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Basem M, Bonnesen K, Schmidt M. Potential of the Danish Comorbidity Index for Acute Myocardial Infarction to discriminate mortality in patients with infective endocarditis. Int J Cardiol 2024; 412:132328. [PMID: 38964553 DOI: 10.1016/j.ijcard.2024.132328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Current risk score models for predicting mortality in infective endocarditis (IE) include data often unavailable in registries, limiting their use for confounding adjustment in population-based research. METHODS This study assessed the Danish Comorbidity Index for Acute Myocardial Infarction (DANCAMI) for its ability to predict 30-day, 1-year, and 5-year mortality in IE patients, compared to the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). The study included all adult Danish patients with first-time IE from 1995 to 2021. The area under the receiver operating characteristic curve (AUC) was estimated using logistic regression to measure discriminatory performance for all-cause and cardiovascular mortality at the specified time intervals. A baseline model included age and sex, while extended models incorporated continuous comorbidity scores. RESULTS We identified 8966 patients with IE. Mortality rates were 12% at 30 days, 26% at 1 year, and 36% at 5 years. For all-cause mortality, AUCs for the baseline versus DANCAMI models were 0.64 vs. 0.69 at 30 days, 0.66 vs. 0.73 at 1 year, and 0.72 vs. 0.79 at 5 years. For cardiovascular mortality, AUCs for baseline versus DANCAMI models were 0.67 vs. 0.69 at 30 days, 0.67 vs. 0.69 at 1 year, and 0.70 vs. 0.71 at 5 years. CCI and ECI demonstrated comparable AUCs to the DANCAMI model. CONCLUSION DANCAMI improved discrimination of short- and long-term mortality in IE patients and may be used for confounder adjustment similarly to CCI and ECI.
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Affiliation(s)
- Mohab Basem
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; University Clinic for Cardiovascular Research, Department of Cardiology, Gødstrup Hospital, Herning, Denmark
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Karisik A, Bader V, Moelgg K, Buergi L, Dejakum B, Komarek S, Eller MT, Toell T, Mayer-Suess L, Pechlaner R, Granna J, Sollereder S, Rossi S, Schoenherr G, Willeit J, Willeit P, Lang W, Kiechl S, Knoflach M, Boehme C. Comorbidities associated with dysphagia after acute ischemic stroke. BMC Neurol 2024; 24:358. [PMID: 39342159 PMCID: PMC11438413 DOI: 10.1186/s12883-024-03863-1] [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: 07/02/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Pre-existing comorbidities increase the likelihood of post-stroke dysphagia. This study investigates comorbidity prevalence in patients with dysphagia after ischemic stroke. METHODS The data of patients with acute ischemic stroke from two large representative cohorts (STROKE-CARD trial 2014-2019 and STROKE-CARD registry 2020-2022 - both study center Innsbruck, Austria) were analyzed for the presence of dysphagia at hospital admission (clinical swallowing examination). Comorbidities were assessed using the Charlson Comorbidity Index (CCI). RESULTS Of 2054 patients with ischemic stroke, 17.2% showed dysphagia at hospital admission. Patients with dysphagia were older (77.8 ± 11.9 vs. 73.6 ± 14.3 years, p < 0.001), had more severe strokes (NIHSS 7(4-12) vs. 2(1-4), p < 0.001) and had higher CCI scores (4.7 ± 2.1 vs. 3.8 ± 2.0, p < 0.001) than those without swallowing impairment. Dysphagia correlated with hypertension (p = 0.034), atrial fibrillation (p < 0.001), diabetes (p = 0.002), non-smoking status (p = 0.014), myocardial infarction (p = 0.002), heart failure (p = 0.002), peripheral arterial disease (p < 0.001), severe chronic liver disease (p = 0.002) and kidney disease (p = 0.010). After adjusting for relevant factors, the associations with dysphagia remained significant for diabetes (p = 0.005), peripheral arterial disease (p = 0.007), kidney disease (p = 0.014), liver disease (p = 0.003) and overall CCI (p < 0.001). CONCLUSIONS Patients with multiple comorbidities have a higher risk of developing post-stroke dysphagia. Therefore, early and thorough screening for swallowing impairment after acute ischemic stroke is crucial especially in those with multiple concomitant diseases. TRIAL REGISTRATION Stroke Card Registry (NCT04582825), Stroke Card Trial (NCT02156778).
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Affiliation(s)
- Anel Karisik
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Vincent Bader
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Kurt Moelgg
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Lucie Buergi
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Michael Thomas Eller
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Julian Granna
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
| | - Simon Sollereder
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
| | - Sonja Rossi
- ICONE - Innsbruck Cognitive Neuroscience, Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Peter Willeit
- Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, The Old Schools, Trinity Ln, Cambridge, UK
| | - Wilfried Lang
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Medical Faculty, Sigmund Freud Private University, Freudplatz 1, Vienna, Austria
| | - Stefan Kiechl
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Michael Knoflach
- VASCage - Centre on Clinical Stroke Research, Adamgasse 23, Innsbruck, Austria.
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
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Feng H, Zhang J, Qin Z, Zhu Y, Zhu X, Chen L, Lu Z, Huang Y. Analysis of readmission and hospitalization expenditures of patients with ischemic stroke suffering from different comorbidities. Heliyon 2024; 10:e36462. [PMID: 39286193 PMCID: PMC11403424 DOI: 10.1016/j.heliyon.2024.e36462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/15/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Background The comorbidities of ischemic stroke (IS) are increasing worldwide. This study aimed to quantitatively assess the effect of different types of comorbidity on readmission and hospitalization expenditures of patients with IS. Methods A retrospective observational study was conducted from the basic insurance claims database of a large city in China, between January 1, 2018, and May 31, 2022. We identified patients with IS aged 18 years and over, who experienced the first episode of IS and had one-year follow-up records. This study divided eighteen different comorbid conditions into two categories (concordant comorbidity and discordant comorbidity) and the IS patients were further categorized into four groups. Multivariable logistic regression models and generalized linear models with log-link and gamma distribution were to estimate the effect of different comorbidity groups on one-year readmission rates and annual hospitalization expenditures. Results In total, 99,649 adult patients with IS were identified. Approximately 94.0 % of patients with IS had at least one comorbidity, and 63.8 % reported concordant comorbidity only. Patients with IS had a readmission rate of 26.7 %, and the mean of annual hospitalization expenditure and annual hospitalization out-of-pocket expenditure (OOPE) were 28086.6 Chinese Yuan (CNY) and 8267.3 CNY, respectively. After adjustment for covariates, the concordant comorbidity-only group had the highest readmission rate, annual hospitalization expenditure, and OOPE compared with the other groups, furthermore, these results increased as the number of comorbidity increased and had statistically significant positive associations. Conclusions The readmission and annual hospitalization expenditures of patients with IS were associated with different comorbidities. Concordant comorbidity increased hospital readmission risk and health expenditures. To better manage the comorbidities of patients with IS, especially concordant comorbidities, it is necessary to establish a routine care strategy specifically for comorbid conditions.
