Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy, and Postoperative Complications: A Population-Based Inception Cohort Study

2016 ◽  
Vol 111 (5) ◽  
pp. 691-704 ◽  
Author(s):  
María E Negrón ◽  
Ali Rezaie ◽  
Herman W Barkema ◽  
Kevin Rioux ◽  
Jeroen De Buck ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Postoperative Complications ◽  
Clostridium Difficile ◽  
Population Based ◽  
Inception Cohort ◽  
Risk Of Death ◽  
Increased Risk

scholarly journals Clostridium difficileInfection Worsens the Prognosis of Ulcerative Colitis

2014 ◽  
Vol 28 (7) ◽  
pp. 373-380 ◽  
Author(s):  
María E Negrón ◽  
Herman W Barkema ◽  
Kevin Rioux ◽  
Jeroen De Buck ◽  
Sylvia Checkley ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Postoperative Complications ◽  
Population Based ◽  
Infectious Complications ◽  
Future Studies ◽  
Laboratory Services ◽  
Increased Risk ◽  
Health Zone ◽  
The Impact ◽  
Control Study

BACKGROUND: The impact ofClostridium difficileinfections among ulcerative colitis (UC) patients is well characterized. However, there is little knowledge regarding the association betweenC difficileinfections and postoperative complications among UC patients.OBJECTIVE: To determine whetherC difficileinfection is associated with undergoing an emergent colectomy and experiencing postoperative complications.METHODS: The present population-based case-control study identified UC patients admitted to Calgary Health Zone hospitals for a flare between 2000 and 2009.C difficiletoxin tests ordered in hospital or 90 days before hospital admission were provided by Calgary Laboratory Services (Calgary, Alberta). Hospital records were reviewed to confirm diagnoses and to extract clinical data. Multivariate logistic regression analyses were performed among individuals tested forC difficileto examine the association betweenC difficileinfection and emergent colectomy and diagnosis of any postoperative complications and, secondarily, an infectious postoperative complication. Estimates were presented as adjusted ORs with 95% CIs.RESULTS:C difficilewas tested in 278 (58%) UC patients and 6.1% were positive.C difficileinfection was associated with an increased risk for emergent colectomy (adjusted OR 3.39 [95% CI 1.02 to 11.23]). Additionally, a preoperative diagnosis ofC difficilewas significantly associated with the development of postoperative infectious complications (OR 4.76 [95% CI 1.10 to 20.63]).CONCLUSION:C difficilediagnosis worsened the prognosis of UC by increasing the risk of colectomy and postoperative infectious complications following colectomy. Future studies are needed to explore whether early detection and aggressive management ofC difficileinfection will improve UC outcomes.

The risk of venous thromboembolism after surgery for esophagogastric malignancy and the impact of chemotherapy: a population-based cohort study

2019 ◽  
Vol 33 (6) ◽  
Author(s):  
Alfred Adiamah ◽  
Lu Ban ◽  
Joe West ◽  
David J Humes
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Cumulative Incidence ◽  
Population Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Esophagogastric Cancer ◽  
The Impact

SUMMARY To define the incidence of postoperative venous thromboembolism (VTE) and effects of chemotherapy in a population undergoing surgery for esophagogastric cancer. This population-based cohort study used linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data from England to identify subjects undergoing esophageal or gastric cancer surgery between 1997 and 2014. Exposures included age, comorbidity, smoking, body mass index, and chemotherapy. Crude rates and adjusted hazard ratios (HRs) were calculated for rate of first postoperative VTE using Cox regression models. The cumulative incidence of VTE at 1 and 6 months was estimated accounting for the competing risk of death from any cause. Of the 2,452 patients identified, 1,012 underwent gastrectomy (41.3%) and 1,440 esophagectomy (58.7%). Risk of VTE was highest in the first month, with absolute VTE rates of 114 per 1,000 person-years (95% CI 59.32–219.10) following gastrectomy and 172.73 per 1,000 person-years (95% CI 111.44–267.74) following esophagectomy. Neoadjuvant and adjuvant chemotherapy was associated with a six-fold increased risk of VTE following gastrectomy, HR 6.19 (95% CI 2.49–15.38). Cumulative incidence estimates of VTE at 6 months following gastrectomy in patients receiving no chemotherapy was 1.90% and esophagectomy 2.21%. However, in those receiving both neoadjuvant and adjuvant chemotherapy, cumulative incidence following gastrectomy was 10.47% and esophagectomy, 3.9%. VTE rates are especially high in the first month following surgery for esophageal and gastric cancer. The cumulative incidence of VTE at 6 months is highest in patients treated with chemotherapy. In this category of patients, targeted VTE prophylaxis may prove beneficial during chemotherapy treatment.

