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Zeremski V, Adolph L, Beer S, Berisha M, Jacobs B, Kahl C, Koenecke C, Kropf S, Panse J, Petersen J, Schmidt-Hieber M, Schneider J, Vucinic V, Walter J, Weigert O, Witte HM, Mougiakakos D. Relevance of different prognostic scores in primary CNS lymphoma in the era of intensified treatment regimens: A retrospective, multicenter analysis of 174 patients. Eur J Haematol 2024; 112:641-649. [PMID: 38164819 DOI: 10.1111/ejh.14159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Treatment intensification (including consolidative high-dose chemotherapy with autologous stem cell transplantation [HDT-ASCT]) significantly improved outcome in primary central nervous system lymphoma (PCNSL) patients. METHODS We conducted a multicenter, retrospective analysis of newly diagnosed PCNSL patients, treated with intensified treatment regimens. The following scores were evaluated in terms of overall survival (OS) and progression-free survival (PFS): Memorial Sloan-Kettering Cancer Center (MSKCC), International Extranodal Lymphoma Study Group (IELSG), and three-factor (3F) prognostic score. Further, all scores were comparatively investigated for model quality and concordance. RESULTS Altogether, 174 PCNSL patients were included. One hundred and five patients (60.3%) underwent HDT-ASCT. Two-year OS and 2-year PFS for the entire population were 73.3% and 48.5%, respectively. The MSKCC (p = .003) and 3F score (p < .001), but not the IELSG score (p = .06), had the discriminatory power to identify different risk groups for OS. In regard to concordance, the 3F score (C-index [0.71]) outperformed both the MSKCC (C-index [0.64]) and IELSG (C-index [0.53]) score. Moreover, the superiority of the 3F score was shown for PFS, successfully stratifying patients in three risk groups, which also resulted in the highest C-index (0.66). CONCLUSION The comparative analysis of established PCNSL risk scores affirm the clinical utility of the 3F score stratifying the widest prognostic spectrum among PCNSL patients treated with intensified treatment approaches.
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Affiliation(s)
- Vanja Zeremski
- Department of Hematology and Oncology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Louisa Adolph
- Department of Internal Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sina Beer
- Department of Hematology and Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Mirjeta Berisha
- Department of Hematology and Oncology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Department of Internal Medicine 5, Hematology and Clinical Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Benedikt Jacobs
- Department of Internal Medicine 5, Hematology and Clinical Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Christoph Kahl
- Department of Hematology, Oncology and Palliative Care, Klinikum Magdeburg, Magdeburg, Germany
- Department of Hematology, Oncology, and Palliative Care, University Medical Center, University of Rostock, Rostock, Germany
| | - Christian Koenecke
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Siegfried Kropf
- Department of Biometry and Medical Informatics, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jens Panse
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Judith Petersen
- Department of Hematology, Cell Therapy, Hemostaseology and Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Martin Schmidt-Hieber
- Clinic of Hematology, Oncology, Pneumology and Nephrology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Jessica Schneider
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Vladan Vucinic
- Department of Hematology, Cell Therapy, Hemostaseology and Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Jeanette Walter
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Center for Integrated Oncology (CIO), Aachen, Bonn, Cologne, Düsseldorf (ABCD), Aachen, Germany
| | - Oliver Weigert
- Department of Internal Medicine III, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Hanno M Witte
- Department of Hematology and Oncology, Federal Armed Hospital Ulm, Ulm, Germany
| | - Dimitrios Mougiakakos
- Department of Hematology and Oncology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Department of Internal Medicine 5, Hematology and Clinical Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
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Mangesius J, Seppi T, Arnold CR, Mangesius S, Kerschbaumer J, Demetz M, Minasch D, Vorbach SM, Sarcletti M, Lukas P, Nevinny-Stickel M, Ganswindt U. Prognosis versus Actual Outcomes in Stereotactic Radiosurgery of Brain Metastases: Reliability of Common Prognostic Parameters and Indices. Curr Oncol 2024; 31:1739-1751. [PMID: 38668035 PMCID: PMC11049204 DOI: 10.3390/curroncol31040132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
This study aims to evaluate the clinical outcome of stereotactic radiosurgery as the sole treatment for brain metastases and to assess prognostic factors influencing survival. A total of 108 consecutive patients with 213 metastases were retrospectively analyzed. Treatment was determined with close-meshed MRI follow-up. Various prognostic factors were assessed, and several prognostic indices were compared regarding their reliability to estimate overall survival. Median overall survival was 15 months; one-year overall survival was 50.5%. Both one- and two-year local controls were 90.9%. The rate of new metastases after SRS was 49.1%. Multivariate analysis of prognostic factors revealed that the presence of extracranial metastases, male sex, lower KPI, and progressive extracranial disease were significant risk factors for decreased survival. Of all evaluated prognostic indices, the Basic Score for Brain Metastases (BSBMs) showed the best correlation with overall survival. A substantial survival advantage was found for female patients after SRS when compared to male patients (18 versus 9 months, p = 0.003). SRS of brain metastasis is a safe and effective treatment option when frequent monitoring for new metastases with MRI is performed. Common prognostic scores lack reliable estimation of survival times. Female sex should be considered as an additional independent positive prognostic factor influencing survival.
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Affiliation(s)
- Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Matthias Demetz
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Danijela Minasch
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Samuel Moritz Vorbach
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Manuel Sarcletti
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Lukas
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | | | - Ute Ganswindt
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Losurdo A, Dipasquale A, Giordano L, Persico P, Lorenzi E, Di Muzio A, Barigazzi C, Korolewicz J, Mehan A, Mohammed O, Scheiner B, Pinato DJ, Santoro A, Simonelli M. Refining patient selection for next-generation immunotherapeutic early-phase clinical trials with a novel and externally validated prognostic nomogram. Front Immunol 2024; 15:1323151. [PMID: 38298193 PMCID: PMC10828843 DOI: 10.3389/fimmu.2024.1323151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Identifying which patient may benefit from immunotherapeutic early-phase clinical trials is an unmet need in drug development. Among several proposed prognostic scores, none has been validated in patients receiving immunomodulating agents (IMAs)-based combinations. Patients and methods We retrospectively collected data of 208 patients enrolled in early-phase clinical trials investigating IMAs at our Institution, correlating clinical and blood-based variables with overall survival (OS). A retrospective cohort of 50 patients treated with IMAs at Imperial College (Hammersmith Hospital, London, UK) was used for validation. Results A total of 173 subjects were selected for analyses. Most frequent cancers included non-small cell lung cancer (26%), hepatocellular carcinoma (21.5%) and glioblastoma (13%). Multivariate analysis (MVA) revealed 3 factors to be independently associated with OS: line of treatment (second and third vs subsequent, HR 0.61, 95% CI 0.40-0.93, p 0.02), serum albumin as continuous variable (HR 0.57, 95% CI 0.36-0.91, p 0.02) and number of metastatic sites (<3 vs ≥3, HR 0.68, 95% CI 0.48-0.98, p 0.04). After splitting albumin value at the median (3.84 g/dL), a score system was capable of stratifying patients in 3 groups with significantly different OS (p<0.0001). Relationship with OS reproduced in the external cohort (p=0.008). Then, from these factors we built a nomogram. Conclusions Prior treatment, serum albumin and number of metastatic sites are readily available prognostic traits in patients with advanced malignancies participating into immunotherapy early-phase trials. Combination of these factors can optimize patient selection at study enrollment, maximizing therapeutic intent.
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Affiliation(s)
- Agnese Losurdo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Angelo Dipasquale
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Pasquale Persico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Elena Lorenzi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Antonio Di Muzio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Chiara Barigazzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - James Korolewicz
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Aman Mehan
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Oreoluwa Mohammed
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Benhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - David J. Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Division of Oncology, Department of Translational Medicine (DIMET), Università del Piemonte Orientale A. Avogadro, Novara, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
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Roepke RML, Besen BAMP, Daltro-Oliveira R, Guazzelli RM, Bassi E, Salluh JIF, Damous SHB, Utiyama EM, Malbouisson LMS. Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study. J Intensive Care Med 2024; 39:44-51. [PMID: 37448331 DOI: 10.1177/08850666231188051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Background: It is not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injury-based scores (Injury Severity Score [ISS] and New ISS [NISS]). Methods: Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016. We retrieved data from the ICU database for critical care scores and calculated ISS and NISS from chart data and whole body computed tomography results. We compared the predictive performance for hospital mortality of each model through discrimination, calibration, and decision-curve analysis. Results: The sample comprised 1053 victims of trauma admitted to the ICU, with 84.2% male patients and mean age of 40 (±18) years. Main injury mechanism was blunt trauma (90.7%). Traumatic brain injury was present in 67.8% of patients; 43.3% with severe TBI. At the time of ICU admission, 846 patients (80.3%) were on mechanical ventilation and 644 (64.3%) on vasoactive drugs. Hospital mortality was 23.8% (251). Median SAPS 3 was 41; median maximum SOFA within 24 h of admission, 7; ISS, 29; and NISS, 41. AUROCs (95% CI) were: SAPS 3 = 0.786 (0.756-0.817), SOFA = 0.807 (0.778-0.837), ISS = 0.616 (0.577-0.656), and NISS = 0.689 (0.649-0.729). In pairwise comparisons, SAPS 3 and SOFA did not differ, while both outperformed the anatomical scores (p < .001). Maximum SOFA within 24 h of admission presented the best calibration and net benefit in decision-curve analysis. Conclusions: Trauma-specific anatomical scores have fair performance in critically ill trauma patients and are outperformed by SAPS 3 and SOFA. Illness severity is best characterized by organ dysfunction and physiological variables than anatomical injuries.
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Affiliation(s)
- Roberta Muriel Longo Roepke
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo, SP, Brazil
- Medical ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Renato Daltro-Oliveira
- Medical ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Estevão Bassi
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Sérgio Henrique Bastos Damous
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Edivaldo Massazo Utiyama
- Trauma and Acute Care Surgery ICU, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Surgical ICU, Anesthesiology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Luciano A, Liguori L, Polcaro G, Sabbatino F, Pepe S. Evaluation of Potential Predictive Biomarkers for Defining Brain Radiotherapy Efficacy in Non-Small Cell Lung Cancer Patients with Brain Metastases: A Case Report and a Narrative Review. Clin Pract 2023; 13:1549-1560. [PMID: 38131685 PMCID: PMC10742049 DOI: 10.3390/clinpract13060136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the second most common cancer worldwide, resulting in 1.8 million deaths per year. Most patients are diagnosed with a metastatic disease. Brain metastases are one of the most common metastatic sites and are associated with severe neurological symptoms, shorter survival, and the worst clinical outcomes. Brain radiotherapy and systemic oncological therapies are currently used for controlling both cancer progression and neurological symptoms. Brain radiotherapy includes stereotactic brain ablative radiotherapy (SBRT) or whole brain radiotherapy (WBRT). SBRT is applied for single or multiple (up to ten) small (diameter less than 4 cm) lesions, whereas WBRT is usually applied for multiple (more than ten) and large (diameter greater than 4 cm) brain metastases. In both cases, radiotherapy application may be viewed as an overtreatment which causes severe toxicities without achieving a significant clinical benefit. Thus far, a number of scoring systems to define the potential clinical benefits derived from brain radiotherapy have been proposed. However, most are not well established in clinical practice. In this article, we present a clinical case of a patient with advanced NSCLC carrying a BRAFV600E mutation and brain metastases. We review the variables in addition to applicable scoring systems considered to have potential for predicting clinical outcomes and benefits of brain radiotherapy in patients with advanced NSCLC and brain metastases. Lastly, we highlight the unmet need of specific scoring systems for advanced NSCLC patients with brain metastases carrying oncogene alterations including BRAFV600E mutations.
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Affiliation(s)
- Angelo Luciano
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (A.L.); (L.L.); (G.P.); (S.P.)
- Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Luigi Liguori
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (A.L.); (L.L.); (G.P.); (S.P.)
- Oncology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Giovanna Polcaro
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (A.L.); (L.L.); (G.P.); (S.P.)
| | - Francesco Sabbatino
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (A.L.); (L.L.); (G.P.); (S.P.)
| | - Stefano Pepe
- Oncology Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy; (A.L.); (L.L.); (G.P.); (S.P.)
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Aspromonte N, Fumarulo I, Petrucci L, Biferali B, Liguori A, Gasbarrini A, Massetti M, Miele L. The Liver in Heart Failure: From Biomarkers to Clinical Risk. Int J Mol Sci 2023; 24:15665. [PMID: 37958649 PMCID: PMC10649397 DOI: 10.3390/ijms242115665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Heart failure (HF) is a clinical syndrome due to heart dysfunction, but in which other organs are also involved, resulting in a complex multisystemic disease, burdened with high mortality and morbidity. This article focuses on the mutual relationship between the heart and liver in HF patients. Any cause of right heart failure can cause hepatic congestion, with important prognostic significance. We have analyzed the pathophysiology underlying this double interaction. Moreover, we have explored several biomarkers and non-invasive tests (i.e., liver stiffness measurement, LSM) potentially able to provide important support in the management of this complex disease. Cardiac biomarkers have been studied extensively in cardiology as a non-invasive diagnostic and monitoring tool for HF. However, their usefulness in assessing liver congestion in HF patients is still being researched. On the other hand, several prognostic scores based on liver biomarkers in patients with HF have been proposed in recent years, recognizing the important burden that liver involvement has in HF. We also discuss the usefulness of a liver stiffness measurement (LSM), which has been recently proposed as a reliable and non-invasive method for assessing liver congestion in HF patients, with therapeutic and prognostic intentions. Lastly, the relationship between LSM and biomarkers of liver congestion is not clearly defined; more research is necessary to establish the clinical value of biomarkers in assessing liver congestion in HF patients and their relationship with LSM.