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Affiliation(s)
- Honghong Feng
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Jiachi Zhang
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Zhenhua Qin
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Yi Zhu
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Xiaodi Zhu
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Lijin Chen
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
| | - Zhengqi Lu
- Department of Neurology, Mental and Neurological Disease Research Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yixiang Huang
- Department of Health Policy & Management, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, 510080, China
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Joundi RA, Hill MD, Stang J, Nicol D, Yu AYX, Kapral MK, King JA, Halabi ML, Smith EE. Association Between Time to Treatment With Endovascular Thrombectomy and Home-Time After Acute Ischemic Stroke. Neurology 2024; 102:e209454. [PMID: 38848515 DOI: 10.1212/wnl.0000000000209454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Home-time is a patient-prioritized stroke outcome that can be derived from administrative data linkages. The effect of faster time-to-treatment with endovascular thrombectomy (EVT) on home-time after acute stroke is unknown. METHODS We used the Quality Improvement and Clinical Research registry to identify a cohort of patients who received EVT for acute ischemic stroke between 2015 and 2022 in Alberta, Canada. We calculated days at home in the first 90 days after stroke. We used ordinal regression across 6 ordered categories of home-time to evaluate the association between onset-to-arterial puncture and higher home-time, adjusting for age, sex, rural residence, NIH Stroke Scale, comorbidities, intravenous thrombolysis, and year of treatment. We used restricted cubic splines to assess the nonlinear relationship between continuous variation in time metrics and higher home-time, and also reported the adjusted odds ratios within time categories. We additionally evaluated door-to-puncture and reperfusion times. Finally, we analyzed home-time with zero-inflated models to determine the minutes of earlier treatment required to gain 1 day of home-time. RESULTS We had 1,885 individuals in our final analytic sample. There was a nonlinear increase in home-time with faster treatment when EVT was within 4 hours of stroke onset or 2 hours of hospital arrival. There was a higher odds of achieving more days at home when onset-to-puncture time was <2 hours (adjusted odds ratio 2.36, 95% CI 1.77-3.16) and 2 to <4 hours (1.37, 95% CI 1.11-1.71) compared with ≥6 hours, and when door-to-puncture time was <1 hour (aOR 2.25, 95% CI 1.74-2.90), 1 to <1.5 hours (aOR 1.89, 95% CI 1.47-2.41), and 1.5 to <2 hours (1.35, 95% CI 1.04-1.76) compared with ≥2 hours. Results were consistent for reperfusion times. For every hour of faster treatment within 6 hours of stroke onset, there was an estimated increase in home-time of 4.7 days, meaning that approximately 1 day of home-time was gained for each 12.8 minutes of faster treatment. DISCUSSION Faster time-to-treatment with EVT for acute stroke was associated with greater home-time, particularly within 4 hours of onset-to-puncture and 2 hours of door-to-puncture time. Within 6 hours of stroke onset, each 13 minutes of faster treatment is associated with a gain of 1 day of home-time.
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Affiliation(s)
- Raed A Joundi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Michael D Hill
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Jillian Stang
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Dana Nicol
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Amy Ying Xin Yu
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Moira K Kapral
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - James A King
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Mary-Lou Halabi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Eric E Smith
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
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Rose DZ, DiGiorgi P, Ramlawi B, Pulungan Z, Teigland C, Calkins H. Minimally invasive epicardial surgical left atrial appendage exclusion for atrial fibrillation patients at high risk for stroke and for bleeding. Heart Rhythm 2024; 21:771-779. [PMID: 38296011 DOI: 10.1016/j.hrthm.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) patients at high risk for stroke and for bleeding may be unsuitable for either oral anticoagulation or endocardial left atrial appendage (LAA) occlusion. However, minimally invasive, epicardial left atrial appendage exclusion (LAAE) may be an option. OBJECTIVE The purpose of this study was to evaluate outcomes of LAAE in high-risk AF patients not receiving oral anticoagulation. METHODS A retrospective analysis of Medicare claims data was conducted to evaluate thromboembolic events in AF patients who underwent LAAE compared to a 1:4 propensity score-matched group of patients who did not receive LAAE (control). Neither group was receiving any oral anticoagulation at baseline or follow-up. Fine-Gray models estimated hazard ratios and evaluated between-group differences. Bootstrapping was applied to generate 95% confidence intervals (CIs). RESULTS The LAAE group (n = 243) was 61% male (mean age 75 years). AF was nonparoxysmal in 70% (mean CHA2DS2-VASc score 5.4; mean HAS-BLED score 4.2). The matched control group (n = 972) had statistically similar characteristics. One-year adjusted estimates of thromboembolic events were 7.3% (95% CI 4.3%-11.1%) in the LAAE group and 12.1% (95% CI 9.5%-14.8%) in the control group. Absolute risk reduction was 4.8% (95% CI 0.6%-8.9%; P = .028). Adjusted hazard ratio for thromboembolic events for LAAE vs non-LAAE was 0.672 (95% CI 0.394-1.146). CONCLUSION In AF patients not taking oral anticoagulation who are at high risk for stroke and for bleeding, minimally invasive, thoracoscopic, epicardial LAAE was associated with a lower rate of thromboembolic events.
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Affiliation(s)
- David Z Rose
- University of South Florida Morsani College of Medicine, Tampa, Florida.
| | | | - Basel Ramlawi
- Lankenau Heart Institute, Main Line Health, Philadelphia, Philadelphia
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Pan ZM, Zeng J, Li T, Hu F, Cai XY, Wang XJ, Liu GZ, Hu XH, Yang X, Lu YH, Liu MY, Gong YP, Liu M, Li N, Li CL. Age-adjusted Charlson comorbidity index is associated with the risk of osteoporosis in older fall-prone men: a retrospective cohort study. BMC Geriatr 2024; 24:413. [PMID: 38730354 PMCID: PMC11084079 DOI: 10.1186/s12877-024-05015-z] [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: 01/08/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. METHODS A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI < 5), and high (aCCI ≥5). The Kaplan Meier method was used to assess the cumulative incidence of osteoporosis by different levels of aCCI. The Cox proportional hazards regression model was used to estimate the association of aCCI with the risk of osteoporosis. Receiver operating characteristic (ROC) curve was adapted to assess the performance for aCCI in osteoporosis screening. RESULTS At baseline, the mean age of all patients was 75.7 years, the mean BMI was 24.8 kg/m2, and 531 (56.1%) patients had high aCCI while 416 (43.9%) were having low aCCI. During a median follow-up of 6.6 years, 296 participants developed osteoporosis. Kaplan-Meier survival curves showed that participants with high aCCI had significantly higher cumulative incidence of osteoporosis compared with those had low aCCI (log-rank test: P < 0.001). When aCCI was examined as a continuous variable, the multivariable-adjusted model showed that the osteoporosis risk increased by 12.1% (HR = 1.121, 95% CI 1.041-1.206, P = 0.002) as aCCI increased by one unit. When aCCI was changed to a categorical variable, the multivariable-adjusted hazard ratios associated with different levels of aCCI [low (reference group) and high] were 1.00 and 1.557 (95% CI 1.223-1.983) for osteoporosis (P < 0.001), respectively. The aCCI (cutoff ≥5) revealed an area under ROC curve (AUC) of 0.566 (95%CI 0.527-0.605, P = 0.001) in identifying osteoporosis in older fall-prone men, with sensitivity of 64.9% and specificity of 47.9%. CONCLUSIONS The current study indicated an association of higher aCCI with an increased risk of osteoporosis among older fall-prone men, supporting the possibility of aCCI as a marker of long-term skeletal-related adverse clinical outcomes.
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Affiliation(s)
- Zi-Mo Pan
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jing Zeng
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ting Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fan Hu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Yan Cai
- Department of Nephrology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xin-Jiang Wang
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Guan-Zhong Liu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xing-He Hu
- Department of Radiology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xue Yang
- Outpatient Department, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Hui Lu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Min-Yan Liu
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Ping Gong
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Miao Liu
- Department of anti-NBC medicine, Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Nan Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Chun-Lin Li
- Department of Endocrinology, The Second Medical Center & National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Shaikh N, Mohammed A, Seddiq M, Kidwai S, Shahzad D, Mahmoud MM. The Effect of the Charlson Comorbidity Index On In-Hospital Complications, Hospital Length of Stay, Mortality, and Readmissions Among Patients Hospitalized for Acute Stroke. Cureus 2024; 16:e60112. [PMID: 38864047 PMCID: PMC11164611 DOI: 10.7759/cureus.60112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
Aim A notable number of people who develop stroke have comorbid medical conditions. The aim of this study is to evaluate the use of the Charlson Comorbidity Index (CCI) to predict in-hospital complications, mortality, length of stay, and readmission rates in stroke patients. Method It is a retrospective study that analyzed patients who were admitted for stroke in a six-month time duration. Stroke was classified into ischemic, hemorrhagic, or undetermined; hospital complications were classified into medical or neurological. Data regarding comorbidities, complications, length of stay, mortality, and readmissions were documented. Comorbidities were then classified by the CCI and split into four categories: zero, mild (1-2), moderate (3-4) and severe (5+). The data was analyzed using SPSS (IBM, Inc., Armonk, US). Results Four hundred and seventy-three adults aged above 18 were hospitalized for acute stroke. There was no correlation between the severity of the CCI score and mortality. Patients with ischemic stroke had a higher CCI correlated with readmission rate (p=0.026) and hospital complications (p=0.054). The two groups with the highest intensive care unit admission rate were mild, followed by the severe group (p=0.001). Our study also revealed that the patients with severe CCI scores had an increased readmission rate (p=0.001). Conclusion There is a correlation between a high CCI score and readmission rate, as well as CCI score with hospital complications in ischemic stroke. Further prospective studies of a longer duration can be undertaken to find further associations with the potential for this score to be used as a predictor in patients hospitalized for stroke.
