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PubMed1989

[The prognosis of thrombocytopenic purpura using predictive criteria evaluation by multivariate analysis methods].

The development of predictive systems with the resources of multivariate analysis let us to do gradually a more objective medicine. In this study we correlate a set of characteristics observed in 39 patients with thrombocytopenic purpura during the first week of medical treatment against the score of severity of the whole purpuric disorder, evaluated a the 25 week of evolution. It was accomplished with a model of multiple logistic regression of successive steps which let us to get the weights of each one of the indicants in order to predict the severity of the whole hemorrhagic diathesis. Probably the more significative indicants of severity are intracranial bleeding, profuse nasal and vaginal bleeding, profuse petechial bleeding and the presence of hematomas.

Adolescent↗

PubMed1991

A multivariate analysis of risk factors for preeclampsia.

OBJECTIVE: --To determine, in a multivariate analysis, risk factors for preeclampsia that could be observed early in pregnancy and to establish whether these risk factors are different for nulliparas and multiparas. DESIGN: --A case-control study of preeclampsia. SETTING: --Women who gave birth at Northern California Kaiser Permanente Medical Centers in 1984 and 1985. PARTICIPANTS: --Preeclamptic cases (n = 139) were determined from discharge diagnosis of severe preeclampsia and by confirmation of blood pressures and proteinuria from medical records. Controls (n = 132) were randomly selected women who had no discharge diagnosis of any hypertensive disorder of pregnancy and who had no evidence of hypertension or proteinuria from medical record review. MAIN VARIABLES EXAMINED: --Medical records were abstracted for information regarding maternal age, race, previous pregnancy history, family medical history, socioeconomic status, employment during pregnancy, body mass, and smoking and alcohol consumption. RESULTS: --Multiple logistic regression analyses confirmed that case patients were more likely than control patients to be nulliparous (adjusted odds ratio [OR], 5.4; 95% confidence interval [Cl], 2.8 to 10.3) and that preeclampsia in a previous pregnancy greatly increased the risk in a subsequent one (adjusted OR, 10.8; 95% Cl, 1.2 to 29.1). However, regardless of parity, preeclamptic women were also more likely to be of high body mass (adjusted OR, 1.7; 95% Cl, 1.2 to 6.2), to work during pregnancy (adjusted OR, 2.1; 95% Cl, 1.1 to 4.4), and to have a family history of hypertension (adjusted OR, 1.7; 95% Cl, 0.92 to 3.2). Having a previous history of a spontaneous abortion was protective but only in multiparous women (adjusted OR for multiparas, 0.09; 95% Cl, 0.02 to 0.48). In contrast, being black was a significant risk for preeclampsia but only in nulliparous women (adjusted OR for nulliparas, 12.3; 95% Cl, 1.6 to 100.8). CONCLUSIONS: --There are a number of risk factors for preeclampsia that may be determined early in a woman's pregnancy. Multiparas and nulliparas share certain risk factors but not others. A cohort investigation is needed to determine the ability of these risk factors to predict who develops preeclampsia.

Adult↗

PubMed1986

[Prognostic evaluation of patients surviving acute myocardial infarct: univariate and multivariate analysis].

The relationship between 31 variables and survival after acute myocardial infarction was evaluated in 432 patients discharged from our Coronary Care Unit from 1975 to 1984. The patients were followed for 1 to 105 months and either univariate and multivariate analysis were performed. For end-point death the significant variables (p less than 0.05) selected by the univariate analysis were: age, diabetes, smoke, heart rate at recovery, supraventricular arrhythmias, cardiac failure and complex ventricular arrhythmias either during recovery, either after discharge and finally spontaneous angina after hospital discharge. Meanwhile, for the end-point cardiac death age, smoke and supraventricular arrhythmias were not yet significant while arterial pressure at recovery and effort angina after hospital discharge were. Multivariate analysis identified cardiac failure during recovery, diabetes, complex ventricular arrhythmias before and spontaneous angina after discharge as independent variables contributing to total mortality: effort angina was a further significant one relatively to cardiac death. Thus, our study points out the importance of multivariate survival analysis when evaluating the relationship between survival after discharge for the effect of other prognostic factors. Moreover, providing identification of high risk cohorts permits appropriate interventions designed to lessen risk.

