Ambulant erworbene Pneumonie: Die Mortalität nachhaltig senken

2020 ◽  
Vol 8 (5) ◽  
pp. 252-253
Author(s):  
Stefan Krüger
Keyword(s):  
Operating Characteristic ◽  
Distress Syndrome ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Roc Curves ◽  
Community Acquired Pneumonia ◽  
Ambulant Erworbene Pneumonie ◽  
Icu Admission ◽  
Failure Assessment

Background: The study aimed to investigate the predictive value of the quick sequential organ failure assessment (qSOFA) for clinical outcomes in emergency patients with community-acquired pneumonia (CAP). Methods: A total of 742 CAP cases from the emergency department (ED) were enrolled in this study. The scoring systems including the qSOFA, SOFA and CURB-65 (confusion, urea, respiratory rate, blood pressure and age) were used to predict the prognostic outcomes of CAP in ICU-admission, acute respiratory distress syndrome (ARDS) and 28-day mortality. According to the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, the accuracies of prediction of the scoring systems were analyzed among CAP patients. Results: The AUC values of the qSOFA, SOFA and CURB-65 scores for ICU-admission among CAP patients were 0.712 (95%CI: 0.678–0.745, P < 0.001), 0.744 (95%CI: 0.711–0.775, P < 0.001) and 0.705 (95%CI: 0.671–0.738, P < 0.001), respectively. For ARDS, the AUC values of the qSOFA, SOFA and CURB-65 scores were 0.730 (95%CI: 0.697–0.762, P < 0.001), 0.724 (95%CI: 0.690–0.756, P < 0.001) and 0.749 (95%CI: 0.716–0.780, P < 0.001), respectively. After 28 days of follow-up, the AUC values of the qSOFA, SOFA and CURB-65 scores for 28-day mortality were 0.602 (95%CI: 0.566–0.638, P < 0.001), 0.587 (95%CI: 0.551–0.623, P < 0.001) and 0.614 (95%CI: 0.577–0.649, P < 0.001) in turn. There were no statistical differences between qSOFA and SOFA scores for predicting ICU-admission (Z = 1.482, P = 0.138), ARDS (Z = 0.321, P = 0.748) and 28-day mortality (Z = 0.573, P = 0.567). Moreover, we found no differences to predict the ICU-admission (Z = 0.370, P = 0.712), ARDS (Z = 0.900, P = 0.368) and 28-day mortality (Z = 0.768, P = 0.442) using qSOFA or CURB-65 scores. Conclusion: qSOFA was not inferior to SOFA or CURB-65 scores in predicting the ICU-admission, ARDS and 28-day mortality of patients presenting in the ED with CAP.

scholarly journals Serum Exosomal MicroRNAs Predict Acute Respiratory Distress Syndrome Events in Patients with Severe Community-Acquired Pneumonia

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Xu Wu ◽  
Chengzhi Wu ◽  
Wenyu Gu ◽  
Haiying Ji ◽  
Lei Zhu
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Community Acquired Pneumonia ◽  
Operating Characteristics ◽  
Predictive Values ◽  
Severe Community Acquired Pneumonia

Background. Severe community-acquired pneumonia (SCAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory distress syndrome (ARDS) with high mortality. This study was aimed at evaluating whether microRNAs (miRNAs) in circulating exosomes have the predictive values for patients at risk of developing ARDS due to SCAP. Methods. ARDS/ALI-relevant miRNAs were obtained by literature search. Exosomes in serum were isolated by ultracentrifugation method and identified by Transmission Electron Microscopy. Then the miR profiling in the exosomes using real-time PCR was analyzed in SCAP patients with or without ARDS. Moreover, multivariate Cox proportional regression analysis was performed to estimate the odds ratio of miRNA for the occurrence of ARDS and prognosis. The receiver operating characteristics (ROC) curves were calculated to discriminate ARDS cases. Finally, the Kaplan-Meier curve using log-rank method was performed to test the equality for survival distributions with different miRNA classifiers. Results. A total of 53 SCAP patients were finally recruited. Ten miRNAs were picked out. Further, a subset of exosomal miRNAs, including the miR-146a, miR-27a, miR-126, and miR-155 in ARDS group exhibited significantly elevated levels than those in non-ARDS group. The combined expression of miR-126, miR-27a, miR-146a, and miR-155 predicted ARDS with an area under the curve of 0.909 (95 % CI 0.815 –1). Only miR-126 was selected to have potential to predict the 28-day mortality (OR=1.002, P=0.024) with its median value classifier. Conclusions. The altered levels of circulating exosomal microRNAs may be useful biologic confirmation of ARDS in patients with SCAP.

