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Zhao K, Zhu Y, Chen X, Yang S, Yan W, Yang K, Song Y, Cui C, Xu X, Zhu Q, Cui ZX, Yin G, Cheng H, Lu M, Liang D, Shi K, Zhao L, Liu H, Zhang J, Chen L, Prasad SK, Zhao S, Zheng H. Machine Learning in Hypertrophic Cardiomyopathy: Nonlinear Model From Clinical and CMR Features Predicting Cardiovascular Events. JACC Cardiovasc Imaging 2024:S1936-878X(24)00183-9. [PMID: 39001729 DOI: 10.1016/j.jcmg.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 04/02/2024] [Accepted: 04/19/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The cumulative burden of hypertrophic cardiomyopathy (HCM) is significant, with a noteworthy percentage (10%-15%) of patients with HCM per year experiencing major adverse cardiovascular events (MACEs). A current risk stratification scheme for HCM had only limited accuracy in predicting sudden cardiac death (SCD) and failed to account for a broader spectrum of adverse cardiovascular events and cardiac magnetic resonance (CMR) parameters. OBJECTIVES This study sought to develop and evaluate a machine learning (ML) framework that integrates CMR imaging and clinical characteristics to predict MACEs in patients with HCM. METHODS A total of 758 patients with HCM (67% male; aged 49 ± 14 years) who were admitted between 2010 and 2017 from 4 medical centers were included. The ML model was built on the internal discovery cohort (533 patients with HCM, admitted to Fuwai Hospital, Beijing, China) by using the light gradient-boosting machine and internally evaluated using cross-validation. The external test cohort consisted of 225 patients with HCM from 3 medical centers. A total of 14 CMR imaging features (strain and late gadolinium enhancement [LGE]) and 23 clinical variables were evaluated and used to inform the ML model. MACEs included a composite of arrhythmic events, SCD, heart failure, and atrial fibrillation-related stroke. RESULTS MACEs occurred in 191 (25%) patients over a median follow-up period of 109.0 months (Q1-Q3: 73.0-118.8 months). Our ML model achieved areas under the curve (AUCs) of 0.830 and 0.812 (internally and externally, respectively). The model outperformed the classic HCM Risk-SCD model, with significant improvement (P < 0.001) of 22.7% in the AUC. Using the cubic spline analysis, the study showed that the extent of LGE and the impairment of global radial strain (GRS) and global circumferential strain (GCS) were nonlinearly correlated with MACEs: an elevated risk of adverse cardiovascular events was observed when these parameters reached the high enough second tertiles (11.6% for LGE, 25.8% for GRS, -17.3% for GCS). CONCLUSIONS ML-empowered risk stratification using CMR and clinical features enabled accurate MACE prediction beyond the classic HCM Risk-SCD model. In addition, the nonlinear correlation between CMR features (LGE and left ventricular pressure gradient) and MACEs uncovered in this study provides valuable insights for the clinical assessment and management of HCM.
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Affiliation(s)
- Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanjie Zhu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Xiuyu Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shujuan Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weipeng Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanyan Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Cui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qingyong Zhu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Zhuo-Xu Cui
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Gang Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huaibin Cheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Minjie Lu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Dong Liang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Ke Shi
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sanjay K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Shihua Zhao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China.
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Liu G, Chen T, Zhang X, Hu B, Yu J. Nomogram for predicting pathologic complete response to neoadjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma. Cancer Med 2024; 13:e7075. [PMID: 38477511 DOI: 10.1002/cam4.7075] [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: 10/10/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE A pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) is seen in up to 40% of the patients with esophageal squamous cell carcinoma (ESCC). No nomogram has been constructed for the prediction of pCR for patients whose primary chemotherapy was a taxane-based regimen. The aim is to identify characteristics associated with a pCR through analyzing multiple pre- and post-nCRT variables and to develop a nomogram for the prediction of pCR for these patients by integrating clinicopathological characteristics and hematological biomarkers. MATERIALS AND METHODS We analyzed 293 patients with ESCC who underwent nCRT followed by esophagectomy. Clinicopathological factors, hematological parameters before nCRT, and hematotoxicity during nCRT were collected. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for pCR. A nomogram model was built and evaluated for both discrimination and calibration. RESULTS After surgery, 37.88% of the study patients achieved pCR. Six variables were included in the nomogram: sex, cN stage, chemotherapy regimen, duration of nCRT, pre-nCRT neutrophil-to-lymphocyte ratio (NLR), and pre-nCRT platelet-to-lymphocyte ratio (PLR). The nomogram indicated good accuracy and consistency in predicting pCR, with a C-index of 0.743 (95% confidence interval: 0.686, 0.800) and a p value of 0.600 (>0.05) in the Hosmer-Lemeshow goodness-of-fit test. CONCLUSIONS Female, earlier cN stage, duration of nCRT (< 62 days), chemotherapy regimen of taxane plus platinum, pre-nCRT NLR (≥2.199), and pre-nCRT PLR (≥99.302) were significantly associated with a higher pCR in ESCC patients whose primary chemotherapy was a taxane-based regimen for nCRT. A nomogram was developed and internally validated, showing good accuracy and consistency.
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Affiliation(s)
- Guihong Liu
- Department of Radiotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Chen
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Zhang
- Department of Radiotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Binbin Hu
- Department of Radiotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiayun Yu
- Department of Radiotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Jiang T, Yang S, Wang G, Tan Y, Liu S. Development and validation of survival nomograms in elder triple-negative invasive ductal breast carcinoma patients. Expert Rev Anticancer Ther 2024; 24:193-203. [PMID: 38366359 DOI: 10.1080/14737140.2024.2320815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/06/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND We aimed to develop a nomogram to predict the overall survival of elderly patients with Triple-negative invasive ductal breast carcinoma (TNIDC). RESEARCH DESIGN AND METHODS 12165 elderly patients with nonmetastatic TNIDC were retrieved from the SEER database from 2010 to 2019 and were randomly assigned to training and validation cohorts. Stepwise Cox regression analysis was used to select variables for the nomogram based on the training cohort. Univariate and multivariate Cox analyses were used to calculate the correlation between variables and prognosis of the patients. Survival analysis was performed for high- and low-risk subgroups based on risk score. RESULTS Eleven predictive factors were identified to construct our nomograms. Compared with the TNM stage, the discrimination of the nomogram revealed good prognostic accuracy and clinical applicability as indicated by C-index values of 0.741 (95% CI 0.728-0.754) against 0.708 (95% CI 0.694-0.721) and 0.765 (95% CI 0.747-0.783) against 0.725 (95% CI 0.705-0.744) for the training and validation cohorts, respectively. Differences in OS were also observed between the high- and low-risk groups (p < 0.001). CONCLUSION The proposed nomogram provides a convenient and reliable tool for individual evaluations for elderly patients with M0_stage TNIDC. However, the model may only for Americans.
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Affiliation(s)
- Tao Jiang
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Sha Yang
- Medical College, Guizhou University Medical College, Guiyang, Guizhou Province, China
| | - Guanghui Wang
- Department of Breast Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Ying Tan
- Department of Neurosurgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Shu Liu
- Guizhou Medical University, Guiyang, Guizhou, China
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Kang X, Liu X, Li Y, Yuan W, Xu Y, Yan H. Development and evaluation of nomograms and risk stratification systems to predict the overall survival and cancer-specific survival of patients with hepatocellular carcinoma. Clin Exp Med 2024; 24:44. [PMID: 38413421 PMCID: PMC10899391 DOI: 10.1007/s10238-024-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/13/2024] [Indexed: 02/29/2024]
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, and patients with HCC have a poor prognosis and low survival rates. Establishing a prognostic nomogram is important for predicting the survival of patients with HCC, as it helps to improve the patient's prognosis. This study aimed to develop and evaluate nomograms and risk stratification to predict overall survival (OS) and cancer-specific survival (CSS) in HCC patients. Data from 10,302 patients with initially diagnosed HCC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017. Patients were randomly divided into the training and validation set. Kaplan-Meier survival, LASSO regression, and Cox regression analysis were conducted to select the predictors of OS. Competing risk analysis, LASSO regression, and Cox regression analysis were conducted to select the predictors of CSS. The validation of the nomograms was performed using the concordance index (C-index), the Akaike information criterion (AIC), the Bayesian information criterion (BIC), Net Reclassification Index (NRI), Discrimination Improvement (IDI), the receiver operating characteristic (ROC) curve, calibration curves, and decision curve analyses (DCAs). The results indicated that factors including age, grade, T stage, N stage, M stage, surgery, surgery to lymph node (LN), Alpha-Fetal Protein (AFP), and tumor size were independent predictors of OS, whereas grade, T stage, surgery, AFP, tumor size, and distant lymph node metastasis were independent predictors of CSS. Based on these factors, predictive models were built and virtualized by nomograms. The C-index for predicting 1-, 3-, and 5-year OS were 0.788, 0.792, and 0.790. The C-index for predicting 1-, 3-, and 5-year CSS were 0.803, 0.808, and 0.806. AIC, BIC, NRI, and IDI suggested that nomograms had an excellent predictive performance with no significant overfitting. The calibration curves showed good consistency of OS and CSS between the actual observation and nomograms prediction, and the DCA showed great clinical usefulness of the nomograms. The risk stratification of OS and CSS was built that could perfectly classify HCC patients into three risk groups. Our study developed nomograms and a corresponding risk stratification system predicting the OS and CSS of HCC patients. These tools can assist in patient counseling and guiding treatment decision making.
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Affiliation(s)
- Xichun Kang
- Department of Epidemiology and Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Xiling Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yaoqi Li
- Department of Epidemiology and Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China
| | - Wenfang Yuan
- Department of the Sixth Infection, The Fifth Hospital of Shijiazhuang, Shijiazhuang, 050021, China
| | - Yi Xu
- Department of Laboratory Medicine, The Fifth Hospital of Shijiazhuang, Shijiazhuang, 050021, China
| | - Huimin Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, 050017, China.