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Affiliation(s)
- Niaz Shaikh
- Internal Medicine, Rashid Hospital, Dubai, ARE
| | - Asna Mohammed
- Internal Medicine, Rashid Hospital, Dubai, ARE
- Internal Medicine, Hackensack University Medical Center, Hackensack, USA
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8
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SN, Agaltsov MV, Alekseeva LI, Almazova II, Andreenko EY, Antipushina DN, Balanova YA, Berns SA, Budnevsky AV, Gainitdinova VV, Garanin AA, Gorbunov VM, Gorshkov AY, Grigorenko EA, Jonova BY, Drozdova LY, Druk IV, Eliashevich SO, Eliseev MS, Zharylkasynova GZ, Zabrovskaya SA, Imaeva AE, Kamilova UK, Kaprin AD, Kobalava ZD, Korsunsky DV, Kulikova OV, Kurekhyan AS, Kutishenko NP, Lavrenova EA, Lopatina MV, Lukina YV, Lukyanov MM, Lyusina EO, Mamedov MN, Mardanov BU, Mareev YV, Martsevich SY, Mitkovskaya NP, Myasnikov RP, Nebieridze DV, Orlov SA, Pereverzeva KG, Popovkina OE, Potievskaya VI, Skripnikova IA, Smirnova MI, Sooronbaev TM, Toroptsova NV, Khailova ZV, Khoronenko VE, Chashchin MG, Chernik TA, Shalnova SA, Shapovalova MM, Shepel RN, Sheptulina AF, Shishkova VN, Yuldashova RU, Yavelov IS, Yakushin SS. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2024; 23:3696. [DOI: 10.15829/1728-8800-2024-3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2024] Open
Abstract
Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.
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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Yu AYX, Kapral MK, Smith EE. Age-Specific Association of Co-Morbidity With Home-Time After Acute Stroke. Can J Neurol Sci 2024:1-9. [PMID: 38532570 DOI: 10.1017/cjn.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To examine the association of co-morbidity with home-time after acute stroke and whether the association is influenced by age. METHODS We conducted a province-wide study using linked administrative databases to identify all admissions for first acute ischemic stroke or intracerebral hemorrhage between 2007 and 2018 in Alberta, Canada. We used ischemic stroke-weighted Charlson Co-morbidity Index of 3 or more to identify those with severe co-morbidity. We used zero-inflated negative binomial models to determine the association of severe co-morbidity with 90-day and 1-year home-time, and logistic models for achieving ≥ 80 out of 90 days of home-time, assessing for effect modification by age and adjusting for sex, stroke type, comprehensive stroke center care, hypertension, atrial fibrillation, year of study, and separately adjusting for estimated stroke severity. We also evaluated individual co-morbidities. RESULTS Among 28,672 patients in our final cohort, severe co-morbidity was present in 27.7% and was associated with lower home-time, with a greater number of days lost at younger age (-13 days at age < 60 compared to -7 days at age 80+ years for 90-day home-time; -69 days at age < 60 compared to -51 days at age 80+ years for 1-year home-time). The reduction in probability of achieving ≥ 80 days of home-time was also greater at younger age (-22.7% at age < 60 years compared to -9.0% at age 80+ years). Results were attenuated but remained significant after adjusting for estimated stroke severity and excluding those who died. Myocardial infarction, diabetes, and cancer/metastases had a greater association with lower home-time at younger age, and those with dementia had the greatest reduction in home time. CONCLUSION Severe co-morbidity in acute stroke is associated with lower home-time, more strongly at younger age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - James A King
- Provincial Research Data Services, Alberta Health Services, Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy Y X Yu
- ICES, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moira K Kapral
- ICES, Toronto, ON, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric E Smith
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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10
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Lin L, Ding L, Fu Z, Zhang L. Machine learning-based models for prediction of the risk of stroke in coronary artery disease patients receiving coronary revascularization. PLoS One 2024; 19:e0296402. [PMID: 38330052 PMCID: PMC10852291 DOI: 10.1371/journal.pone.0296402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/12/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND To construct several prediction models for the risk of stroke in coronary artery disease (CAD) patients receiving coronary revascularization based on machine learning methods. METHODS In total, 5757 CAD patients receiving coronary revascularization admitted to ICU in Medical Information Mart for Intensive Care IV (MIMIC-IV) were included in this cohort study. All the data were randomly split into the training set (n = 4029) and testing set (n = 1728) at 7:3. Pearson correlation analysis and least absolute shrinkage and selection operator (LASSO) regression model were applied for feature screening. Variables with Pearson correlation coefficient<9 were included, and the regression coefficients were set to 0. Features more closely related to the outcome were selected from the 10-fold cross-validation, and features with non-0 Coefficent were retained and included in the final model. The predictive values of the models were evaluated by sensitivity, specificity, area under the curve (AUC), accuracy, and 95% confidence interval (CI). RESULTS The Catboost model presented the best predictive performance with the AUC of 0.831 (95%CI: 0.811-0.851) in the training set, and 0.760 (95%CI: 0.722-0.798) in the testing set. The AUC of the logistic regression model was 0.789 (95%CI: 0.764-0.814) in the training set and 0.731 (95%CI: 0.686-0.776) in the testing set. The results of Delong test revealed that the predictive value of the Catboost model was significantly higher than the logistic regression model (P<0.05). Charlson Comorbidity Index (CCI) was the most important variable associated with the risk of stroke in CAD patients receiving coronary revascularization. CONCLUSION The Catboost model was the optimal model for predicting the risk of stroke in CAD patients receiving coronary revascularization, which might provide a tool to quickly identify CAD patients who were at high risk of postoperative stroke.
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Affiliation(s)
- Lulu Lin
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Li Ding
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Zhongguo Fu
- Department of Neurology, Shenyang First People’s Hospital, Shenyang, Liaoning, China
| | - Lijiao Zhang
- Department of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
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11
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Kang Y, Stoddard G, Stehlik J, Stephens C, Facelli J, Gouripeddi R, Horne BD. Developing 60-Day Readmission Risk Score among Home Healthcare Patients with Heart Failure. Home Healthc Now 2024; 42:42-51. [PMID: 38190163 DOI: 10.1097/nhh.0000000000001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Heart failure (HF) readmissions are common, costly, and often preventable. Despite the implementation of HF programs across clinical settings, rehospitalization is still common. Efforts to identify risk factors for 60-day rehospitalization among HF patients exist, but risk scoring has not been utilized in home healthcare. The purpose of this study was to develop a 60-day rehospitalization risk score for home care patients with HF. This study is a secondary data analysis of a retrospective cross-sectional dataset that was composed of data using the Outcome Assessment Information Set (OASIS)-C version for patients with HF. We computed the Charlson Comorbidity Index (CCI) to use as a confounder. The risk score was computed from the final logistic regression model regression coefficients. The median age was 78 years old, 45.4% were male, and 81.0% were White. We identified 10 significant risk factors including CCI score. The risk score achieved a c-statistic of 0.70 in this patient sample. This risk score could prove useful in clinical practice for guiding attention and decision-making for personalized care of patients with unrecognized or under-treated health needs.