Abstract 62: Recovery-based Prediction of Who Is Using a G-tube at 6 Weeks Post-stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Andria L Ford ◽  
Christopher Leon-Guerrero ◽  
Jasmin Chua ◽  
Lynda Loehr ◽  
David Carpenter ◽  
...  
Keyword(s):  
Speech Therapy ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Tube Placement ◽  
Icu Admission ◽  
Post Stroke ◽  
Standard Clinical Practice ◽  
Point G ◽  
Dysphagic Patients

Background: Decision-making regarding gastrostomy tube (G-tube) placement prolongs hospital stay in the inpatient stroke setting. Studies have predicted who receives G-tube placement at discharge, but have not assessed which factors predict who is actually using a G-tube long-term by assessing dysphagia recovery and G-tube needs in follow-up. Methods: Stroke patients from an inpatient stroke service were prospectively recruited if dysphagia was identified on the clinical speech therapy dysphagia test, defined as Mann Assessment of Swallowing Ability (MASA) score < 178. Variables associated with dysphagia were prospectively collected. G-tubes were placed in patients according to standard clinical practice based on speech therapy recommendations and family discussion. Follow-up included a 6 week swallowing quality of life survey (SWAL-QOL, 12 items including if a G-tube is currently being used). Univariate predictors of G-tube use at 6 weeks were assessed allowing calculation of a “G-tube Score” for prediction of who required a G-tube at 6 weeks. Score performance was measured by receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: Of 146 dysphagic patients (median NIHSS=15), 31% were discharged with a G-tube. Of those completing 6 week SWAL-QOL (N=61), 26% of patients who had received a G-tube, no longer needed a G-tube. Univariate predictors of needing a G-tube included: age ≥ 70 (p=0.017), NIHSS ≥ 18 (p=0.006), ICU admission (p=0.007), respiratory failure requiring intubation (p=0.001), and MASA score < 110 (p<0.0001). 4 and 5 point G-tube scores performed well in predicting 6 week G-tube needs (AUCs 0.88 and 0.92, respectively). The optimal cut-off for both scores, preserving sensitivity and maintaining specificity, was a score of 2 points (Fig). Conclusion: Carrying 2 of the following early factors: age ≥ 70, NIHSS ≥ 18, ICU admission, and intubation, yields a high likelihood of requiring a G-tube beyond 6 weeks post-stroke.

scholarly journals A novel predictor of clinical progression in patients on active surveillance for prostate cancer

2019 ◽  
Vol 13 (8) ◽  
Author(s):  
Guan Hee Tan ◽  
Antonio Finelli ◽  
Ardalan Ahmad ◽  
Marian Wettstein ◽  
Alexandre Zlotta ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Progression Free Survival ◽  
Roc Curves ◽  
Standard Of Care ◽  
Low Risk ◽  
Clinical Progression