- Clinical Research Center, The Fifth Hospital of Shijiazhuang, Shijiazhuang, 050021, China.
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Xie Y, Lei C, Ma Y, Li Y, Yang M, Zhang Y, Law KN, Wang N, Qu S. Prognostic nomograms for breast cancer with lung metastasis: a SEER-based population study. BMC Womens Health 2024; 24:16. [PMID: 38172874 PMCID: PMC10765699 DOI: 10.1186/s12905-023-02848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lung metastasis is a significant adverse predictor of prognosis in patients with breast cancer. Accurate estimation for the prognosis of patients with lung metastasis and population-based validation for the models are lacking. In the present study, we aimed to establish the nomogram to identify prognostic factors correlated with lung metastases and evaluate individualized survival in patients with lung metastasis based on SEER (Surveillance, Epidemiology, and End Results) database. METHODS We selected 1197 patients diagnosed with breast cancer with lung metastasis (BCLM) from the SEER database and randomly assigned them to the training group (n = 837) and the testing group (n = 360). Based on univariate and multivariate Cox regression analysis, we evaluated the effects of multiple variables on survival in the training group and constructed a nomogram to predict the 1-, 2-, and 3-year survival probability of patients. The nomogram were verified internally and externally by Concordance index (C-index), Net Reclassification (NRI), Integrated Discrimination Improvement (IDI), Decision Curve Analysis (DCA), and calibration plots. RESULTS According to the results of multi-factor Cox regression analysis, age, histopathology, grade, marital status, bone metastasis, brain metastasis, liver metastasis, human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), progesterone receptor (PR), surgery, neoadjuvant therapy and chemotherapy were considered as independent prognostic factors for patients with BCLM. The C-index in the training group was 0.719 and the testing group was 0.695, respectively. The AUC values of the 1-, 2-, and 3-year prognostic nomogram in the training group were 0.798, 0.790 and 0.793, and the corresponding AUC values in the testing group were 0.765, 0.761 and 0.722. The calculation results of IDI and NRI were shown. The nomograms significantly improved the risk reclassification for 1-, 2-, and 3-year overall mortality prediction compared with the AJCC 7th staging system. According to the calibration plot, nomograms showed good consistency between predicted and actual overall survival (OS) values for the patients with BCLM. DCA showed that nomograms had better net benefits at different threshold probabilities at different time points compared with the AJCC 7th staging system. CONCLUSIONS Nomograms that predicted 1-, 2-, and 3-year OS for patients with BCLM were successfully constructed and validated to help physicians in evaluating the high risk of mortality in breast cancer patients.
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Affiliation(s)
- Yude Xie
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Chiseng Lei
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yuhua Ma
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yuan Li
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Mei Yang
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yan Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Kin Nam Law
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Ningxia Wang
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Shaohua Qu
- Department of Breast Surgery, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China.
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Wu M, Luan J, Zhang D, Fan H, Qiao L, Zhang C. Development and validation of a clinical prediction model for glioma grade using machine learning. Technol Health Care 2024; 32:1977-1990. [PMID: 38306068 DOI: 10.3233/thc-231645] [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] [Indexed: 02/03/2024]
Abstract
BACKGROUND Histopathological evaluation is currently the gold standard for grading gliomas; however, this technique is invasive. OBJECTIVE This study aimed to develop and validate a diagnostic prediction model for glioma by employing multiple machine learning algorithms to identify risk factors associated with high-grade glioma, facilitating the prediction of glioma grading. METHODS Data from 1114 eligible glioma patients were obtained from The Cancer Genome Atlas (TCGA) database, which was divided into a training set (n= 781) and a test set (n= 333). Fifty machine learning algorithms were employed, and the optimal algorithm was selected to construct a prediction model. The performance of the machine learning prediction model was compared to the clinical prediction model in terms of discrimination, calibration, and clinical validity to assess the performance of the prediction model. RESULTS The area under the curve (AUC) values of the machine learning prediction models (training set: 0.870 vs. 0.740, test set: 0.863 vs. 0.718) were significantly improved from the clinical prediction models. Furthermore, significant improvement in discrimination was observed for the Integrated Discrimination Improvement (IDI) (training set: 0.230, test set: 0.270) and Net Reclassification Index (NRI) (training set: 0.170, test set: 0.170) from the clinical prognostic model. Both models showed a high goodness of fit and an increased net benefit. CONCLUSION A strong prediction accuracy model can be developed using machine learning algorithms to screen for high-grade glioma risk predictors, which can serve as a non-invasive prediction tool for preoperative diagnostic grading of glioma.
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Affiliation(s)
- Mingzhen Wu
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Jixin Luan
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Di Zhang
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Hua Fan
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Lishan Qiao
- School of Mathematics, Liaocheng University, Shandong, China
| | - Chuanchen Zhang
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
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Yang S, Zhang Y, Jiao X, Liu J, Wang W, Kuang T, Gong J, Li J, Yang Y. Padua prediction score may be inappropriate for VTE risk assessment in hospitalized patients with acute respiratory conditions: A Chinese single-center cohort study. IJC HEART & VASCULATURE 2023; 49:101301. [PMID: 38035260 PMCID: PMC10684791 DOI: 10.1016/j.ijcha.2023.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
Background The Padua Prediction Score (PPS) recommended by the guidelines lacks effective external validation in a Chinese cohort. This study sought to assess the accuracy of the PPS to predict venous thromboembolism (VTE) risk in medical inpatients with acute respiratory conditions. Methods This consecutive cohort study included 1,574 inpatients from January to August 2019. The occurrence rate of VTE in patients classified at high-risk and low-risk groups according to PPS and Caprini risk assessment model (RAM) was compared. The discriminatory capability of the RAMs was evaluated in all the patients and the subgroup without pharmacological prophylaxis. Reclassification parameters were also used to assess the clinical utility. Results 170 (10.8%) patients were objectively confirmed as having VTE during hospitalization. The incidence rate of VTE in low-risk patients was 6.3% by PPS, which was significantly higher than that by Caprini RAM (2.6%, p < 0.001). The area under the curve (AUC) for PPS and Caprini RAM was 0.714 (95%CI, 0.672-0.756) and 0.760 (95%CI, 0.724-0.797), respectively (p = 0.003). The AUC of Caprini RAM was larger than PPS even in subgroups without pharmacological prophylaxis (0.774 vs 0.709, p = 0.002). Compared with Caprini RAM, the net reclassification index was estimated at 0.037 (p = 0.436), and integrated discrimination improvement was 0.015 (p = 0.495) by PPS. Conclusions According to our cohort study, PPS may not be appropriate to predict VTE risk in hospitalized patients with acute respiratory conditions. An accurate, widely applicable, validated RAM needs to be further constructed in Chinese medical inpatients.
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Affiliation(s)
| | | | - Xiaojing Jiao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiayu Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tuguang Kuang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Juanni Gong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jifeng Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanhua Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Zhang P, Zhang Z, Li D, Han R, Li H, Ma J, Xu P, Qi Z, Liu L, Zhang A. Association of remnant cholesterol with intracranial atherosclerosis in community-based population: The ARIC study. J Stroke Cerebrovasc Dis 2023; 32:107293. [PMID: 37604080 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To evaluate the association between remnant cholesterol (remnant-C) and intracranial atherosclerotic disease (ICAD) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS We studied 1,564 participants with data on lipid profiles and high-resolution vessel wall MRI (VWMRI) from the ARIC-NCS. Remnant-C was computed as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol (LDL-C). The primary outcomes were the presence of intracranial plaques and luminal stenosis. Contributors were separated into four different groups based on remnant-C (22 mg/dL) and LDL-C (100 mg/dL) levels to investigate the function of remnant-C vs. LDL-C on ICAD. Multivariable logistic regression models were utilized to estimate the correlation among the discordant/concordant remnant-C and LDL-C, and ICAD. RESULTS A total of 1,564 participants were included (age 76.2 ± 5.3). After multivariable adjustment, log remnant-C was correlated with greater ICAD risk [odds ratio (OR) 1.36, 95% confidence interval (CI) 1.01 to 1.83]. The lower remnant-C/higher LDL-C group and the higher remnant-C/lower LDL-C group manifested a 1.53-fold (95% CI 1.06 to 2.20) and 1.52-fold (95% CI 1.08 to 2.14) greater risk of ICAD, relative to those having lower remnant-C/low LDL-C. Additionally, remnant-C ≥ 22 mg/dL distinguished participants at a greater risk of the presence of any stenosis compared to those at lower levels, even in participants with optimal levels of LDL-C. CONCLUSIONS Elevated levels of remnant-C were connected to ICAD independent of LDL-C and traditional risk factors. The mechanisms of remnant-C association with ICAD probably offer insight into preventive risk-factor of ischemic stroke.
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Affiliation(s)
- Peng Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Ziheng Zhang
- Clinical Medical College, Jining Medical University, Jining, China
| | - Daojing Li
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Rongrong Han
- Clinical Medical College, Jining Medical University, Jining, China
| | - Hongfang Li
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Jinfeng Ma
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Peng Xu
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Ziyou Qi
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Lixia Liu
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China
| | - Aimei Zhang
- Department of Neurology, the Affiliated Hospital of Jining Medical University, Jining, China.
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Yang B, Teng M, You H, Dong Y, Chen S. A Nomogram for Predicting Survival in Advanced Non-Small-Cell Lung Carcinoma Patients: A Population-Based Study. Cancer Invest 2023; 41:672-685. [PMID: 37490629 DOI: 10.1080/07357907.2023.2241547] [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: 07/27/2022] [Revised: 12/17/2022] [Accepted: 07/21/2023] [Indexed: 07/27/2023]
Abstract
Non-small-cell lung cancer (NSCLC) remains the most common malignant cancer. We identified 43140 advanced NSCLC patients from the SEER database to develop and validate a new prognostic model. The prognostic performance was evaluated by P value, concordance index, net reclassification index, integrated discrimination improvement, and decision curve analysis. The following variables were contained in the final prognostic model: age, sex, race, TNM stage, and grade and treatment options. Compared to the AJCC staging system, this prognostic model is conducive to the implementation of individualized clinical treatment schemes and can be an important part of the precise medical care of NSCLC tumors.