Increased risk of cancer in ulcerative colitis: a population-based cohort study

1999 ◽  
Vol 94 (4) ◽  
pp. 1047-1052 ◽  
Author(s):  
Per Karlen ◽  
Robert Lofberg ◽  
Olle Brostrom ◽  
Carl-Eric Leijonmarck ◽  
Goran Hellers ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cohort Study ◽  
Population Based ◽  
Increased Risk ◽  
Risk Of Cancer

scholarly journals Multimorbidity, ageing and mortality: normative data and cohort study in an American population

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042633
Author(s):  
Walter A Rocca ◽  
Brandon R Grossardt ◽  
Cynthia M Boyd ◽  
Alanna M Chamberlain ◽  
William V Bobo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Race And Ethnicity ◽  
Age Groups ◽  
Population Based ◽  
Olmsted County ◽  
Risk Of Death ◽  
Rochester Epidemiology Project ◽  
Risk Of Mortality ◽  
Increased Risk

ObjectivesTo describe the percentile distribution of multimorbidity across age by sex, race and ethnicity, and to demonstrate the utility of multimorbidity percentiles to predict mortality.DesignPopulation-based descriptive study and cohort study.SettingOlmsted County, Minnesota (USA).ParticipantsWe used the medical records-linkage system of the Rochester Epidemiology Project (REP; http://www.rochesterproject.org) to identify all residents of Olmsted County, Minnesota who reached one or more birthdays between 1 January 2005 and 31 December 2014 (10 years).MethodsFor each person, we obtained the count of chronic conditions (out of 20 conditions) present on each birthday by extracting all of the diagnostic codes received in the 5 years before the index birthday from the electronic indexes of the REP. To compare each person’s count to peers of same age, the counts were transformed into percentiles of the total population and displayed graphically across age by sex, race and ethnicity. In addition, quintiles 1, 2, 4 and 5 were compared with quintile 3 (reference) to predict the risk of death at 1 year, 5 years and through end of follow-up using time-to-event analyses. Follow-up was passive using the REP.ResultsWe identified 238 010 persons who experienced a total of 1 458 094 birthdays during the study period (median of 6 birthdays per person; IQR 3–10). The percentiles of multimorbidity across age did not vary noticeably by sex, race or ethnicity. In general, there was an increased risk of mortality at 1 and 5 years for quintiles 4 and 5 of multimorbidity. The risk of mortality for quintile 5 was greater for younger age groups and for women.ConclusionsThe assignment of multimorbidity percentiles to persons in a population may be a simple and intuitive tool to assess relative health status, and to predict short-term mortality, especially in younger persons and in women.

scholarly journals Suicide and self-harm in adult survivors of critical illness: population based cohort study

BMJ ◽  
2021 ◽  
pp. n973
Author(s):  
Shannon M Fernando ◽  
Danial Qureshi ◽  
Manish M Sood ◽  
Michael Pugliese ◽  
Robert Talarico ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Life Support ◽  
Invasive Mechanical Ventilation ◽  
Public Health Problem ◽  
Population Based ◽  
Administrative Databases ◽  
Risk Of Death ◽  
Increased Risk ◽  
Self Harm

Abstract Objective To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. Design Population based cohort study using linked and validated provincial databases. Setting Ontario, Canada between January 2009 and December 2017 (inclusive). Participants Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. Main outcome measures The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. Results 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors ( v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). Conclusions Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.

scholarly journals Mortality in Eosinophilic Esophagitis – a nationwide, population-based matched cohort study from 2005 to 2017

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Lovisa Röjler ◽  
John J. Garber ◽  
Bjorn Roelstraete ◽  
Marjorie M. Walker ◽  
Jonas F. Ludvigsson
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Eosinophilic Esophagitis ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Risk Of Death ◽  
Gastrointestinal Pathology ◽  
Increased Risk

Background: There is a lack of knowledge about mortality in eosinophilic esophagitis (EoE). Therefore, this study aimed to examine the mortality in EoE. Methods: A nationwide, population-based matched cohort study was conducted of all EoE patients in Sweden diagnosed between July 2005 and December 2017. Individuals with EoE (n = 1,625) were identified through prospectively recorded histopathology codes from all gastrointestinal pathology reports in Sweden, representing 28 pathology departments (the ESPRESSO study). Each individual with EoE was then matched with up to five reference individuals from the general population (n = 8,003) for age, sex, year of birth, and place of residence. We used the Cox proportional hazard modeling to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (95% CI) while adjusting for other potential confounders. In sensitivity analyses, mortality in EoE patients was compared with mortality in their siblings. Results: Through December 2017, 34 deaths were confirmed in EoE patients (4.60 per 1,000 person-years) compared with 165 in reference individuals (4.57 per 1,000 person-years). This rate corresponds to an aHR of 0.97 (95% CI = 0.67–1.40). HRs were similar in males (aHR = 1.00 [0.66–1.51]) and females (aHR = 0.92 [0.38–2.18]). We observed no increased risk in mortality due to esophageal or other gastrointestinal cancers in patients with EoE (aHR = 1.02 [0.51–2.02]). Mortality was similar in EoE patients and their siblings (aHR = 0.91 [0.44–1.85]). Conclusion: In this nationwide, population-based matched cohort study in Sweden, there was no increased risk of death in patients with EoE compared with their siblings and the general population.

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