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Affiliation(s)
- Nadia Aspromonte
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (I.F.); (M.M.)
- Department of Cardiovascular and Thoracic Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Isabella Fumarulo
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (I.F.); (M.M.)
- Department of Cardiovascular and Thoracic Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Lucrezia Petrucci
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy; (L.P.); (B.B.); (A.L.); (A.G.); (L.M.)
- Department of Medical and Surgical Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Bianca Biferali
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy; (L.P.); (B.B.); (A.L.); (A.G.); (L.M.)
- Department of Medical and Surgical Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Antonio Liguori
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy; (L.P.); (B.B.); (A.L.); (A.G.); (L.M.)
- Department of Medical and Surgical Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy; (L.P.); (B.B.); (A.L.); (A.G.); (L.M.)
- Department of Medical and Surgical Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy; (I.F.); (M.M.)
- Department of Cardiovascular and Thoracic Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Luca Miele
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy; (L.P.); (B.B.); (A.L.); (A.G.); (L.M.)
- Department of Medical and Surgical Sciences, A. Gemelli University Policlinic Foundation IRCCS, 00168 Rome, Italy
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7
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Bidari A, Zarei E, Hassanzadeh M, Gholizadeh Mesgarha M, Pour Mohammad A, Shafiei R, Mortaja M, Naderkhani M. Development of a Scoring Method Based on a Chest CT Scan to Determine the Outcomes of COVID-19 Patients. Cureus 2023; 15:e47354. [PMID: 38022268 PMCID: PMC10657166 DOI: 10.7759/cureus.47354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction As COVID-19 shifts from pandemic urgency to endemic management, healthcare systems are faced with the evolving challenge of providing optimized care and adept resource allocation in this evolving landscape of the disease. However, the timely management and accurate assessment of disease severity remains a cornerstone of effective treatment. This study presents a pioneering scoring system, based on the primary chest CT scan findings, to predict patient outcomes and to equip clinicians with a tool that can expedite decision-making. Method A retrospective cohort study was conducted involving 406 confirmed COVID-19 cases referred to two of our hospitals in Tehran, between February and April 2020. Radiographic and CT scan data were sourced from the imaging archive system and evaluated by a certified radiologist. We devised distinct severity scores for CT findings, demographic factors, and clinical indicators. These were synthesized into a comprehensive severity score to forecast critical patient outcomes, such as mortality, ICU admission, intubation, or extended hospitalization. Of the total cases, 161 (39.7%) were classified as severe, while 245 (60%) fell into the low or moderate severity category. Results The mean score of demographic, CT scan, and clinical characteristics was significantly higher for those in the severe COVID-19 than the non-severe group. The cutoff score for predicting the outcomes in COVID-19 patients for demographic, clinical, and chest CT scan factors was 2.5, 9.5, and 8.5, respectively. Multivariate analysis indicated that each unit increase in these scores elevated the odds of fatal outcomes by 24%, 2.8%, and 12%, respectively. Then, using the comprehensive severity score, which is the sum of the above scores, we further predicted the disease severity. Conclusion The findings suggest that our innovative scoring system, based on initial chest CT scan findings, serves as a robust predictor of COVID-19 outcomes.
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Affiliation(s)
- Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, IRN
| | - Elham Zarei
- Department of Radiology, Iran University of Medical Sciences, Tehran, IRN
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Iran University of Medical Sciences, Tehran, IRN
| | | | | | - Reyhaneh Shafiei
- School of Medicine, Iran University of Medical Sciences, Tehran, IRN
| | - Mahsa Mortaja
- Cancer Research Center, Tehran University of Medical Sciences, Tehran, IRN
| | - Mahya Naderkhani
- Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, IRN
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Madrazo M, López-Cruz I, Piles L, Alberola J, Micó Gandia J, María Eiros J, Artero A. Lactate/albumin ratio prognostic value for mortality in patients older than 65 years with complicated urinary tract infection. Rev Clin Esp 2023:S2254-8874(23)00056-5. [PMID: 37105384 DOI: 10.1016/j.rceng.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Lactate to albumin ratio (LAR) is an emerging sepsis biomarker that has been tested for mortality in patients with sepsis of different focus. Our goal is to evaluate the prognostic value of LAR in patients admitted to the hospital due to complicated urinary tract infections. METHODS Prospective observational study of patients older than 65 years diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for LAR, qSOFA and SOFA. RESULTS 341 UTI cases were analyzed. 30-day mortality (20.2% vs. 6.7%, p < 0.001) and longer hospital stay (5 [4-8] vs. 4 [3-7], p 0.018) were associated with LAR ≥ 0.708. LAR has no statistically significant differences compared to qSOFA and SOFA for predicting 30-day mortality (AUROC 0.737 vs. 0.832 and 0.777 respectively, p 0.119 and p 0.496). The sensitivity of LAR was similar to the sensitivity of qSOFA and SOFA (60.8% vs. 84.4% and 82.2, respectively, p 0.746 and 0.837). However, its specificity was lower than the specificity of qSOFA (60.8% vs. 75%, p 0.003), but similar to the specificity of SOFA (60.8% vs. 57.8%, p 0.787). CONCLUSION LAR has no significant differences with other well-stablished scores in sepsis, such as qSOFA and SOFA, to predict 30-day mortality in patients with complicated UTI.
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Affiliation(s)
| | | | - Laura Piles
- Doctor Peset University Hospital, Valencia, Spain
| | | | | | - José María Eiros
- Rio Hortega University Hospital, Universidad de Valladolid, Spain
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Yuan F, Damien C, Gaspard N. Prognostic scores in status epilepticus: A systematic review and meta-analysis. Epilepsia 2023; 64:17-28. [PMID: 36271624 DOI: 10.1111/epi.17442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 01/21/2023]
Abstract
The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta-analysis of the area under the receiver-operating characteristic curve (AUC) and for meta-analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in-hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta-analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE-EAC (Epidemiology-based Mortality Score in Status Epilepticus - Etiology, Age, level of Consciousness), five for EMSE-EACE (EMSE - Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE-EAC, EMSE-EACE, and ENDIT was 0.74 (95% CI: 0.71-0.78), 0.68 (95% CI 0.63-0.72), 0.77 (95% CI: 0.72-0.81), and 0.78 (95% CI: 0.70-0.87), respectively. The pooled sensitivity of STESS-3, STESS-4, EMSE-EACE-64, and ENDIT-4 was 0.83 (95% CI: 0.80-0.86), 0.60 (95% CI: 0.55-0.65), 0.76 (95% CI: 0.67-0.83), and 0.70 (95% CI: 0.55-0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48-0.52), 0.74 (95% CI: 0.72-0.76), 0.63 (95% CI: 0.59-0.67), and 0.65 (95% CI: 0.61-0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24-0.30), 0.35 (95% CI: 0.29-0.41), 0.33 (95% CI: 0.24-0.43), and 0.20 (95% CI: 0.13-0.27). Their pooled NPV was 0.94 (95% CI: 0.93-0.96), 0.90 (95% CI: 0.89-0.92), 0.89 (95% CI: 0.80-0.98), and 0.95 (95% CI: 0.92-0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in-hospital mortality, with the EMSE-EAC having a lower discriminative power. STESS-3 has the highest sensitivity, and STESS-4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores.
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Affiliation(s)
- Fang Yuan
- Neurology Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Charlotte Damien
- Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Nicolas Gaspard
- Service de Neurologie, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium.,Neurology Department, Yale University School of Medicine, New Haven, Connecticut, USA
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10
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Chauhan R, Saxena N, Kapur N, Kardam D. Comparison of modified Glasgow-Imrie, Ranson, and Apache II scoring systems in predicting the severity of acute pancreatitis. Pol Przegl Chir 2022; 95:6-12. [PMID: 36806163 DOI: 10.5604/01.3001.0015.8384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Aim:</b> The course of acute pancreatitis is variable with patients at risk of poor outcomes. The purpose of this study was to compare Modified Glasgow-Imrie, Ranson, and APACHE II scoring systems in predicting the severity of acute pancreatitis. </br></br> <b> Material and Methods: </b> After a brief history, clinical examination and qualifying inclusion criteria, 70 patients (41 women, 29 men) diagnosed with acute pancreatitis were included in the study. The three scores were calculated for each patient and evaluated for their role in the assessment of specific outcomes. </br></br> <b>Results:</b> 34.3% patients were diagnosed with severe acute pancreatitis, while 65.7% patients had mild acute pancreatitis. A strong positive correlation was found between all the prognostic scores and the severity of disease. In the prediction of the severity of disease according to AUC, it was found that Glasgow-Imrie score had an AUC of 0.864 (0.7560.973), followed very closely by APACHE II score with an AUC of 0.863 (0.7580.968). APACHE II had the highest sensitivity (79.17%) in predicting severity while Glasgow-Imrie score was the most specific (97.83%) of all the scores. Patients with a Glasgow-Imrie score above the cut-off value of 3 had more complications and a longer hospital stay. </br></br> <b>Conclusion:</b> The Glasgow-Imrie score was comparable to APACHE II score and better than Ranson score statistically in predicting the severity of acute pancreatitis. Its administration in predicting the severity of acute pancreatitis is recommended.
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Affiliation(s)
- Rohit Chauhan
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Saxena
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeti Kapur
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Dinesh Kardam
- Department of General & Minimally Invasive Surgery, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes JG, Cruz-Lemini M, Thursz MR, Atkinson SR, Sarin SK, Kim W, Chavez-Araujo R, Higuera-de la Tijera MF, Singal AK, Shah VH, Kamath PS, Duarte-Rojo A, Charles EA, Vargas V, Jager M, Rautou PE, Rincon D, Zamarripa F, Restrepo-Gutiérrez JC, Torre A, Lucey MR, Arab JP, Mathurin P, Louvet A, García-Tsao G, González JA, Verna EC, Brown RS, Argemi J, Fernández-Carrillo C, Clemente A, Alvarado-Tapias E, Forrest E, Allison M, Bataller R. The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study. Am J Gastroenterol 2022; 117:301-310. [PMID: 34962498 PMCID: PMC8999152 DOI: 10.14309/ajg.0000000000001596] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 10/27/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.
