scholarly journals 3217 Catatonia, Delirium and Coma: Implications for Mortality

2019 ◽  
Vol 3 (s1) ◽  
pp. 37-37
Author(s):  
Jo Ellen Wilson ◽  
Sarasota Mihalko ◽  
Stephan Heckers ◽  
Pratik P. Pandharipande ◽  
Timothy D. Girard ◽  
...  
Keyword(s):  
Survival Time ◽  
Critically Ill ◽  
Median Survival ◽  
Critically Ill Patients ◽  
Median Survival Time ◽  
Rating Scale ◽  
Brain Dysfunction ◽  
Survival Times ◽  
Dsm 5 ◽  
Acute Brain Dysfunction

OBJECTIVES/SPECIFIC AIMS: Delirium, a form of acute brain dysfunction, characterized by changes in attention and alertness, is a known independent predictor of mortality in the Intensive Care Unit (ICU). We sought to understand whether catatonia, a more recently recognized form of acute brain dysfunction, is associated with increased 30-day mortality in critically ill older adults. METHODS/STUDY POPULATION: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Coma, was defined as a Richmond Agitation Scale score of −4 or −5. We used the Cox Proportional Hazards model predicting 30-day mortality after adjusting for delirium, coma and catatonia status. RESULTS/ANTICIPATED RESULTS: We enrolled 335 medical, surgical or trauma critically ill patients with 1103 matched delirium and catatonia assessments. Median age was 58 years (IQR: 48 - 67). Main indications for admission to the ICU included: airway disease or protection (32%; N=100) or sepsis and/or shock (25%; N=79. In the unadjusted analysis, regardless of the presence of catatonia, non-delirious individuals have the highest median survival times, while delirious patients have the lowest median survival time. Comparing the absence and presence of catatonia, the presence of catatonia worsens survival (Figure 1). In a time-dependent Cox model, comparing non-delirious individuals, holding catatonia status constant, delirious individuals have 1.72 times the hazards of death (IQR: 1.321, 2.231) while those with coma have 5.48 times the hazards of death (IQR: 4.298, 6.984). For DSM-5 catatonia scores, a 1-unit increase in the score is associated with 1.18 times the hazards of in-hospital mortality. Comparing two individuals with the same delirium status, an individual with a DSM-5 catatonia score of 0 (no catatonia) will have 1.178 times the hazard of death (IQR: 1.086, 1.278), while an individual with a score of 3 catatonia items (catatonia) present will have 1.63 times the hazard of death. DISCUSSION/SIGNIFICANCE OF IMPACT: Non-delirious individuals have the highest median survival times, while those who are comatose have the lowest median survival times after a critical illness, holding catatonia status constant. Comparing the absence and presence of catatonia, the presence of catatonia seems to worsen survival. Those individual who are both comatose and catatonic have the lowest median survival time.

scholarly journals Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

Critical Care ◽  
2011 ◽  
Vol 15 (2) ◽  
pp. R78 ◽  
Author(s):  
Stuart McGrane ◽  
Timothy D Girard ◽  
Jennifer L Thompson ◽  
Ayumi K Shintani ◽  
Alison Woodworth ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Brain Dysfunction ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Acute Brain Dysfunction

Vascular endothelial growth factor expression and vascular density as prognostic markers of survival in patients with low-grade astrocytoma

1998 ◽  
Vol 88 (3) ◽  
pp. 513-520 ◽  
Author(s):  
Saleem I. Abdulrauf ◽  
Klaus Edvardsen ◽  
Khang L. Ho ◽  
Xiao Yi Yang ◽  
Jack P. Rock ◽  
...  
Keyword(s):  
Growth Factor ◽  
Survival Time ◽  
Malignant Transformation ◽  
Median Survival ◽  
Median Survival Time ◽  
Tumor Tissue ◽  
Low Grade ◽  
Survival Times ◽  
Content Type ◽  
Fine Print