Adult↗

PubMedDate not supplied

Multivariate analysis of risk factors influencing survival in 110 ethnic Chinese with papillary thyroid cancer.

Data from 110 Chinese patients presenting with papillary thyroid cancer to a single institution up to December 1985 have been analyzed to evaluate the possible risk factors affecting survival. There were 83 women and 27 men with an age range of 15 to 78 years (mean 45 years, median 42 years). The longest follow-up period is 39 years and the median 10 years. Cervical lymph node recurrence more than 6 months after surgery developed in 12 patients, of whom 1 died with a concomitant distant metastasis. "Thyroid bed" tumor recurrence, after apparently complete surgery, presented in 10 patients and resulted in 5 deaths. Distant metastases were identified in 17 patients with 7 deaths. Another 4 patients died from advanced local disease incompletely resectable on presentation. The following seven risk factors for survival were selected for multivariate analysis: age, sex, tumor size, histologic evidence of extrathyroidal spread, lymph node recurrence, neck recurrence, and distant metastases. Age, size, neck recurrence, and distant metastases were all significant on univariate analysis. Using Cox proportional hazards regression in the multivariate analysis of these seven factors, only age (p < 0.0001) was shown to be significant. Age over 40 years on first diagnosis was a highly significant indicator of high risk (p = 0.0003, log-rank).

Adolescent↗

PubMed1992

Multivariate analysis of dietary habits in 931 elderly Japanese males: smoking, food frequency and food preference.

To define the influence of smoking on dietary patterns and food preference in elderly Japanese, a mail survey was conducted on about 3000 subjects aged 65 years and older. A multivariate analysis of dietary frequency data regarding 15 food items on 931 male respondents suggested that frequency of intake of plant food, including vegetables and fruits, was lower in smokers than in nonsmokers. Another multivariate analysis of food preference data regarding 18 food items on the same subjects suggested that smoking decreased the desire for plant food.

Aged↗

PubMed1995

Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis.

BACKGROUND: Mitral valve repair has been suggested as providing a better postoperative outcome than valve replacement for mitral regurgitation, but this impression has been obscured by differences in baseline characteristics and has not been confirmed in multivariate analyses. METHODS AND RESULTS: The outcomes in 195 patients with valve repair and 214 with replacement for organic mitral regurgitation were compared using multivariate analysis. All patients had preoperative echocardiographic assessment of left ventricular function. Before surgery, patients with valve repair were less symptomatic than those with replacement (42% in New York Heart Association functional class I or II versus 24%, respectively; P = .001), had less atrial fibrillation (41% versus 53%; P = .017), and had a better ejection fraction (63 +/- 9% versus 60 +/- 12%, P = .016). After valve repair, compared with valve replacement, overall survival at 10 years was 68 +/- 6% versus 52 +/- 4% (P = .0004), overall operative mortality was 2.6% versus 10.3% (P = .002), operative mortality in patients under age 75 was 1.3% versus 5.7% (P = .036), and late survival (in operative survivors) at 10 years was 69 +/- 6% versus 58 +/- 5% (P = .018). Late survival after valve repair was not different from expected survival. After surgery, ejection fraction decreased significantly in both groups but was higher after valve repair (P = .001). Multivariate analysis indicated an independent beneficial effect of valve repair on overall survival (hazard ratio, 0.39; P = .00001), operative mortality (odds ratio, 0.27; P = .026), late survival (hazard ratio, 0.44; P = .001), and postoperative ejection fraction (P = .001). CONCLUSIONS: Valve repair significantly improves postoperative outcome in patients with mitral regurgitation and should be the preferred mode of surgical correction. The low operative mortality is an incentive for early surgery before ventricular dysfunction occurs.