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Affiliation(s)
- Bo Yang
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Mengmeng Teng
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Haisheng You
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Yalin Dong
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China
| | - Siying Chen
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Shannxi, China
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10
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Zhang Y, Tan H, Jia L, He J, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of preoperative glucose concentration with mortality in patients undergoing craniotomy for brain tumor. J Neurosurg 2023; 138:1254-1262. [PMID: 36308478 DOI: 10.3171/2022.9.jns221251] [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: 05/26/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperglycemia is associated with worse outcomes in ambulatory settings and specialized hospital settings, but there are sparse data on the importance of preoperative blood glucose measurement before brain tumor craniotomy. The authors sought to investigate the association between preoperative glucose level and 30-day mortality rate in patients undergoing brain tumor resection. METHODS This retrospective cohort study included patients undergoing craniotomy for brain tumors at West China Hospital, Sichuan University, from January 2011 to March 2021. Surgical mortality rates were evaluated in patients who had normal glycemia (< 5.6 mmol/L) as well as mild (5.6-6.9 mmol/L), moderate (7.0-11.0 mmol/L), and severe hyperglycemia (> 11.0 mmol/L). RESULTS The study included 12,281 patients who underwent tumor resection via craniotomy. The overall 30-day mortality rate was 2.0% (242/12,281), whereas the rates for normal glycemia and mild, moderate, and severe hyperglycemia were 1.5%, 2.5%, 3.8%, and 6.5%, respectively. Compared with normal glycemia, the odds of mortality at 30 days were higher in patients with mild hyperglycemia (adjusted odds ratio [OR] 1.44, 95% confidence interval [CI] 1.05-2.00), moderate hyperglycemia (OR 2.04, 95% CI 1.41-2.96), and severe hyperglycemia (OR 3.76, 95% CI 1.96-7.20; p < 0.001 for trend). When blood glucose was analyzed as a continuous variable, for each 1 mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.13 (95% CI 1.08-1.19). The addition of a preoperative glucose level significantly improved the area under the curve and categorical net reclassification index for prediction of mortality. CONCLUSIONS In patients undergoing craniotomy for brain tumors, even mild hyperglycemia was associated with an increased mortality rate, at a glucose level that was much lower than the commonly applied level.
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Affiliation(s)
- Yu Zhang
- Departments of1Neurosurgery and
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Huiwen Tan
- 2Endocrinology, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Lu Jia
- 3Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi
| | - Jialing He
- Departments of1Neurosurgery and
- 5Department of Neurosurgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong
| | - Pengfei Hao
- 3Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi
| | - Tiangui Li
- 6Department of Neurosurgery, Longquan Hospital, Chengdu, Sichuan, China
| | - Yangchun Xiao
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Liyuan Peng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Yuning Feng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | | | - Haidong Deng
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Peng Wang
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
| | - Weelic Chong
- 7Department of Medical Oncology, Thomas Jefferson University, Philadelphia; and
| | - Yang Hai
- 8Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lvlin Chen
- 4Affiliated Hospital of Chengdu University, Chengdu, Sichuan
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11
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Lurati Buse GA, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck-Schimmer B, Spadaro S, Matute P, Bolliger D, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Wulf H, Larmann J, Corneci D, Chammartin-Basnet F, Howell SJ. Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study. Br J Anaesth 2023; 130:655-665. [PMID: 37012173 DOI: 10.1016/j.bja.2023.02.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery. METHODS This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated. RESULTS In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71-0.77], ROC AUCbaseline+4METs 0.74 [0.71-0.77], ROC AUCbaseline+floors climbed 0.75 [0.71-0.78], AUCbaseline+fitnessvspeers 0.74 [0.71-0.77], and AUCbaseline+physical activity 0.75 [0.72-0.78]). CONCLUSIONS Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery. CLINICAL TRIAL REGISTRATION NCT03016936.
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Affiliation(s)
- Giovanna A Lurati Buse
- Anesthesiology Department University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Eckhard Mauermann
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stefan De Hert
- Department of Anaesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Miodrag Filipovic
- Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Purificación Matute
- Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Bolliger
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Sanem Cakar Turhan
- Department of Anesthesiology and ICU, Ankara University Medical School, Ankara, Turkey
| | - Judith van Waes
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Filipa Lagarto
- Department of Anesthesiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kassiani Theodoraki
- Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Anil Gupta
- Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Jörg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Luca Guzzetti
- Anesthesia and Intensive Care Department, University Hospital, Varese, Italy
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland
| | - Hinnerk Wulf
- Department of Anesthesiology and Critical Care Medicine, University Hospital Marburg, Marburg, Germany
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Corneci
- Carol Davila University of Medicine and Pharmacy Bucharest Head of Anesthesia and Intensive Care Department I, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Frederique Chammartin-Basnet
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Simon J Howell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Xie M, Yuan K, Zhu X, Chen J, Zhang X, Xie Y, Wu M, Wang Z, Liu R, Liu X. Systemic Immune-Inflammation Index and Long-Term Mortality in Patients with Stroke-Associated Pneumonia. J Inflamm Res 2023; 16:1581-1593. [PMID: 37092129 PMCID: PMC10120842 DOI: 10.2147/jir.s399371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/25/2023] Open
Abstract
Background Systemic immune inflammation has been investigated as a prognostic marker of different diseases. This study is designed to assess the association of systemic immune-inflammation index (SII) with long-term mortality of stroke-associated pneumonia (SAP) patients. Methods Patients aged ≥18 years with SAP were selected from the Nanjing Stroke Registry Program in China. We retrospectively evaluated systemic immune-inflammation response with SII and pneumonia severity with the pneumonia severity index and the confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older score. To explore the correlation between SII and mortality in SAP patients, multivariable Cox regressions and competing risk regressions were conducted. Mediation analysis was also performed to assess the role of pneumonia severity. Results Among 611 patients in the SAP population, death occurred in 164 patients (26.8%) during the median follow-up of 3.0 (1.2-4.6) years. In multivariate analysis, higher SII scores could predict increased mortality in patients with SAP (adjusted hazard ratio 2.061; 95% confidence interval, 1.256-3.383; P = 0.004), and the association was mediated by pneumonia severity. Moreover, adding SII to traditional models improved their predictive ability for mortality. Conclusion Our study displayed that SII was characterized in SAP patients with different prognoses. Elevated SII scores increased the risk of mortality. Further research is required for the clinical practice of the index among SAP patients.
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Affiliation(s)
- Mengdi Xie
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Kang Yuan
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Xinyi Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Jingjing Chen
- Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, People’s Republic of China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhaojun Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Rui Liu, Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210000, Jiangsu Province, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Correspondence: Xinfeng Liu, Department of Neurology, Jinling Hospital, Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210000, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
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13
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Shi Y, Zheng Z, Liu Y, Wu Y, Wang P, Liu J. Leveraging Machine Learning Techniques to Forecast Chronic Total Occlusion before Coronary Angiography. J Clin Med 2022; 11:jcm11236993. [PMID: 36498568 PMCID: PMC9739483 DOI: 10.3390/jcm11236993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronic total occlusion (CTO) remains the most challenging procedure in coronary artery disease (CAD) for interventional cardiology. Although some clinical risk factors for CAD have been identified, there is no personalized prognosis test available to confidently identify patients at high or low risk for CTO CAD. This investigation aimed to use a machine learning algorithm for clinical features from clinical routine to develop a precision medicine tool to predict CTO before CAG. METHODS Data from 1473 CAD patients were obtained, including 1105 in the training cohort and 368 in the testing cohort. The baseline clinical characteristics were collected. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors that impact the diagnosis of CTO. A CTO predicting model was established and validated based on the independent predictors using a machine learning algorithm. The area under the curve (AUC) was used to evaluate the model. RESULTS The CTO prediction model was developed with the training cohort using the machine learning algorithm. Eight variables were confirmed as 'important': gender (male), neutrophil percentage (NE%), hematocrit (HCT), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), ejection fraction (EF), troponin I (TnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP). The model achieved good concordance indices of 0.724 and 0.719 in the training and testing cohorts, respectively. CONCLUSIONS An easy-to-use tool to predict CTO in patients with CAD was developed and validated. More research with larger cohorts are warranted to improve the prediction model, which can support clinician decisions on the early discerning CTO in CAD patients.
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Affiliation(s)
- Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Ze Zheng
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Yanci Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Yongxin Wu
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China
| | - Ping Wang
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, 2 Anzhen Road, Chaoyang District, Beijing 100029, China
- Correspondence: ; Fax: +86-010-64456998
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14
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Luo XY, Zhang YM, Zhu RQ, Yang SS, Zhou LF, Zhu HY. Development and validation of novel nomograms to predict survival of patients with tongue squamous cell carcinoma. World J Clin Cases 2022; 10:11726-11742. [PMID: 36405263 PMCID: PMC9669853 DOI: 10.12998/wjcc.v10.i32.11726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is no unified standard to predict postoperative survival in patients with tongue squamous cell carcinoma (TSCC), hence the urgency to develop a model to accurately predict the prognosis of these patients.
AIM To develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) of patients with TSCC.
METHODS A cohort of 3454 patients with TSCC from the Surveillance, Epidemiology, and End Results (SEER) database was used to develop nomograms; another independent cohort of 203 patients with TSCC from the Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Zhejiang University School of Medicine, was used for external validation. Univariate and multivariate analyses were performed to identify useful variables for the development of nomograms. The calibration curve, area under the receiver operating characteristic curve (AUC) analysis, concordance index (C-index), net reclassification index (NRI), and decision curve analysis (DCA) were used to assess the calibration, discrimination ability, and clinical utility of the nomograms.