It has long been recognized that some patients with low-grade astrocytoma may survive for many years, whereas in others the disease follows a more malignant course resulting in a short survival time, usually due to malignant transformation into higher-grade tumors. Object. The aim of this study was to investigate angiogenesis in the initial biopsy specimen of tumor tissue as a biological marker to identify patients with low-grade astrocytoma who are at high risk of malignant tumor transformation or death. Methods. Tumor tissue was studied in 74 consecutively treated adult patients in whom a diagnosis of diffuse supratentorial hemispheric histologically proven fibrillary low-grade astrocytoma was made and who underwent surgery between January 1972 and January 1994. Studies were conducted using monoclonal antibodies to the antigens of the proliferation-associated Ki-67 (MIB-1), factor VIII, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and epidermal growth factor (EGF). The overall 5-year survival rate for the entire patient population was 65%, with a median survival time of 7.5 years. The total mean follow-up period was 6.1 years. All tumors showed a low proliferative potential at the time of the initial operation, as demonstrated by an MIB-1 labeling index of less than 1.5%. Patients with more than seven microvessels in tumor tissue (29 cases) had a shorter survival time (mean 3.8 years) than those with seven or fewer microvessels (mean survival 11.2 years). This difference in survival times was significant by univariate (p = 0.001) and stepwise multivariate analyses (p < 0.001). Tumors with a larger number of microvessels also had a greater chance of undergoing malignant transformation (p = 0.001). Similarly, significant staining for VEGF was correlated with shorter survival times when using univariate (p = 0.003) and multivariate (p = 0.008) analyses and with a greater chance of malignant transformation (p = 0.002). Patients with tumors staining positive for VEGF (39 individuals) had a median survival time of 5.3 years, and those with tumors negative for VEGF (35 patients) had a median survival time of 11.2 years. No association was observed between bFGF, EGF, and survival or malignant transformation. The stepwise multivariate analysis included histological and clinical variables simultaneously. Conclusions. The authors have shown that microvessel density and VEGF levels are independent prognostic markers of survival in fibrillary low-grade astrocytoma. This finding leads them to propose that fibrillary diffuse low-grade astrocytoma is not a single pathological entity but is composed of a spectrum of tumors with differing propensities to undergo malignant transformation that is at least partly based on their inherent angiogenic potential.

Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients

2008 ◽  
Vol 34 (10) ◽  
pp. 1907-1915 ◽  
Author(s):  
A. Morandi ◽  
P. Pandharipande ◽  
M. Trabucchi ◽  
R. Rozzini ◽  
G. Mistraletti ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Brain Dysfunction ◽  
International Differences ◽  
Acute Brain Dysfunction

BIOMARKERS OF INFLAMMATION AND COAGULOPATHY PREDICT THE DURATION OF ACUTE BRAIN DYSFUNCTION IN CRITICALLY ILL PATIENTS.

2006 ◽  
Vol 34 ◽  
pp. A19 ◽  
Author(s):  
Timothy D Girard ◽  
Brenda T Pun ◽  
James C Jackson ◽  
Richard W Light ◽  
E Wesley Ely ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Brain Dysfunction ◽  
Acute Brain Dysfunction

scholarly journals Canine lymphoma: a retrospective study (2009 – 2010)

2012 ◽  
Vol 81 (6) ◽  
pp. 341-351
Author(s):  
F. Mortier ◽  
S. Daminet ◽  
S. Vandenabeele ◽  
I. Van de Maele
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Complete Blood Count ◽  
Abdominal Ultrasound ◽  
Serum Biochemistry ◽  
Survival Times ◽  
Canine Lymphoma ◽  
Multicentric Lymphoma ◽  
Histological Results

This study reviews the medical records of 56 dogs diagnosed with lymphoma based on the cytological and/or histological results between January 1, 2009 and December 31, 2010. Most of the dogs were middle-aged to old, and were diagnosed with multicentric lymphoma (ML) (n=36). The majority of the dogs were presented in stages III to V (n=55) and substage b (n=43). A complete blood count and serum biochemistry, urinalysis, serum protein electrophoresis, thoracic radiographs and/or abdominal ultrasound were performed. The results correlated with previously described results in the literature. Therapy was initiated in 80% of the dogs (n=45). After diagnosis, the median survival time of 62% of these dogs (n=28) treated with only prednisolone was 32 days (range 3 – 224 days). For 24% of the dogs (n=11) treated with chemotherapy, the median survival time was 119 days (range 11 - 273 days). Surgical resection of the macroscopic tumor was performed in the remaining six dogs (13%). Three of these dogs received subsequent prednisolone therapy. The median survival time of these six dogs was 47 days (range 0 – 669 days). The dogs that received chemotherapy had significantly longer survival times than those treated with only prednisolone, although negative prognostic factors were present in all of the cases treated with chemotherapy.

