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PubMed1995

Multivariate analysis of donor risk factors for pancreas allograft failure after simultaneous pancreas-kidney transplantation.

BACKGROUND: Donor and recipient selection criteria for pancreas allograft are not standardized and may vary from center to center. METHODS: Simultaneous pancreas-kidney transplantations performed between April 1988 and June 1994 were reviewed (n = 61), and univariate and multivariate analyses of factors that affect pancreas graft survival were performed. Analysis of all cases and cases excluding early thrombosis were performed separately. RESULTS: Pancreas graft survival when early thrombosis was excluded and in the overall group was 76% and 70%, respectively, at 1 year. Although blood group and donor gender were weak predictors of graft survival by univariate analysis, neither affected graft survival in the multivariate model. Risk factors for graft failure as determined by Cox regression analysis and in descending order of significance were (1) duration of brain death before procurement, (2) length of donor admission, and (3) donor age of 40 years or older. The risk of graft failure for each of these factors was increased 2.2-, 3.2-, and 4-fold, respectively. Prolonged brain death was the only risk factor in the overall group, suggesting an association with early thrombosis. CONCLUSIONS: Center-specific donor risk factors for pancreas graft survival after simultaneous pancreas-kidney transplantation were identified in this study, the importance of which need to be better defined.

Adult↗

PubMed2000

Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs.

OBJECTIVE: This study describes differences between public and private substance abuse treatment programs. METHOD: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. RESULTS: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. CONCLUSIONS: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide sub stance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.

Humans↗

PubMed2005

Factors predicting survival in stage IV colorectal carcinoma patients after palliative treatment: a multivariate analysis.

BACKGROUND: The prognostic impact of primary tumor resection in patients presenting with unresectable synchronous metastases from colorectal carcinoma (CRC) is not well established. In the present study, we analyzed fifteen factors to define the value of primary tumor resection with regard to prognosis. PATIENTS AND METHODS: We identified 186 consecutive patients with proven stage IV CRC from the year 1995 to 2001. Variables were tested for their relationship to survival in univariate analyses with the Kaplan-Meier method and the log rank test. Factors that showed a significant impact were included in a Cox proportional hazards model. The tests were repeated for 107 patients who had no symptoms from their primary tumor. RESULTS: Overall there were six independent variables with a relationship to survival: performance status, ASA-class, CEA level, metastatic load, extent of primary tumor, and chemotherapy. In the asymptomatic patients we investigated 13 factors, 3 of which proved to be independent predictors of survival: performance status, CEA level, and chemotherapy. Resection of primary tumor was only predictive of survival if in-hospital mortality was excluded. CONCLUSION: Resection of the tumor, if possible, is doubtless the best option for stage IV CRC patients with severe symptoms caused by their primary tumor. In asymptomatic patients, chemotherapy is preferable to surgery.

Aged↗

PubMed1992

Sequence ordinations: a multivariate analysis approach to analysing large sequence data sets.

Ordination is a powerful method for analysing complex data sets but has been largely ignored in sequence analysis. This paper shows how to use principal coordinates analysis to find low-dimensional representations of distance matrices derived from aligned sets of sequences. The method takes a matrix of Euclidean distances between all pairs of sequence and finds a coordinate space where the distances are exactly preserved. The main problem is to find a measure of distance between aligned sequences that is Euclidean. The simplest distance function is the square root of the percentage difference (as measured by identities) between two sequences, where one ignores any positions in the alignment where there is a gap in any sequence. If one does not ignore positions with a gap, the distances cannot be guaranteed to be Euclidean but the deleterious effects are trivial. Two examples of using the method are shown. A set of 226 aligned globins were analysed and the resulting ordination very successfully represents the known patterns of relationship between the sequences. In the other example, a set of 610 aligned 5S rRNA sequences were analysed. Sequence ordinations complement phylogenetic analyses. They should not be viewed as a complete alternative.