Aged↗

PubMed1992

Relationships among the symptoms of the elderly as revealed by multivariate analysis: a preliminary study.

One hundred and sixty-eight elderly subjects in a geriatric hospital and the adjoining nursing home were examined in a study of relationships among the items of Hasegawa's dementia scale. A three-dimensional model using multivariate analysis demonstrated the relationships among items. The results led to the identification of six clinical groups determined by the presence of stroke and the score on the dementia scale. Nonstroke subjects of middle intellectual level had disturbances of memory and orientation. This group fell into two categories during the course of a five-year follow-up study: severe dementia and intellectual deterioration. Retrospective multivariate analysis results suggested that features characteristic of the severe intellectual deterioration group were earlier disturbances of orientation and distant memory. This statistical method uses only objective clinical data in order to avoid subjective and, often, biased judgments.

Aged↗

PubMed1992

Multivariate analysis of postoperative complications after esophageal resection.

To determine the contributing factors for eight postoperative complications after esophagectomy through a right thoracoabdominal approach, a multivariate analysis was carried out on preoperative and intraoperative variables in 141 patients with thoracic esophageal cancer. Although postoperative complications occurred in 125 patients, only 7 died of such complications. The multivariate analysis indicated that the retrosternal route was a significant factor predisposing to postoperative atelectasis. Age, preoperative arterial oxygen tension, and volume transfused were significant factors predisposing to postoperative hypoxemia, whereas age, routes other than the intrathoracic route, and volume transfused were significant factors predisposing to prolonged respiratory support. In addition, preoperative total serum bilirubin level and volume transfused were significant factors predisposing to postoperative hyperbilirubinemia; preoperative serum creatinine level was a significant contributing factor for postoperative renal insufficiency; and sex, antesternal route, and substituted colon were significant contributing factors for anastomotic leakage. There were no significant factors predisposing to postoperative pneumonia and liver dysfunction. These significant factors should be taken into consideration not only during perioperative management but also when choosing the operative procedures and extending the surgical indication for esophagectomy through a right thoracoabdominal approach.

Age Factors↗

PubMedDate not supplied

Papillary thyroid carcinoma: a multivariate analysis of prognostic factors including an evaluation of the p-TNM staging system.

OBJECTIVE: To analyse the prognostic factors in papillary thyroid carcinoma, and in particular to evaluate the accuracy of the pathological tumour, nodes, metastases (p-TNM) staging. DESIGN: Retrospective univariate and multivariate analysis. SETTING: University hospital in Norway. SUBJECTS: 167 patients who were operated on for papillary thyroid carcinoma between 1971 and 1985. Main outcome measures--Death of papillary thyroid carcinoma, and length of recurrence free survival. RESULTS: Male sex, increasing age, larger tumours, and spread of growth beyond the thyroid all independently increased the risk of dying of papillary thyroid carcinoma, whereas the period of recurrence free survival was influenced only by the presence of regional metastases and the patient's age. The age related p-TNM staging is suitable for predicting the likelihood of death, but is less accurate in the prediction of recurrence free survival. The age of 45 years is too low to be useful in predicting survival, especially in women. CONCLUSION: The identification of sex in the multivariate analysis as a strong independent predictor of death of papillary thyroid cancer suggests that the prognostic value of the age related p-TNM staging system could be improved if sex was adjusted for, and if a different age was used for men and women.

Adult↗

PubMed1995

Polymorphisms in alcohol metabolizing enzyme genes and alcoholic cirrhosis in Japanese patients: a multivariate analysis.

Alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH), and P450IIE1 are the primary enzymes that catalyze the conversion of ethanol to acetaldehyde and then to acetate. Genetic polymorphisms have been reported in ADH2, ADH3, ALDH2, and the 5'-flanking region of P450IIEI. In this study, we used multivariate analysis to determine which genetic polymorphisms in alcohol metabolizing enzymes were independently associated with the development of alcoholic cirrhosis. Thirty-four noncirrhotic alcoholic patients, including 27 with fatty liver and 7 with nonspecific changes, and 46 patients with alcoholic liver cirrhosis were studied. Restriction fragment length polymorphisms (RFLPs) in the ADH2 and P450IIE1 genes were detected by digestion of polymerase chain reaction (PCR)-amplified DNA with MaeIII and RsaI, respectively. In the ALDH2 gene, RFLPs were detected by differences in the MboII site after PCR amplification. By multivariate analysis of four significant factors including total alcohol intake, ADH, ALDH, and P450IIE1 using the multiple logistic regression model, genotype ADH2(2)/ADH2(2) (P = .029) and genotype c1/c1 of P450IIE1 (P = .013) were found to be independently associated with alcoholic cirrhosis. The odds ratios for ADH2(2)/ADH2(2) genotype and the type A genotype of P450IIE1 (c1/c1) were 4.600 and 4.006, respectively. These results suggest that ADH2 and P450IIE1 gene polymorphisms may be independently associated with the development of alcoholic liver cirrhosis in Japan.

Adult↗

PubMed1995

Prognostic value of echocardiography compared to other clinical findings. Multivariate analysis based on long-term survival in 456 patients.

The prognostic significance of conventional clinical and echocardiographic data in patients referred to echocardiography was retrospectively analyzed. 456 patients (206 females and 250 males) were studied in the department of cardiology in a district hospital. Survival after 3 years was 64%. By multivariate analysis five factors contained independent, significant, prognostic information (hazard ratios for death are given in parentheses): left ventricular wall motion score index (WMI) < or = 1.2 by echocardiography (2.5), status as inpatient (2.1), age > 65 years (1.7), clinical heart failure (1.9) and atrial fibrillation (1.5). A stepwise multivariate analysis was performed by entering variables into a model initially forced to contain information on age, hospitalization status, treatment of heart failure and heart rhythm. In this analysis, a poor WMI (< or = 1.2) and a dilated right ventricle contained further independent prognostic information. In conclusion, among conventional clinical and echocardiographic data, WMI was the most powerful predictor of long-term survival, and despite knowledge of major clinical features echocardiography provided further prognostic information.

Aged↗

PubMed1991

Radiotherapy in T1 laryngeal cancer: prognostic factors for locoregional control and survival, uni- and multivariate analysis.

From 1975 through 1985, 194 patients with T1 glottic, 37 patients with T1 supraglottic, and 3 patients with T1 subglottic cancer were treated with radiotherapy. Local control and ultimate locoregional control (after salvage surgery) was 91% and 97% for T1 glottic, 84% and 81% for T1 supraglottic, and 2/3 and 3/3, respectively for subglottic tumors. In uni- and multivariate analysis local control for glottic tumors was associated with extension of the tumor on the vocal cord (entire length of vocal cord vs others, p = 0.01) and continuation of smoking after therapy (yes/no, p = 0.03). No prognostic factor for local control was found in supraglottic tumors. However, regional control and survival were impaired by N stage (N0 vs N+, p less than 0.0005), local recurrence (yes/no, p less than 0.0005), and extension of the tumor (one supraglottic subsite vs more than one, p less than 0.05). Mild late complications were seen in 13% of patients without salvage therapy. Following univariate analysis, field size, fraction size (greater than 2 Gy), maximum tumor dose (greater than 70 Gy), age, post-treatment biopsy, and tumor site were associated with complication rate. Following multivariate analysis, site, fraction size, maximum tumor dose, and continuation of smoking after therapy were independent prognostic factors for mild late complications (mostly arytenoid edema).

Adult↗

PubMed1994

Postoperative bone re-growth in lumbar spinal stenosis. A multivariate analysis of 48 patients.

