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Vetsch T, Eggmann S, Jardot F, von Gernler M, Engel D, Beilstein CM, Wuethrich PY, Eser P, Wilhelm M. Ventilatory efficiency as a prognostic factor for postoperative complications in patients undergoing elective major surgery: a systematic review. Br J Anaesth 2024; 133:178-189. [PMID: 38644158 DOI: 10.1016/j.bja.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO2). The aim of this systematic review was to summarise evidence regarding VE/VCO2 as a prognostic factor for postoperative complications in patients undergoing major surgery. METHODS A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies. RESULTS From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains 'study confounding' and 'statistical analysis'. VE/VCO2 was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO2 was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO2 from the final multivariable regression owing to data-driven model-building approaches. CONCLUSIONS This systematic review identifies VE/VCO2 as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42022369944).
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Affiliation(s)
- Thomas Vetsch
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - François Jardot
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc von Gernler
- Medical Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Centre for Rehabilitation & Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zhang L, Liu Y, Zou J, Wang T, Hu H, Zhou Y, Lu Y, Qiu T, Zhou J, Liu X. The Development and Evaluation of a Prediction Model for Kidney Transplant-Based Pneumocystis carinii Pneumonia Patients Based on Hematological Indicators. Biomedicines 2024; 12:366. [PMID: 38397968 PMCID: PMC10886538 DOI: 10.3390/biomedicines12020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND This study aimed to develop a simple predictive model for early identification of the risk of adverse outcomes in kidney transplant-associated Pneumocystis carinii pneumonia (PCP) patients. METHODS This study encompassed 103 patients diagnosed with PCP, who received treatment at our hospital between 2018 and 2023. Among these participants, 20 were categorized as suffering from severe PCP, and, regrettably, 13 among them succumbed. Through the application of machine learning techniques and multivariate logistic regression analysis, two pivotal variables were discerned and subsequently integrated into a nomogram. The efficacy of the model was assessed via receiver operating characteristic (ROC) curves and calibration curves. Additionally, decision curve analysis (DCA) and a clinical impact curve (CIC) were employed to evaluate the clinical utility of the model. The Kaplan-Meier (KM) survival curves were utilized to ascertain the model's aptitude for risk stratification. RESULTS Hematological markers, namely Procalcitonin (PCT) and C-reactive protein (CRP)-to-albumin ratio (CAR), were identified through machine learning and multivariate logistic regression. These variables were subsequently utilized to formulate a predictive model, presented in the form of a nomogram. The ROC curve exhibited commendable predictive accuracy in both internal validation (AUC = 0.861) and external validation (AUC = 0.896). Within a specific threshold probability range, both DCA and CIC demonstrated notable performance. Moreover, the KM survival curve further substantiated the nomogram's efficacy in risk stratification. CONCLUSIONS Based on hematological parameters, especially CAR and PCT, a simple nomogram was established to stratify prognostic risk in patients with renal transplant-related PCP.
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Affiliation(s)
- Long Zhang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yiting Liu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jilin Zou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Tianyu Wang
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Haochong Hu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yujie Zhou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Yifan Lu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Tao Qiu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jiangqiao Zhou
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Xiuheng Liu
- Department of Organ Transplantation, Renmin Hospital of Wuhan University, Wuhan 430060, China; (L.Z.); (Y.L.); (J.Z.); (T.W.); (H.H.); (Y.Z.); (Y.L.); (T.Q.)