Amino Acid Sequence↗

PubMed1999

6-Substituted benzopyrans as potassium channel activators: synthesis, vasodilator properties, and multivariate analysis.

During the last 10 years compounds have been discovered which can activate or block KATP channels. In particular, K channel activators (KCA) have been found to be smooth muscle relaxants with their main utility in hypertension and bronchodilation. In this paper we describe the synthesis of new KCA of the benzopyran type with a fixed 4-substituent and a systematic variation in the 6-position. The relaxant potency in rat aorta and trachea was used for biological characterization of the benzopyrans. In both biological test systems, they exhibit potency ranges of more than 3 log units. Structure-activity relationships are investigated by principal component analysis (PCA) and partial least-squares (PLS) analysis. Most striking outliers in an initial PLS analysis of the entire database were the unsubstituted 6-H compound 13 as well as 34 and 35. For the remaining set of 31 compounds, a 3-component PLS model explains the variance in biological activity to 81% in the aortic and to 82% in the tracheal test system. 6-Substituents influence affinity by a direct (presumably dipolar) interaction with the receptor site. According to the 2D-plot of the partial PLS weights, a strong electronegativity as well as high values for the integy moment and for the heat of formation in water dominate the first component; low values for substituent size (as defined by globularity or surface) are in addition favorable for high potency. High lipophilicity and low minimum energies of interaction dominate the second component. Chemical descriptors for the biological potency of the test set in rat aorta and rat trachea are very similar according to the almost identical projection of the Y-variables onto the X-component space.

Animals↗

PubMed2001

Manual differential cell counts help predict bacterial infection. A multivariate analysis.

We developed logistic regression models that combine information from the automated CBC and manual 100-cell differential counts to predict bacterial infection. The logistic models were fitted from a case group of 116 patients with proven bacterial infection and a control group of 930 presumably uninfected outpatients. A 4-variable, 15-parameter model, which includes automated absolute neutrophil, manual band, and manual immature granulocyte counts, performed best with a receiver operating characteristic (ROC) curve area of 89%. A more practical 2-variable model including automated absolute neutrophil and manual band counts performed almost as well with an ROC curve area of 86%. The automated neutrophil count-only model is less informative with an ROC curve area of 78%. The combined information from automated and manual differential cell counts more accurately predicts bacterial infection than automated counting alone. Despite these modest improvements, the high cost of manual differential cell counts dictates careful patient selection. The supplemental information gained from manual differential counts is most useful for patients with low to normal neutrophil counts (8,000/microL [8.0 x 10(9)/L] or less). Further studies are indicated to determine the characteristic patient populations deriving maximal benefit from this information.

Adolescent↗

PubMed1997

Treatment with cisplatin and fluorouracil alternating with radiation favourably affects prognosis of inoperable squamous cell carcinoma of the head and neck: results of a multivariate analysis on 273 patients.