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Affiliation(s)
- D Morales-Arráez
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Gastroenterology and Hepatology, Hospital Universitario de Canarias, Canarias, Spain
| | - M Ventura-Cots
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - J Altamirano
- Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain
| | - J G Abraldes
- Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada
| | - M Cruz-Lemini
- Women and Perinatal Research Group, Obstetrics and Gynecology Department, Sant Pau University Hospital, Barcelona, Spain, and Maternal and Child Health and Development Network (SAMID, RD16/0022/0015), Instituto de Salud Carlos III, Spanish Ministry of Health, Spain
| | - M R Thursz
- Department of Metabolism, Digestive disease and Reproduction, Imperial College London, UK
| | - S R Atkinson
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Department of Metabolism, Digestive disease and Reproduction, Imperial College London, UK
| | - S K Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - W Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - R Chavez-Araujo
- Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - A K Singal
- Division of Gastroenterology and Hepatology, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - V H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - P S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Duarte-Rojo
- Division of Gastroenterology and Hepatology, Department of Medicine, the University of Arkansas for Medical Science, Little Rock, Arkansas, USA
| | - E A Charles
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - V Vargas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Universidad Autónoma, Barcelona, CIBERehd, Barcelona, Spain
| | - M Jager
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
| | - P E Rautou
- Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, DHU Unity, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France
- Inserm, UMR-970, Paris Cardiovascular Research Center, PARCC, Paris, France
| | - D Rincon
- Hepatology Department, Hospital General Universitario Gregorio Marañón, CIBERehd and Universidad Complutense, Madrid, Spain
| | - F Zamarripa
- Gastroenterology, Juarez Hospital, Mexico City, Mexico
| | - J C Restrepo-Gutiérrez
- Liver Transplant Program, Hospital Pablo Tobon Uribe, University of Antioquia, Medellin, Colombia
| | - A Torre
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - M R Lucey
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - J P Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Mathurin
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
- LIRIC-Lille Inflammation Research International Center-U995, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - A Louvet
- Service des Maladies de l'Appareil Digestif et de la Nutrition, CHU Lille, Lille, France
| | - G García-Tsao
- Section of Digestive Diseases, Yale University School of Medicine/VA-CT Healthcare System, New Haven/West Haven, Connecticut¸ USA
| | - J A González
- Gastroenterology Department, Hospital Universitario "Dr. José E González" Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - E C Verna
- Division of Digestive and Liver Diseases, Department of Medicine and Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA
| | - R S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - J Argemi
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit, Clinica Universidad de Navarra, IdisNA. Pamplona, Spain
| | - C Fernández-Carrillo
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - A Clemente
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
- Liver Unit and Digestive Department H.G.U. Gregorio Marañón, Madrid, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - E Alvarado-Tapias
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - E Forrest
- Glasgow Royal Infirmary, Glasgow, UK
| | - M Allison
- Liver Unit, Cambridge Biomedical Research Centre, Cambridge, UK
| | - R Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
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Spence S, Doonan J, Farhan-Alanie OM, Chan CD, Tong D, Cho HS, Sahu MA, Traub F, Gupta S. Does the modified Glasgow Prognostic Score aid in the management of patients undergoing surgery for a soft-tissue sarcoma? : an international multicentre study. Bone Joint J 2022; 104-B:168-176. [PMID: 34969280 DOI: 10.1302/0301-620x.104b1.bjj-2021-0874.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The modified Glasgow Prognostic Score (mGPS) uses preoperative CRP and albumin to calculate a score from 0 to 2 (2 being associated with poor outcomes). mGPS is validated in multiple carcinomas. To date, its use in soft-tissue sarcoma (STS) is limited, with only small cohorts reporting that increased mGPS scores correlates with decreased survival in STS patients. METHODS This retrospective multicentre cohort study identified 493 STS patients using clinical databases from six collaborating hospitals in three countries. Centres performed a retrospective data collection for patient demographics, preoperative blood results (CRP and albumin levels and neutrophil, leucocyte, and platelets counts), and oncological outcomes (disease-free survival, local, or metastatic recurrence) with a minimum of two years' follow-up. RESULTS We found that increased mGPS, tumour size, grade, neutrophil/lymphocyte ratio, and disease recurrence were associated with reduced survival. Importantly, mGPS was the best at stratifying prognosis and could be used in conjunction with tumour grade to sub-stratify patient survival. CONCLUSION This study demonstrated that prognosis of localized STS strongly correlates with mGPS, as an increasing score is associated with a poorer outcome. We note that 203 patients (41%) with an STS have evidence of systemic inflammation. We recommend the mGPS and other biochemical blood indicators be introduced into the routine diagnostic assessment in STS patients to stratify patient prognosis. Its use will support clinical decision-making, especially when morbid treatment options such as amputation are being considered. Cite this article: Bone Joint J 2022;104-B(1):168-176.
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Affiliation(s)
| | - Stephanie Spence
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Corey D Chan
- North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne, UK
| | - Daniel Tong
- Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - Hwan Seong Cho
- Seoul National University Bundang Hospital Cancer Center, Seoul, South Korea
| | | | - Frank Traub
- Centre for Soft Tissue Sarcoma, GIST and Bone Tumors, Eberhard-Karls-University, Tuebingen, Germany
| | - Sanjay Gupta
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Belba M, Deda L, Belba G. Measurements Of Injury-Related Outcomes: Statistical And Analytical Data From Albania. Ann Burns Fire Disasters 2021; 34:301-311. [PMID: 35035322 PMCID: PMC8717911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/29/2021] [Indexed: 06/14/2023]
Abstract
Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury.
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Affiliation(s)
- M.K. Belba
- University of Medicine, Tirana, Albania
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
| | - L.N. Deda
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
| | - G.P. Belba
- University Hospital Center ‘Mother Teresa’, Tirana, Albania
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Lee Y, Schaubel DE. Facility profiling under competing risks using multivariate prognostic scores: Application to kidneytransplant centers. Stat Methods Med Res 2021; 31:563-575. [PMID: 34879778 DOI: 10.1177/09622802211052873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The performance of health care facilities (e.g. hospitals, transplant centers, etc.) is often evaluated through time-to-event outcomes. In this paper, we consider the case where, for each subject, the failure event is due to one of several mutually exclusive causes (competing risks). Since the distribution of patient characteristics may differ greatly by the center, some form of covariate adjustment is generally necessary in order for center-specific outcomes to be accurately compared (to each other or to an overall average). We propose a weighting method for comparing facility-specific cumulative incidence functions to an overall average. The method directly standardizes each facility's non-parametric cumulative incidence function through a weight function constructed from a multivariate prognostic score. We formally define the center effects and derive large-sample properties of the proposed estimator. We evaluate the finite sample performance of the estimator through simulation. The proposed method is applied to the end-stage renal disease setting to evaluate the center-specific pre-transplant mortality and transplant cumulative incidence functions from the Scientific Registry of Transplant Recipients.
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Affiliation(s)
- Youjin Lee
- Department of Biostatistics, 6752Brown University, USA
| | - Douglas E Schaubel
- Center for Causal Inference, 14640University of Pennsylvania, USA.,Department of Biostatistics, Epidemiology & Informatics, 14640University of Pennsylvania, USA
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Oikonomou T, Orfanidou A, Goulis I, Ntogramatzi F, Athanasiadou Z, Papatheodoridis GV, Cholongitas E. New prognostic score based on galectin-3 has similar performance to model for end-stage liver disease and sodium score in patients with stable decompensated cirrhosis. Ann Gastroenterol 2021; 34:728-735. [PMID: 34475745 PMCID: PMC8375656 DOI: 10.20524/aog.2021.0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Galectin-3 (gal-3) has been proposed as a marker of established renal impairment, with predictive value in stable decompensated cirrhosis. Methods 150 stable decompensated patients were assessed in 2 transplant centers. Patients' renal function was assessed using 51Chromium-EDTA ("true" glomerular filtration rate). We measured basic laboratory variables and gal-3 in serum samples. Factors associated with patients' outcomes were determined. Results Our patients were followed up for 12 months (range 1-48, interquartile range [IQR] 6, 95% confidence interval [CI] 10-13.5) and their mean prognostic scores were Child-Turcotte-Pugh (CTP) 7±2 and model for end-stage liver disease and sodium (MELD-Na) 15±6. Median gal-3 levels were 22 ng/mL. In a multivariate analysis of 94 patients (training group), gal-3 (hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.011-1.041; P=0.003) and serum sodium (HR 1.032, 95%CI 1.006-1.062; P=0.05) were the only factors independently associated with patients' outcomes. Kaplan-Meier analysis using the median gal-3 values revealed different times of survival (log-rank P=0.006). We derived a new prognostic score, (0.026) × serum gal-3+ (-0.079) × serum sodium, with very good discriminative accuracy for the outcome (area under the curve [AUC] 0.71, 95%CI 0.63-0.88), similar to that of the MELD-Na score (AUC 0.69, 95%CI 0.67-0.89; P=0.73), while its diagnostic accuracy was validated in the remaining 56 decompensated patients (AUC 0.81, 95%CI 0.65-0.97). Conclusions Gal-3 proved to be an accurate and plausible biomarker of renal dysfunction in patients with decompensated cirrhosis. A new prognostic model incorporating gal-3 and sodium was derived, with very good discriminative accuracy for the outcome.
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Affiliation(s)
- Theodora Oikonomou
- Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University of Thessaloniki (Theodora Oikonomou, Ioannis Goulis)
| | - Afroditi Orfanidou
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens (Afroditi Orfanidou, George V. Papatheodoridis)
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokration General Hospital, Medical School of Aristotle University of Thessaloniki (Theodora Oikonomou, Ioannis Goulis)
| | - Fani Ntogramatzi
- Department of Biochemistry, (Fani Ntogramatzi, Zoi, Athanasiadou)
| | - Zoi Athanasiadou
- Department of Biochemistry, (Fani Ntogramatzi, Zoi, Athanasiadou)
| | - George V Papatheodoridis
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens (Afroditi Orfanidou, George V. Papatheodoridis)
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, (Evangelos Cholongitas), Greece
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Di Federico A, Andrini E, Sisi M, Nuvola G, Lamberti G, Lenzi B, Nobili E, Gelsomino F, Ardizzoni A. Single-agent carboplatin in extensive disease small-cell lung cancer patient with liver failure: a case report within the experience of a single institution. Anticancer Drugs 2021; 32:755-757. [PMID: 33661187 PMCID: PMC9911106 DOI: 10.1097/cad.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Until recently, platinum-based chemotherapy has represented the benchmark for the treatment of extensive disease small-cell lung cancer (ED-SCLC). ED-SCLC patients are often diagnosed with poor performance status (PS ≥2) and/or compromised organ functions. In fact, up to 63% of ED-SCLC has extensive liver involvement at diagnosis, which correlates with a poor prognosis. Whether to treat patients with tumor-related organ failure is still debated and the selection of those who could benefit from chemotherapy is crucial. Moreover, severe liver impairment contraindicates the administration of etoposide. Among 74 consecutive ED-SCLC patients followed at our institution from January 2017 to November 2019, three patients received single-agent carboplatin as a first-line treatment due to liver failure. We provide a brief description of a former heavy smoker 70-year-old man who was diagnosed with ED-SCLC and severe liver involvement leading to liver failure. The patient received a first-line treatment with single-agent carboplatin, obtaining a partial response, clinical benefit and the normalization of laboratory test, which documented the complete recovery of liver function. The intent of our work is to highlight the feasibility of single-agent carboplatin in ED-SCLC patients with tumor-related hepatic failure but preserved Eastern Cooperative Oncology Group PS, suggesting that this therapeutic option should not be discouraged a priori. Indeed, the identification of specific tools guiding physicians in the selection of patients who might benefit from the treatment is remarkably needed; meanwhile, the use of available prognostic score (e.g. Manchester score) might be of great value and should be considered in clinical practice.
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Affiliation(s)
- Alessandro Di Federico
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
| | - Elisa Andrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
| | - Monia Sisi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
| | - Giacomo Nuvola
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Barbara Lenzi
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elisabetta Nobili
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Gelsomino
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant’Orsola-Malpighi University Hospital
- Divisione di Oncologia Medica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Burhamah W, Qahi I, Oroszlányová M, Shuaibi S, Alhunaidi R, Alduwailah M, Alhenaidi M, Mohammad Z. Prognostic Factors and Predictors of In-Hospital Mortality Among COVID-19 Patients Admitted to the Intensive Care Unit: An Aid for Triage, Counseling, and Resource Allocation. Cureus 2021; 13:e16577. [PMID: 34322358 PMCID: PMC8299433 DOI: 10.7759/cureus.16577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains today a global health pandemic. Those with severe infection are at risk of rapid clinical deterioration; as a result, intensive care unit (ICU) admission is not uncommon in such patients. A number of determinants have been identified as predictors of poor prognosis and in-hospital mortality, ranging from demographic characteristics, laboratory and/or radiological findings. AIM To identify determinants of in-hospital mortality and examine the accuracy of seven early warning scores in predicting in-hospital mortality. METHODS This is a retrospective study conducted in Kuwait from July 2020 to March 2021, and participants were adult patients with a positive test on the real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and who met the criteria for ICU admission. Data collected included: demographics, clinical status on hospital arrival, laboratory test results, and ICU course. Furthermore, we calculated seven early warning scores for each of our patients. RESULTS A total of 133 patients were admitted to our COVID-19 ICU with a median age of 59 years. Arrival to ICU on mechanical ventilation (MV), developing in-hospital complications, having chronic kidney disease (CKD), having a high white blood count (WBC), lactate dehydrogenase (LDH), lactate, or urea levels were found to be significant predictors of in-hospital mortality. Furthermore, the 4C mortality score for COVID-19, VACO index for COVID-19 mortality, and the PRIEST COVID-19 clinical severity score proved to be the most superior in predicting in-hospital mortality. CONCLUSION Identifying high-risk patients and those with a poor prognosis allows for efficient triaging and the delivery of high-standard care while minimizing the strain on the healthcare system.
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Affiliation(s)
- Waleed Burhamah
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Iman Qahi
- Department of General Surgery, Mubarak AlKabeer Hospital, Kuwait, KWT
| | - Melinda Oroszlányová
- College of Engineering and Technology, American University of the Middle East, Kuwait, KWT
| | - Sameera Shuaibi
- Department of Internal Medicine, Al-Adan Hospital, Kuwait, KWT
| | - Razan Alhunaidi
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - May Alduwailah
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - Maryam Alhenaidi
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
| | - Zahraa Mohammad
- Department of Internal Medicine, Kuwait University, Health Sciences Center, School of Medicine, Kuwait, KWT
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18
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Colombo CJ, Colombo RE, Maves RC, Branche AR, Cohen SH, Elie MC, George SL, Jang HJ, Kalil AC, Lindholm DA, Mularski RA, Ortiz JR, Tapson V, Liang CJ. Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort. Crit Care Explor 2021; 3:e0474. [PMID: 34278310 PMCID: PMC8280088 DOI: 10.1097/cce.0000000000000474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours. SETTING A multisite international inpatient trial. PATIENTS A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia. INTERVENTIONS Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment. MEASUREMENTS AND MAIN RESULTS For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60-0.68), and improved with addition of age (c-index, 0.66-0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65-0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68-0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59-0.69) and improved with addition of age (c-index, 0.63-0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05). CONCLUSIONS In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.