RESULTS Eight variables were selected and used to develop nomograms for patients with TSCC. The C-index (0.741 and 0.757 for OS and CSS in the training cohort and 0.800 and 0.830 in the validation cohort, respectively) and AUC indicated that the discrimination abilities of these nomograms were acceptable. The calibration curves of OS and CSS indicated that the predicted and actual values were consistent in both the training and validation cohorts. The NRI values (training cohort: 0.493 and 0.482 for 3- and 5-year OS and 0.424 and 0.402 for 3- and 5-year CSS; validation cohort: 0.635 and 0.750 for 3- and 5-year OS and 0.354 and 0.608 for 3- and 5-year CSS, respectively) and DCA results indicated that the nomograms were significantly better than the tumor-node-metastasis staging system in predicting the prognosis of patients with TSCC.
CONCLUSION Our nomograms can accurately predict patient prognoses and assist clinicians in improving decision-making concerning patients with TSCC in clinical practice.
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Affiliation(s)
- Xia-Yan Luo
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Ya-Min Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Run-Qiu Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Shan-Shan Yang
- Department of Stomatology, Sanmen People’s Hospital, Taizhou 317100, Zhejiang Province, China
| | - Lu-Fang Zhou
- Department of Stomatology, Jiangshan People's Hospital, Quzhou 324199, Zhejiang Province, China
| | - Hui-Yong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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15
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Huang X, Wang D, Zhang Q, Ma Y, Zhao H, Li S, Deng J, Ren J, Yang J, Zhao Z, Xu M, Zhou Q, Zhou J. Radiomics for prediction of intracerebral hemorrhage outcomes: A retrospective multicenter study. Neuroimage Clin 2022; 36:103242. [PMID: 36279754 PMCID: PMC9668657 DOI: 10.1016/j.nicl.2022.103242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Accurate risk stratification of patients with intracerebral hemorrhage (ICH) could help refine adjuvant therapy selection and better understand the clinical course. We aimed to evaluate the value of radiomics features from hematomal and perihematomal edema areas for prognosis prediction and to develop a model combining clinical and radiomic features for accurate outcome prediction of patients with ICH. METHODS This multicenter study enrolled patients with ICH from January 2016 to November 2021. Their outcomes at 3 months were recorded based on the modified Rankin Scale (good, 0-3; poor, 4-6). Independent clinical and radiomic risk factors for poor outcome were identified through multivariate logistic regression analysis, and predictive models were developed. Model performance and clinical utility were evaluated in both internal and external cohorts. RESULTS Among the 1098 ICH patients evaluated (mean age, 60 ± 13 years), 703 (64 %) had poor outcomes. Age, hemorrhage volume and location, and Glasgow Coma Scale (GCS) were independently associated with outcomes. The area under the receiver operating characteristic curve (AUC) of the clinical model was 0.881 in the external validation cohort. Addition of the Rad-score (combined hematoma and perihematomal edema area) improved predictive accuracy and model performance (AUC, 0.893), net reclassification improvement, 0.140 (P < 0.001), and integrated discrimination improvement, 0.050 (P < 0.001). CONCLUSIONS The radiomics features of hematomal and perihematomal edema area have additional value in prognostic prediction; moreover, addition of radiomic features significantly improves model accuracy.
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Affiliation(s)
- Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Qiaoying Zhang
- Department of Radiology, Xi'an Central Hospital, Xi An 710000, China
| | - Yaqiong Ma
- Second Clinical School, Lanzhou University, Lanzhou 730030, China; Department of Radiology, Gansu Provincial Hospital, Lanzhou 730030, China
| | - Hui Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | | | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Zhiyong Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou 730030, China
| | - Min Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China; Department of Neurosurgery, Lanzhou University Second Hospital Lanzhou 730030, China.
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16
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Zhang X, Li G, Sun Y. Nomogram Including Serum Ion Concentrations to Screen for New-Onset Hypertension in Rural Chinese Populations Over a Short-Term Follow-up. Circ J 2022; 86:1464-1473. [PMID: 35569931 DOI: 10.1253/circj.cj-22-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND This study aimed to establish a clinically useful nomogram to evaluate the probability of hypertension onset in the Chinese population. METHODS AND RESULTS A prospective cohort study was conducted in 2012-2013 and followed up in 2015 to identify new-onset hypertension in 4,123 participants. The dataset was divided into development (n=2,748) and verification (n=1,375) cohorts. After screening risk factors by lasso regression, a multivariate Cox regression risk model and nomogram were established. Among the 4,123 participants, 818 (19.8%) developed hypertension. The model identified 10 risk factors: age, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, high pulse rate, history of diabetes, family history of hypertension and stroke, intake frequency of bean products, and intensity of physical labor. The C-indices of the model in the development and validation cohorts were 0.744 and 0.768, respectively. After the inclusion of serum calcium and magnesium concentrations, the C-indices in the development and validation cohorts were 0.764 and 0.791, respectively, with areas under the curve for the updated model of 0.907 and 0.917, respectively. The calibration curve showed that the nomogram accurately predicted the probability of hypertension. The updated nomogram was clinically beneficial across thresholds of 10-60%. CONCLUSIONS The newly developed nomogram has good predictive ability and may effectively assess hypertension risk in high-risk rural areas in China.
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Affiliation(s)
- Xueyao Zhang
- Department of Cardiology, First Hospital of China Medical University
| | - Guangxiao Li
- Department of Medical Record Management, First Hospital of China Medical University
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University
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17
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Więckowska B, Kubiak KB, Jóźwiak P, Moryson W, Stawińska-Witoszyńska B. Cohen's Kappa Coefficient as a Measure to Assess Classification Improvement following the Addition of a New Marker to a Regression Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610213. [PMID: 36011844 PMCID: PMC9407914 DOI: 10.3390/ijerph191610213] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 05/27/2023]
Abstract
The need to search for new measures describing the classification of a logistic regression model stems from the difficulty in searching for previously unknown factors that predict the occurrence of a disease. A classification quality assessment can be performed by testing the change in the area under the receiver operating characteristic curve (AUC). Another approach is to use the Net Reclassification Improvement (NRI), which is based on a comparison between the predicted risk, determined on the basis of the basic model, and the predicted risk that comes from the model enriched with an additional factor. In this paper, we draw attention to Cohen's Kappa coefficient, which examines the actual agreement in the correction of a random agreement. We proposed to extend this coefficient so that it may be used to detect the quality of a logistic regression model reclassification. The results provided by Kappa's reclassification were compared with the results obtained using NRI. The random variables' distribution attached to the model on the classification change, measured by NRI, Kappa, and AUC, was presented. A simulation study was conducted on the basis of a cohort containing 3971 Poles obtained during the implementation of a lower limb atherosclerosis prevention program.
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Affiliation(s)
- Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna B. Kubiak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Paulina Jóźwiak
- Department of Preventive Medicine, Poznan University of Medical Sciences, 60-781 Poznan, Poland
| | - Wacław Moryson
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Barbara Stawińska-Witoszyńska
- Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Jiang L, Cai X, Yao D, Jing J, Mei L, Yang Y, Li S, Jin A, Meng X, Li H, Wei T, Wang Y, Pan Y, Wang Y. Association of inflammatory markers with cerebral small vessel disease in community-based population. J Neuroinflammation 2022; 19:106. [PMID: 35513834 PMCID: PMC9072153 DOI: 10.1186/s12974-022-02468-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study investigated the relationships of neutrophil count (NC), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) with cerebral small vessel disease (CSVD). Methods A total of 3052 community-dwelling residents from the Poly-vasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study were involved in this cross-sectional study. CSVD burden and imaging markers, including white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces in basal ganglia (BG-EPVS), were assessed according to total CSVD burden score. The associations of NC, NLR and SII with CSVD and imaging markers were evaluated using logistic regression models. Furthermore, two-sample Mendelian randomization (MR) analysis was performed to investigate the genetically predicted effect of NC on CSVD. The prognostic performances of NC, NLR and SII for the presence of CSVD were assessed. Results At baseline, the mean age was 61.2 ± 6.7 years, and 53.5% of the participants were female. Higher NC was suggestively associated with increased total CSVD burden and modified total CSVD burden (Q4 vs. Q1: common odds ratio (cOR) 1.33, 95% CI 1.05–1.70; cOR 1.28, 95% CI 1.02–1.60) and marginally correlated with the presence of CSVD (OR 1.29, 95% CI 1.00–1.66). Furthermore, elevated NC was linked to a higher risk of lacune (OR 2.13, 95% CI 1.25–3.62) and moderate-to-severe BG-EPVS (OR 1.67, 95% CI 1.14–2.44). A greater NLR was related to moderate-to-severe BG-EPVS (OR 1.68, 95% CI 1.16–2.45). Individuals with a higher SII had an increased risk of modified WMH burden (OR 1.35, 95% CI 1.08–1.69) and moderate-to-severe BG-EPVS (OR 1.70, 95% CI 1.20–2.41). MR analysis showed that genetically predicted higher NC was associated with an increased risk of lacunar stroke (OR 1.20, 95% CI 1.04–1.39) and small vessel stroke (OR 1.21, 95% CI 1.06–1.38). The addition of NC to the basic model with traditional risk factors improved the predictive ability for the presence of CSVD, as validated by the net reclassification index and integrated discrimination index (all p < 0.05). Conclusions This community-based population study found a suggestive association between NC and CSVD, especially for BG-EPVS and lacune, and provided evidence supporting the prognostic significance of NC. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02468-0.