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12
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Bonnesen K, Heide-Jørgensen U, Sørensen HT, Schmidt M. Ability of the DANCAMI to predict the risk ischemic stroke and mortality in patients with atrial fibrillation/flutter. J Stroke Cerebrovasc Dis 2023; 32:107219. [PMID: 37453409 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107219] [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: 02/24/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES Comparison of the danish comorbidity index for acute myocardial infarction (DANCAMI), the charlson comorbidity index (CCI), the elixhauser comorbidity index (ECI), and the CHA2DS2-VASc score to predict ischemic stroke, cardiovascular mortality, and all-cause mortality after atrial fibrillation/flutter. MATERIALS AND METHODS A population-based cohort study of all Danish patients with incident atrial fibrillation/flutter during 2000-2020 (n=361,901). C-Statistics were used to evaluate the discriminatory performance for predicting 1 and 5-year risks of the outcomes for a baseline model (including age and sex) +/- the individual indices. RESULTS For the DANCAMI, the 5-year risk did not increase with comorbidity burden for ischemic stroke (5.9% for low vs. 5.6% for severe) but did increase for cardiovascular mortality (10% for low vs. 16% for severe) and all-cause mortality (33% for low vs. 61% for severe). C-Statistics for predicting 5-year ischemic stroke risk were similar for all models (0.64). C-Statistics for predicting 5-year cardiovascular mortality risk were also similar for the baseline (0.76), the DANCAMI (0.77), the CCI (0.76), the ECI (0.76), and the CHA2DS2-VASc (0.76) models. C-Statistics for predicting 5-year all-cause mortality risk were lower for the baseline (0.71) and the CHA2DS2-VASc (0.71) models than for the DANCAMI (0.75), the CCI (0.74), and the ECI (0.74) models. The 1-year C-Statistics were comparable. CONCLUSION The DANCAMI predicted ischemic stroke and cardiovascular mortality risks similar to the CCI, the ECI, and the CHA2DS2-VASc. The DANCAMI predicted all-cause mortality risk similar to the CCI and the ECI, but better than the baseline and the CHA2DS2-VASc.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
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13
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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Quan H, Faris P, Yu AYX, Kapral MK, Smith EE. Association of co-morbidity with acute stroke mortality by age and time since stroke: A population-based study. J Stroke Cerebrovasc Dis 2023; 32:107236. [PMID: 37429113 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107236] [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: 12/11/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To examine whether the association of co-morbidity with mortality after acute stroke is influenced by stroke type, age, sex, or time since stroke. MATERIALS AND METHODS We conducted a province-wide population-based study using linked administrative databases to identify all admissions for acute stroke between 2007-2018 in Alberta, Canada. We used Cox proportional hazard models to determine the association of severe co-morbidity based on the Charlson Co-morbidity Index with 1-year mortality after stroke, assessing for effect modification by stroke type, age, and sex, and with adjustment for estimated stroke severity, comprehensive stroke centre care, hypertension, atrial fibrillation, and year of study. We used a piecewise model to analyze the impact of co-morbidity across four time periods. RESULTS We had 28,672 patients in our final cohort (87.8% ischemic stroke). The hazard of mortality with severe co-morbidity was higher for individuals with ischemic stroke (adjusted hazard ratio [aHR] 2.20, 95% CI 2.07-2.32) compared to those with intracerebral hemorrhage (aHR 1.70, 95% CI 1.51-1.92; pint<0.001), and higher in individuals under age 75 (aHR 3.20, 95% CI 2.90-3.53) compared to age ≥75 (aHR 1.93, 95% CI 1.82-2.05, pint<0.001). There was no interaction by sex. The hazard ratio increased in a graded fashion at younger ages and was higher after the first 30 days of acute stroke. CONCLUSION There was a stronger association between co-morbidity and mortality at younger age and in the subacute phase of stroke. Further research is needed to determine the reason for these findings and identify ways to improve outcomes among those with stroke and co-morbid conditions at young age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada.
| | - James A King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Michael D Hill
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
| | - Peter Faris
- The O'Brien Institute for Public Health, University of Calgary, Health Services Statistical and Analytic Methods, Data and Analytics (DnA), Alberta Health Services, Foothills Medical Centre, Calgary, AB Canada
| | - Amy Y X Yu
- ICES, Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada
| | - Moira K Kapral
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
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14
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Bonnesen K, Mols RE, Løgstrup B, Gustafsson F, Eiskjær H, Schmidt M. The Ability of Comorbidity Indices to Predict Mortality After Heart Transplantation: A Validation of the Danish Comorbidity Index for Acute Myocardial Infarction, Charlson Comorbidity Index, and Elixhauser Comorbidity Index. Transplant Direct 2023; 9:e1438. [PMID: 36935871 PMCID: PMC10019203 DOI: 10.1097/txd.0000000000001438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 03/17/2023] Open
Abstract
Advanced heart failure patients often have comorbidities of prognostic importance. However, whether total pretransplantation comorbidity burden predicts mortality in patients treated with heart transplantation (HTx) is unknown. We used population-based hospital and prescription data to examine the ability of the Danish Comorbidity Index for Acute Myocardial Infarction (DANCAMI), DANCAMI restricted to noncardiovascular diseases, Charlson Comorbidity Index, and Elixhauser Comorbidity Index to predict 30-d, 1-y, 5-y, and 10-y all-cause and cardiovascular mortality after HTx. Methods We identified all adult Danish patients with incident HTx from the Scandiatransplant Database between March 1, 1995, and December 31, 2018 (n = 563). We calculated Harrell's C-Statistics to examine discriminatory performance. Results The C-Statistic for predicting 1-y all-cause mortality after HTx was 0.58 (95% confidence interval [CI], 0.50-0.65) for a baseline model including age and sex. Adding comorbidity score to the baseline model did not increase the C-Statistics for DANCAMI (0.58; 95% CI, 0.50-0.65), DANCAMI restricted to noncardiovascular diseases (0.57; 95% CI, 0.50-0.64), Charlson Comorbidity Index (0.59; 95% CI, 0.51-0.66), or Elixhauser Comorbidity Index (0.58; 95% CI, 0.51-0.65). The results for 30-d, 5-y, and 10-y all-cause and cardiovascular mortality were consistent. Conclusions After accounting for patient age and sex, none of the commonly used comorbidity indices added predictive value to short- or long-term all-cause or cardiovascular mortality after HTx.
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Affiliation(s)
- Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rikke E. Mols
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Løgstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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15
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Moura LM, Donahue MA, Yan Z, Smith LH, Hsu J, Newhouse JP, Lee S, Haneuse S, Hernandez-Diaz S, Blacker D. Comparative Effectiveness and Safety of Seizure Prophylaxis Among Adults After Acute Ischemic Stroke. Stroke 2023; 54:527-536. [PMID: 36544249 PMCID: PMC9870933 DOI: 10.1161/strokeaha.122.039946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Older adults occasionally receive seizure prophylaxis in an acute ischemic stroke (AIS) setting, despite safety concerns. There are no trial data available about the net impact of early seizure prophylaxis on post-AIS survival. METHODS Using a stroke registry (American Heart Association's Get With The Guidelines) individually linked to electronic health records, we examined the effect of initiating seizure prophylaxis (ie, epilepsy-specific antiseizure drugs) within 7 days of an AIS admission versus not initiating in patients ≥65 years admitted for a new, nonsevere AIS (National Institutes of Health Stroke Severity score ≤20) between 2014 and 2021 with no recorded use of epilepsy-specific antiseizure drugs in the previous 3 months. We addressed confounding by using inverse-probability weights. We performed standardization accounting for pertinent clinical and health care factors (eg, National Institutes of Health Stroke Severity scale, prescription counts, seizure-like events). RESULTS The study sample included 151 patients who received antiseizure drugs and 3020 who did not. The crude 30-day mortality risks were 219 deaths per 1000 patients among epilepsy-specific antiseizure drugs initiators and 120 deaths per 1000 among noninitiators. After standardization, the estimated mortality was 251 (95% CI, 190-307) deaths per 1000 among initiators and 120 (95% CI, 86-144) deaths per 1000 among noninitiators, corresponding to a risk difference of 131 (95% CI, 65-200) excess deaths per 1000 patients. In the prespecified subgroup analyses, the risk difference was 52 (95% CI, 11-72) among patients with minor AIS and 138 (95% CI, 52-222) among moderate-to-severe AIS patients. Similarly, the risk differences were 86 (95% CI, 18-118) and 157 (95% CI, 57-219) among patients aged 65 to 74 years and ≥75 years, respectively. CONCLUSIONS There was a higher risk of 30-day mortality associated with initiating versus not initiating seizure prophylaxis within 7 days post-AIS. This study does not support the role of seizure prophylaxis in reducing 30-day poststroke mortality.