PURPOSE: The goal of the present analyses is to assess the association between different therapeutic approaches and both the probability of achieving a complete response and the risk of death in patients with stage III-IV, inoperable, squamous cell carcinoma of the head and neck (SCC-HN). PATIENTS AND METHODS: Between August 1983 and December 1990, 273 patients with stage III-IV, previously untreated, unresectable SCC of the oral cavity, pharynx and larynx, were included into two consecutive randomized multi-institutional trials (HN-7 and HN-8 protocols) coordinated by the National Institute for Cancer Research (NICR) of Genoa. The HN-7 protocol compared neo-adjuvant chemotherapy (four cycles of vinblastine, 6 mg/m2 i.v. followed by bleomycin, 30 IU i.m. six hours later, day 1; methotrexate, 200 mg i.v., day 2; leucovorin, 45 mg orally, day 3) (VBM) followed by standard radiotherapy (70-75 Gy in 7-8 weeks) (55 patients) to alternating chemoradiotherapy based on four cycles of the same chemotherapy alternated with three splits of radiation, 20 Gy each (61 patients). In the HN-8 protocol standard radiotherapy (77 patients) was compared to the same alternating program as the one used in the previous protocol but employing cisplatin, 20 mg/m2/day and fluorouracil, 200 mg/m2/day, bolus, both given for five consecutive days (CF) instead of VBM (80 patients). A single database was created with the patients on the two protocols. Age at diagnosis, gender, site of the primary tumor, size of the primary, nodal involvement, performance status and treatment approach were analyzed by the multiple logistic regression model and the Cox regression method. The analyses were repeated including the treating institutions as a covariate (coordinating center versus others). RESULTS: The multiple logistic regression analysis indicates that treatment (alternating more so than others, regardless of the chemotherapy regimen used) (P = 0.0001) is more likely to be associated with complete response. In addition, size of the primary tumor (P = 0.004), nodal involvement (P = 0.02) and performance status (P = 0.009) are prognostic variables affecting the probability of achieving a complete response. The Cox regression analysis indicates that treatment, performance status, size of the primary tumor, nodal involvement and, marginally, site of the primary tumor, are independent prognostic variables affecting the risk of death. When the radiation-alone therapy is adopted as the reference treatment, the relative risk of death is 0.58 (95% confidence interval (CI) 0.40-0.84) for alternating CF and radiation, 0.79 (95% CI 0.53-1.16) for alternating VBM and radiation and 1.30 (95% CI 0.89-1.92) for sequential VBM and radiation. When the treating institution is included in the model, a 34% increased risk of death (P = 0.04) is observed for patients treated outside the coordinating center. CONCLUSION: In our series of patients with advanced, unresectable SCC-HN, treatment with cisplatin and fluorouracil alternating with radiation was associated with a more favourable prognosis. The role of the treating institution in the modulation of the treatment outcomes was also relevant.

Adult↗

PubMed2003

Postpartum contraceptive acceptance in León, Mexico: a multivariate analysis.

OBJECTIVES: The aim of the present study was to identify the reasons for the acceptance or rejection of contraceptive methods among postpartum women at the Hospital of Obstetrics and Gynecology in León, Mexico. METHODS: A prospective cross-sectional study of 1025 postpartum women was undertaken. Reasons for acceptance or refusal of contraceptives were registered in a written survey. Twelve sociodemographic variables were included as predictors in a logistic regression analysis; the acceptance or refusal was the dependent variable, and statistical significance was set at 0.05. RESULTS: There were 513 patients who accepted contraceptives (50.0%) and 512 (50.0%) who refused them. The main reasons for accepting contraceptives were definitive desire for no more children (17.0%) and satisfaction with previous contraceptive methods (21.5%). The main contraceptive methods chosen were intrauterine device (67.7%) and tubal sterilization (28.5%). Reasons for contraceptive refusal were husband's rejection (33.2%) and delaying contraceptive use until after finishing the postpartum period (31.8%). In the logistic regression model, the variables previous deliveries (p < 0.001), number of Cesarean sections (p < 0.001) and women's level of education (p < 0.02) were included as predictors of acceptance. CONCLUSIONS: Previous deliveries, previous Cesarean sections and women's level of education were significant in contraception acceptance. The rejection of contraceptives was mainly attributed to husbands.

Adolescent↗

PubMed1995

Thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a multivariate analysis of factors predicting the response to plasma exchange.