STUDY DESIGN: Forty-eight patients who underwent posterior decompressive surgery for lumbar spinal stenosis were studied. The effect of bone re-growth after posterior decompression in lumbar spinal stenosis on clinical outcome and the factors promoting the bone re-growth were investigated with a multivariate analysis model. METHODS: Bone re-growth at the sites operated upon was evaluated as a percentage of re-growth of the original laminectomy site based upon plain radiographs. The degree of bone re-growth was classified into four groups: 1) no significant re-growth (Group I, bone regrowth rate 10% or less); mild (Group II, 11% to 40%), moderate (Group III, 41% to 70%), and marked (Group IV, 71% to 100%). The average follow-up period was 4.5 years (range, 2 to 7 years). RESULTS: No significant bone re-growth was shown in 6% of the patients. Mild re-growth was shown in 50%, moderate re-growth in 29%, and marked re-growth in 15%. A multivariate analysis indicated that a total block in the preoperative myelogram, a follow-up period of more than 5 years, decompression at more than three spinal levels, and age under 60 years were associated with moderate or marked bone re-growth. Spinal instability accelerated the bone re-growth mainly in the mid and later follow-up intervals. Spinal levels adjacent to a fusion showed more bone re-growth. Patients with moderate and marked bone re-growth had poorer clinical outcomes than those with no significant and mild bone re-growth. CONCLUSION: Bone re-growth in a surgical defect will occur in most patients after posterior decompression. Moderate and marked postoperative bone re-growth are possibly related to recurrence of neurologic symptoms in the middle of and later on in follow-up periods.

Aged↗

PubMedDate not supplied

Impact of neck dissection on survival in well-differentiated thyroid cancer: a multivariate analysis of 218 cases.

The management of cervical lymph node metastases in well-differentiated carcinoma of the thyroid has been highly controversial. In the Department of Surgery (II), Kanazawa University Hospital, the surgical management of cervical lymph node metastases in curable well-differentiated carcinoma of the thyroid has been changed from a conservative approach to an aggressive one since 1973. In order to determine whether an aggressive approach for cervical lymph node metastases is adequate, a retrospective multivariate analysis was carried out of 218 cases of well-differentiated thyroid cancer. The patients have been followed up from 5 to 30 years. Multivariate analysis was conducted following Cox's model. As for the results, the aggressive management of cervical lymph node metastases appeared to have an impact on survival. Furthermore, age and sex were confirmed to be important prognostic factors and a partial lobectomy was confirmed to be inadequate as a type of thyroidectomy.

Adenocarcinoma↗

PubMed1995

[Prognostic factors in curative resection of stomach carcinoma. A uni- and multivariate analysis].

The TNM system, including tumor infiltration (T category), lymph node infiltration (N category) and metastasis (M category), is a well-established system of prognostic factors. To evaluate the prognostic importance of patient characteristics and tumor parameters 5 clinical and 13 pathological factors were analyzed. Data on 200 consecutive patients with histologically verified stomach cancer were prospectively recorded using a standardized form. In the subgroup with curative resection (R0, n = 108) a uni- and multivariate analysis was performed with respect to 5-year survival. In the univariate analysis statistical significance was demonstrated for the following factors: tumor size, tumor localization, T category, N category, number of infiltrated lymph nodes infiltrated, lymph node compartments, tumor stage, lymph node ratio: infiltrated/inspected. Multivariate analysis, taking into consideration the interaction between prognostic factors, revealed only two factors as statistically significant: number of infiltrated lymph nodes and tumor size. Our results and those in the literature indicate that the infiltration of lymph nodes is the most relevant prognostic factor. In addition to the TNM system the number of infiltrated lymph nodes seems to be of prognostic importance.

Adult↗

PubMed1989

[Effective evaluation of combination chemotherapy in stage I-II of non-Hodgkin's lymphoma--a comparison of treatment with multivariate analysis].