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Affiliation(s)
- Lidia M.V.R. Moura
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Maria A. Donahue
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Zhiyu Yan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Louisa H. Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John Hsu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joseph P. Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- National Bureau of Economic Research, Cambridge, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Harvard Kennedy School, Cambridge, Massachusetts
| | - Schwamm Lee
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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16
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Díaz del Arco C, Estrada Muñoz L, Ortega Medina L, Molina Roldán E, Cerón Nieto MÁ, García Gómez de las Heras S, Fernández Aceñero MJ. Clinicopathological differences, risk factors and prognostic scores for western patients with intestinal and diffuse-type gastric cancer. World J Gastrointest Oncol 2022; 14:1162-1174. [PMID: 35949214 PMCID: PMC9244993 DOI: 10.4251/wjgo.v14.i6.1162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/01/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the molecular era, the Laurén system is still a cost-effective and widely implemented classification for gastric cancer (GC) and it has been recently associated with clinical, histological and molecular features of these tumors. Despite recent advances in the understanding of the molecular biology of GC, there is a need to develop new prognostic tools for patient stratification in clinical practice. Thus, the identification of easily available prognostic factors in patients with intestinal and diffuse-type tumors can significantly improve risk assessment and patient stratification in GC.
AIM To identify clinicopathological differences, risk factors, and to develop cost-effective prognostic scores for patients with intestinal and diffuse-type GC.
METHODS Retrospective study of all patients undergoing surgery for GC at a tertiary referral center from 2001 to 2019. 286 cases met inclusion criteria (intestinal: 190, diffuse: 96). Clinical data and gross findings were collected. All specimens were reviewed by two independent pathologists and a detailed protocol for histologic evaluation was followed. Five tissue microarrays (TMAs) were constructed and sections of the TMA block were immunostained for HERCEPTEST, MSH2, MSH6, MLH1 and PMS2. Statistical analyses were performed and prognostic scores were developed based on hazard ratios.
RESULTS Intestinal and diffuse-type GC showed different epidemiological, clinicopathological and prognostic features. Diffuse tumors were significantly associated with younger age, less symptomatology, flat morphology, deeper invasion, perineural infiltration, advanced stage at diagnosis, administration of adjuvant therapy and poorer prognosis. Intestinal lesions were fungoid or polypoid, showed necrosis, desmoplasia, microsatellite instability and HERCEPTEST positivity and were diagnosed at earlier stages. Tumor depth, desmoplasia, macroscopic type and lymph node involvement were independently related to the Laurén subtype. Furthermore, intestinal and diffuse GC were associated with different risk factors for progression and death. Vascular invasion, perineural infiltration and growth pattern were important prognostic factors in intestinal-type GC. On the contrary, tumor size and necrosis were significant prognosticators in diffuse-type GC. Our recurrence and cancer-specific death scores for patients with intestinal and diffuse-type GC showed an excellent patient stratification into three (diffuse GC) or four (intestinal) prognostic groups.
CONCLUSION Our findings support that Laurén subtypes represent different clinicopathological and biological entities. The development of specific prognostic scores is a useful and cost-effective strategy to improve risk assessment in GC.
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Affiliation(s)
- Cristina Díaz del Arco
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid 28040, Spain
| | - Lourdes Estrada Muñoz
- Department of Surgical Pathology, Hospital Rey Juan Carlos, Madrid 28933, Spain
- Department of Basic Medical Sciences, Rey Juan Carlos University, Madrid 28933, Spain
| | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid 28040, Spain
| | - Elena Molina Roldán
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
| | | | | | - M Jesús Fernández Aceñero
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
- Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid 28040, Spain
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17
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External validation of the Passive Surveillance Stroke Severity Indicator. Neurol Sci 2022; 50:399-404. [PMID: 35478064 DOI: 10.1017/cjn.2022.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Passive Surveillance Stroke Severity (PaSSV) Indicator was derived to estimate stroke severity from variables in administrative datasets but has not been externally validated. METHODS We used linked administrative datasets to identify patients with first hospitalization for acute stroke between 2007-2018 in Alberta, Canada. We used the PaSSV indicator to estimate stroke severity. We used Cox proportional hazard models and evaluated the change in hazard ratios and model discrimination for 30-day and 1-year case fatality with and without PaSSV. Similar comparisons were made for 90-day home time thresholds using logistic regression. We also linked with a clinical registry to obtain National Institutes of Health Stroke Scale (NIHSS) and compared estimates from models without stroke severity, with PaSSV, and with NIHSS. RESULTS There were 28,672 patients with acute stroke in the full sample. In comparison to no stroke severity, addition of PaSSV to the 30-day case fatality models resulted in improvement in model discrimination (C-statistic 0.72 [95%CI 0.71-0.73] to 0.80 [0.79-0.80]). After adjustment for PaSSV, admission to a comprehensive stroke center was associated with lower 30-day case fatality (adjusted hazard ratio changed from 1.03 [0.96-1.10] to 0.72 [0.67-0.77]). In the registry sample (N = 1328), model discrimination for 30-day case fatality improved with the inclusion of stroke severity. Results were similar for 1-year case fatality and home time outcomes. CONCLUSION Addition of PaSSV improved model discrimination for case fatality and home time outcomes. The validity of PASSV in two Canadian provinces suggests that it is a useful tool for baseline risk adjustment in acute stroke.
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18
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Validation of the Danish Comorbidity Index for Acute Myocardial Infarction for predicting one-year mortality in patients with venous thromboembolism. Thromb Res 2022; 212:9-18. [DOI: 10.1016/j.thromres.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/17/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
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Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:8-35. [PMID: 34991091 DOI: 10.1159/000521288] [Citation(s) in RCA: 468] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022]
Abstract
The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient's unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.
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Affiliation(s)
- Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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20
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Association of material deprivation with discharge location and length of stay after inpatient stroke rehabilitation in Ontario: a retrospective, population-based cohort study. CMAJ Open 2022; 10:E50-E55. [PMID: 35078823 PMCID: PMC8920538 DOI: 10.9778/cmajo.20200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low socioeconomic status is associated with increased risk of stroke and worse poststroke functional status. The aim of this study was to determine whether socioeconomic status, as measured by material deprivation, is associated with direct discharge to long-term care or length of stay after inpatient stroke rehabilitation. METHODS We performed a retrospective, population-based cohort study of people admitted to inpatient rehabilitation in Ontario, Canada, after stroke. Community-dwelling adults (aged 19-100 yr) discharged from acute care with a most responsible diagnosis of stroke between Sept. 1, 2012, and Aug. 31, 2017, and subsequently admitted to an inpatient rehabilitation bed were included. We used a multivariable logistic regression model to examine the association between material deprivation quintile (from the Ontario Marginalization Index) and discharge to long-term care, and a multivariable negative binomial regression model to examine the association between material deprivation quintile and rehabilitation length of stay. RESULTS A total of 18 736 people were included. There was no association between material deprivation and direct discharge to long-term care (most v. least deprived: odds ratio [OR] 1.07, 95% confidence interval [CI] 0.89-1.28); however, people living in the most deprived areas had a mean length of stay 1.7 days longer than that of people in the least deprived areas (p = 0.004). This difference was not significant after adjustment for other baseline differences (relative change in mean 1.02, 95% CI 0.99-1.04). INTERPRETATION People admitted to inpatient stroke rehabilitation in Ontario had similar discharge destinations and lengths of stay regardless of their socioeconomic status. In future studies, investigators should consider further examining the associations of material deprivation with upstream factors as well as potential mitigation strategies.
