative delirium risk scoring tool using data from the Australian and New Zealand Hip Fracture Registry: an analysis of 6672 patients 2017-2018

Background and purposeThis study aimed to determine the incidence, predictors of postoperative delirium and develop a post-surgery delirium risk scoring tool.Patients and MethodsA total of 6672 hip fracture patients with documented assessment for delirium were analyzed from the Australia and New Zealand Hip Fracture Registry between June 2017 and December 2018.Thirty-six variables for the prediction of delirium using univariate and multivariate logistic regression were assessed. The models were assessed for diagnostic accuracy using C-statistic and calibration using Hosmer-Lemeshow goodness-of-fit test. A Delirium Risk Score was developed based on the regression coefficients.ResultsDelirium developed in 2599/6672 (39.0%) hip fracture patients. Seven independent predictors of delirium were identified; age above 80 years (OR=1.6 CI 1.4-1.9; p=0.001), male (OR=1.3 CI 1.1-1.5; p=0.007), absent pre-operative cognitive assessment (OR=1.5 CI 1.3-1.9; p=0.001), impaired pre-operative cognitive state (OR=1.7 CI 1.3 -2.1; p=0.001), surgery delay (OR=1.7 CI 1.2-2.5; p=0.002) and mobilisation day 1 post-surgery (OR=1.9 CI 1.4-2.6; p=0.001). The C-statistics for the training and validation datasets were 0.74 and 0.75, respectively. Calibration was good (χ2=35.72 (9); p<0.001). The Delirium Risk Score for patients ranged from 0 to 42 in the validation data and when used alone as a risk predictor, had similar levels of diagnostic accuracy (C-statistic=0.742) indicating its potential for use as a stand-alone risk scoring tool.ConclusionWe have designed and validated a delirium risk score for predicting delirium following surgery for a hip fracture using seven predicting factors. This could assist clinicians in identifying high risk patients requiring higher levels of observation and post-surgical care.     

有症状颈动脉狭窄患者颈动脉斑块的稳定性:高分辨率磁共振成像研究

目的 探讨高分辨率磁共振成像(high-resolution magnetic resonance inaging,HR-MRI)评价有症状颈动脉狭窄患者斑块稳定性的价值以及不稳定斑块和血管重度狭窄的危险因素.方法 纳入有症状颈动脉狭窄患者,通过HR-MRI评价有症状颈动脉狭窄患者颈动脉斑块成分判断斑块的稳定性.收集行颈动脉内膜切除术患者的颈动脉斑块进行病理学检查,比较术前HR-MRI与术后病 理学检查结果的一致性.收集所有患者的临床资料,分析颈动脉斑块稳定性和血管狭窄程度的危险因素.结果 共219例狭窄程度＞50％的有症状颈动脉狭窄患者接受HR-MRI检查.其中102例(46.6％)存在稳定斑块,117例(53.4％)患者存在不稳定斑块;118例(53.9％)中度狭窄,101例(46.1％)重度狭窄.35例患者接受颈动脉内膜切除术,其中19例(54.3％) HR-MRI显示斑块不稳定,20例(57.1％)病理学检查显示斑块不稳定,二者高度一致(κ =0.942,P＜0.001).不稳定斑块组男性(P=0.007)、高脂血症(P=0.013)、吸烟(P＜0.001)的患者构成比以及总胆固醇(P=0.001)、低密度脂蛋白胆固醇(P＜0.001)和空腹血糖(P=0.001)水平显著高于稳定斑块组.多变量logistw 回归分析显示,男性[优势比(odds ratio,OR)2.33,95％可信区间(confidence interval,CI) 1.08 ～ 5.04;P=0.032]、吸烟(OR 3.45,95％ CI 1.67～7.14;P=0.001)和空腹血糖水平较高(OR 1.26,95％ CI 1.07～1.48;P =0.006)是斑块不稳定的独立危险因素.中度狭窄组与重度狭窄组患者的所有资料均未显示出显著性差异.结论 HR-MRI能准确评估有症状颈动脉狭窄患者的斑块稳定性.性别、吸烟和空腹血糖增高是颈动脉不稳定斑块的独立危险因素.     

Use of audio computer-assisted self-interviews to assess tuberculosis-related risk behaviors.

The objective of this study was to compare self-reported tuberculosis and human immunodeficiency virus (HIV) risk factors obtained from computer-assisted questionnaires and interviewer-assisted questionnaires among participants of a needle exchange program. Between June 1998 and May 1999, needle exchange program participants requesting tuberculosis screening underwent interviews regarding demographics and risk factors for tuberculosis and HIV infection. The first 190 participants underwent traditional interviewer-assisted questionnaires, whereas the remaining 92 underwent computer-assisted questionnaires. Data were analyzed by interview technique using odds ratios (OR) and multiple logistic regression. Among 282 participants, demographic characteristics, health status, HIV serostatus, visits to homeless shelters, alcohol intake, and cigarette smoking were all similar by interview technique. However, respondents receiving computer-assisted questionnaires were more likely than those receiving interviewer-assisted questionnaires to report smoking marijuana (OR = 5.56), crack (OR = 1.88), and heroin (OR = 2.60); as well as sharing cocaine smoking equipment (OR = 4.49), sharing heroin smoking equipment (OR = 2.85), "shotgunning" (OR = 4.48), and visiting crack houses (OR = 4.39). In the final multivariate model, respondents receiving computer-assisted questionnaires were more likely to report "shotgunning" and visiting a crack house relative to respondents receiving interviewer-assisted questionnaires. In conclusion, increased odds of high-risk behaviors for tuberculosis and HIV infection among computer-assisted questionnaire respondents support the use of computer-assisted questionnaires to ascertain risk behavior data for both tuberculosis and HIV. Keywords: tuberculosis; HIV; self-report; drug use; computer-assisted