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Affiliation(s)
- Lingling Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Dongxiao Yao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
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19
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Ma Y, Ma Q, Wang X, Yu T, Dang Y, Shang J, Li G, Hou Y. Incremental Prognostic Value of Pericoronary Adipose Tissue Thickness Measured Using Cardiac Magnetic Resonance Imaging After Revascularization in Patients With ST-Elevation Myocardial Infarction. Front Cardiovasc Med 2022; 9:781402. [PMID: 35317286 PMCID: PMC8934413 DOI: 10.3389/fcvm.2022.781402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimPericoronary adipose tissue (PCAT) reflects pericoronary inflammation and is associated with coronary artery disease. We aimed to identify the association between local PCTA thickness using cardiac magnetic resonance (CMR) and prognosis of patients with ST-elevation myocardial infarction (STEMI), and to investigate the incremental prognostic value of PCAT thickness in STEMI after reperfusion.MethodsA total of 245 patients with STEMI (mean age, 55.61 ± 10.52 years) who underwent CMR imaging within 1 week of percutaneous coronary intervention therapy and 35 matched controls (mean age, 53.89 ± 9.45 years) were enrolled. PCAT thickness indexed to body surface area at five locations, ventricular volume and function, infarct-related parameters, and global strain indices were evaluated using CMR. Associations between PCAT thickness index and 1-year major adverse cardiovascular events (MACE) after STEMI were calculated. The prognostic value of the standard model based on features of clinical and CMR and updated model including PACT thickness index were further assessed.ResultsPatients with MACE had a more significant increase in PCAT thickness index at superior interventricular groove (SIVGi) than patients without MACE. The SIVGi was significantly associated with left ventricular ejection fraction (LVEF), infarct size, and global deformation. SIVGi > 4.98 mm/m2 was an independent predictor of MACE (hazard ratio, 3.2; 95% CI: 1.6–6.38; p < 0.001). The updated model significantly improved the power of prediction and had better discrimination ability than that of the standard model for predicting 1-year MACE (areas under the ROC curve [AUC] = 0.8 [95% CI: 0.74–0.87] vs. AUC = 0.76 [95% CI: 0.68–0.83], p < 0.05; category-free net reclassification index [cfNRI] = 0.38 [95% CI: 0.1–0.53, p = 0.01]; integrated discrimination improvement [IDI] = 0.09 [95% CI: 0.01–0.18, p = 0.02]).ConclusionsThis study demonstrated SIVGi as an independent predictor conferred incremental value over standard model based on clinical and CMR factors in 1-year MACE predictions for STEMI.
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Affiliation(s)
- Yue Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaonan Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuxue Dang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Yang Hou
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20
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Yin T, Shi S, Zhu X, Cheang I, Lu X, Gao R, Zhang H, Yao W, Zhou Y, Li X. A Survival Prediction for Acute Heart Failure Patients via Web-Based Dynamic Nomogram with Internal Validation: A Prospective Cohort Study. J Inflamm Res 2022; 15:1953-1967. [PMID: 35342297 PMCID: PMC8947803 DOI: 10.2147/jir.s348139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose The current study aimed to develop a convenient and accurate prognostic dynamic nomogram model for the risk of all-cause death in acute heart failure (AHF) patients that incorporates clinical characteristics including N-terminal pro-brain natriuretic peptide (NT-pro BNP) and growth stimulation expresses gene 2 protein (ST2). Patients and Methods We prospectively studied 537 consecutive AHF patients and derived a clinical prediction model. The least absolute shrinkage and selection operator regression model combined with clinical characteristics were used for dimensional reduction and feature selection. Multivariate Cox proportional hazard analysis and “Dynnom” package were used to build the dynamic nomogram for prediction of 1-,2-,and 5-year overall survival for AHF. With bootstrap validation, the time-dependent concordance index (C-index) and calibration curves were used to assess predictive discrimination and accuracy. The contributions of NT-pro BNP and ST2 to the nomogram were evaluated using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), while decision curve analysis (DCA) was used to assess clinical value. Results Patients were randomly divided into derivation (74.9%, n=402) and validation (25.1%, n=135) cohorts. Optimal independent prognostic factors for 1-,2-, and 5-year all-cause mortality were BS-ACMR (B: NT-pro BNP; S: ST2; A: age; C: complete right bundle branch block; M: mean arterial pressure; and R: red cell distribution width >14.5%); these were incorporated into the dynamic nomogram (https://bs-acmr-nom.shinyapps.io/dynnomapp/) with bootstrap validation. The C-indexes in the derivation (0.793) and validation (0.782) cohorts were consistent with comparable performance parameters. The calibration curve showed good agreement between the nomogram-predicted and actual survival. Adding NT-pro BNP and ST2 provided a significant net benefit and improved performance over other less adequate schemes in terms of DCA of survival probability compared to those neglecting either of these two factors. Conclusion The study constructed a dynamic BS-ACMR nomogram, which is a convenient, practical and effective clinical decision-making tool for providing accurate prognosis in AHF patients.
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Affiliation(s)
- Ting Yin
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Shi Shi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Xu Zhu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Xinyi Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Rongrong Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215002, People’s Republic of China
| | - Wenming Yao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Yanli Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, People’s Republic of China
- Correspondence: Xinli Li; Yanli Zhou, Tel +86 136 1157 3111; +86 137 7787 9077, Email ;
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21
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Li G, Shi C, Li T, Ouyang N, Guo X, Chen Y, Li Z, Zhou Y, Yang H, Yu S, Sun G, Sun Y. A nomogram integrating non-ECG factors with ECG to screen left ventricular hypertrophy among hypertensive patients from northern China. J Hypertens 2022; 40:264-273. [PMID: 34992197 DOI: 10.1097/hjh.0000000000003003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We aimed to establish and validate a user-friendly and clinically practical nomogram for estimating the probability of echocardiographic left ventricular hypertrophy (echo-LVH) indexed to BSA among hypertensive patients from northern China. METHODS A total of 4954 hypertensive patients were recruited from a population-based cohort study from January 2012 to August 2013. The dataset was randomly split into two sets: training (n = 3303) and validation (n = 1651). Three nomograms were initially constructed. That is the Cornell product nomogram, the non-ECG nomogram, and the integrated nomogram which integrated non-ECG risk factors and Cornell-voltage duration product. The least absolute shrinkage and selection operator strategies were employed to screen for non-ECG features. The performance of the nomograms was evaluated using discrimination, calibration, and decision curve analysis (DCA). The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were also calculated. RESULTS The AUCs, NRIs, IDIs, and DCA curves of the nomograms demonstrated that the integrated nomogram performed best among all three nomograms. The integrated nomogram incorporated age, sex, educational level, hypertension duration, SBP, DBP, eGFR, sleep duration, tea consumption, and the Cornell-voltage duration product. The AUC was 0.758 and had a good calibration (Hosmer-Lemeshow test, P = 0.73). Internal validation showed an acceptable AUC of 0.735 and good calibration was preserved (Hosmer-Lemeshow test, P = 0.19). The integrated nomogram was clinically beneficial across a range of thresholds of 10-50%. CONCLUSION The integrated nomogram is a convenient and reliable tool that enables early identification of hypertensive patients at high odds of LVH and can assist clinicians in their decision-making.
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Affiliation(s)
- Guangxiao Li
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
- Department of Medical Record Management Center, the First Hospital of China Medical University, Shenyang, China
| | - Chuning Shi
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Tan Li
- Department of the Cardiovascular Ultrasound, the First Hospital of China Medical University, Shenyang, China
| | - Nanxiang Ouyang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - XiaoFan Guo
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Yanli Chen
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Ying Zhou
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Hongmei Yang
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Shasha Yu
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, Shenyang, China
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22
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Egashira K, Sueta D, Komorita T, Yamamoto E, Usuku H, Tokitsu T, Fujisue K, Nishihara T, Oike F, Takae M, Hanatani S, Takashio S, Ito M, Yamanaga K, Araki S, Soejima H, Kaikita K, Matsushita K, Tsujita K. HFA-PEFF scores: prognostic value in heart failure with preserved left ventricular ejection fraction. Korean J Intern Med 2022; 37:96-108. [PMID: 34929994 PMCID: PMC8747922 DOI: 10.3904/kjim.2021.272] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 03/03/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS The Heart Failure Association (HFA)-PEFF score is recognized as a simple method to diagnose heart failure (HF) with preserved ejection fraction (HFpEF). This study aimed to evaluate the relationship between HFA-PEFF scores and cardiovascular outcomes in HFpEF patients. METHODS A total of 502 consecutive HFpEF patients were prospectively observed for up to 1,500 days. Cardiovascular outcomes were compared between two groups of patients, defined by their HFA-PEFF scores: those who scored 2-4 (the intermediate-score group) and those who scored 5-6 group (the high-score group). Overall, 236 cardiovascular events were observed during the follow-up period (median, 1,159 days). RESULTS Kaplan-Meier analysis showed that there were significant differences in composite cardiovascular events and HF-related events between the intermediate-score group and the high-score group (p = 0.003 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis showed that the HFA-PEFF scores significantly predicted future HF-related events (hazard ratio, 1.66; 95% confidence interval [CI], 1.11 to 2.50; p = 0.014); receiver operating characteristic analysis confirmed this relationship (area under the curve, 0.633; 95% CI, 0.574 to 0.692; p < 0.001). The cutoff HFA-PEFF score for the identification of HF-related events was 4.5. Decision curve analysis revealed that combining the HFA-PEFF score with conventional prognostic factors improved the prediction of HF-related events. CONCLUSION HFA-PEFF scores may be useful for predicting HF-related events in HFpEF patients.
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Affiliation(s)
- Koichi Egashira
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takashi Komorita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takanori Tokitsu
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichiro Fujisue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taiki Nishihara
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Fumi Oike
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masafumi Takae
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Miwa Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Ouyang N, Li G, Wang C, Sun Y. Construction of a risk assessment model of cardiovascular disease in a rural Chinese hypertensive population based on lasso-Cox analysis. J Clin Hypertens (Greenwich) 2021; 24:38-46. [PMID: 34882961 PMCID: PMC8783342 DOI: 10.1111/jch.14403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022]
Abstract
Many assessments have been used to predict cardiovascular risks in the general population, but their applicability in patients with hypertension needs to be further evaluated. In the current study, a cardiovascular risk assessment model was constructed in a hypertensive population. This prospective cohort study was conducted with cardiovascular examinations in rural northeast China in 2012 and 2013, and followed up to collect cardiovascular events in 2015 and 2018. Data were derived from 4763 hypertensive patients who were free of cardiovascular disease (CVD) at baseline and completed follow‐up. After lasso regression was used to screen for risk factors of CVD at baseline, a multivariate Cox regression risk model was established and a nomogram was developed. The model was validated using an independent test set (one third of data not used for model building). Among 4763 patients, 354 (7.43%) had a cardiovascular event during a median follow‐up of 4.66 years. Nine risk factors were screened by lasso regression, including sex, age, current smoking, body mass index (BMI), history of transient ischemic attack (TIA), family history of hypertension, family history of stroke, physical labor intensity, and high low‐density lipoprotein cholesterol (LDL‐C). The c‐index of the CVD model was 0.707, and that of an updated model with baseline blood pressure was 0.732. In the validated cohort the respective c‐indexes were 0.665 and 0.714. An assessment model of CVD risk was established in a hypertensive population which may provide an original prevention strategy for hypertensive populations in rural China, and further reduce the CVD burden.