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Affiliation(s)
- Christopher J Colombo
- Madigan Army Medical Center, Tacoma, WA
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rhonda E Colombo
- Madigan Army Medical Center, Tacoma, WA
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Ryan C Maves
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
- Naval Medical Center, San Diego, CA
| | | | | | | | - Sarah L George
- Saint Louis University and St. Louis VA Medical Center, Saint Louis, MO
| | - Hannah J Jang
- Department of Community Health Systems, School of Nursing and Center for Nursing Excellence and Innovation, University of California San Francisco, San Francisco, CA
| | | | - David A Lindholm
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
- Brooke Army Medical Center, San Antonio, TX
| | - Richard A Mularski
- The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Justin R Ortiz
- University of Maryland School of Medicine, Baltimore, MD
| | | | - C Jason Liang
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, Bethesda, MD
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Breccia M, Efficace F, Scalzulli E, Ciotti G, Maestrini G, Colafigli G, Martelli M. Measuring prognosis in chronic myeloid leukemia: what's new? Expert Rev Hematol 2021; 14:577-585. [PMID: 34075852 DOI: 10.1080/17474086.2021.1938534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The outcome of chronic myeloid leukemia (CML) patients in chronic phase has changed after the introduction of tyrosine kinase inhibitors (TKIs). The life expectancy is actually similar to that of the general population. Prognostic stratification at baseline is part of a patient-centered approach to decide the best therapeutic approach.Areas covered: In this review, the current prognostic factors examined at baseline are detailed and the meaning is explained. A broad research on Medline, Embase and archives from EHA and ASH congresses, was performed. Prognostic factors have been divided into patient-related (age, gender, comorbidities, etc.) and disease-related (additional cytogenetic abnormalities, type of transcript, etc). New information about genomic data and the potential role of patient-reported outcomes is also discussed.Expert Opinion: Prognostic factors at baseline should be considered to evaluate the long-term probability of disease-related death, the possible toxicity, and the projected long-term overall survival. The genomic assessment would provide the basis for a genomic-based risk and help in oriented decision-making process.
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Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Emilia Scalzulli
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Giulia Ciotti
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Giacomo Maestrini
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Gioia Colafigli
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
| | - Maurizio Martelli
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy
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20
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Foncea CG, Sporea I, Lupușoru R, Moga TV, Bende F, Șirli R, Popescu A. Day-4 Lille Score Is a Good Prognostic Factor and Early Predictor in Assessing Therapy Response in Patients with Liver Cirrhosis and Severe Alcoholic Hepatitis. J Clin Med 2021; 10:jcm10112338. [PMID: 34071799 PMCID: PMC8198529 DOI: 10.3390/jcm10112338] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Lille score at Day 7 (LM7) helps to predict the outcome of patients with severe alcoholic hepatitis (sAH) undergoing corticotherapy. Several scores such as Maddrey’s discriminant function (MDF), MELD, ABIC, and GAHS are used for a 28-day mortality prognosis. Our study aimed to evaluate if the assessment of the Lille score at 4 days (LM4) is as useful as the Lille score at Day 7 (LM7) to predict response to corticosteroids and 28-day mortality and evaluate the utility of severity scores at admission for predicting the prognosis of patients with liver cirrhosis (LC) and severe alcoholic hepatitis (sAH). A retrospective study was performed, and all consecutive patients with AH and MDF > 32 without contraindications to corticosteroids were included. Prognostic scores were evaluated at admission, and 28-day mortality was assessed. Response to corticotherapy was assessed by LM4 and LM7. Results: A total of 55/103 patients with sAH (51.5%) had MDF > 32 and received corticosteroids. There was no difference between the proportion of patients with a responder LM4 versus LM7 (27% vs. 36%, p = 0.31). The mean value for LM4 was 0.64 ± 0.3 versus 0.60 ± 0.3 for LM7 (p = 0.48). Precisely 90.3% of patients were correctly identified as responders or not by LM4 compared with LM7. The best model for predicting 28-day mortality was composed of MELD and LM4/LM7, with an accuracy of 0.90 for both combinations. Conclusion: LM4 could be used instead of LM7 for predicting response to corticosteroid therapy in patients with sAH and LC, as well as 28-day mortality. Using LM4, we could avoid prolonged use of this therapy and its complications.
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Affiliation(s)
- Camelia Gianina Foncea
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Raluca Lupușoru
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Science, University of Medicine and Pharmacy “Victor Babeș”, 300041 Timișoara, Romania
| | - Tudor Voicu Moga
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Felix Bende
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Roxana Șirli
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, Piața Eftimie Murgu 2, 300041 Timișoara, Romania; (C.G.F.); (I.S.); (R.L.); (T.V.M.); (F.B.); (R.Ș.)
- Center of Advanced Research in Gastroenterology and Hepatology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: ; Tel.: +40-748-331233
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21
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Al Darazi G, Martin E, Delord JP, Korakis I, Betrian S, Estrabaut M, Poublanc M, Gomez-Roca C, Filleron T. Improving patient selection for immuno-oncology phase 1 trials: External validation of six prognostic scores in a French Cancer Center. Int J Cancer 2021; 148:2502-2511. [PMID: 33231298 DOI: 10.1002/ijc.33409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
We compared the performance of six prognostic scores (Royal Marsden Hospital, MDACC: MD Anderson Clinical Center and MDACC + NLR: neutrophil-to-lymphocyte ratio, MD Anderson - immune checkpoint inhibitors (MDA-ICI), GRIm: Gustave Roussy Immune Score and LIPI: Lung Immune Prognostic Index) in predicting overall survival (OS) in phase I trial patients treated with immune checkpoint inhibitors (ICI). Medical records of patients with advanced solid tumors enrolled in ICI phase I trials between 2015 and 2018 at Institut Universitaire du Cancer de Toulouse-Oncopole were reviewed. The performance of prognostic scores on OS was compared using different criteria. A total of 259 patients were included. Median age was 63 years (range: 18-83). Main primary cancers were melanoma (19%), head and neck (16%), lung (13%) and bladder (10%). With a median follow-up of 15 months (95% confidence interval [CI] = [11.6;17.5]), median OS was 12.5 months (95% CI = [10.3;16.0]). All scores were associated with OS. The MDACC, LIPI and GRIm scores performed better than the others. Concordance of risk group assignment between the scoring systems was poor. According to our results, the MDACC, GRIm and LIPI scores better suited to ICI phase I settings. Adequate scoring would allow better patient selection in early ICI trials, especially during the critical period of dose escalation, and in proof-of-concept expansion cohorts.
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Affiliation(s)
- Ghassan Al Darazi
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Jean-Pierre Delord
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Iphigenia Korakis
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Sarah Betrian
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Myriam Estrabaut
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Muriel Poublanc
- Clinical Research Department, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Carlos Gomez-Roca
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
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Abstract
The incidence of brain metastases (BM) is estimated between 20% and 40% of patients with solid cancer. The most common cause of this failure is lung cancer, and in locally advanced non-small cell lung cancer (NSCLC) BM represent a common site of relapse in 30-55% cases. The basic criteria of therapeutic decision-making are based on the significant prognostic factors which are components of prognostic scores. The standard approach to treatment of BM from NSCLC include whole brain radiotherapy (WBRT) which is used as adjuvant modality after local therapy (surgery or stereotactic radiosurgery) or as primary treatment and it remains the primary modality of treatment for patients with multiple metastases. WBRT is also used in combination with systemic therapy. The aim of presented review of literature is trying to answer which patients with BM from NSCLC should receive WBRT and when it could be omitted. There were presented the aspects of application of WBRT in relation to (I) choice between WBRT or the best supportive care and (II) employment of WBRT in combination with local treatment modalities [surgical resection or stereotactic radio-surgery (SRS)] and/or with systemic therapy. According to data from literature we concluded that the most important factor that needs to be considered when assessing the suitability of a patient for WBRT is the patient's prognosis based on the Lung-molGPA score. WBRT should be applied in treatment of multiple BM from lung cancer in patients with favourable prognosis and in in patients with presence of EML4-ALK translocation before therapy with crizotinib. Whereas WBRT could be omitted in patients with poor prognosis and after primary SRS.
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Affiliation(s)
- Beata Sas-Korczynska
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.,Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Monika Rucinska
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Loureiro H, Becker T, Bauer-Mehren A, Ahmidi N, Weberpals J. Artificial Intelligence for Prognostic Scores in Oncology: a Benchmarking Study. Front Artif Intell 2021; 4:625573. [PMID: 33937744 PMCID: PMC8086599 DOI: 10.3389/frai.2021.625573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction: Prognostic scores are important tools in oncology to facilitate clinical decision-making based on patient characteristics. To date, classic survival analysis using Cox proportional hazards regression has been employed in the development of these prognostic scores. With the advance of analytical models, this study aimed to determine if more complex machine-learning algorithms could outperform classical survival analysis methods. Methods: In this benchmarking study, two datasets were used to develop and compare different prognostic models for overall survival in pan-cancer populations: a nationwide EHR-derived de-identified database for training and in-sample testing and the OAK (phase III clinical trial) dataset for out-of-sample testing. A real-world database comprised 136K first-line treated cancer patients across multiple cancer types and was split into a 90% training and 10% testing dataset, respectively. The OAK dataset comprised 1,187 patients diagnosed with non-small cell lung cancer. To assess the effect of the covariate number on prognostic performance, we formed three feature sets with 27, 44 and 88 covariates. In terms of methods, we benchmarked ROPRO, a prognostic score based on the Cox model, against eight complex machine-learning models: regularized Cox, Random Survival Forests (RSF), Gradient Boosting (GB), DeepSurv (DS), Autoencoder (AE) and Super Learner (SL). The C-index was used as the performance metric to compare different models. Results: For in-sample testing on the real-world database the resulting C-index [95% CI] values for RSF 0.720 [0.716, 0.725], GB 0.722 [0.718, 0.727], DS 0.721 [0.717, 0.726] and lastly, SL 0.723 [0.718, 0.728] showed significantly better performance as compared to ROPRO 0.701 [0.696, 0.706]. Similar results were derived across all feature sets. However, for the out-of-sample validation on OAK, the stronger performance of the more complex models was not apparent anymore. Consistently, the increase in the number of prognostic covariates did not lead to an increase in model performance. Discussion: The stronger performance of the more complex models did not generalize when applied to an out-of-sample dataset. We hypothesize that future research may benefit by adding multimodal data to exploit advantages of more complex models.
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Affiliation(s)
- Hugo Loureiro
- Data Science, Pharmaceutical Research and Early Development Informatics (pREDi), Roche Innovation Center Munich (RICM), Penzberg, Germany.,Institute of Computational Biology, Helmholtz Zentrum Munich, Munich, Germany.,TUM School of Life Sciences Weihenstephan, Technical University of Munich, Freising, Germany
| | - Tim Becker
- Data Science, Pharmaceutical Research and Early Development Informatics (pREDi), Roche Innovation Center Munich (RICM), Penzberg, Germany
| | - Anna Bauer-Mehren
- Data Science, Pharmaceutical Research and Early Development Informatics (pREDi), Roche Innovation Center Munich (RICM), Penzberg, Germany
| | - Narges Ahmidi
- Institute of Computational Biology, Helmholtz Zentrum Munich, Munich, Germany
| | - Janick Weberpals
- Data Science, Pharmaceutical Research and Early Development Informatics (pREDi), Roche Innovation Center Munich (RICM), Penzberg, Germany
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Yengo-Kahn AM, Patel PD, Kelly PD, Wolfson DI, Dawoud F, Ahluwalia R, Bonfield CM, Guillamondegui OD. The value of simplicity: externally validating the Baylor cranial gunshot wound prognosis score. J Neurosurg 2021:1-9. [PMID: 33690151 DOI: 10.3171/2020.9.jns201891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gunshot wounds to the head (GSWH) are devastating injuries with a grim prognosis. Several prognostic scores have been created to estimate mortality and functional outcome, including the so-called Baylor score, an uncomplicated scoring method based on bullet trajectory, patient age, and neurological status on admission. This study aimed to validate the Baylor score within a temporally, institutionally, and geographically distinct patient population. METHODS Data were obtained from the trauma registry at a level I trauma center in the southeastern US. Patients with a GSWH in which dural penetration occurred were identified from data collected between January 1, 2009, and June 30, 2019. Patient demographics, medical history, bullet trajectory, intent of GSWH (e.g., suicide), admission vital signs, Glasgow Coma Scale score, pupillary response, laboratory studies, and imaging reports were collected. The Baylor score was calculated directly by using its clinical components. The ability of the Baylor score to predict mortality and good functional outcome (Glasgow Outcome Scale score 4 or 5) was assessed using the receiver operating characteristic curve and the area under the curve (AUC) as a measure of performance. RESULTS A total of 297 patients met inclusion criteria (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male). A total of 205 (69.0%) patients died, whereas 69 (23.2%) patients had good functional outcome. Overall, the Baylor score showed excellent discrimination of mortality (AUC = 0.88) and good functional outcome (AUC = 0.90). Baylor scores of 3-5 underestimated mortality. Baylor scores of 0, 1, and 2 underestimated good functional outcome. CONCLUSIONS The Baylor score is an accurate and easy-to-use prognostic scoring tool that demonstrated relatively stable performance in a distinct cohort between 2009 and 2019. In the current era of trauma management, providers may continue to use the score at the point of admission to guide family counseling and to direct investment of healthcare resources.