Introduction: Active surveillance (AS) is standard of care in low-risk prostate cancer (PC). This study describes a novel total cancer location (TCLo) density metric and aims to determine its performance in predicting clinical progression (CP) and grade progression (GP).     Methods: This was a retrospective study of patients on AS after confirmatory biopsy (CBx). We excluded patients with Gleason ≥7 at CBx and <2 years follow-up. TCLo was the number of locations with positive cores at diagnosis (DBx) and CBx. TCLo density was TCLo / prostate volume (PV). CP was progression to any active treatment while GP occurred if Gleason ≥7 was identified on repeat biopsy or surgical pathology. Independent predictors of time to CP or GP were estimated with Cox regression. Kaplan-Meier analysis compared progression-free survival curves between TCLo density groups. Test characteristics of TCLo were explored with receiver operating characteristic (ROC) curves.     Results: We included 181 patients who had CBx between 2012-2015, and met inclusion criteria. The mean age of patients was 62.58 years (SD=7.13) and median follow-up was 60.9 months (IQR=23.4). A high TCLo density score (>0.05) was independently associated with time to CP (HR 4.70, 95% CI: 2.62-8.42, p<0.001), and GP (HR 3.85, 95% CI: 1.91-7.73, p<0.001). ROC curves showed TCLo density has greater area under the curve than number of positive cores at CBx in predicting progression.     Conclusion: TCLo density is able to stratify patients on AS for risk of CP and GP. With further validation, it could be added to the decision-making algorithm in AS for low-risk localized PC.

scholarly journals Variables Affecting Peri-Implant Radiographic Bone Loss-8-23 Years Follow-Up

2020 ◽  
Vol 10 (23) ◽  
pp. 8591
Author(s):  
Michael Saminsky ◽  
Anat Ben Dor ◽  
Jacob Horwitz
Keyword(s):  
Bone Loss ◽  
Goodness Of Fit ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Factors Associated ◽  
Implant Placement ◽  
Dental Records

The aim of this study is to evaluate factors associated with long-term peri-implant bone-loss and to create a statistical model explaining bone-loss. The dental records in a private periodontal practice were screened for implant-patients with a minimal follow-up period of 8 years with periapical radiographs at implant-placement (T0) and last follow-up (Tf). Collected data included demographics, general health, medications, periodontal parameters, implant parameters, bone augmentation procedures, restoration and antagonist data, number of supportive periodontal appointments (SPT), and radiographic bone-loss between T0 and Tf. Bivariate and Mixed Logistic Regression analyses were performed. “Goodness-of-fit” of the model was elaborated with Receiver Operating Characteristic Curve (ROC) analyses. Thirty-seven patients receiving 142 implants were included. Mean clinical follow-up period was 11.7 ± 3.7 years (range 8–23). Most implants 64.4% were SPT-maintained more than twice a year. Patients with osteoporosis and smokers were prone to increased radiographic peri-implant bone-loss. External-hex implants placed without guided bone regeneration (GBR) and implants 10–12 mm long and diameter of 3.7–4 mm showed less peri-implant bone-loss. The model’s Area Under the Curve (AUC) was 76.9% (Standard Error 4.6%, CI 67.8%–86%).

Which Inotropic Drug, Dobutamine or Milrinone, Is Clinically More Effective in the Treatment of Postligation Cardiac Syndrome in Preterm Infants?

2020 ◽  
Author(s):  
Levent Korkmaz ◽  
Ahmet Ozdemir ◽  
Özge Pamukçu ◽  
Tamer Güneş ◽  
Mehmet Adnan Ozturk
Keyword(s):  
Blood Pressure ◽  
Operating Characteristic ◽  
Ductus Arteriosus ◽  
Area Under The Curve ◽  
Therapeutic Effects ◽  
Study Group ◽  
Cardiac Syndrome ◽  
Before And After ◽  
The Difference