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Affiliation(s)
- Nanxiang Ouyang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management, First Hospital of China Medical University, Shenyang, China
| | - Chang Wang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
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24
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A machine learning–based clinical decision support algorithm for reducing unnecessary coronary angiograms. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 3:21-30. [PMID: 35265932 PMCID: PMC8890355 DOI: 10.1016/j.cvdhj.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Conventional clinical risk scores and diagnostic algorithms are proving to be suboptimal in the prediction of obstructive coronary artery disease, contributing to the low diagnostic yield of invasive angiography. Machine learning could help better predict which patients would benefit from invasive angiography vs other noninvasive diagnostic modalities. Objective To reduce patient risk and cost to the healthcare system by improving the diagnostic yield of invasive coronary angiography through optimized outpatient selection. Methods Retrospective analysis of 12 years of referral data from a provincial cardiac registry, including all patients referred for invasive angiography of more than 1.4 million individuals in Ontario, Canada. Stable outpatients undergoing coronary angiography during the study period were included in the analysis. The training set (80% random sample, n = 23,750) was used to develop 8 prediction models in Python using grid-search cross-validation. The test set (20% random sample, n = 5938), evaluated the discrimination performance of each model. Results The machine-learning model achieved a substantially better performance (area under the receiver operating characteristics curve: 0.81) than existing models for predicting obstructive coronary artery disease in patients referred for invasive angiography. It significantly outperformed both the reference model and current clinical practice with a net reclassification index of 27.8% (95% confidence interval [CI]: [24.9%–30.8%], P value <.01) and 44.7% (95% CI: [42.4%–47.0%], P value <.01), respectively. Conclusion This prediction model, when coupled with a point-of-care, online decision support tool to be used by referring physicians, could improve the diagnostic yield of invasive coronary angiography in stable, elective outpatients, thus improving patient safety and reducing healthcare costs.
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Xu J, Green R, Kim M, Lord J, Ebshiana A, Westwood S, Baird AL, Nevado-Holgado AJ, Shi L, Hye A, Snowden SG, Bos I, Vos SJB, Vandenberghe R, Teunissen CE, Kate MT, Scheltens P, Gabel S, Meersmans K, Blin O, Richardson J, De Roeck EE, Engelborghs S, Sleegers K, Bordet R, Rami L, Kettunen P, Tsolaki M, Verhey FRJ, Alcolea D, Lleó A, Peyratout G, Tainta M, Johannsen P, Freund-Levi Y, Frölich L, Dobricic V, Frisoni GB, Molinuevo JL, Wallin A, Popp J, Martinez-Lage P, Bertram L, Blennow K, Zetterberg H, Streffer J, Visser PJ, Lovestone S, Proitsi P, Legido-Quigley C. Sex-Specific Metabolic Pathways Were Associated with Alzheimer's Disease (AD) Endophenotypes in the European Medical Information Framework for AD Multimodal Biomarker Discovery Cohort. Biomedicines 2021; 9:1610. [PMID: 34829839 PMCID: PMC8615383 DOI: 10.3390/biomedicines9111610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND physiological differences between males and females could contribute to the development of Alzheimer's Disease (AD). Here, we examined metabolic pathways that may lead to precision medicine initiatives. METHODS We explored whether sex modifies the association of 540 plasma metabolites with AD endophenotypes including diagnosis, cerebrospinal fluid (CSF) biomarkers, brain imaging, and cognition using regression analyses for 695 participants (377 females), followed by sex-specific pathway overrepresentation analyses, APOE ε4 stratification and assessment of metabolites' discriminatory performance in AD. RESULTS In females with AD, vanillylmandelate (tyrosine pathway) was increased and tryptophan betaine (tryptophan pathway) was decreased. The inclusion of these two metabolites (area under curve (AUC) = 0.83, standard error (SE) = 0.029) to a baseline model (covariates + CSF biomarkers, AUC = 0.92, SE = 0.019) resulted in a significantly higher AUC of 0.96 (SE = 0.012). Kynurenate was decreased in males with AD (AUC = 0.679, SE = 0.046). CONCLUSIONS metabolic sex-specific differences were reported, covering neurotransmission and inflammation pathways with AD endophenotypes. Two metabolites, in pathways related to dopamine and serotonin, were associated to females, paving the way to personalised treatment.
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Affiliation(s)
- Jin Xu
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK; (J.X.); (A.E.); (S.G.S.)
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
| | - Rebecca Green
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London SE5 8AF, UK
| | - Min Kim
- Steno Diabetes Center, 2820 Gentofte, Denmark;
| | - Jodie Lord
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
| | - Amera Ebshiana
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK; (J.X.); (A.E.); (S.G.S.)
| | - Sarah Westwood
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; (S.W.); (A.L.B.); (A.J.N.-H.); (L.S.)
| | - Alison L. Baird
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; (S.W.); (A.L.B.); (A.J.N.-H.); (L.S.)
| | - Alejo J. Nevado-Holgado
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; (S.W.); (A.L.B.); (A.J.N.-H.); (L.S.)
| | - Liu Shi
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; (S.W.); (A.L.B.); (A.J.N.-H.); (L.S.)
| | - Abdul Hye
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
| | - Stuart G. Snowden
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK; (J.X.); (A.E.); (S.G.S.)
| | - Isabelle Bos
- Alzheimer Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (I.B.); (R.V.); (M.T.K.); (P.S.); (P.J.V.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, 6211 LK Maastricht, The Netherlands; (S.J.B.V.); (F.R.J.V.)
| | - Stephanie J. B. Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, 6211 LK Maastricht, The Netherlands; (S.J.B.V.); (F.R.J.V.)
| | - Rik Vandenberghe
- Alzheimer Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (I.B.); (R.V.); (M.T.K.); (P.S.); (P.J.V.)
| | - Charlotte E. Teunissen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Mara Ten Kate
- Alzheimer Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (I.B.); (R.V.); (M.T.K.); (P.S.); (P.J.V.)
- Department of Radiology and Nuclear Medicine, VU University Medical Center, 1081 HV Amsterdam, The Netherlands;
| | - Philip Scheltens
- Alzheimer Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (I.B.); (R.V.); (M.T.K.); (P.S.); (P.J.V.)
| | - Silvy Gabel
- Department of Clinical Chemistry, Neurochemistry Laboratory, Amsterdam Neuroscience, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands;
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, 3000 Leuven, Belgium;
- University Hospital Leuven, 3000 Leuven, Belgium
| | - Karen Meersmans
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, 3000 Leuven, Belgium;
- University Hospital Leuven, 3000 Leuven, Belgium
| | - Olivier Blin
- Clinical Pharmacology & Pharmacovigilance Department, Aix-Marseille University-CNRS, 13007 Marseille, France;
| | - Jill Richardson
- Neurosciences Therapeutic Area, GlaxoSmithKline R&D, Stevenage SG1 2NY, UK;
| | - Ellen Elisa De Roeck
- Center for Neurosciences, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, 2000 Antwerp, Belgium; (S.E.); (J.S.)
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, 2000 Antwerp, Belgium; (S.E.); (J.S.)
- Department of Neurology and Center for Neurosciences (C4N), UZ Brussel and Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium
| | - Kristel Sleegers
- Department of Neurology and Memory Clinic, Hospital Network Antwerp (ZNA) Middelheim and Hoge Beuken, University of Antwerp, 2000 Antwerp, Belgium;
- Complex Genetics of Alzheimer’s Disease Group, VIB Center for Molecular Neurology, VIB, 2000 Antwerp, Belgium
| | - Régis Bordet
- Department of Medical Pharmacology, Université de Lille, 59000 Lille, France;
| | - Lorena Rami
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Hospital Clínic of Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (L.R.); (J.L.M.)
| | - Petronella Kettunen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.K.); (A.W.)
| | - Magda Tsolaki
- 1st Department of Neurology, AHEPA University Hospital, 546 21 Thessaloniki, Greece;
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, 6211 LK Maastricht, The Netherlands; (S.J.B.V.); (F.R.J.V.)
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (D.A.); (A.L.)
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (D.A.); (A.L.)
| | | | - Mikel Tainta
- Fundación CITA-Alzhéimer Fundazioa, 20009 San Sebastian, Spain;
| | - Peter Johannsen
- Danish Dementia Research Centre, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Yvonne Freund-Levi
- Department of Neurobiology, Caring Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden;
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Valerija Dobricic
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Cardiogenetics, University of Lübeck, 23562 Lübeck, Germany; (V.D.); (L.B.)
| | - Giovanni B. Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, 1205 Geneva, Switzerland;
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - José Luis Molinuevo
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Hospital Clínic of Barcelona, August Pi Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (L.R.); (J.L.M.)
- Barcelona Beta Brain Research Center, Unversitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Anders Wallin
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (P.K.); (A.W.)
| | - Julius Popp
- Old Age Psychiatry, Department of Psychiatry, University Hospital Lausanne, 1011 Lausanne, Switzerland;
- Department of Geriatric Psychiatry, University Hospital of Psychiatry Zürich, 8008 Zürich, Switzerland
| | - Pablo Martinez-Lage
- Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, 20009 San Sebastian, Spain;
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Cardiogenetics, University of Lübeck, 23562 Lübeck, Germany; (V.D.); (L.B.)