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Affiliation(s)
- Aaron M Yengo-Kahn
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Pious D Patel
- 2Vanderbilt University School of Medicine, Nashville
| | - Patrick D Kelly
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Fakhry Dawoud
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.,3Quillen College of Medicine, East Tennessee State University, Mountain Home, Tennessee
| | - Ranbir Ahluwalia
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.,4College of Medicine, Florida State University, Tallahassee, Florida; and
| | | | - Oscar D Guillamondegui
- 5Division of Trauma, Emergency Surgery, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
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Kelly PD, Patel PD, Yengo-Kahn AM, Wolfson DI, Dawoud F, Ahluwalia R, Guillamondegui OD, Bonfield CM. Incorporating conditional survival into prognostication for gunshot wounds to the head. J Neurosurg 2021:1-10. [PMID: 33690152 DOI: 10.3171/2020.9.jns202723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several scores estimate the prognosis for gunshot wounds to the head (GSWH) at the point of hospital admission. However, prognosis may change over the course of the hospital stay. This study measures the accuracy of the Baylor score among patients who have already survived the acute phase of hospitalization and generates conditional outcome curves for the duration of hospital stay for patients with GSWH. METHODS Patients in whom GSWH with dural penetration occurred between January 2009 and June 2019 were identified from a trauma registry at a level I trauma center in the southeastern US. The Baylor score was calculated using component variables. Conditional overall survival and good functional outcome (Glasgow Outcome Scale score of 4 or 5) curves were generated. The accuracy of the Baylor score in predicting mortality and functional outcome among acute-phase survivors (survival > 48 hours) was assessed using receiver operating characteristic curves and the area under the curve (AUC). RESULTS A total of 297 patients were included (mean age 38.0 [SD 15.7] years, 73.4% White, 85.2% male), and 129 patients survived the initial 48 hours of admission. These acute-phase survivors had a decreased mortality rate of 32.6% (n = 42) compared to 68.4% (n = 203) for all patients, and an increased rate of good functional outcome (48.1%; n = 62) compared to the rate for all patients (23.2%; n = 69). Among acute-phase survivors, the Baylor score accurately predicted mortality (AUC = 0.807) and functional outcome (AUC = 0.837). However, the Baylor score generally overestimated true mortality rates and underestimated good functional outcome. Additionally, hospital day 18 represented an inflection point of decreasing probability of good functional outcome. CONCLUSIONS During admission for GSWH, surviving beyond the acute phase of 48 hours doubles the rates of survival and good functional outcome. The Baylor score maintains reasonable accuracy in predicting these outcomes for acute-phase survivors, but generally overestimates mortality and underestimates good functional outcome. Future prognostic models should incorporate conditional survival to improve the accuracy of prognostication after the acute phase.
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Affiliation(s)
- Patrick D Kelly
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | - Pious D Patel
- 2Vanderbilt University School of Medicine, Nashville
| | - Aaron M Yengo-Kahn
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville
| | | | - Fakhry Dawoud
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.,3Quillen College of Medicine, East Tennessee State University, Mountain Home, Tennessee
| | - Ranbir Ahluwalia
- 1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.,4College of Medicine, Florida State University, Tallahassee, Florida; and
| | - Oscar D Guillamondegui
- 5Division of Trauma, Emergency Surgery, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
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Riecke K, Müller V, Weide R, Schmidt M, Park-Simon TW, Möbus V, Mundhenke C, Polasik A, Lübbe K, Hesse T, Laakmann E, Thill M, A Fasching P, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Witzel I. Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry-Comparison of Three Different GPA Prognostic Scores. Cancers (Basel) 2021; 13:844. [PMID: 33671376 DOI: 10.3390/cancers13040844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
Simple Summary The incidence of brain metastases from breast cancer is increasing and the treatment is still a major challenge. Several scores have been developed in order to estimate the prognosis of patients with brain metastases by objective criteria. Here, we validated all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer patients with brain metastases in the Brain Metastases in the German Breast Cancer (BMBC) registry. Although all three available GPA-scores were associated with OS, they all show limitations mainly in predicting short-term (below 3 months) survival but also in long-term (above 12 months) survival. We discuss the test performances of all scores in our work and provide evidence how physicians should use them as a tool to select patients for different treatment options. Abstract Several scores have been developed in order to estimate the prognosis of patients with brain metastases (BM) by objective criteria. The aim of this analysis was to validate all three published graded-prognostic-assessment (GPA)-scores in a subcohort of 882 breast cancer (BC) patients with BM in the Brain Metastases in the German Breast Cancer (BMBC) registry. The median age at diagnosis of BM was 57 years. All in all, 22.3% of patients (n = 197) had triple-negative, 33.4% (n = 295) luminal A like, 25.1% (n = 221) luminal B/HER2-enriched like and 19.2% (n = 169) HER2 positive like BC. Age ≥60 years, evidence of extracranial metastases (ECM), higher number of BM, triple-negative subtype and low Karnofsky-Performance-Status (KPS) were all associated with worse overall survival (OS) in univariate analysis (p < 0.001 each). All three GPA-scores were associated with OS. The breast-GPA showed the highest probability of classifying patients with survival above 12 months in the best prognostic group (specificity 68.7% compared with 48.1% for the updated breast-GPA and 21.8% for the original GPA). Sensitivities for predicting 3 months survival were very low for all scores. In this analysis, all GPA-scores showed only moderate diagnostic accuracy in predicting the OS of BC patients with BM.
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Frost F, Nazareth D, Shaw M, Al-Aloul M. Assessing the validity and applicability of the French 3-year prognostic score in the UK cystic fibrosis population - a national cohort study. Transpl Int 2021; 34:436-444. [PMID: 33486768 DOI: 10.1111/tri.13805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/11/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
Models that predict outcomes, aid prognostication and inform the assessment of urgency for lung transplantation (LT) in CF are in demand. A prognostic score derived from the French adult CF registry to predict death or LT over 3-year follow-up was described in 2017 and validated using Canadian CF registry data. We assessed its performance in the UK CF population. The French prognostic score was applied to untransplanted adults with CF. The index year (2014) and outcomes (Death or LT) were evaluated to 2017. Receiver operator characteristics plots and area under curve (AUC) was computed. 4407 adults with CF met the inclusion criteria. After 3 years, 7.1% (P < 0.001) were dead or had received LT compared to the French (12.8%) and Canadian (9.4%) cohorts. The French score deemed 592 (26.2%) 'High-risk' - death/LT occurred in 189/592 (30.2%), less than previously reported in France and Canada (P < 0.0001). The discriminatory power of the French score was lower (AUC 0.830) than reported. Recalibration yielded only marginal improvement in model performance (AUC 0.833). The French prognostic score does not perform as well in the UK as reported elsewhere. Bespoke UK scores are needed to aid prognostication and inform LT decision-making.
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Affiliation(s)
- Freddy Frost
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Dilip Nazareth
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
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Cheng Z, Liu Z, Yuan Y, Liu Z, He Y, Jiang P. Predictive value of serum soluble B7-H4 in acute pancreatitis. Eur J Clin Invest 2020; 50:e13346. [PMID: 32648937 DOI: 10.1111/eci.13346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/06/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies reported that soluble B7-H4 (sB7-H4) was significantly related to the progression and prognosis of inflammatory diseases, and whether sB7-H4 is related to the severity and prognosis of acute pancreatitis (AP) timely has not been reported. MATERIALS AND METHODS Clinical database data of 446 AP patients were retrospectively collected, and the correlation between the expression serum levels of sB7-H4 with inflammatory factors and prognostic scores was analysed in AP patients. RESULTS Soluble B7-H4 was significantly correlated with IL-6, IL-8, TNF-α, PCT, CRP levels and WBC count (P < .01), with correlation coefficients of R = .61, .53, .46, .60, .57 and .47, respectively, and AUCs were 0.905, 0.837, 0.797, 0.858, 0.890, 0.841 and 0.855, respectively. In addition, sB7-H4 was significantly correlated with the Ranson score, APACHE II score and BISAP score (P < .001), with correlation coefficients of R = .58, .63 and .59, respectively. The AUCs of assessing local complications of AP were 0.908, 0.863, 0.785 and 0.844, respectively; assessing organ failure were 0.872, 0.790, 0.796 and 0.857, respectively; and assessing in-hospital mortality were 0.839, 0.821, 0.796 and 0.823, respectively. CONCLUSIONS Soluble B7-H4 could be used as a marker for the diagnosis, severity assessment and poor prognosis assessment of AP patients, which may have potential clinical applications.
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Affiliation(s)
- Zhixiang Cheng
- Department Hepatobiliary & Pancreat Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zhengfang Liu
- Department Neurology, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Yuan
- Department Hepatobiliary & Pancreat Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Zhisu Liu
- Department Hepatobiliary & Pancreat Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yueming He
- Department Hepatobiliary & Pancreat Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Ping Jiang
- Department Hepatobiliary & Pancreat Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
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Hahn AW, Alhalabi O, Msaouel P, Meric-Bernstam F, Naing A, Jonasch E, Piha-Paul S, Hong D, Pant S, Yap T, Campbell E, Le H, Tannir NM, Roszik J, Subbiah V. Validation of prognostic scoring systems for patients with metastatic renal cell carcinoma enrolled in phase I clinical trials. ESMO Open 2020; 5:e001073. [PMID: 33229506 PMCID: PMC7684827 DOI: 10.1136/esmoopen-2020-001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/09/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND For patients with metastatic renal cell carcinoma (mRCC) who progress on standard-of-care therapies, there is an unmet need for novel treatments. Phase I clinical trials are designed to test the safety, toxicity and optimal dosing of novel agents. Herein, we analysed the outcomes of patients with mRCC enrolled in phase I trials and assess the utility of prognostic scores. METHODS Patients with all histologies of mRCC were included if they received treatment on a phase I clinical trial at MD Anderson Cancer Center (MDACC). Survival outcomes were calculated using Cox proportional hazard model. Prognostic value of the International Metastatic RCC Database Consortium (IMDC), Royal Marsden Hospital (RMH) and MDACC scores was assessed using the likelihood ratio (LR) χ2 test and the c-index. RESULTS Among 82 patients with mRCC who received treatment, 21 patients participated in more than one trial, resulting in 106 trial participants (TP). Median prior therapies was two. For all TPs, median overall survival (OS) was 31.2 months, progression-free survival (PFS) was 5.9 months and objective response rate was 22%. Median OS and PFS were significantly shorter with increasing IMDC, RMH and MDACC scores. The RMH and MDACC scores outperformed the IMDC score for predicting OS (RMH LR χ2=8.64; MDACC LR χ2=7.74; IMDC LR χ2=2.36) and PFS (RMH LR χ2=17.5; MDACC LR χ2=20.3; IMDC LR χ2=4.28). CONCLUSIONS The RMH and MDACC prognostic scores can be used to predict OS for patients with mRCC in phase I trials and may guide patient selection. Patients with mRCC should be considered for phase I trials.
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Affiliation(s)
- Andrew W Hahn
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Omar Alhalabi
- Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pavlos Msaouel
- Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy Yap
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erick Campbell
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hung Le
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nizar M Tannir
- Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason Roszik
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Genomic Medicine, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Özdemir U, Ortaç Ersoy E, Yüksel RC, Kaya E, Aygencel G, Türkoğlu M, Topeli A, Güven M, Sungur M, Altintaş ND. Value of prognostic scores in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis patients in intensive care unit: a multicenter retrospective cohort study from Turkey. Turk J Med Sci 2020; 50:1223-1230. [PMID: 32304194 PMCID: PMC7491289 DOI: 10.3906/sag-1911-86] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 04/18/2020] [Indexed: 11/11/2022] Open
Abstract
Background/aim There is a need for a scoring system for predicting ICU prognosis of patients with ANCA-associated vasculitis (AAV), but there are limited data on it in the literature. Therefore, we aimed to determine the scores that can estimate the prognosis of patients with AAV during intensive care follow up. Materials and methods All adult patients admitted to the medical ICUs of 4 reference university hospitals in Turkey due to AAV activation and/or disease/treatment complications in the last 10 years were included in this study. Demographic data, treatments before ICU, the Birmingham Vasculitis Activity Score (BVAS) score at the time of vasculitis diagnosis, and BVAS, APACHE II, SOFA, and SAPS II scores at the ICU admission, treatments, procedures, and complications during ICU stay were recorded for all AAV patients. Results Thirty-four patients were included in the study. The median age of the patients was 60 (42–70) years, and 64.7% were male. Twenty-five patients were diagnosed with Granulomatosis with polyangiitis, and 9 were diagnosed with Microscopic polyangiitis. The most common ICU admission causes were hemorrhage (85.3%) and sepsis/septic shock (67.6%). Twenty patients (58.8%) died in the ICU follow up. There were significant differences in APACHE II (P = 0.004) and SAPS II (P = 0.044) scores between survivors and nonsurvivors, while there were no significant differences in BVAS (during diagnosis P = 0.089 and ICU admission P = 0.539) and SOFA (P = 0.097) scores. APACHE II score was found to be an independent risk factor for ICU mortality (OR = 1.231, CI 95% = 1.011–1.498, P = 0.038) according to logistic regression analysis. An APACHE II score of greater than 20.5 predicted ICU mortality with 80% sensitivity and 70% specificity (AUC = 0.8, P = 0.004, Likelihood ratio = 2.6) according to the ROC curve analysis. Conclusion APACHE II score can be used for the prediction of ICU mortality in AAV patients.