The aim of this study was to investigate pretreatment prognostic factors that could be useful in predicting the response to plasma exchange in thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS). Thirty-two patients with TTP/HUS, treated with plasma exchange at our institution from 1980 to 1994, were studied. The main clinical and laboratory data at the beginning of plasma exchanges were analyzed by the Cox stepwise logistic regression, applied to either treatment failure or death. Seventeen (53%) patients attained a complete remission and 22 (69%) survived (five in advanced renal failure and long-term hemodialysis). Longer delay in initiating plasma exchanges, presence of stupor or coma, and higher creatinine levels at the beginning of plasma exchanges were independent predictors of treatment failure. Stupor or coma at the beginning of plasma exchanges was the only predictor of mortality from unremitted TTP/HUS. Hemoglobin levels, platelet count, and LDH activity, traditionally envisaged as markers of disease activity, neither correlated with previous duration of TTP/HUS nor had any prognostic value. Early diagnosis of TTP/HUS and prompt initiation of intensive plasma exchange emerged from this study as the most effective interventions for improving the prognosis of TTP/HUS patients.

Adolescent↗

PubMed2006

A multivariate analysis of the factors predicting hearing outcome after surgery for cholesteatoma in children.

OBJECTIVE: To explore factors influencing hearing outcomes in children treated by canal wall up (CWU) and canal wall down (CWD) mastoid surgery. METHODS: Retrospective cohort study including three units in Bristol and Bath, UK. Ninety consecutive children underwent cholesteatoma mastoid surgery, with the first procedure between 1998 and 2001; minimum follow up was three disease-free years. RESULTS: The CWU and CWD cohorts significantly differed in pre-operative stage and hearing. After disease eradication, air conduction (AC) thresholds changed by +4.0 dB (95 per cent confidence intervals (95% CI) -2.0, 10.1) in the CWD group and -5.3 dB (95% CI -9.3, 1.3) in the CWU group (p=0.029). Using multiple linear regression to account for cohort differences, AC thresholds were increased by: pre-operative AC threshold (p<0.0001), initial ossicular stage (p=0.013), and CWD-surgery (p=0.005). CONCLUSION: Disease-free hearing was better with CWU-surgery, less initial ossicular damage, and better pre-operative hearing. Worse initial disease increased the likelihood of CWD surgery. Wider use of ossiculoplasty in the CWU cohort (51 per cent vs 5 per cent) may partially explain the superior results.

Adolescent↗

PubMed2005

The covariance between the number of accidents and the number of victims in multivariate analysis of accident related outcomes.

In this study some statistical issues involved in the simultaneous analysis of accident related outcomes of the road traffic process are investigated. Since accident related outcomes like the number of victims, fatalities or accidents show interdependencies, their simultaneous analysis requires that these interdependencies are taken into account. One particular interdependency is the number of fatal accidents that is always smaller than the number of fatalities as at least one fatality results from a fatal accident. More generally, when the number of accidents increases, the number of people injured as a result of these accidents will also increase. Since dependencies between accident related outcomes are reflected in the variance-covariance structure of the outcomes, the main focus of the present study is on establishing this structure. As this study shows it is possible to derive relatively simple expressions for estimates of the variances and covariances of (logarithms of) accidents and victim counts. One example reveals a substantial effect of the inclusion of covariance terms in the estimation of a confidence region of a mortality rate. The accuracy of the estimated variance-covariance structure of the accident related outcomes is evaluated using samples of real life accident data from The Netherlands. Additionally, the effect of small expected counts on the variance estimate of the logarithm of the counts is investigated.

Accidents, Traffic↗

PubMed1990

Do HMOs reduce health care costs? A multivariate analysis of two Medicare HMO demonstration projects.

Charge data from two Medicare HMO demonstration projects were analyzed to determine if prepaid plans achieved cost savings for enrolled beneficiaries. Fallon Community Health Plan of Massachusetts did not reduce total charges significantly for survivors in their first year postenrollment. However, the plan enjoyed reductions in total charges per month after the first year of nearly 38 percent (41 percent for Part A; 31 percent for Part B). Savings for decedents were more modest, reducing total charges per month by around 27 percent (19 percent, Part A; 68 percent, Part B). Greater Marshfield Community Health Plan of Wisconsin was not successful in controlling charges during the demonstration period. Marshfield incurred losses in the first postenrollment year for survivors due to a 38 percent increase in total charges per month (18 percent, Part A; 73 percent, Part B). In the second year postenrollment, the Marshfield plan was able to reduce losses for survivors to roughly 11 percent (-6 percent, Part A; 44 percent, Part B). For decedents, Marshfield experienced an increase in total charges per month of approximately 21 percent relative to fee-for-service comparisons, with Part B charges again much higher than those of the comparison group (47 percent).