- Department of Psychology, University of Oslo, 0315 Oslo, Norway
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden; (K.B.); (H.Z.)
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 415 45 Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 413 45 Mölndal, Sweden; (K.B.); (H.Z.)
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 415 45 Mölndal, Sweden
- UK Dementia Research Institute at UCL, London WC1E 6BT, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London WC1N 3BG, UK
| | - Johannes Streffer
- Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, 2000 Antwerp, Belgium; (S.E.); (J.S.)
| | - Pieter Jelle Visser
- Alzheimer Center, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; (I.B.); (R.V.); (M.T.K.); (P.S.); (P.J.V.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centrum Limburg, Maastricht University, 6211 LK Maastricht, The Netherlands; (S.J.B.V.); (F.R.J.V.)
| | - Simon Lovestone
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK; (S.W.); (A.L.B.); (A.J.N.-H.); (L.S.)
- Janssen-Cilag UK Ltd., Oxford HP12 4EG, UK
| | - Petroula Proitsi
- Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London SE5 9RT, UK; (R.G.); (J.L.); (A.H.); (S.L.)
| | - Cristina Legido-Quigley
- Institute of Pharmaceutical Science, King’s College London, London SE1 9NH, UK; (J.X.); (A.E.); (S.G.S.)
- Steno Diabetes Center, 2820 Gentofte, Denmark;
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Singleton MJ, Yuan Y, Dawood FZ, Howard G, Judd SE, Zakai NA, Howard VJ, Herrington DM, Soliman EZ, Cushman M. Multiple Blood Biomarkers and Stroke Risk in Atrial Fibrillation: The REGARDS Study. J Am Heart Assoc 2021; 10:e020157. [PMID: 34325516 PMCID: PMC8475705 DOI: 10.1161/jaha.120.020157] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Atrial fibrillation is associated with increased stroke risk; available risk prediction tools have modest accuracy. We hypothesized that circulating stroke risk biomarkers may improve stroke risk prediction in atrial fibrillation. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study is a prospective cohort study of 30 239 Black and White adults age ≥45 years. A nested study of stroke cases and a random sample of the cohort included 175 participants (63% women, 37% Black adults) with baseline atrial fibrillation and available blood biomarker data. There were 81 ischemic strokes over 5.2 years in these participants. Adjusted for demographics, stroke risk factors, and warfarin use, the following biomarkers were associated with stroke risk (hazard ratio [HR]; 95% CI for upper versus lower tertile): cystatin C (3.16; 1.04–9.58), factor VIII antigen (2.77; 1.03–7.48), interleukin‐6 (9.35; 1.95–44.78), and NT‐proBNP (N‐terminal B‐type natriuretic peptide) (4.21; 1.24–14.29). A multimarker risk score based on the number of blood biomarkers in the highest tertile was developed; adjusted HRs of stroke for 1, 2, and 3+ elevated blood biomarkers, compared with none, were 1.75 (0.57–5.40), 4.97 (1.20–20.5), and 9.51 (2.22–40.8), respectively. Incorporating the multimarker risk score to the CHA2DS2VASc score resulted in a net reclassification improvement of 0.34 (95% CI, 0.04–0.65). Conclusions Findings in this biracial cohort suggested the possibility of substantial improvement in stroke risk prediction in atrial fibrillation using blood biomarkers or a multimarker risk score.
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Affiliation(s)
- Matthew J Singleton
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Ya Yuan
- Department of Biostatistics University of Alabama at Birmingham AL
| | | | - George Howard
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham AL
| | - Neil A Zakai
- Departments of Medicine and Pathology & Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT
| | | | - David M Herrington
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Elsayed Z Soliman
- Section of Cardiology Department of Internal Medicine Wake Forest School of Medicine Winston-Salem NC.,Epidemiological Cardiology Research Center Wake Forest School of Medicine Winston-Salem NC
| | - Mary Cushman
- Departments of Medicine and Pathology & Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT
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Hu J, Rezoagli E, Zadek F, Bittner EA, Lei C, Berra L. Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial. Anesth Analg 2021; 132:1548-1558. [PMID: 33481401 DOI: 10.1213/ane.0000000000005381] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cardiac surgery with cardiopulmonary bypass (CPB) is associated with a high risk of postoperative acute kidney injury (AKI). Due to limitations of current diagnostic strategies, we sought to determine whether free hemoglobin (fHb) ratio (ie, levels of fHb at the end of CPB divided by baseline fHb) could predict AKI after on-pump cardiac surgery. METHODS This is a secondary analysis of a randomized controlled trial comparing the effect of nitric oxide (intervention) versus nitrogen (control) on AKI after cardiac surgery (NCT01802619). A total of 110 adult patients in the control arm were included. First, we determined whether fHb ratio was associated with AKI via multivariable analysis. Second, we verified whether fHb ratio could predict AKI and incorporation of fHb ratio could improve predictive performance at an early stage, compared with prediction using urinary biomarkers alone. We conducted restricted cubic spline in logistic regression for model development. We determined the predictive performance, including area under the receiver-operating-characteristics curve (AUC) and calibration (calibration plot and accuracy, ie, number of correct predictions divided by total number of predictions). We also used AUC test, likelihood ratio test, and net reclassification index (NRI) to compare the predictive performance between competing models (ie, fHb ratio versus neutrophil gelatinase-associated lipocalin [NGAL], N-acetyl-β-d-glucosaminidase [NAG], and kidney injury molecule-1 [KIM-1], respectively, and incorporation of fHb ratio with NGAL, NAG, and KIM-1 versus urinary biomarkers alone), if applicable. RESULTS Data stratified by median fHb ratio showed that subjects with an fHb ratio >2.23 presented higher incidence of AKI (80.0% vs 49.1%; P = .001), more need of renal replacement therapy (10.9% vs 0%; P = .036), and higher in-hospital mortality (10.9% vs 0%; P = .036) than subjects with an fHb ratio ≤2.23. fHb ratio was associated with AKI after adjustment for preestablished factors. fHb ratio outperformed urinary biomarkers with the highest AUC of 0.704 (95% confidence interval [CI], 0.592-0.804) and accuracy of 0.714 (95% CI, 0.579-0.804). Incorporation of fHb ratio achieved better discrimination (AUC test, P = .012), calibration (likelihood ratio test, P < .001; accuracy, 0.740 [95% CI, 0.617-0.832] vs 0.632 [95% CI, 0.477-0.748]), and significant prediction increment (NRI, 0.638; 95% CI, 0.269-1.008; P < .001) at an early stage, compared with prediction using urinary biomarkers alone. CONCLUSIONS Results from this exploratory, hypothesis-generating retrospective, observational study shows that fHb ratio at the end of CPB might be used as a novel, widely applicable biomarker for AKI. The use of fHb ratio might help for an early detection of AKI, compared with prediction based only on urinary biomarkers.
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Affiliation(s)
- Jie Hu
- From the Department of Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Francesco Zadek
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Chong Lei
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Key Experimental Factors of Machine Learning-Based Identification of Surgery Cancellations. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6247652. [PMID: 33688420 PMCID: PMC7914093 DOI: 10.1155/2021/6247652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/21/2020] [Accepted: 02/13/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to provide effective methods for the identification of surgeries with high cancellation risk based on machine learning models and analyze the key factors that affect the identification performance. The data covered the period from January 1, 2013, to December 31, 2014, at West China Hospital in China, which focus on elective urologic surgeries. All surgeries were scheduled one day in advance, and all cancellations were of institutional resource- and capacity-related types. Feature selection strategies, machine learning models, and sampling methods are the most discussed topic in general machine learning researches and have a direct impact on the performance of machine learning models. Hence, they were considered to systematically generate complete schemes in machine learning-based identification of surgery cancellations. The results proved the feasibility and robustness of identifying surgeries with high cancellation risk, with the considerable maximum of area under the curve (AUC) (0.7199) for random forest model with original sampling using backward selection strategy. In addition, one-side Delong test and sum of square error analysis were conducted to measure the effects of feature selection strategy, machine learning model, and sampling method on the identification of surgeries with high cancellation risk, and the selection of machine learning model was identified as the key factors that affect the identification of surgeries with high cancellation risk. This study offers methodology and insights for identifying the key experimental factors for identifying surgery cancellations, and it is helpful to further research on machine learning-based identification of surgeries with high cancellation risk.
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Lamarche F, Agharazii M, Madore F, Goupil R. Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure: A Prospective Study. Hypertension 2020; 77:319-327. [PMID: 33307853 PMCID: PMC7803443 DOI: 10.1161/hypertensionaha.120.16163] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text. Compared with brachial blood pressure (BP), central systolic BP (SBP) can provide a better indication of the hemodynamic strain inflicted on target organs, but it is unclear whether this translates into improved cardiovascular risk stratification. We aimed to assess which of central or brachial BP best predicts cardiovascular risk and to identify the central SBP threshold associated with increased risk of future cardiovascular events. This study included 13 461 participants of CARTaGENE with available central BP and follow-up data from administrative databases but without cardiovascular disease or antihypertensive medication. Central BP was estimated by radial artery tonometry, calibrated for brachial SBP and diastolic BP (type I), and a generalized transfer function (SphygmoCor). The outcome was major adverse cardiovascular events. Cox proportional-hazards models, differences in areas under the curves, net reclassification indices, and integrated discrimination indices were calculated. Youden index was used to identify SBP thresholds. Over a median follow-up of 8.75 years, 1327 major adverse cardiovascular events occurred. The differences in areas under the curves, net reclassification indices, and integrated discrimination indices were of 0.2% ([95% CI, 0.1–0.3] P<0.01), 0.11 ([95% CI, 0.03–0.20] P=0.01), and 0.0004 ([95% CI, −0.0001 to 0.0014] P=0.3), all likely not clinically significant. Central and brachial SBPs of 112 mm Hg (95% CI, 111.2–114.1) and 121 mm Hg (95% CI, 120.2–121.9) were identified as optimal BP thresholds. In conclusion, central BP measured with a type I device is statistically but likely not clinically superior to brachial BP in a general population without prior cardiovascular disease. Based on the risk of major adverse cardiovascular events, the optimal type I central SBP appears to be 112 mm Hg.