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Affiliation(s)
- Uğur Özdemir
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Recep Civan Yüksel
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Erhan Kaya
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
| | - Gülbin Aygencel
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Melda Türkoğlu
- Division of Intensive Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Division of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Muhammet Güven
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Murat Sungur
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey
| | - Neriman Defne Altintaş
- Division of Intensive Care Medicine, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey
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Mazzaschi G, Minari R, Zecca A, Cavazzoni A, Ferri V, Mori C, Squadrilli A, Bordi P, Buti S, Bersanelli M, Leonetti A, Cosenza A, Ferri L, Rapacchi E, Missale G, Petronini PG, Quaini F, Tiseo M. Soluble PD-L1 and Circulating CD8+PD-1+ and NK Cells Enclose a Prognostic and Predictive Immune Effector Score in Immunotherapy Treated NSCLC patients. Lung Cancer 2020; 148:1-11. [PMID: 32768804 DOI: 10.1016/j.lungcan.2020.07.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Upfront criteria to foresee immune checkpoint inhibitors (ICIs) efficacy are far from being identified. Thus, we integrated blood descriptors of pro-inflammatory/immunosuppressive or effective anti-tumor response to non-invasively define predictive immune profiles in ICI-treated advanced non-small cell lung cancer (NSCLC). METHODS Peripheral blood (PB) was prospectively collected at baseline from 109 consecutive NSCLC patients undergoing ICIs as first or more line treatment. Soluble PD-L1 (sPD-L1) (immunoassay), CD8+PD-1+ and NK (FACS) cells were assessed and interlaced to generate an Immune effector Score (IeffS). Lung Immune Prognostic Index (LIPI) was computed by LDH levels and derived Neutrophil-to-Lymphocyte Ratio (dNLR). All these parameters were correlated with survival outcome and treatment response. RESULTS High sPD-L1 and low CD8+PD-1+ and NK number had negative impact on PFS (P < 0.001), OS (P < 0.01) and ICI-response (P < 0.05). Thus, sPD-L1high, CD8+PD-1+low and NKlow were considered as risk factors encompassing IeffS, whose prognostic power outperformed that of individual features and slightly exceeded that of LIPI. Accordingly, the absence of these risk factors portrayed a favorable IeffS characterizing patients with significantly (P < 0.001) prolonged PFS (median NR vs 2.3 months) and OS (median NR vs 4.1) and greater benefit from ICIs (P < 0.01). We then combined each risk parameter composing IeffS and LIPI (LDHhigh, dNLRhigh), thus defining three distinct prognostic classes. A remarkable impact of IeffS-LIPI integration was documented on survival outcome (PFS, HR = 4.61; 95%CI = 2.32-9.18; P < 0.001; OS, HR=4.03; 95%CI=1.91-8.67; P < 0.001) and ICI-response (AUC=0.90, 95%CI=0.81-0.97, P < 0.001). CONCLUSION Composite risk models based on blood parameters featuring the tumor-host interaction might provide accurate prognostic scores able to predict ICI benefit in NSCLC patients.
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Affiliation(s)
- G Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine & Surgery, University of Parma, Italy
| | - R Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - A Zecca
- Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - A Cavazzoni
- Department of Medicine & Surgery, University of Parma, Italy
| | - V Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - C Mori
- Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - A Squadrilli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - P Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - M Bersanelli
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - A Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - A Cosenza
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - L Ferri
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - E Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Missale
- Department of Medicine & Surgery, University of Parma, Italy; Infectious Diseases and Hepatology Unit, Laboratory of Viral Immunopathology, University Hospital of Parma, Italy
| | - P G Petronini
- Department of Medicine & Surgery, University of Parma, Italy
| | - F Quaini
- Department of Medicine & Surgery, University of Parma, Italy
| | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine & Surgery, University of Parma, Italy
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Moreno Berggren D, Kjellander M, Backlund E, Engvall M, Garelius H, Lorenz F, Nilsson L, Rasmussen B, Lehmann S, Hellström-Lindberg E, Jädersten M, Ungerstedt J, Ejerblad E. Prognostic scoring systems and comorbidities in chronic myelomonocytic leukaemia: a nationwide population-based study. Br J Haematol 2020; 192:474-483. [PMID: 32501529 DOI: 10.1111/bjh.16790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/04/2020] [Indexed: 01/07/2023]
Abstract
Outcomes in chronic myelomonocytic leukaemia (CMML) are highly variable and may be affected by comorbidity. Therefore, prognostic models and comorbidity indices are important tools to estimate survival and to guide clinicians in individualising treatment. In this nationwide population-based study, we assess comorbidities and for the first time validate comorbidity indices in CMML. We also compare the prognostic power of: the revised International Prognostic Scoring System (IPSS-R), CMML-specific prognostic scoring system (CPSS), MD Anderson Prognostic Scoring System (MDAPS) and Mayo score. In this cohort of 337 patients with CMML, diagnosed between 2009 and 2015, the median overall survival was 21·3 months. Autoimmune conditions were present in 25% of the patients, with polymyalgia rheumatica and Hashimoto's thyroiditis being most common. Of the tested comorbidity indices: the Charlson Comorbidity Index (CCI), Haematopoietic cell transplantation-specific Comorbidity Index (HCT-CI) and Myelodysplastic Syndrome-Specific Comorbidity Index (MDS-CI), CCI had the highest C-index (0·62) and was the only comorbidity index independently associated with survival in multivariable analyses. When comparing the prognostic power of the scoring systems, the CPSS had the highest C-index (0·69). In conclusion, using 'real-world' data we found that the CCI and CPSS have the best prognostic power and that autoimmune conditions are overrepresented in CMML.
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Affiliation(s)
- Daniel Moreno Berggren
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Matilda Kjellander
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Backlund
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Marie Engvall
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Hege Garelius
- Section for Haematology and Coagulation, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fryderyk Lorenz
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lars Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Bengt Rasmussen
- School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Sören Lehmann
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
| | - Eva Hellström-Lindberg
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Jädersten
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Johanna Ungerstedt
- Center for Hematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital and PO Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Ejerblad
- Department of Medical Science, Section of Hematology, Uppsala University, Uppsala, Sweden
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Cruz NM, Gergis U, Silver RT. Myelofibrosis: best practices, controversies and 2019 update. Expert Rev Hematol 2019; 13:71-84. [PMID: 31709843 DOI: 10.1080/17474086.2020.1691519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Recent advances in the prognostic scheme and treatment of primary and secondary myelofibrosis (MF) have resulted in an overwhelming amount of clinical information to assimilate. The authors believe a comprehensive review that summarizes the most recent published literature, could serve as guidelines for the practicing hematologist.Areas covered: The authors provide a summary of landmark articles regarding epidemiology, symptoms, and pathogenesis of disease. The authors conducted a systematic literature review to answer questions regarding differences between primary myelofibrosis (PMF) and secondary myelofibrosis (SMF), appropriate use and selection of the current risk-stratification models, early versus late treatment of MF and current practices in allogeneic hematopoietic stem cell transplantation (allo-HCT) for MF. The authors conclude the article with their clinical opinion based on their experience and literature review. The purpose of this article is to identify current practices, address any variation, identify and investigate conflicting results and produce statements to guide decision-making.Expert opinion: In this section, the authors advocate for and provide examples of a standardized way of incorporating future discoveries in the pathogenesis and risk-stratification models of MF. They also discuss the importance of using only one risk-stratification model for PMF and one for SMF and their reasoning for early instead of late treatment of MF.
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Affiliation(s)
- Nicole M Cruz
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Usama Gergis
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Richard T Silver
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY, USA.,Richard T. Silver, M.D. Myeloproliferative Neoplasms (MPN) Center, Weill Cornell Medical College, New York, NY, USA
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Bellini A, Marulli G, Breda C, Ferrigno P, Terzi S, Lomangino I, Lo Giudice F, Brombin C, Laurino L, Pezzuto F, Calabrese F, Rea F. Predictors of behaviour in solitary fibrous tumours of the pleura surgically resected: Analysis of 107 patients. J Surg Oncol 2019; 120:761-767. [PMID: 31309564 DOI: 10.1002/jso.25634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Gold standard therapy for solitary fibrous tumour of the pleura is complete surgical resection. Aims of this retrospective study are to evaluate oncological and surgical outcomes and to verify the clinical reliability of prognostic scores presented in literature. METHODS Study population: 107 patients surgically treated between 1972 and 2018. Male/female ratio: 1/2.45; median age at surgery: 60 years (range, 19-80); peduncle lesions 69.8%; visceral pleura origin 72.9%; benign histology 73.8%; median diameter 8 cm (range 1 to 35, 27 cases giant [≥15 cm]). RESULTS After a median follow up of 7 years, 12 patients had recurrence. By multivariate analysis, malignant histology (P = .03; HR, 4.17; 95% CI, 1.15-15.06), origin from parietal pleura (P = .03; HR, 3.90; 95% CI, 1.08-14.09), England (P = .002; HR, 1.98; 95% CI, 1.28-3.07), Diebold (P = .008; HR, 1.96; 95% CI, 1.20-3.22) and Tapias (P = .003; HR, 1.75; 95% CI, 1.20-2.53) scores were found independent significant predictors of relapse. Giant tumours were associated with open surgery (P = .003), origin from parietal pleura (P = .011) and intraoperative bleeding (P > .001). Overall 10-year disease-free survival (DFS) rate was 81%. Predictors of worst DFS were parietal pleura origin (P = .002), malignant histology (P = .006) and all the prognostic scores. CONCLUSIONS Malignant histology and origin from parietal pleura were significant predictors of tumour recurrence and worst DFS. The use of current scoring systems can help to predict clinical behaviour. Patients with higher risk of relapse can benefit from closer follow up, prolonged over 10 years.
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Affiliation(s)
- Alice Bellini
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy
| | - Cristiano Breda
- Thoracic Surgery Unit, L'Angelo Hospital, Venice-Mestre, Italy
| | - Pia Ferrigno
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Ivan Lomangino
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | | | - Claudia Brombin
- Thoracic Surgery Unit, L'Angelo Hospital, Venice-Mestre, Italy
| | - Licia Laurino
- Pathology Unit, L'Angelo Hospital, Venice-Mestre, Italy
| | - Federica Pezzuto
- Pathologic Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Fiorella Calabrese
- Pathologic Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
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Bohn J, Schneeweiss S, Glynn RJ, Toh S, Wyss R, Desai R, Gagne JJ. Controlling Confounding in a Study of Oral Anticoagulants: Comparing Disease Risk Scores Developed Using Different Follow-Up Approaches. EGEMS (Wash DC) 2019; 7:27. [PMID: 31346542 DOI: 10.5334/egems.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: Little is known about how disease risk score (DRS) development should proceed under different pharmacoepidemiologic follow-up strategies. In an analysis of dabigatran vs. warfarin and risk of major bleeding, we compared the results of DRS adjustment when models were developed under “intention-to-treat” (ITT) and “as-treated” (AT) approaches. Methods: We assessed DRS model discrimination, calibration, and ability to induce prognostic balance via the “dry run analysis”. AT treatment effects stratified on each DRS were compared with each other and with a propensity score (PS) stratified reference estimate. Bootstrap resampling of the historical cohort at 10 percent–90 percent sample size was performed to assess the impact of sample size on DRS estimation. Results: Historically-derived DRS models fit under AT showed greater decrements in discrimination and calibration than those fit under ITT when applied to the concurrent study population. Prognostic balance was approximately equal across DRS models (–6 percent to –7 percent “pseudo-bias” on the hazard ratio scale). Hazard ratios were between 0.76 and 0.78 with all methods of DRS adjustment, while the PS stratified hazard ratio was 0.83. In resampling, AT DRS models showed more overfitting and worse prognostic balance, and led to hazard ratios further from the reference estimate than did ITT DRSs, across sample sizes. Conclusions: In a study of anticoagulant safety, DRSs developed under an AT principle showed signs of overfitting and reduced confounding control. More research is needed to determine if development of DRSs under ITT is a viable solution to overfitting in other settings.