Correlates of survival and the Daumas-Duport grading system for astrocytomas

1991 ◽  
Vol 74 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Tai Seung Kim ◽  
Andrea L. Halliday ◽  
E. Tessa Hedley-Whyte ◽  
Karen Convery
Keyword(s):  
Radiation Therapy ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Massachusetts General Hospital ◽  
Cox Proportional Hazards Model ◽  
Grading System ◽  
Survival Times ◽  
Histological Features ◽  
Grade 3

✓ In order to examine the correlation between prognosis and the histological features of nuclear atypia, mitosis, endothelial proliferation, and necrosis in supratentorial adult astrocytomas, the authors reviewed 251 such cases treated at the Massachusetts General Hospital between 1972 and 1980. One point was given for the presence of each feature. The total number of features was translated into a grade as follows: none of the four features = Grade 1 (one patient), one feature = Grade 2 (36 patients), two features = Grade 3 (33 patients), and three or four features = Grade 4 (181 patients). The period of survival was significantly associated with grade, the presence or absence of each of the four histological features, patient's age, type of operation, radiation therapy, and extent of tumor (log rank, p < 0.05). The variables associated with grade were age (p < 0.001) and radiation therapy (p < 0.02). After adjustment for these variables using a Cox proportional-hazards model, the difference in overall survival time between patients in Grades 2 and 3 was not statistically significant. When comparable groups of patients were examined in terms of age or receipt of radiation therapy, the median survival times differed markedly. Patients 50 years of age or less had a median survival time of 68 months (Grade 2 tumors), 29 months (Grade 3 tumors), and 13 months (Grade 4 tumors). Patients over 50 years of age had a median survival time of 6 months (Grade 2 and 4 tumors) and 9 months (Grade 3 tumors). Those patients who had received radiation therapy had a median survival time of 68 months (Grade 2 tumors), 21 months (Grade 3 tumors), and 11 months (Grade 4 tumors). Those patients who did not receive radiation therapy had a median survival time of 1 month (Grade 2 tumors) and 2 months (Grade 3 and 4 tumors); over half of these patients died within 2 months of surgery. This grading system, originally proposed by Daumas-Duport, et al., is simple, objective, and reproducible, and correlates well with survival times. The authors recommend that astrocytomas be graded on a scale of 1 to 4, with Grade 1 reserved for the rare adult supratentorial astrocytoma with none of the four histological features.

Predicting Mean Survival Time from Reported Median Survival Time for Cancer Patients

2016 ◽  
Vol 37 (4) ◽  
pp. 391-402 ◽  
Author(s):  
Mette L. Lousdal ◽  
Ivar Sønbø Kristiansen ◽  
Bjørn Møller ◽  
Henrik Støvring
Keyword(s):  
Weibull Distribution ◽  
Survival Time ◽  
Cancer Patients ◽  
Median Survival ◽  
Median Survival Time ◽  
Survival Times ◽  
Empirical Prediction ◽  
Mean Survival Time ◽  
Prediction Approach

Background: Mean duration of survival following treatment is a prerequisite for cost-effectiveness analyses used for assessing new and costly life-extending therapies for cancer patients. Mean survival time is rarely reported due to censoring imposed by limited follow-up time, whereas the median survival time often is. The empirical relationship between mean and median survival time for cancer patients is not known. Aim: To derive the empirical associations between mean and median survival time across cancer types and to validate this empirical prediction approach and compare it with the standard approach of fitting a Weibull distribution. Methods: We included all patients in Norway diagnosed from 1960 to 1999 with one of the 13 most common solid tumor cancers until emigration, death, or 31 December 2011, whichever came first. Observed median, restricted mean, and mean survival times were obtained in subcohorts defined by patients’ sex, age, cancer type, and time period of diagnosis, which had nearly complete follow-up. Based on theoretical considerations, we fitted a linear relationship between observed means and medians on the log scale. For validation, we estimated mean survival from medians of bootstrap samples with artificially induced censoring and compared with fitting a Weibull distribution. Results: A linear relationship between log-mean survival time and log-median survival time was identified for the 6 cancers with shortest survival plus metastasized breast and prostate cancers. The predicted means of the empirical approach had smaller bias than the standard Weibull approach. Conclusion: For cancer diagnoses with poor prognosis, mean survival times could be predicted from corresponding medians. This empirical prediction approach is useful for validation of estimates of mean survival time and sensitivity analyses in settings with aggregated data only.

scholarly journals The Information from Medical Data Based: Prevalence and Expected Median Survival Time of Drug-Induced Hepatotoxicity Among Thai Patients with TB

2021 ◽  
Author(s):  
Santisith Khiewkhern ◽  
Nuchnapa Pratumchai ◽  
Parichart Sattayarak ◽  
Patcharin Phuwilert ◽  
Supattra Noo-In ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Liver Function Tests ◽  
Survival Times ◽  
Hospital Data ◽  
Drug Induced ◽  
Cross Sectional ◽  
Treatment Regimens ◽  
Kaplan Meier