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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Sivakumar J, Forshaw MJ, Lam S, Peters CJ, Allum WH, Whibley J, Sinclair RCF, Snowden CP, Hii MW, Sivakumar H, Read M. Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data. Dis Esophagus 2022; 35:6524743. [PMID: 35138383 DOI: 10.1093/dote/doac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/28/2021] [Indexed: 12/11/2022]
Abstract
Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of aerobic fitness in patients undergoing surgery. While peak oxygen uptake during exercise (VO2peak) and anaerobic threshold have demonstrated a moderate correlation with the development of complications following esophagectomy, no clinically useful threshold values have been defined. By pooling patient level data from existing studies, we aimed to define optimal thresholds for preoperative CPET parameters to predict patients at high risk of postoperative complications. Studies reporting on the relationship between preoperative CPET variables and post-esophagectomy complications were determined from a comprehensive literature search. Patient-level data were obtained from six contributing centers for pooled-analyses. Outcomes of interest included cardiopulmonary and non-cardiopulmonary complications, unplanned intensive care unit readmission, and 90-day and 12-month all-cause mortality. Receiver operating characteristic curves and logistic regression models estimated the predictive value of CPET parameters for each individual outcome of interest. This analysis comprised of 621 patients who underwent CPET prior to esophagectomy during the period from January 2004 to March 2017. For both anaerobic threshold and VO2peak, none of the receiver operating characteristic curves achieved an area under the curve value > 0.66 for the outcomes of interest. The discriminatory ability of CPET for determining high-risk patients was found to be poor in patients undergoing an esophagectomy. CPET may only carry an adjunct role to clinical decision-making.
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Affiliation(s)
- Jonathan Sivakumar
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Matthew J Forshaw
- Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Stephen Lam
- Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Christopher J Peters
- Department of Surgery and Cancer, Imperial College London of St Mary's Hospital, London, UK
| | | | - Jessica Whibley
- Department of Physiotherapy, Royal Marsden Hospital, London, UK
| | - Rhona C F Sinclair
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | | | - Michael W Hii
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Harry Sivakumar
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia
| | - Matthew Read
- Department of Surgery, The University of Melbourne, Melbourne, Australia.,Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
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["I better stay at home…"-health system decisions to support the use of routine healthcare during the COVID-19 pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:277-284. [PMID: 33580268 PMCID: PMC7880208 DOI: 10.1007/s00103-021-03282-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/14/2021] [Indexed: 12/20/2022]
Abstract
Hintergrund In der COVID-19-Pandemie ging die Versorgung nichtübertragbarer Erkrankungen zeitweise deutlich zurück, auch weil Menschen Angst vor einer Ansteckung hatten. Wir führen eine Bestandsaufnahme zur organisationalen Gesundheitskompetenz in der Regelversorgung nichtübertragbarer Erkrankungen in der ersten Welle der COVID-19-Pandemie durch und fragen: Inwiefern wurden Menschen mit gesundheitlichen Beschwerden dabei unterstützt, gesundheitskompetente Entscheidungen für oder gegen die Inanspruchnahme von Versorgungsleistungen zu treffen? Methodik Strukturierende Inhaltsanalyse der Internetpräsenzen der Mitglieder der Arbeitsgemeinschaft der Wissenschaftlich Medizinischen Fachgesellschaften (AWMF; n = 179), der kassen(zahn)ärztlichen Vereinigungen (K(Z)Ven; n = 38), ausgewählter Krankenkassen (n = 21), ausgewählter Behandlungseinrichtungen (n = 25) und überregionaler Anbieter von Gesundheitsinformationen (n = 5) zu Informationen und Angeboten zum Thema. Ergebnisse Die geprüften Internetpräsenzen informieren weitgehend rund um COVID-19, aber nur selten darüber, wie man sich bei einer (vermuteten) anderen Erkrankung in Bezug auf die Inanspruchnahme von Versorgungsleistungen verhält. 2 Portale von Anbietern von Gesundheitsinformationen, eine Krankenkasse, aber keine der KVen bieten explizite Entscheidungshilfen an. KVen weisen öfter, aber nicht durchgängig auf die generelle Möglichkeit von Videosprechstunden hin. Diskussion Für die meisten Patient*innen gab es damit keine gezielten Informationen zu dem Thema. Angesichts der Fortdauer der COVID-19-Pandemie gilt es, vorhandene vertrauenswürdige, qualitativ hochwertige Informations- und Beratungskapazitäten auszubauen und ihre Bekanntheit zu erhöhen, um gesundheitskompetente Entscheidungen auch in der Pandemie zu ermöglichen.
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