Sixty-one patients with non-Hodgkin's lymphoma (Stage I and II) were treated solely with radiotherapy or in combination with chemotherapy. A multivariate analysis was used to identify the prognostic factors that significantly affected the treatment outcome. The variables examined included: stage of disease, according to the Ann Arbor classification, sex, age, pathological criteria, according to the LSG, the presence or absence of systemic symptoms, the sites of disease involvement, the LDH, the bulk of the disease, and the combination chemotherapy. Variables achieving a p-value in the 0 to 0.10 range with a multivariate analysis for the overall survival were the stage of disease, the sites of the disease involvement, the bulk of the disease, and the combination chemotherapy. Finally, the overall survival was affected by bulk of the disease (p less than 0.01) and the combination chemotherapy (p less than 0.01). The 5-year survival rates were 84.4% for stage I and 50.7% for stage II. The survival rates were 47.5% for radiotherapy treatment alone and 75.3% for combination chemotherapy. It thus was concluded that combination chemotherapy was effective for treatment of stages I and II of non-Hodgkin's lymphoma.

Adolescent↗

PubMed1992

Selection of patients for programmed ventricular stimulation: a clinical decision-making model based on multivariate analysis of clinical variables.

OBJECTIVE: This study was conducted to assess the utility of clinical variables in predicting the inducibility of sustained ventricular arrhythmias in a heterogeneous group of patients undergoing programmed ventricular stimulation. METHODS: Variables were considered in a simulated chronologic order to determine the incremental information added by the signal-averaged electrocardiogram (ECG) and left ventricular ejection fraction. All patients undergoing baseline programmed ventricular stimulation for induction of ventricular tachyarrhythmia during a 30-month period were included in the study. Fourteen historical, ECG, signal-averaged ECG and left ventricular wall motion variables were evaluated for their ability in predicting inducibility of a sustained ventricular arrhythmia, a "positive" event, at programmed ventricular stimulation. RESULTS: On univariate analysis of the clinical variables, comparison between patients with positive or negative results showed significant differences in 10 of the 14 clinical variables: major cardiac diagnosis, history of ventricular tachycardia, myocardial infarction by history or ECG, all five signal-averaged ECG variables, left ventricular ejection fraction and presence of left ventricular aneurysm. On multivariate analysis, five independent variables were determined to be important: history of ventricular tachycardia, historical or ECG evidence of myocardial infarction, history of loss of consciousness, filtered QRS duration on the signal-averaged ECG and left ventricular ejection fraction. However, with sequential multivariate analysis, a model based only on historical and conventional ECG data was found to do as well as a model that included signal-averaged ECG and left ventricular ejection fraction data. CONCLUSIONS: Routinely available noninvasive historical, ECG, signal-averaged ECG and left ventricular wall motion variables can be used to accurately predict the outcome of programmed ventricular stimulation. The majority of the predictive power was obtained with the routine model, using only historical and ECG data. The signal-averaged ECG and left ventricular wall motion analysis added no significant incremental information.

Aged↗

PubMed1988

[Gastric adenocarcinoma surgically treated. A multivariate analysis of prognostic factors].

One hundred and twelve curatively resected gastric adenocarcinomas were studied retrospectively to appreciate the survival factors. Twenty different criteria (clinic, histologic and therapeutic parameters) were assessed using univariate and then multivariate analysis (semi parametric regression (COX's) model). Only three criteria were very important according to the multivariate analysis: 1) invasion of neighboring organs (p less than 0.006) with a relative risk score (RRS) of 4.26; 2) intravascular or intralymphatic tumor embols outside the tumor (p less than 0.004; RRS = 2.11); 3) invaded distal nodes (located at the origin of the vessels (p less than 0.04; RRS = 1.88). A prognosis index was described according to these results. A repartition of the patients in three prognostic groups according to these 3 criteria was proposed. Future, trials should consider these three different prognostic groups.

Adenocarcinoma↗