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Affiliation(s)
- Shannon L MacDonald
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont.
| | - Ruth E Hall
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Chaim M Bell
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Shawna Cronin
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
| | - Susan B Jaglal
- Departments of Medicine (MacDonald, Bell) and Physical Therapy (Jaglal), and Institute of Health Policy, Management and Evaluation (MacDonald, Hall, Bell, Cronin, Jaglal), University of Toronto; Sinai Health (MacDonald, Bell); ICES (Hall, Bell, Jaglal), Toronto, Ont.; Institute for Better Health (Hall), Trillium Health Partners, Mississauga, Ont.; Toronto Rehabilitation Institute (Cronin, Jaglal), University Health Network, Toronto, Ont
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21
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Gaisenok OV, Rezvaya AA. [A comparative analysis of the clinical and anamnestic status of patients with chronic occlusion of the carotid arteries based on the data of observational registries]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:33-41. [PMID: 36582159 DOI: 10.17116/jnevro202212212233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the clinical and anamnestic status of patients with chronic carotid artery occlusion (CCAO) based on the analysis of risk factors, demographic and clinical and anatomical characteristics, the dynamics of the disease; to evaluate ongoing drug therapy, the incidence of strokes (MI) and deaths (according to the local registry compared with the results of other observational studies). MATERIAL AND METHODS PubMed and eLibrary searches for a systematic review were performed from October 24 to December 10, 2021 independently by two investigators. Out of 870 articles, based on inclusion/exclusion criteria, 8 studies were selected and included in the systematic review. RESULTS A comparative analysis of the clinical and anamnestic status of patients with CCAO according to the present review showed the following data on the prevalence of the main risk factors/diseases: hypertension - 79.1%; male gender - 83.7%; smoking - 46%; diabetes mellitus - 30.5%. Of the entire of own Duplex registry group (n=2548), 7 patients were identified with CCAO (0.27%). All patients were male (mean age 71.3±9.4 years). Endpoints were recorded in 5 of 7 participants during the follow-up period (8.9 years): 5 deaths, 2 fatal MI, 1 non-fatal MI, 1 myocardial infarction. A significant impact of the fact of MI on the survival of patients was confirmed using the standard log-rank test (p=0.02 and the Cox-Mendel test (p=0.04). The incidence of MI during the prospective follow-up according to the analyzed studies ranged from 4.3% (within a month of follow-up) to 42.8% (with a follow-up of 8.9 years), and averaged 12%. CONCLUSIONS A comparative analysis of the clinical and anamnestic status of patients with CCAO based on data from observational registers showed that the probability of detecting this pathology is associated with age and male gender. Data obtained from prospective observation of patients with CCAO in our own study show that the development of MI is one of the main factors affecting the survival of this category of patients.
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Affiliation(s)
- O V Gaisenok
- United Hospital with Outpatient Department of the Administrative Department of the President of the Russian Federation, Moscow, Russia
| | - A A Rezvaya
- Central State Medical Academy of the Administrative Department of the President of the Russian Federation, Moscow, Russia
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22
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Han TS, Fry CH, Fluck D, Gulli G, Affley B, Robin J, Kakar P, Sharma P. Predicting Stroke Complications in Hospital and Functional Status at Discharge by Clustering of Cardiovascular Diseases a Multi-Centre Registry-Based Study of Acute Stroke. J Stroke Cerebrovasc Dis 2021; 31:106162. [PMID: 34689050 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Indicators for outcomes following acute stroke are lacking. We have developed novel evidence-based criteria for identifying outcomes of acute stroke using the presence of clusters of coexisting cardiovascular disease (CVD). MATERIALS AND METHODS Analysis of prospectively collected data from the Sentinel Stroke National Audit Programme (SSNAP). A total of 1656 men (mean age ±SD=73.1yrs±13.2) and 1653 women (79.3yrs±13.0) were admitted with acute stroke (83.3% ischaemic, 15.7% intracranial haemorrhagic), 1.0% unspecified) in four major UK hyperacute stroke units (HASU) between 2014 and 2016. Four categories from cardiovascular disease Congestive heart failure, Atrial fibrillation, pre-existing Stroke and Hypertension (CASH).were constructed: CASH-0 (no coexisting CVD); CASH-1 (any one coexisting CVD); CASH-2 (any two coexisting CVD); CASH-3 (any three or all four coexisting CVD). These were tested against outcomes, adjusted for age and sex. RESULTS Compared to CASH-0, individuals with CASH-3 had greatest risks of in-hospital mortality (11.1% vs 24.5%, OR=1.8, 95%CI=1.3-2.7) and disability (modified Rankin Scale score ≥4) at discharge (24.2% vs 46.2%, OR=1.9, 95%CI=1.4-2.7), urinary tract infection (3.8% vs 14.6%, OR= 3.3, 95%CI= 1.9-5.5), and pneumonia (7.1% vs 20.6%, OR= 2.6, 95%CI= 1.7-4.0); length of stay on HASU >14 days (29.8% vs 39.3%, OR=1.8, 95%CI=1.3-2.6); and joint-care planning (20.9% vs 29.8%, OR=1.4, 95%CI=1.0-2.0). CONCLUSIONS We present a simple tool for estimating the risk of adverse outcomes of acute stroke including death, disability at discharge, nosocomial infections, prolonged length of stay, as well as any joint care planning. CASH-0 indicates a low level and CASH-3 indicates a high level of risk of such complications after stroke.
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Affiliation(s)
- Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK.
| | - Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, BS8 1TD UK.
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Giosue Gulli
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Jonathan Robin
- Department of Acute Medicine, Ashford and St Peter's NHS Foundation Trust, Chertsey, GU9 0PZ, UK.
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom KT18 7EG, UK.
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, TW20 0EX, UK; Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London W6 8RF, UK.
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MacDonald SL, Hall RE, Bell CM, Cronin S, Jaglal SB. Sex differences in the outcomes of adults admitted to inpatient rehabilitation after stroke. PM R 2021; 14:779-785. [PMID: 34181304 DOI: 10.1002/pmrj.12660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/17/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Several differences have been reported between male and female patients with stroke in clinical and sociodemographic features, treatment, and outcomes. Potential effects in the inpatient rehabilitation population are unclear. OBJECTIVE To evaluate the differences between male and female patients in discharge functional status, length of stay, and discharge home after inpatient rehabilitation for stroke. DESIGN Retrospective, population-based cohort study. SETTING Inpatient rehabilitation centers in Ontario, Canada. PARTICIPANTS Male (N = 10,684) and female (N = 9459) patients discharged from acute care between September 1, 2012 and August 31, 2017, with a diagnosis of stroke and subsequently admitted to inpatient rehabilitation. EXPOSURE VARIABLE Female sex. MAIN OUTCOME MEASURES Discharge Functional Independence Measure (FIM) score, length of stay, and discharge home. RESULTS Female patients had a lower functional status at discharge (mean FIM score 94.1 vs. 97.8, p < .001) and a lower proportion were discharged home (81.1% vs. 82.9%, p = .001). Female and male patients had similar rehabilitation length of stay (mean 31.8 vs. 31.7 days, p = .90). In the adjusted analyses, there was no difference in discharge functional status between male and female patients (FIM score β -.20 [95% confidence interval [CI] -0.64 to 0.25]). Female patients had a mean length of stay 2% shorter (0.98 [95% CI 0.96-0.99]) and a higher odds of discharge home (odds ratio [OR] 1.14 [95% CI 1.05-1.24]). CONCLUSIONS There were no clinically significant sex differences in outcomes after inpatient rehabilitation for stroke. Observed sex disparities in the general stroke population may not be directly applicable to individuals undergoing inpatient rehabilitation.