Aged↗

PubMed2005

Antifibrinolytic use and bleeding during surgery on the descending thoracic aorta: a multivariate analysis.

OBJECTIVES: The purpose of this study was to determine the potential benefit of antifibrinolytic (AF) therapy in improving hemostasis in descending aortic surgery in which extracorporeal distal perfusion is used. DESIGN: Retrospective database study. SETTING: University hospital. PARTICIPANTS: Seventy-two patients who underwent descending thoracic or thoracoabdominal aortic replacement during the period from January 1993 through December 1996 when the use of AF therapy was emerging. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Seventy-two records met criteria for inclusion. The use of AF therapy had no significant effect on any bleeding or transfusion outcome in any model. Excessive chest tube drainage postoperatively was independently associated with repeat surgery and intraoperative hypothermia. The risk of receiving a red blood cell (RBC) transfusion was independently predicted by low preoperative hemoglobin and age > or =65 years. Cross-clamp was an independent predictor of receiving a transfusion of non-RBC products (p = 0.03). CONCLUSIONS: The authors could not show a beneficial effect of AF therapy on bleeding and transfusion, although current practice shows that this therapy continues to be used. Because heterogeneity of patient population exists and bias cannot be completely excluded, a prospective investigation evaluating efficacy and safety in this population is warranted.

Aged↗

PubMed1998

[Multivariate analysis of the associations between laboratory data and clinical features among patients with infectious mononucleosis syndrome].

Infectious mononucleosis (IM) syndrome is typically caused by EBV, but also by drugs and other organisms such as CMV and HBV. It demonstrates a wide range of clinical and laboratory characteristics, presumably depending on the age of onset. However, associations of laboratory abnormalities with the clinical features have not been well documented. We evaluated here, the associations among patients with IM syndrome using of multiple regression (MR) and multiple logistic regression (MLR) analyses. We examined 90 (40 males, 50 females) patients, who were admitted to our hospital with IM syndrome. The diagnostic criteria were fever and presence of atypical lymphocytes (> 5% of the WBC or the count including monocytes > 5000/microliter), and at least 3 of 7 clinical features: tonsillitis, lymphadenopathy, skin rash, hepato-, spleno-megaly, hepatic dysfunction. The diagnosis of EBV was serologically confirmed in 41 cases. MR revealed that the higher age group tended to have lower platelet counts, and that lower platelet counts were associated with higher ALT levels. In addition, MLR revealed that patients with skin rash tended not to have splenomegaly. The frequency of splenomegaly was not related to age, contrary to the findings of previous reports. These findings are useful to differentiate IM syndrome based on laboratory data.

Adolescent↗

PubMedDate not supplied

A multivariate analysis of the relationship between work ability and S. japonicum infection in Dongting Lake region, in China.

A cross-sectional case-control study on the association between the reduced work ability and S. japonicum infection was carried out in a moderate endemic area for schistosomiasis japonica in the southern part of Dongting lake in China. A total of 120 cases with reduced work ability and 240 controls paired to the case by age, sex, occupation and without reduced work ability, participated in the study. The mean age for individuals was 37.6 years old (21-60), the ratio of male:female was 60:40, the prevalence of S. japonicum in the individuals was 28.3%. The results obtained in this study showed that the infection of S. japonicum in case and control groups was 49.2% (59/120) and 17.9% (43/240), respectively. Odds ratio for reduced work ability among those who had schistosomiasis was 4.34 (95%), confidence interval was 2.58-7.34, and among those who had S. japonicum infection (egg per gram > 100) was up to 12.67 (95%), confidence interval was 3.64-46.39. After odds ratio was adjusted by multiple logistic regression, it was confirmed that heavier intensity of S. japonicum infection and splenomegaly due to S. japonicum infection were the main risk factors for reduced work ability in the population studied.