Objective This study aimed to detect which of the two main medicines suggested in the treatment of postligation cardiac syndrome (PLCS)—dobutamine or mirinone—possesses a more therapeutic effect. While doing this, clinicians are provided with a broader perspective on the treatment and follow-up of cases. The desire was to increase the treatability and monitor ability of the cases in question and hence their survivability. Study Design A retrospective review of a cohort of infants with PLCS was conducted between March 2012 and December 2018. In the treatment of infants with PLCS, dobutamine (dobutamine study group-DSG) or milrinone (milrinone study group-MSG) was used. The respiration, cardiac, echocardiography, and perfusion parameters of the cases were assessed both before and after ligation. Based on the data obtained, both the effects of the medicines on PLCS and the difference between their therapeutic effects were studied. The accuracy of prognostication was assessed with receiver operating characteristic analyses. Results PLCS was detected in 29 (34.1%) of 85 patent ductus arteriosus ligation cases in total. Of all the PLCS cases, 13 (44.8%) were treated with dobutamine and 16 (55.2%) with milrinone. It was observed that the effects of the medicines on the respiratory system and cardiovascular system manifested in the third and 6th hour, respectively. It was detected that both medicines had more effect on the systolic blood pressure (SBP) (area under the curve [AUC]: 0.997/0.996, p = 0.001/0.002) than on the diastolic blood pressure (AUC: 0.911/0.843, p = 0.032/0.046). Conclusion Dobutamine and milrinone, two primary medicines that can be used in the treatment of cases with PLCS, possess similar therapeutic effects on this pathology. In addition, their postoperative therapeutic effects on the SBP are more in the foreground.

scholarly journals Sequence-Based Discovery of Antibacterial Peptides Using Ensemble Gradient Boosting

Proceedings ◽  
2020 ◽  
Vol 66 (1) ◽  
pp. 6
Author(s):  
Ehdieh Khaledian ◽  
Shira L. Broschat
Keyword(s):  
Operating Characteristic ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Gradient Boosting ◽  
Support Vector ◽  
Antibacterial Peptides ◽  
Therapeutic Approaches ◽  
Laboratory Procedures ◽  
Feature Selection Techniques ◽  
Better Than

Antimicrobial resistance is driving pharmaceutical companies to investigate different therapeutic approaches. One approach that has garnered growing consideration in drug development is the use of antimicrobial peptides (AMPs). Antibacterial peptides (ABPs), which occur naturally as part of the immune response, can serve as powerful, broad-spectrum antibiotics. However, conventional laboratory procedures for screening and discovering ABPs are expensive and time-consuming. Identification of ABPs can be significantly improved using computational methods. In this paper, we introduce a machine learning method for the fast and accurate prediction of ABPs. We gathered more than 6000 peptides from publicly available datasets and extracted 1209 features (peptide characteristics) from these sequences. We selected the set of optimal features by applying correlation-based and random forest feature selection techniques. Finally, we designed an ensemble gradient boosting model (GBM) to predict putative ABPs. We evaluated our model using receiver operating characteristic (ROC) curves, calculating the area under the curve (AUC) for several different models for comparison, including a recurrent neural network, a support vector machine, and iAMPpred. The AUC for the GBM was ~0.98, more than 3% better than any of the other models.

Diagnostic power of lecithin/sphingomyelin ratio and fluorescence polarization assays for respiratory distress syndrome compared by relative operating characteristic curves

1994 ◽  
Vol 40 (4) ◽  
pp. 541-545 ◽  
Author(s):  
T M Bender ◽  
L R Stone ◽  
J S Amenta
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Fluorescence Polarization ◽  
Laboratory Tests ◽  
Operating Characteristic ◽  
Distress Syndrome ◽  
Roc Curves ◽  
Relative Operating Characteristic ◽  
Diagnostic Power ◽  
S Curve

Abstract Amniotic fluids from 328 patients were analyzed for lecithin/sphingomyelin (L/S) ratio and surfactant/albumin (S/A) ratio by fluorescence polarization. Of this group, 61 neonates showed respiratory distress syndrome (RDS) on delivery within 3 days of testing. We compared the power of the L/S and S/A in diagnosing pulmonary maturity, using relative operating characteristic (ROC) curves. The area defined by the ROC curve of the S/A test exceeded the area defined by the L/S curve, but this difference was not statistically significant. The diagnostic power of the S/A test appears to be at least equal to that of the standard L/S test. A review of five cases of RDS in which laboratory tests had suggested maturity showed that neither the L/S nor the S/A could satisfactorily resolve the problem of false interpretations of maturity, particularly in mothers with diabetes mellitus who underwent cesarean section.