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Affiliation(s)
- Shannon L MacDonald
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada
| | - Ruth E Hall
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Sinai Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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24
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Jang WM, Lee J, Eun SJ, Yim J, Kim Y, Kwak MY. Travel time to emergency care not by geographic time, but by optimal time: A nationwide cross-sectional study for establishing optimal hospital access time to emergency medical care in South Korea. PLoS One 2021; 16:e0251116. [PMID: 33939767 PMCID: PMC8092794 DOI: 10.1371/journal.pone.0251116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
Increase in travel time, beyond a critical point, to emergency care may lead to a residential disparity in the outcome of patients with acute conditions. However, few studies have evaluated the evidence of travel time benchmarks in view of the association between travel time and outcome. Thus, this study aimed to establish the optimal hospital access time (OHAT) for emergency care in South Korea. We used nationwide healthcare claims data collected by the National Health Insurance System database of South Korea. Claims data of 445,548 patients who had visited emergency centers between January 1, 2006 and December 31, 2014 were analyzed. Travel time, by vehicle from the residence of the patient, to the emergency center was calculated. Thirteen emergency care-sensitive conditions (ECSCs) were selected by a multidisciplinary expert panel. The 30-day mortality after discharge was set as the outcome measure of emergency care. A change-point analysis was performed to identify the threshold where the mortality of ECSCs changed significantly. The differences in risk-adjusted mortality between patients living outside of OHAT and those living inside OHAT were evaluated. Five ECSCs showed a significant threshold where the mortality changed according to their OHAT. These were intracranial injury, acute myocardial infarction, other acute ischemic heart disease, fracture of the femur, and sepsis. The calculated OHAT were 71-80 min, 31-40 min, 70-80 min, 41-50 min, and 61-70 min, respectively. Those who lived outside the OHAT had higher risks of death, even after adjustment (adjusted OR: 1.04-7.21; 95% CI: 1.03-26.34). In conclusion, the OHAT for emergency care with no significant increase in mortality is in the 31-80 min range. Optimal travel time to hospital should be established by optimal time for outcomes, and not by geographic time, to resolve the disparities in geographical accessibility to emergency care.
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Affiliation(s)
- Won Mo Jang
- Department of Public Health and Community Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Juyeon Lee
- Center for Public Health, National Medical Center, Seoul, South Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jun Yim
- Center for Public Health, National Medical Center, Seoul, South Korea
- Department of Citizen Health, University of Seoul, Seoul, South Korea
| | - Yoon Kim
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, South Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Mi Young Kwak
- Center for Public Health, National Medical Center, Seoul, South Korea
- * E-mail:
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Bajic B, Galic I, Mihailovic N, Ristic S, Radevic S, Cupic VI, Kocic S, Arnaut A. Performance of Charlson and Elixhauser Comorbidity Index to Predict in-Hospital Mortality in Patients with Stroke in Sumadija and Western Serbia. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:970-977. [PMID: 34183955 PMCID: PMC8223561 DOI: 10.18502/ijph.v50i5.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/15/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Comorbidities are major predictors of in-hospital mortality in stroke patients. The Charlson comorbidity index (CCI) and the Elikhauser comorbidity index (ECI) are scoring systems for classifying comorbidities. We aimed to compare the performance of the CCI and ECI to predict in-hospital mortality in stroke patients. METHODS We included patients hospitalized for stroke in the Clinical Center of Kragujevac, Serbia for the last 7 years. Hospitalizations caused by stroke, were identified by the International Classification of Diseases-10 (ICD-10) codes I60.0 - I69.9. All patients were divided into two cohorts: Alive cohort (n=3297) and Mortality cohort (n=978). RESULTS There were significant associations between higher CCIS and increased risk of in-hospital mortality (HR = 1.07, 95% CI = 1.01-1.12) and between higher ECIS and increased risk of in-hospital mortality (HR = 1.04, 95% CI = 0.99-1.09). Almost 2/3 patients (66.9%) had comorbidities included in the CCI score and 1/3 patients (30.2%) had comorbidities included in the ECI score. The statistically significant higher CCI score (t = -3.88, df = 1017.96, P <0.01) and ECI score (t = -6.7, df = 1447.32, P <0.01) was in the mortality cohort.Area Under the Curve for ECI score was 0.606 and for CCI score was 0.549. CONCLUSION Both, the CCI and the ECI can be used as scoring systems for classifying comorbidities in the administrative databases, but the model's ECI Score had a better discriminative performance of in-hospital mortality in the stroke patients than the CCI Score model.
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Affiliation(s)
- Biljana Bajic
- Health Promotion Center, Institute of Public Health Montenegro, Podgorica, Montenegro
| | - Igor Galic
- Center for Control and Prevention of Noncommunicable Diseases, Institute for Public Health Montenegro, Podgorica, Montenegro
| | - Natasa Mihailovic
- Department of Biostatistics and Informatics, Institute of Public Health Kragujevac, Kragujevac, Serbia
| | - Svetlana Ristic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Violeta Iric Cupic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanja Kocic
- Department of Biostatistics and Informatics, Institute of Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Arnaut
- Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Yao Z, Zheng X, Zheng Z, Wu K, Zheng J. Construction and validation of a machine learning-based nomogram: A tool to predict the risk of getting severe coronavirus disease 2019 (COVID-19). IMMUNITY INFLAMMATION AND DISEASE 2021; 9:595-607. [PMID: 33713584 PMCID: PMC8127556 DOI: 10.1002/iid3.421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 01/09/2023]
Abstract
Background Identifying patients who may develop severe coronavirus disease 2019 (COVID‐19) will facilitate personalized treatment and optimize the distribution of medical resources. Methods In this study, 590 COVID‐19 patients during hospitalization were enrolled (Training set: n = 285; Internal validation set: n = 127; Prospective set: n = 178). After filtered by two machine learning methods in the training set, 5 out of 31 clinical features were selected into the model building to predict the risk of developing severe COVID‐19 disease. Multivariate logistic regression was applied to build the prediction nomogram and validated in two different sets. Receiver operating characteristic (ROC) analysis and decision curve analysis (DCA) were used to evaluate its performance. Results From 31 potential predictors in the training set, 5 independent predictive factors were identified and included in the risk score: C‐reactive protein (CRP), lactate dehydrogenase (LDH), Age, Charlson/Deyo comorbidity score (CDCS), and erythrocyte sedimentation rate (ESR). Subsequently, we generated the nomogram based on the above features for predicting severe COVID‐19. In the training cohort, the area under curves (AUCs) were 0.822 (95% CI, 0.765–0.875) and the internal validation cohort was 0.762 (95% CI, 0.768–0.844). Further, we validated it in a prospective cohort with the AUCs of 0.705 (95% CI, 0.627–0.778). The internally bootstrapped calibration curve showed favorable consistency between prediction by nomogram and the actual situation. And DCA analysis also conferred high clinical net benefit. Conclusion In this study, our predicting model based on five clinical characteristics of COVID‐19 patients will enable clinicians to predict the potential risk of developing critical illness and thus optimize medical management.