Adult↗

PubMed1997

Mapping tsetse habitat suitability in the common fly belt of southern Africa using multivariate analysis of climate and remotely sensed vegetation data.

The distribution of Glossina morsitans centralis, Glossina morsitans morsitans and Glossina pallidipes are described in part of southern Africa, using a range of multivariate techniques applied to climate and remotely sensed vegetation data. Linear discriminant analysis is limited in its predictive power by the assumption of common covariances in the classes within multivariate environment space. Maximum likelihood classification is one of a variety of alternative methods that do not have this constraint, and produce a better prediction, particularly when a priori probabilities of presence and absence are taken into account. The best predictions are obtained when the habitat is subdivided, prior to classification, on the basis of a bimodality detected on the third component axis of a principal component analysis. The results of the predictions were good, particularly for G.m.centralis and G.m.morsitans, which gave overall correct predictions of 92.8% and 85.1%, with a Kappa index of agreement between the prediction and the training data of 0.7305 and 0.641 respectively. For G.pallidipes, 91.7% of predictions were correct but the value of Kappa was only 0.549. Very clear differences are demonstrated between the habitats of the two subspecies G.m.centralis and G.m.morsitans.

Africa, Southern↗

PubMed1989

Predictors of excessive blood use after coronary artery bypass grafting. A multivariate analysis.

One hundred fifty-nine consecutive patients who underwent coronary artery bypass grafting were studied to determine clinical and laboratory predictors of excessive postoperative packed red blood cell transfusion. Consideration of the distribution of packed red blood cells administered revealed that the patients could be divided into two groups: those patients who received 5 units of red blood cells or less (group I, n = 139) and those patients who received more than 5 units of packed red blood cells (group II, n = 20). The Mann-Whitney test or Fisher's exact test was used whenever appropriate to test differences between these two groups with respect to twelve patient variables. Patients in group II were found to have a significantly longer preoperative template bleeding time and decreased preoperative packed red blood cell volume (p less than 0.0008 for both variables). In addition, group II patients were significantly older (p = 0.026), were more likely to have had preoperative heparin therapy (p = 0.049), and contained a greater proportion of women (p = 0.0048). Of interest, variables that did not achieve statistical significance between groups were partial thromboplastin time, prothrombin time, platelet count, preoperative hematocrit level, urgency of operation, recent ingestion of aspirin, and recent heparin administration. All of the measured variables were used in a stepwise logistic regression analysis to identify the best predictors of the need for more than 5 units of packed red blood cells after operation. Of the variables examined, bleeding time (p less than 0.001; chi 2 improvement = 15.1) and red blood cell volume (p = 0.009; chi 2 improvement = 6.8) were the best predictors of excessive postoperative packed red blood cell use. On the basis of a 50% logistic probability level, the specificity and sensitivity of these two variables in predicting greater than a 5-unit transfusion requirement were 85% and 99%, respectively. A clinically useful nomogram based on this logistic model is presented. This nomogram suggests that a ratio of bleeding time to red blood cell volume of 0.0071 or greater is associated with a greater than 70% chance of requiring more than 5 units of packed red blood cells. We conclude that preoperative bleeding time and red blood cell volume are useful predictors of excessive postoperative blood transfusion. These results suggest that factors other than aspirin therapy may be associated with bleeding time prolongation leading to excessive postoperative transfusion.

Aged↗

PubMed1994

Abuse history and chronic pain in women: II. A multivariate analysis of abuse and psychological morbidity.

OBJECTIVE: To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women. METHODS: We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety and somatization. RESULTS: This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety. CONCLUSIONS: The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.

Adolescent↗