scholarly journals Post-transplant monitoring of lymphocyte counts predict the occurrence of CMV infection in early phase of kidney transplantation

2020 ◽  
Author(s):  
Sujuan Feng ◽  
Jing Yang ◽  
Xiaodong Zhang
Keyword(s):  
Kidney Transplantation ◽  
Peripheral Blood ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Cmv Dnaemia

Abstract Objectives The aim of this study was to assess whether monitoring of the number of lymphocytes in peripheral blood was helpful for evaluating the risk of cytomegalovirus (CMV) infection after kidney transplantation. Methods The total numbers of lymphocyte in peripheral blood were measured at baseline and posttransplant months 1, 3 and 6. Risk factors for DNAemia in KTRs were analyzed using univariate logistic regression analyses. Areas under receiver operating characteristic (ROC) curves were applied to assess the accuracy of lymphocyte counts for predicting CMV DNAemia. Results After follow-up 6 months, CMV replication was detected in 12 (31.6%) kidney transplant recipients (KTRs). The total lymphocyte counts were significantly decreased in KTRs with CMV DNAemia in 1, 3 and 6 months. There was a negative correlation between CMV copies and the lymphocyte counts in 1, 3 and 6 months post-transplantation, and the decrease of lymphocyte counts in the 6 months post-transplantation was the risk factor of CMV DNAemia in the KTR. Patients with lymphocyte counts 1.085×109 cells/L had higher cumulative incidence of CMV infection.Conclusions The lymphocyte counts post kidney transplantation may be used as a simple and effective indicator for monitoring the CMV infection status in KTR and for predicting the risk of CMV DNAemia.

Quick Sepsis-related Organ Failure Assessment to predict ICU admission and mortality in community-acquired pneumonia

2017 ◽  
Author(s):  
Maria Dolores Martinez Pitarch ◽  
Guido Palomino Pacsi ◽  
María Luisa Planells Prats ◽  
María Bóveda Garcia ◽  
Andreu Belmonte Domingo
Keyword(s):  
Organ Failure ◽  
Community Acquired Pneumonia ◽  
Icu Admission ◽  
Failure Assessment

scholarly journals Novel Physique Index for the Screening of Skeletal Dysplasia at Birth

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 331
Author(s):  
Ryoji Aoki ◽  
Nobuhiko Nagano ◽  
Aya Okahashi ◽  
Shoko Ohashi ◽  
Yoshinori Fujinaka ◽  
...  
Keyword(s):  
Birth Weight ◽  
Skeletal Dysplasia ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Regression Equations ◽  
Fetal Ultrasound ◽  
The Mean ◽  
Gestational Age At Birth ◽  
Age At Birth

This study aimed to devise a novel physique index and investigate its accuracy in identifying newborns with skeletal dysplasia in comparison with head circumference (HC)/height (HT) ratio. The birth weight (W), HT, and HC at birth of 1500 newborns were retrospectively collected. The linear regression equations and coefficients of determination (R2) were determined. The formulated equation was corrected by the mean weight for gestational age at birth (Wcorr) as a novel physique index for screening skeletal dysplasia. The index accuracy was assessed using receiver operating characteristic (ROC) curves in 11 newborns by fetal ultrasound and compared with that of the HC/HT ratio. The R2 values between W and HT, (HT)2, and (HT) 3 were 0.978, 0.990, and 0.993, respectively. Those between W and HC, (HC)2, and (HC)3 were 0.974, 0.984, and 0.988, respectively. W/Wcorr × (HC/HT)3 was used as a novel physique index. Seven newborns had skeletal dysplasia. Our novel physique index had a higher area under the curve (AUC), sensitivity, and specificity than the HC/HT ratio (AUC: 1.00 vs. 0.86, sensitivity: 1.00 vs. 0.86, and specificity: 1.00 vs. 0.75, respectively). Our novel physique index was more accurate than HC/HT ratio and has the potential to accurately identify newborns with skeletal dysplasia.

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