Background: Hepatotoxicity is very frequent and is a dangerously adverse effect of anti-TB medications. This effect can reduce the effectiveness of the treatment by compromising treatment regimens. Among these first-line quadruple therapy drugs (INH, RMP, PZA, and EMB), INH, RMP, and PZA are metabolized mostly by the liver, and due to this, are likely hepatotoxic. However, the survival times of hepatotoxicity among patients with TB in Thailand are currently not available. The aims of the present study were to assess the prevalence and survival time of drug-induced hepatotoxicity in patients with TB. Methods: A cross-sectional retrospective study was performed to explore the survival time of the development of drug-induced hepatotoxicity among 327 patients with TB who received standard drug treatment at the TB clinic in Phichit Hospital. Data was collected from the HOSxP program and medical records from 2016 to 2018. Kaplan-Meier and Cox’s regressions were used for data analysis. Results: The results showed that prevalence of drug-induced hepatotoxicity was 6.42% and confirmed that patients with TB who were <50 years of age will be a median survival time on drug-induced hepatotoxicity is 17 days and 30 days for those who age group ≥50 years. Conclusion: The median survival time of drug-induced hepatotoxicity among patients with TB who were <50 years of age is 17 days. So, patients with TB whose ages are less than 50 years should receive liver function tests such as AST and ALT and investigate risk behavior before receiving the anti- TB treatment.

Prognostic Value of Seric Immunoglobulins in CLL: Analysis of 331 Patients with a Median Follow-Up Time of 7.5 Years.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4961-4961
Author(s):  
Réda Garidi ◽  
Marie-Noëlle Guilhaume ◽  
Ioana Vaida ◽  
Marie Brevet ◽  
Jean-Claude Mazière ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Prognostic Value ◽  
Cox Model ◽  
Survival Rates ◽  
Initial Dosage ◽  
Mean Value ◽  
Survival Times ◽  
Global Survival

Abstract Prognostic value of seric immunoglobulins in CLL has been rarely studied. So we look at all our CLL and we find 331 pts with an initial dosage of IgG, IgA and IgM without M component at diagnosis or during the first year of survey. Ages at diagnosis range from 38 to 93 yrs and median age is 66 yrs. Sex ratio M/F is 1.55 and staging according to Binet’s system notes 264 stages A (188 stages A0), 43 stages B and 24 stages C. IgG levels range from 0.9 to 22.2 g per l with a mean value of 9.38±3.18 g. In logistic regression, IgG level is linked with sex, age, number of lymphoid area according to Binet’s system, blood lymphocytosis and hemoglobin levels used as continuous values. IgA range from 0.1 to 7.8 g (mean value=1.66±1.03 g) and is linked with the same parameters and platelet level too. At least, IgM range from 0 to 3.4 g (mean value=0.78±0.63 g) and is linked with age, number of lymphoid area, blood lymphocytosis and platelet levels. Immunoglobulins levels are also linked with LDH, β2-microglobulin, sCD23 and sCD25 values. Looking at “corrected” survival after exclusion of not CLL-related deaths including those due to a solid tumor because this complication is independent of initial prognostic factors of CLL, we find that the best cut-off values are 7 g for IgG and 2 g for IgA. For IgG, median survival time is 14.6 yrs for the 268 pts with initial IgG ≥ 7 g versus 6.5 yrs for the 63 other pts (p=0.00004). For IgA, the best cut-off value is 2 g: median survival time is >13.3 yrs for the 100 pts with IgA ≥ 2 g versus 10 yrs for the 231 other pts (p=0.04). These 2 cut-off values are independent and so we can build a prognostic system: 98 pts with IgG ≥ 7 g and IgA ≥ 2 g - 172 pts with IgG < 7 g or IgA < 2 g - 61 pts with low IgG and IgA levels. Median “corrected” survival times of these 3 groups are statistically different: > 13.3, 10.6 and 6.8 yrs (p=0.0009) and when we look at global survival, rates are more different: >13.3, 8.6 and 5.7 yrs (p=0.00009). Same data are noted among stage A patients only and among stage A0 too. So when we opposite this system and with Binet’s and Rai’s classifications, only Rai’s system is ruled out by Cox model looking at “corrected” or global survival. Curiously, this new system has no impact of initiation on treatment among stage A pts while it is linked to evolution to stage C (p=0.05). Finally, we find no correlation with occurrence of an M component or an immunological complication, and also with occurrence of a zoster infection or a Richter syndrome while it is a trend for occurrence of a second neoplasia (p=0.06).

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