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Singh SK, Sen Sarma M, Yadav R, Kumar S, Prasad R, Yachha SK, Srivastava A, Poddar U. Prognostic scoring systems and outcome of endovascular radiological intervention of chronic Budd-Chiari syndrome in children. Liver Int 2018; 38:1308-1315. [PMID: 29297972 DOI: 10.1111/liv.13683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/19/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Prognostic scoring systems (PSS) have not been validated in children with chronic Budd-Chiari syndrome (BCS). We aimed to analyse the long-term outcome of radiological intervention (RI) and validate the PSS in children. METHODS Chronic BCS children were analysed in four subgroups: (i) SI: successful intervention (primary or secondary stent patency) (ii) PO: poor outcome (refractory stent block or requirement of liver transplantation), (iii) NU: naïve unintervened (awaiting RI) and (iv) DBI: died before intervention. PSS analysed included Paediatric end-stage liver disease (PELD), Rotterdam, BCS-Transjuglar intrahepatic Portosystemic shunt (BCS-TIPS) index, Zeitoun, Child-Pugh and Model for end-stage liver disease. RESULTS Of 113 BCS children, 48 children underwent 53 successful primary RI. Actuarial probability of vascular patency was 87% at 1 year and 82% at 5 years follow-up. Four groups (SI: n = 40, PO: n = 7, NU: n = 13, DBI: n = 6) were analysed. Univariate analysis showed pre-intervention PELD score [PO: 11 (-1-23) vs SI: 2 (-8-25), P = .009] with a cut-off of 4 (AUC: 0.809, 86% sensitivity, 75% specificity) determined PO following intervention. In unintervened group (NU vs DBI), multivariate analysis demonstrated that Zeitoun score predicted death independently (OR 15.4, 95% CI: 1.17-203.56, P = .04) with a cut-off of 4.3 (AUC: 0.923, 83% sensitivity and 77% specificity). CONCLUSIONS Children with BCS have a favourable long-term outcome. Among those undergoing RI, pre-intervention PELD score determines the outcome. Survival is determined by Zeitoun score in those unintervened.
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Affiliation(s)
- Sumit K Singh
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajanikant Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sheo Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Raghunandan Prasad
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Abstract
Surgery, stereotactic radiosurgery, radiotherapy, and chemotherapy including novel targeted therapy strategies and any combination thereof as well as supportive care are the key elements for treatment of brain metastases. Goals of microsurgery are to obtain tissue samples for histologic diagnosis (particularly in case of uncertainty about the unknown primary tumor but also in the context of future targeted therapies), to relieve burden from space-occupying effects, to improve local tumor control, and to prolong overall survival. Complete surgical resection improves local tumor control and may even affect overall survival. Stereotactic radiosurgery is an equal effective alternative for metastases up to 3 cm in diameter, especially in highly eloquent or deep seated location. Gross total resection (as defined by immediate postoperative MRI) does not necessarily have to be combined with whole brain radiotherapy (WBRT), at least for patients with good performance status and controlled systemic disease. Particularly in cases of incomplete resections, focal irradiation or radiosurgery of the resection cavity or tumor remnant rather than WBRT may be attempted.
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Affiliation(s)
- Niklas Thon
- Department of Neurosurgery, University of Munich LMU, Munich, Germany
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Montalbán C, Díaz-López A, Dlouhy I, Rovira J, Lopez-Guillermo A, Alonso S, Martín A, Sancho JM, García O, Sánchez JM, Rodríguez M, Novelli S, Salar A, Gutiérrez A, Rodríguez-Salazar MJ, Bastos M, Domínguez JF, Fernández R, Gonzalez de Villambrosia S, Queizan JA, Córdoba R, de Oña R, López-Hernandez A, Freue JM, Garrote H, López L, Martin-Moreno AM, Rodriguez J, Abraira V, García JF. Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β 2 -microglobulin yields a more accurate GELTAMO-IPI. Br J Haematol 2017; 176:918-928. [PMID: 28106247 DOI: 10.1111/bjh.14489] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022]
Abstract
The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (β2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and β2M as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.
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Affiliation(s)
- Carlos Montalbán
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Antonio Díaz-López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Ivan Dlouhy
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | - Jordina Rovira
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | | | - Sara Alonso
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Alejandro Martín
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Juan M Sancho
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Olga García
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Jose M Sánchez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Rodríguez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Silvana Novelli
- Department of Haematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonio Salar
- Department of Haematology, Hospital del Mar, Barcelona, Spain
| | - Antonio Gutiérrez
- Department of Haematology, Hospital Universitari Son Espases, Palma de Mallorca (IdISPa), Spain
| | | | - Mariana Bastos
- Department of Haematology, Hospital Gregorio Marañón, Madrid, Spain
| | - Juan F Domínguez
- Department of Haematology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Rubén Fernández
- Department of Haematology, Hospital de Cabueñes, Gijón, Spain
| | | | - José A Queizan
- Department of Haematology, Hospital General de Segovia, Segovia, Spain
| | - Raul Córdoba
- Department of Haematology, Fundación Jimenez Díaz, Madrid, Spain
| | - Raquel de Oña
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Julian M Freue
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Heidys Garrote
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Lourdes López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Jose Rodriguez
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Víctor Abraira
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan F García
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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Radisavljevic MM, Bjelakovic GB, Nagorni AV, Stojanovic MP, Radojkovicn MD, Jovic JZ, Ignjatovic AM, Radisavljevic MM, Simonovic MM. Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores? Med Princ Pract 2017; 26:169-175. [PMID: 27676412 PMCID: PMC5588345 DOI: 10.1159/000451057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 09/27/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To identify the prognostic score that is the best predictor of outcome in patients hospitalized with decompensated liver cirrhosis. MATERIAL AND METHODS In this prospective study, 126 patients were enrolled and followed up for 29 months. For each patient, prognostic scores were calculated; these included the Child-Turcotte-Pugh score (CTP score), CTP creatinine-modified I score, CTP creatinine-modified II score, Model for End-Stage Liver Disease (MELD score), MELD model for end-stage liver disease sodium-modified score, Integrated MELD score, updated MELD score, United Kingdom MELD, and the MELD score remodeled by serum sodium index (MESO index). Cox regression analysis was used to assess the ability of each of the scores for predicting mortality in patients with alcoholic cirrhosis. Their discriminatory ability was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS The updated MELD score had the highest predictive value (3.29) among the tested scores (95% CI: 2.26-4.78). ROC curve analysis demonstrated that the MELD score of 22.50 (AUC = 0.914, 95% CI: 0.849-0.978; p < 0.001) had the best discriminative ability for identifying patients with a high risk of mortality; the next best was the MESO index of 16.00 (AUC = 0.912, 95% CI: 0.847-0.978; p < 0.001). CONCLUSION The risk of mortality was highest in patients with the highest updated MELD score, and those with MELD scores >22.50 and a MESO index >16.00.
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Affiliation(s)
- Mirjana M. Radisavljevic
- Department of Gastroenterology, Belgrade, Serbia
- *Dr. Mirjana M. Radisavljevic, Department of Gastroenterology, Clinical Center of Nis, Stanoja Bunusevca Street 16/41, RS-18000 Nis (Serbia), E-Mail
| | | | | | | | | | - Jasna Z. Jovic
- Department of Department of Gastroenterology, Medical Military Academy Belgrade, Belgrade, Serbia
| | | | | | - Maja M. Simonovic
- Department of Clinic for Mental Health, Clinical Center of Nis, Belgrade, Serbia
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Gowin K, Coakley M, Kosiorek H, Mesa R. Discrepancies of applying primary myelofibrosis prognostic scores for patients with post polycythemia vera/essential thrombocytosis myelofibrosis. Haematologica 2016; 101:e405-e406. [PMID: 27354022 DOI: 10.3324/haematol.2016.149013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Krisstina Gowin
- Mayo Clinic Arizona, Department of Hematology, Scottsdale, AZ, USA
| | - Maria Coakley
- Department of Medical Oncology, Cork University Hospital, Wilton, Ireland
| | - Heidi Kosiorek
- Mayo Clinic Arizona, Department of Health Sciences Research, Section of Biostatistics, Scottsdale, AZ, USA
| | - Ruben Mesa
- Mayo Clinic Arizona, Department of Hematology, Scottsdale, AZ, USA
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Manerikar S, Hariharan S. Do Serially Recorded Prognostic Scores Predict Outcome Better Than One-Time Recorded Score on Admission? A Prospective Study in Adult Intensive Care Patients. J Intensive Care Med 2016; 32:480-486. [PMID: 26768423 DOI: 10.1177/0885066615625937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The prognosticating ability of one-time recorded Acute Physiology and Chronic Health Evaluation (APACHE) IV score was compared with serially recorded Mortality Prediction Model (MPM) II scores. DESIGN AND METHODS A prospective observational study was conducted for a period of 6 months. Acute Physiology and Chronic Health Evaluation IV score was recorded during the first day on intensive care unit (ICU) admission. Mortality Prediction Model II was recorded on admission, 24, 48, and 72 hours. Predicted mortality was compared with observed mortality. The systems were calibrated and tested for discriminant functions. RESULTS One hundred and fifty patients were studied. The observed mortality was 21.3%. The mean predicted hospital mortality by APACHE IV was 20.6%. The mean predicted hospital mortality rate by serial MPM II measurements was 27.7%, 24.3%, 25.5%, and 25.8%. The area under the receiver-operating characteristic curve was 0.87 for APACHE IV and 0.82, 0.84, 0.85, and 0.89 for MPM II series. Both systems calibrated well with similar degree of goodness of fit. CONCLUSION Acute Physiology and Chronic Health Evaluation IV on admission predicted hospital mortality better than serially recorded MPM, which overestimated mortality. Also, APACHE IV had a slightly better discrimination compared to MPM II on admission. One-time recording of APACHE IV on admission may be sufficient for prognostication of ICU patients rather than serial MPM scores.
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Affiliation(s)
- Sangeeta Manerikar
- 1 Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, St Augustine, West Indies
| | - Seetharaman Hariharan
- 1 Anaesthesia and Intensive Care Unit, Faculty of Medical Sciences, The University of the West Indies, St Augustine, West Indies
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Mattishent K, Kwok CS, Mahtani A, Pelpola K, Myint PK, Loke YK. Prognostic indices for early mortality in ischaemic stroke - meta-analysis. Acta Neurol Scand 2016; 133:41-8. [PMID: 25968234 DOI: 10.1111/ane.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. METHODS We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. RESULTS We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82-0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE - these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84-0.87). CONCLUSIONS Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.
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Affiliation(s)
- K. Mattishent
- Norwich Medical School; University of East Anglia; Norwich UK
| | - C. S. Kwok
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. Mahtani
- Norwich Medical School; University of East Anglia; Norwich UK
| | - K. Pelpola
- Southend University Hospital Trust; Westcliff-on-Sea UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; School of Medicine & Dentistry; University of Aberdeen; Aberdeen UK
| | - Y. K. Loke
- Norwich Medical School; University of East Anglia; Norwich UK
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Sánchez-Hurtado LA, Ángeles-Veléz A, Tejeda-Huezo BC, García-Cruz JC, Juárez-Cedillo T. Validation of a prognostic score for mortality in elderly patients admitted to Intensive Care Unit. Indian J Crit Care Med 2016; 20:695-700. [PMID: 28149026 PMCID: PMC5225769 DOI: 10.4103/0972-5229.195702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: The performance of a prognostic score must be evaluated prior to being used. The aim of the present study was to evaluate the predictive ability of hospital mortality of Simplified Acute Physiology Score 3 (SAPS 3) score in elderly patients admitted to Intensive Care Units (ICUs). Aims: The aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to ICU. Settings and Design: This study was conducted as a prospective cohort, in two mixed ICUs. Patients and Methods: Two hundred and eleven elderly patients were included. Interventions: None. We compared the predictive accuracy of SAPS 3 measured at the first hour at ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) measured with the worst values in the first 24 h at ICU. The patients were followed until hospital discharge. Statistical Analysis Used: Evaluation of discrimination through area under curve receiver operating characteristic (aROC) and calibration by Hosmer-Lemeshow (HL) test. Results: The median age was 68 years. The hospital mortality rate was 35.54%. The mean value of SAPS 3 was 62.54 ± 12.51 and APACHE II was 17.46 ± 6.77. The mortality predicted by APACHE II was 24.98 ± 19.96 and for standard SAPS 3 equation 41.18 ± 22.34. The discrimination for SAPS 3 model was aROC = 0.68 (0.62–0.75) and to APACHE II aROC = 0.70 (0.63–0.78). Calibration: APACHE II with HL 10.127 P = 0.26, and standard SAPS 3 equation HL 7.204 P = 0.51. Conclusions: In this study, the prognostic model of SAPS 3 was not found to be accurate in predicting mortality in geriatric patients requiring ICU admission.