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Affiliation(s)
- Florence Lamarche
- From the Hôpital du Sacré-Coeur de Montréal, Déparetment de médicine, Université de Montréal, Montréal, Qc, Canada (F.L., F.M., R.G.)
| | - Mohsen Agharazii
- CHU de Québec, Hôtel-Dieu de Québec, Département de médecine, Université Laval, Québec, Qc, Canada (M.A.)
| | - François Madore
- From the Hôpital du Sacré-Coeur de Montréal, Déparetment de médicine, Université de Montréal, Montréal, Qc, Canada (F.L., F.M., R.G.)
| | - Rémi Goupil
- From the Hôpital du Sacré-Coeur de Montréal, Déparetment de médicine, Université de Montréal, Montréal, Qc, Canada (F.L., F.M., R.G.)
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Gómez-Cuervo C, Rivas A, Visonà A, Ruiz-Giménez N, Blanco-Molina Á, Cañas I, Portillo J, López-Miguel P, Flores K, Monreal M. Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index. Findings from the RIETE. J Thromb Thrombolysis 2020; 51:1017-1025. [PMID: 32945982 DOI: 10.1007/s11239-020-02274-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
Old patients receiving anticoagulant therapy for venous thromboembolism (VTE) are at an increased risk for bleeding. We used data from the RIETE registry to assess the prognostic ability of the Comorbidity Charlson Index (CCI) to predict the risk for major bleeding in patients aged > 75 years receiving anticoagulation for VTE beyond the third month. We calculated the area under the receiver-operating characteristic curve (AUC), the category-based net reclassification index (NRI) and the net benefit (NB). We included 4303 patients with a median follow-up of 706 days (interquartile range [IQR] 462-1101). Of these, 147 (3%) developed major bleeding (27 died of bleeding). The AUC was 0.569 (95% CI 0.524-0.614). Patients with CCI ≤ 4 points were at a lower risk for adverse outcomes than those with CCI > 10 (major bleeding 0.81 (95% CI 0.53-1.19) vs. 2.21 (95% CI 1.18-3.79) per 100 patient-years; p < 0.05; all-cause death 1.9 (95% CI 1.45-2.44) vs. 15.67 (95% CI 12.63-19.22) per 100 patient-years; p < 0.05). A cut-off point of 4 points (CCI4) had a sensitivity of 82% (95% CI 75-89) and a specificity of 30% (95% CI 29-31) to predict major bleeding beyond the third month. CCI4 reclassification improved the NB of the RIETE bleeding score to predict bleeding beyond the third month (CCI4 NB 1.78% vs. RIETE NB 0.44%). Although the AUC of the CCI to predict major bleeding was modest, it could become an additional help to select patients aged > 75 years that obtain more benefit of extended anticoagulation, due to a lower risk for bleeding and better survival.
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Affiliation(s)
- Covadonga Gómez-Cuervo
- Department of Internal Medicine, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n 28041, Madrid, Spain.
| | - Agustina Rivas
- Department of Pneumonology, Hospital Universitario Araba, Álava, Spain
| | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Nuria Ruiz-Giménez
- Department of Internal Medicine, Hospital Universitario, de La Princesa, Madrid, Spain
| | | | - Inmaculada Cañas
- Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - José Portillo
- Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Patricia López-Miguel
- Department of Pneumonology, Hospital General, Universitario de Albacete, Albacete, Spain
| | - Katia Flores
- Department of Hematology, Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, Spain
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Wu JY, Wang YF, Ma H, Li SS, Miao HL. Nomograms predicting long-term survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas: A population-based study. World J Gastroenterol 2020; 26:535-549. [PMID: 32089629 PMCID: PMC7015718 DOI: 10.3748/wjg.v26.i5.535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/06/2020] [Accepted: 01/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are few effective tools to predict survival in patients with invasive intraductal papillary mucinous neoplasms of the pancreas.
AIM To develop comprehensive nomograms to individually estimate the survival outcome of patients with invasive intraductal papillary mucinous neoplasms of the pancreas.
METHODS Data of 1219 patients with invasive intraductal papillary mucinous neoplasms after resection were extracted from the Surveillance, Epidemiology, and End Results database, and randomly divided into the training (n = 853) and the validation (n = 366) cohorts. Based on the Cox regression model, nomograms were constructed to predict overall survival and cancer-specific survival for an individual patient. The performance of the nomograms was measured according to discrimination, calibration, and clinical utility. Moreover, we compared the predictive accuracy of the nomograms with that of the traditional staging system.
RESULTS In the training cohort, age, marital status, histological type, T stage, N stage, M stage, and chemotherapy were selected to construct nomograms. Compared with the American Joint Committee on Cancer 7th staging system, the nomograms were generally more discriminative. The nomograms passed the calibration steps by showing high consistency between actual probability and nomogram prediction. Categorial net classification improvements and integrated discrimination improvements suggested that the predictive accuracy of the nomograms exceeded that of the American Joint Committee on Cancer staging system. With respect to decision curve analyses, the nomograms exhibited more preferable net benefit gains than the staging system across a wide range of threshold probabilities.
CONCLUSION The nomograms show improved predictive accuracy, discrimination capability, and clinical utility, which can be used as reliable tools for risk classification and treatment recommendations.
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Affiliation(s)
- Jia-Yuan Wu
- Department of Clinical Research, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Yu-Feng Wang
- School of Public Health, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
| | - Huan Ma
- School of Public Health, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
| | - Sha-Sha Li
- School of Public Health, Guangdong Medical University, Zhanjiang 524023, Guangdong Province, China
| | - Hui-Lai Miao
- Department of Clinical Research, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
- Department of Hepatobiliary Surgery, the Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524003, Guangdong Province, China
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Dalgaard F, Pieper K, Verheugt F, Camm AJ, Fox KA, Kakkar AK, Pallisgaard JL, Rasmussen PV, Weert HV, Lindhardt TB, Torp-Pedersen C, Gislason GH, Ruwald MH, Harskamp RE. GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: a Danish nationwide validation study. BMJ Open 2019; 9:e033283. [PMID: 31719095 PMCID: PMC6858250 DOI: 10.1136/bmjopen-2019-033283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To externally validate the accuracy of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) model against existing risk scores for stroke and major bleeding risk in patients with non-valvular AF in a population-based cohort. DESIGN Retrospective cohort study. SETTING Danish nationwide registries. PARTICIPANTS 90 693 patients with newly diagnosed non-valvular AF were included between 2010 and 2016, with follow-up censored at 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES External validation was performed using discrimination and calibration plots. C-statistics were compared with CHA2DS2VASc score for ischaemic stroke/systemic embolism (SE) and HAS-BLED score for major bleeding/haemorrhagic stroke outcomes. RESULTS Of the 90 693 included, 51 180 patients received oral anticoagulants (OAC). Overall median age (Q1, Q3) were 75 (66-83) years and 48 486 (53.5%) were male. At 1-year follow-up, a total of 2094 (2.3%) strokes/SE, 2642 (2.9%) major bleedings and 10 915 (12.0%) deaths occurred. The GARFIELD-AF model was well calibrated with the predicted risk for stroke/SE and major bleeding. The discriminatory value of GARFIELD-AF risk model was superior to CHA2DS2VASc for predicting stroke in the overall cohort (C-index: 0.71, 95% CI: 0.70 to 0.72 vs C-index: 0.67, 95% CI: 0.66 to 0.68, p<0.001) as well as in low-risk patients (C-index: 0.64, 95% CI: 0.59 to 0.69 vs C-index: 0.57, 95% CI: 0.53 to 0.61, p=0.007). The GARFIELD-AF model was comparable to HAS-BLED in predicting the risk of major bleeding in patients on OAC therapy (C-index: 0.64, 95% CI: 0.63 to 0.66 vs C-index: 0.64, 95% CI: 0.63 to 0.65, p=0.60). CONCLUSION In a nationwide Danish cohort with non-valvular AF, the GARFIELD-AF model adequately predicted the risk of ischaemic stroke/SE and major bleeding. Our external validation confirms that the GARFIELD-AF model was superior to CHA2DS2VASc in predicting stroke/SE and comparable with HAS-BLED for predicting major bleeding.
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Affiliation(s)
- Frederik Dalgaard
- Cardiology, Gentofte Hospital, Hellerup, Copenhagen, Denmark
- Duke Clinical Research Institute, Duke University, Durham, United States
| | - Karen Pieper
- Duke Clinical Research Institute, Duke University, Durham, United States
- Department of Clinical Research, Thrombosis Research Institute, London, UK
| | - Freek Verheugt
- Onze Lieve Vrouwe Gasthuis, Amsterdam, Noord-Holland, the Netherlands
| | - A John Camm
- Department of Cardiology, University of London St George's Molecular and Clinical Sciences Research Institute, London, UK
| | - Keith Aa Fox
- Cardiology, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ajay K Kakkar
- Department of Clinical Research, Thrombosis Research Institute, London, UK
- Department of Surgery, University College London, London, United Kingdom
| | | | | | - Henk van Weert
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health and Amsterdam Cardiovascular Sciences Research Institutes, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Christian Torp-Pedersen
- Cardiology, Gentofte Hospital, Hellerup, Copenhagen, Denmark
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerod, Denmark
| | - Gunnar H Gislason
- Cardiology, Gentofte Hospital, Hellerup, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin H Ruwald
- Cardiology, Gentofte Hospital, Hellerup, Copenhagen, Denmark
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health and Amsterdam Cardiovascular Sciences Research Institutes, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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33
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Lüscher TF. Arrhythmias and their management in long QT, ARVC, and atrial fibrillation. Eur Heart J 2019; 40:1819-1822. [PMID: 33215660 DOI: 10.1093/eurheartj/ehz401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals, London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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