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Affiliation(s)
- Zhixian Yao
- Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Zheng
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhong Zheng
- Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Wu
- Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junhua Zheng
- Shanghai Medical Aid Team in Wuhan, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.,Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chien SH, Yao M, Li CC, Chang PY, Yu MS, Huang CE, Tan TD, Lin CH, Yeh SP, Li SS, Wang PN, Liu YC, Gau JP. Charlson comorbidity index predicts outcomes of elderly after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia and myelodysplastic syndrome. J Formos Med Assoc 2021; 120:2144-2152. [PMID: 33423899 DOI: 10.1016/j.jfma.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the curative therapy for acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS), but advanced age with multiple comorbidities limits the eligibility for allo-HSCT. We conducted a retrospective study to investigate the comorbidities assessments and prognostic factors that predict outcomes for these patients. METHODS Clinical data of patients older than 50 years who had received diagnoses of AML or MDS and underwent allo-HSCT were obtained. Information on patient characteristics, including age, gender, allogeneic transplant type, conditioning regimens, Charlson comorbidity index (CCI), and presence of acute graft-versus-host disease (GVHD) or chronic GVHD, were collected and analyzed. RESULTS Two hundred fifty-five elderly patients with a median age at allo-HSCT of 57 years were included. The significant prognostic factors associated with worse overall survival (OS) were CCI ≥3 (hazard ratio: 1.88) and grade III-IV acute GVHD (3.18). Similar findings were noted in the non-relapse mortality analysis. To investigate the effects of chronic GVHD on patient outcomes, OS analysis was performed for those with survival >100 days after transplantation. The results revealed CCI ≥3 (1.88) and grade III-IV acute GVHD (2.73) remained poor prognostic factors for OS, whereas mild chronic GVHD (0.43) was associated with better OS. CONCLUSION This cohort study suggests that CCI ≥3 predicts poor outcomes, primarily due to a higher NRM risk. Careful management of GVHD after transplantation could improve outcomes in elderly patients with AML or MDS after allo-HSCT.
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Affiliation(s)
- Sheng-Hsuan Chien
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming Yao
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Cheng Li
- Department of Hematology and Oncology, Buddhist Tzu-Chi General Hospital, Hualien, Taiwan; Tai Cheng Stem Cell Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ying Chang
- Division of Hematology and Oncology, Department of Medicine, Tri-Service General Hospital, Taiwan; National Defense Medical Center, Taiwan
| | - Ming-Sun Yu
- Division of Hematology and Oncology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cih-En Huang
- Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Tao-Yuan, Taiwan
| | - Tran-Der Tan
- Koo Foundation Sun Yat-Sen Cancer Center, Taiwan
| | - Cheng-Hsien Lin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Su-Peng Yeh
- Division of Hematology and Oncology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sin-Syue Li
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Nan Wang
- Division of Hematology, Chang Gung Medical Foundation, Linkou Branch, Tao-Yuan, Taiwan
| | - Yi-Chang Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jyh-Pyng Gau
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Díaz del Arco C, Estrada Muñoz L, Molina Roldán E, Ortega Medina L, García Gómez de las Heras S, Chávez Á, Fernández Aceñero MJ. Proposal for a clinicopathological prognostic score for resected gastric cancer patients. Saudi J Gastroenterol 2020; 27:44-53. [PMID: 33047677 PMCID: PMC8083245 DOI: 10.4103/sjg.sjg_208_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Factors other than pTNM stage have been associated with gastric cancer (GC) prognosis, and several alternative prognostic scores have been constructed. Our aims are to identify prognostic factors in western GC patients and to build clinicopathological prognostic models for overall survival (OS) and disease-free survival (DFS). METHODS A Retrospective study of 204 cases of GC resected during the years 2000 to 2014 was conducted in our hospital. Clinicopathological features were assessed, univariate and multivariate analysis were performed and prognostic scores were constructed. RESULTS Most patients were diagnosed at pTNM stages II and III (36.9% and 48.1%, respectively). According to Laurén classification, tumors were intestinal (55.8%), diffuse (35.2%) and mixed (9%). During follow-up, 43.5% of patients had tumor recurrence, and 28.6% died due to tumor. Univariate analysis showed that patient age, Laurén subtype, signet-ring cell morphology, pTNM stage, tumor grade, perineural invasion, growth pattern, intratumoral inflammation, adjuvant therapy, and desmoplasia were significantly related to tumor progression or death. Multivariate analysis showed that Laurén subtype, pT stage, and lymph node ratio (LNR) were significantly and independently associated with GC recurrence. Laurén subtype and LNR were significantly related to patient survival. Prognostic scores for tumor progression and death were developed and patients were classified into four prognostic groups which showed good prognostic performance. CONCLUSION A prognostic model comprising histological features such as Laurén subtype can be easily applied in clinical practice, and provides more prognostic information than pTNM stage alone. These models can further stratify resected GC patients and have the potential to aid in the individualization of patient management.
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Affiliation(s)
- Cristina Díaz del Arco
- Department of Surgery and Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Spain,Department of Pathology, Hospital Clínico San Carlos, Madrid, Spain,Address for correspondence: Dr. Cristina Díaz del Arco, Department of Surgical Pathology, Hospital Clínico San Carlos. C/Profesor Martín Lagos S/N, 28040, Madrid, Spain. E-mail:
| | - Lourdes Estrada Muñoz
- Department of Pathology, Hospital Rey Juan Carlos, Madrid, Spain,Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Madrid, Spain
| | | | - Luis Ortega Medina
- Department of Surgery and Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Spain,Department of Pathology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ángela Chávez
- Department of Surgery, School of Medicine, Autónoma University of Madrid, Madrid, Spain
| | - Ma Jesús Fernández Aceñero
- Department of Surgery and Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Spain,Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Payette Y, de Moura CS, Boileau C, Bernatsky S, Noisel N. Is there an agreement between self-reported medical diagnosis in the CARTaGENE cohort and the Québec administrative health databases? Int J Popul Data Sci 2020; 5:1155. [PMID: 34232968 PMCID: PMC7473265 DOI: 10.23889/ijpds.v5i1.1155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Population health studies often use existing databases that are not necessarily constituted for research purposes. The question arises as to whether different data sources such as in administrative health data (AHD) and self-report questionnaires are equivalent and lead to similar information. OBJECTIVES The main objective of this study was to assess the level of agreement between self-reported medical conditions and medical diagnosis captured in AHD. A secondary objective was to identify predictors of agreement among medical conditions between the two data sources. Therefore, the purposes of the study were to explore the extent to which these two methods of commonly used public health data collection provide concordant records and identify the main predictors of statistical variations. METHODS Data were extracted from CARTaGENE, a population-based cohort in Québec, Canada, which was linked to the provincial health insurance records of the same individuals, namely the MED-ÉCHO database from the Régie de l'assurance maladie du Québec (RAMQ) and the fee-for-service billing records provided by the physician, for the time period 1998-2012. Agreement statistics (kappa coefficient) along with sensitivity, specificity and predictive positive value were calculated for 19 chronic conditions and 12 types of cancers. Logistic regressions were used to identify predictors of concordance between self-report and AHD from significant covariates (sex, age groups, education, region, income, heavy utilization of health care system and Charlson comorbidity index). RESULTS Agreement between self-reported data and AHD across diseases ranged from kappa of 0.09 for chronic renal failure to 0.86 for type 2 diabetes. Sensitivity of self-reported data was higher than 50% for 14 out of the 31 medical conditions studied, especially for myocardial infarction (88.62%), breast cancer (86.28%), and diabetes (85.06%). Specificity was generally high with a minimum value of 89.70%. Lower concordance between data sources was observed for higher frequency of health care utilization and higher comorbidity scores. CONCLUSION Overall, there was moderate agreement between the two data sources but important variations were found depending on the type of disease. This suggests that CARTaGENE's participants were generally able to correctly identify the kind of diseases they suffer from, with some exceptions. These results may help researchers choose adequate data sources according to specific study objectives. These results also suggest that Québec's AHD seem to underestimate the prevalence of some chronic conditions, which might result in inaccurate estimates of morbidity with consequences for public health surveillance.
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Affiliation(s)
- Y Payette
- CARTaGENE Cohort and Biobank, CHU Sainte-Justine, Montréal, Québec, Canada
| | - CS de Moura
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - C Boileau
- CARTaGENE Cohort and Biobank, CHU Sainte-Justine, Montréal, Québec, Canada
| | - S Bernatsky
- Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Québec, Canada
| | - N Noisel
- CARTaGENE Cohort and Biobank, CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Environmental and Occupational Health, School of Public Health, University of Montreal, Montreal, Québec, Canada
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