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Affiliation(s)
- Luis Alejandro Sánchez-Hurtado
- Department of Critical Care Medicine, Hospital Especialidades "Antonio Fraga Mouret" Centro Médico Nacional La Raza Mexican, Institute of Social Security, Mexico City, Mexico; Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Adrian Ángeles-Veléz
- Department of Critical Care Medicine, Hospital Especialidades "Antonio Fraga Mouret" Centro Médico Nacional La Raza Mexican, Institute of Social Security, Mexico City, Mexico
| | - Brigette Carmen Tejeda-Huezo
- Department of Critical Care Medicine, Hospital Especialidades "Antonio Fraga Mouret" Centro Médico Nacional La Raza Mexican, Institute of Social Security, Mexico City, Mexico
| | - Juan Carlos García-Cruz
- Department of Medicine, Division of Geriatric Medicine, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Department of Medicine, Clinical Epidemiology Research Unit, Dr. Carlos McGregor Sánchez Regional General Hospital No. 1, Mexican Institute of Social Security, Mexico City, Mexico; Department of Medicine, Faculty of High Studies Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
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Mattishent K, Kwok CS, Ashkir L, Pelpola K, Myint PK, Loke YK. Prognostic Tools for Early Mortality in Hemorrhagic Stroke: Systematic Review and Meta-Analysis. J Clin Neurol 2015; 11:339-48. [PMID: 26256658 PMCID: PMC4596099 DOI: 10.3988/jcn.2015.11.4.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Several risk scores have been developed to predict mortality in intracerebral hemorrhage (ICH). We aimed to systematically determine the performance of published prognostic tools. Methods We searched MEDLINE and EMBASE for prognostic models (published between 2004 and April 2014) used in predicting early mortality (<6 months) after ICH. We evaluated the discrimination performance of the tools through a random-effects meta-analysis of the area under the receiver operating characteristic curve (AUC) or c-statistic. We evaluated the following components of the study validity: study design, collection of prognostic variables, treatment pathways, and missing data. Results We identified 11 articles (involving 41,555 patients) reporting on the accuracy of 12 different tools for predicting mortality in ICH. Most studies were either retrospective or post-hoc analyses of prospectively collected data; all but one produced validation data. The Hemphill-ICH score had the largest number of validation cohorts (9 studies involving 3,819 patients) within our systematic review and showed good performance in 4 countries, with a pooled AUC of 0.80 [95% confidence interval (CI)=0.77-0.85]. We identified several modified versions of the Hemphill-ICH score, with the ICH-Grading Scale (GS) score appearing to be the most promising variant, with a pooled AUC across four studies of 0.87 (95% CI=0.84-0.90). Subgroup testing found statistically significant differences between the AUCs obtained in studies involving Hemphill-ICH and ICH-GS scores (p=0.01). Conclusions Our meta-analysis evaluated the performance of 12 ICH prognostic tools and found greater supporting evidence for 2 models (Hemphill-ICH and ICH-GS), with generally good performance overall.
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Affiliation(s)
- Katharina Mattishent
- Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Chun Shing Kwok
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Liban Ashkir
- Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Kelum Pelpola
- Department of Elderly Medicine, Southend University Hospital Trust, Westcliff-on-Sea, Essex, UK
| | - Phyo Kyaw Myint
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, Scotland, UK
| | - Yoon Kong Loke
- Health Evidence Synthesis Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
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Hassan EA, Abdel Rehim ASE. Creatinine modified Child-Turcotte-Pugh and integrated model of end-stage liver disease scores as predictors of spontaneous bacterial peritonitis-related in-hospital mortality: Applicable or not. J Gastroenterol Hepatol 2015; 30:1205-10. [PMID: 25678363 DOI: 10.1111/jgh.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS Despite intensive management, spontaneous bacterial peritonitis (SBP) is associated with poor prognosis especially in hospitalized patients. Therefore, the aim of this study was to determine prognostic factors for SBP-related in-hospital mortality, and to evaluate the predictive power of Child-Pugh (CP), model of end-stage liver disease (MELD), creatinine modified Child-Turcotte-Pugh (CrCTP), and integrated MELD (iMELD) for identifying the best score to predict mortality. METHODS Predictors of SBP-related in-hospital mortality were assessed using regression analysis over 100 cirrhotic patients. Predictive abilities of CP, MELD, CrCTP, and iMELD were compared using the area under receiver operating characteristic curve (AUC). RESULTS SBP-related in-hospital mortality was 22%. Age, serum creatinine, bilirubin, sodium, CrCTP, MELD, and iMELD were associated with mortality. Using AUC, CrCTP, and iMELD was significantly better than CP and MELD in predicting in-hospital mortality, where iMELD had the highest AUC (0.862). The cut-off with the best ability to predict in-hospital mortality was 43.5 for iMELD. CONCLUSION Age, serum creatinine, bilirubin, and sodium were associated with SBP-related in-hospital mortality. The incorporation of these variables into CP and MELD significantly improves their predictive ability. iMELD followed by CrCTP provided useful prognostic information for critically ill patients with SBP.
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Affiliation(s)
- Elham Ahmed Hassan
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Corrales-Medina FF, Herzog C, Hess K, Egas-Bejar D, Hong DS, Falchook G, Anderson P, Nunez C, Huh WW, Naing A, Tsimberidou AM, Wheler J, Paul SP, Janku F, Kleinerman ES, Kurzrock R, Subbiah V. Clinical characteristics and outcomes of pediatric oncology patients with aggressive biology enrolled in phase I clinical trials designed for adults: the university of Texas MD anderson cancer center experience. Oncoscience 2015; 1:522-530. [PMID: 25587555 PMCID: PMC4278323 DOI: 10.18632/oncoscience.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Children (patients ≤ 18 years of age) are not usually included on pharmaceutical industry sponsored Phase I trials. Methods We reviewed the medical records of 40 patients ≤ 18 years treated in ≥ 1 phase I trial at MD Anderson. Results The median OS was 8.5 months (95% CI, 5.5-13.2 months). In the multivariate analysis, age ≥15 only predicted increased OS (P = 0.0065), and >3 prior therapies (P = 0.053) predicted decreased OS. The median PFS was 2.8 months (95% CI, 2.3-4.1 months). In the multivariate analysis, independent factors that predicted increased PFS were age ≥15 years (P < 0.001) and prior radiation therapy (P = 0.049); performance status >1 (P < 0.001) and >3 prior therapies (P = 0.002) predicted decreased PFS. RMH score ≥ 2 and MDACC score ≥ 3 were associated with decreased median OS (P = 0.029 and P = 0.031 respectively). Conclusions It is feasible to conduct phase I studies in pediatric patients based on adult protocols. In the era of targeted therapy more trials should allow pediatric patients earlier in the drug development especially if deemed safe in adults in early phase trials. Translational Relevance Most pharmaceutical industry sponsored trials exclude patients less than 18 years in phase I clinical trials. Even in the era of targeted therapy pediatric patients usually have to wait for most phases of trials to be completed in adults before being allowed to enroll in clinical trials of new therapies, even in the advanced metastatic and relapsed setting. Some investigator initiated phase 1 trials of combinations of US FDA approved agents allow patients less than 18 years. We report the preliminary analyses of the outcomes of pediatric patients enrolled in phase I studies initially designed for adults, but allowing for enrollment of patients under 18.
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Affiliation(s)
- Fernando F Corrales-Medina
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cynthia Herzog
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniela Egas-Bejar
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gerald Falchook
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Pete Anderson
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Pediatric Hematology/Oncology/BMT, Levine Children's Hospital/Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Cesar Nunez
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Winston W Huh
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wheler
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarina Piha Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eugenie S Kleinerman
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Razelle Kurzrock
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Children's Cancer Hospital, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Egleston BL, Uzzo RG, Beck JR, Wong YN. A Simple Method for Evaluating Within Sample Prognostic Balance Achieved by Published Comorbidity Summary Measures. Health Serv Res 2014; 50:1179-94. [PMID: 25523400 DOI: 10.1111/1475-6773.12276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To demonstrate how a researcher can investigate the appropriateness of a published comorbidity summary measure for use with a given sample. DATA SOURCE Surveillance, Epidemiology, and End Results linked to Medicare claims data. STUDY DESIGN We examined Kaplan-Meier estimated survival curves for four diseases within strata of a comorbidity summary measure, the Charlson Comorbidity Index. DATA COLLECTION We identified individuals with early-stage kidney cancer diagnosed from 1995 to 2009. We recorded comorbidities present in the year before diagnosis. PRINCIPAL FINDINGS The use of many comorbidity summary measures is valid under appropriate conditions. One condition is that the relationships of the comorbidities with the outcome of interest in a researcher's own population are comparable to the relationships in a published algorithm's population. The original comorbidity weights from the Charlson Comorbidity Index seemed adequate for three of the diseases in our sample. We found evidence that the Charlson Comorbidity Index might underestimate the impact of one disease in our sample. CONCLUSION Examination of survival curves within strata defined by a comorbidity summary measure can be a useful tool for determining whether a published method appropriately accounts for comorbidities. A comorbidity score is only as good as those variables included.
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Affiliation(s)
- Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111
| | - Robert G Uzzo
- Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - J Robert Beck
- Office of Academic Affairs, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Yu-Ning Wong
- Medical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
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Abstract
Despite alcoholic hepatitis (AH) is the most acute manifestation of alcohol-related liver disease, its treatment remains controversial. Corticosteroids, given either as monotherapy or together with N-acetylecysteine, have been associated with a moderate short-term survival benefit in patients with severe disease. The Maddrey's discriminant function; Glasgow alcoholic hepatitis score; age, bilirubin, INR and creatinine score; and the Model for end-stage liver disease have been proposed for stratifying prognosis in AH enabling selection of the patients to treat. Definition of treatment non-responders using the Lille model after 7 days of therapy may prevent a detrimental impact of prolonged corticosteroids. Pentoxifylline is an effective alternative reducing the occurrence of hepatorenal syndrome. Emerging evidence supports use of liver transplantation in a strictly selected subset of corticosteroid non-responders.
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Affiliation(s)
- Vassilios Papastergiou
- The Royal Free Sheila Sherlock Liver Centre and UCL Institute of Liver and Digestive Health, Royal Free Hospital and UCL, London, UK
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Tabouret E, Metellus P, Gonçalves A, Esterni B, Charaffe-Jauffret E, Viens P, Tallet A. Assessment of prognostic scores in brain metastases from breast cancer. Neuro Oncol 2013; 16:421-8. [PMID: 24311640 DOI: 10.1093/neuonc/not200] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is the second most common cause of brain metastases (BM). Optimal management of BM from BC is still debated. In an attempt to provide appropriate treatment and to assist with optimal patient selection, several specific prognostic classifications for BM from BC have been established. We evaluated the prognostic value and validity of the 6 proposed scoring systems in an independent population of BC patients with BM. METHODS We retrospectively reviewed all consecutive BC patients referred to our institution for newly diagnosed BM between October 1995 and July 2011 (n = 149). Each of the 6 scores proposed for BM from BC (Sperduto, Niwinska, Park, Nieder, Le Scodan, and Claude) was applied to this population. The discriminative ability of each score was assessed using the Brier score and the C-index. Individual prognostic values of clinical and histological factors were analyzed using uni- and multivariate analyses. RESULTS Median overall survival was 15.1 months (95% CI,11.5-18.7). Sperduto-GPA (P < .001), Nieder (P < .001), Park (P < .001), Claude (P < .001), Niwinska (P < .001), and Le Scodan (P = .034) scores all showed significant prognostic value. The Nieder score showed the best discriminative ability (C-index, 0.672; Brier score error reduction, 16.1%). CONCLUSION The majority of prognostic scores were relevant for patients with BM from BC in our independent population, and the Nieder score seems to present the best predictive value but showed a relatively low positive predictive value. Thus, these results remain insufficient and challenge the routine use of these scoring systems.
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Affiliation(s)
- Emeline Tabouret
- APHM, Timone Hospital, Departement of Neuro-Oncology, Marseille, France (E.T.); L'institut Paoli-Calmettes, Department of Medical Oncology, Marseille, France (E.T., A.G.); APHM, Timone Hospital, Department of Neurosurgery, Marseille, France (P.M.); L'institut Paoli-Calmettes, Department of Biostatistics, Marseille, France (B.E.); UMR911, CRO2, Aix-Marseille Université, Marseille, France (P.M.); L'institut Paoli-Calmettes, Department of Anatomic Pathology, Marseille, France (E.C.-J.); L'institut Paoli-Calmettes, Department of Radiotherapy, Marseille, France (A.T.)
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Grabhorn E, Nielsen D, Hillebrand G, Brinkert F, Herden U, Fischer L, Ganschow R. Successful outcome of severe Amanita phalloides poisoning in children. Pediatr Transplant 2013; 17:550-5. [PMID: 23721499 DOI: 10.1111/petr.12108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2013] [Indexed: 12/01/2022]
Abstract
Amanita phalloides intoxication can lead to FHF with high mortality, especially in children. There is still ongoing discussion about the optimal treatment and decision criteria for emergency liver transplantation (LTx). Here, we summarize our experience with outcomes in five children. Five children with severe A. phalloides intoxication were treated at our tertiary center from 1995 to 2010 and studied retrospectively with respect to clinical and laboratory aspects that might help to decide between LTx or conservative therapy only. The findings are discussed with regard to recommended treatment and transplantation criteria for adults. All patients survived, of whom two of five received emergency LTx. Three patients survived with conservative treatment consisting of intravenous silibinin, NAC, detoxification measures, and intensive care. Indications for LTx in two children were progressive brain edema and cardiovascular failure. Children with FHF due to A. phalloides intoxication should be considered early for emergency LTx but should be monitored closely for the necessity of definite LTx. Early detoxification with active charcoal as well as silibinin and NAC seems to improve the outcome. Late recovery of liver function after day 4 post-ingestion is possible.
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Affiliation(s)
- Enke Grabhorn
- Department of Pediatric Hepatology and Liver Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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