scholarly journals Which prognostic score for abdominal sepsis? Analysis of final results of PIPAS (Physiological Indicators for Prognosis in Abdominal Sepsis) study in a single center

2018 ◽  
Author(s):  
Stefano Raimondo ◽  
Massimo Sartelli ◽  
Federico Coccolini ◽  
Paola Fugazzola ◽  
Raffaele Bova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Surgical Complications ◽  
Prognostic Score ◽  
Abdominal Sepsis ◽  
Diffuse Peritonitis ◽  
Single Center ◽  
Oxygen Saturation Level ◽  
Icu Admission ◽  
Level Of Consciousness

Intra-abdominal infections (cIAIs) constitute an important cause of morbidity and mortality. Numerous risk factors may influence prognosis of cIAIs. This study aims to evaluate which parameters and scores may better predict prognostic outcomes in cIAIs. This is a single-center prospective observational study. Data from sixty-five patients were collected during a four-month period. Univariate and multivariate analysis for physiological parameters and ROC curves for SIRS, qSOFA and WISS scores were calculated in relation to mortality, intensive care unit (ICU) admission and surgical complications. Blood oxygen saturation level (SpO2), heart and respiratory rate, systolic blood pressure (SBP), level of consciousness, INR, C-reactive protein (CRP), white blood cells, source control and health care-acquired infections affect prognosis in cIAIs according to univariate analysis. On multivariate analysis level of consciousness, SpO2, CRP, diffuse peritonitis, INR and SBP significantly influenced prognosis in cIAIs. AUROC for WISS score were 0.89 for mortality, 0.86 for major complications, 0.76 for ICU admission. In our study many risk factors adversely affect prognostic outcomes in cIAIs; PIPAS study probably may provide even better results on that. Moreover, WISS score reached remarkable performance in predicting mortality and major surgical complications in abdominal sepsis; qSOFA did not achieve satisfactory results in none of analyzed outcomes.

Multivariate analysis of risk factors for Nuss bar infections: A single center study

2018 ◽  
Vol 53 (6) ◽  
pp. 1226-1229 ◽  
Author(s):  
Robert J. Obermeyer ◽  
Nina S. Cohen ◽  
Sheema Gaffar ◽  
Robert E. Kelly ◽  
M. Ann Kuhn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

A Prognostic Score for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: Analysis of 2189 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2783-2783
Author(s):  
Apostolia-Maria Tsimberidou ◽  
Peter McLaughlin ◽  
Susan O’Brien ◽  
Sijin Wen ◽  
William G. Wierda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Score ◽  
Lymphocytic Leukemia ◽  
Testing Time ◽  
Small Lymphocytic Lymphoma ◽  
Β2 Microglobulin ◽  
Risk Of Death ◽  
Genomic Aberrations

Abstract Introduction: The prognosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is heterogeneous. The purpose of this study was to assess factors predicting survival in patients with CLL/SLL. Methods: Characteristics at diagnosis were collected from 2189 patients with CLL/SLL who presented to The University of Texas M. D. Anderson Cancer Center between 1985 and 2005. Univariate and multivariate analyses for survival were performed. Pretreatment parameters that remained independently significant in the multivariate analysis were used to design a model to predict an individual patient’s risk of death: the CLL/SLL score. Results. The median age of patients was 58 years (range, 17–90 years). Overall, 1052 patients required treatment for CLL/SLL and 853 (81%) received fludarabine-based therapy. A multivariate analysis of 23 prognostic factors identified the following to have independent adverse significance for survival: 17p del and 6q del +/− other genomic aberrations (p<0.0001), age > 60 years (p<0.0001), albumin < 3.5 g/dL (p<0.0001), β2-microglobulin ≥ 2 mg/L (p<0.0001), creatinine ≥ 1.6 mg/dL (p<0.0001), hemoglobin <11 g/dL (p=0.001), presence of hepatomegaly (p=0.005), male sex (p=0.006), and absolute lymphocyte count ≥ 30 x 109/L (p=0.004). Other factors, such as IgVH mutation and CD38 or ZAP-70 expression, did not significantly correlate with survival, probably because these data were not available in enough patients and follow-up from the testing time was relatively short. The top five pretreatment parameters that remained independently significant in the multivariate analysis were used to design the CLL/SLL score in 1564 patients who had available data for all five parameters. Since the relative risks associated with each of the top five independently significant risk factors were comparable, the relative risk of death could be determined by summing the number of risk factors present at diagnosis. At 5 years, 96%, 79%, 69%, 30%, and 16% of patients with 0, 1, 2, 3, or 4 (including 1 patient with a score of 5) risk factors, respectively, are expected to be alive [insert Figure here]. Conclusions: A prognostic score to predict survival in patients with CLL/SLL is proposed. The score is based on the five most statistically significant independent factors, i.e., 17p or 6q del +/− other genomic aberrations; age; and levels of β2-microglobulin, albumin, and creatinine. This score may be used to identify specific risk groups, to improve treatment choices and to compare different therapeutic approaches in patients with CLL/SLL. Figure Figure

scholarly journals Risk Factors of Candida parapsilosis Catheter-Related Bloodstream Infection

2021 ◽  
Vol 9 ◽  
Author(s):  
Dina Hussein Yamin ◽  
Azlan Husin ◽  
Azian Harun
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Bloodstream Infection ◽  
Candida Parapsilosis ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Solid Organ ◽  
Care Hospital ◽  
Icu Admission ◽  
Catheter Related Bloodstream Infection

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080–0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125–8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.

scholarly journals Acute kidney injury in hospitalized patients with COVID-19

2020 ◽  
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
João Oliveira ◽  
Filipe Marques ◽  
João Bernardo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Single Center ◽  
Transient Aki ◽  
Worse Prognosis

Abstract Introduction: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients ranges from 0.5 to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19.Methods: We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and Transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions.Results: In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). On a multivariate analysis, older age (adjusted OR 1.08 (95% CI 1.02-1.13), p=0.004), lower Hb level (adjusted OR 0.69 (95% CI 0.53-0.91), p=0.007) and acidemia at presentation (adjusted OR 5.53 (95% CI 1.70-18.63), p=0.005), duration of AKI (adjusted OR 7.91 for persistent AKI (95% CI 2.39-26.21), p=0.001) and severity of AKI (adjusted OR 2.30 per increase in KDIGO stage (95% CI 1.10-4.82), p=0.027) were independent predictors of mortality.Conclusion: AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

Systemic lupus erythematosus–associated diffuse alveolar hemorrhage: a single-center, matched case–control study in China

Lupus ◽  
2020 ◽  
Vol 29 (7) ◽  
pp. 795-803 ◽  
Author(s):  
Yiduo Sun ◽  
Cong Zhou ◽  
Jiuliang Zhao ◽  
Qian Wang ◽  
Dong Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lupus Erythematosus ◽  
Case Control ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Single Center ◽  
Systemic Lupus

Background This study described clinical characteristics and outcome in systemic lupus erythematosus (SLE) patients with diffuse alveolar hemorrhage (DAH), and investigated risk factors and prognostic factors for DAH. Methods We conducted a retrospective nested case–control analysis in a single-center cohort. We enrolled 94 SLE patients with DAH. For each case of DAH, two age-, sex-, and SLE courses–matched controls were randomly selected from our cohort. All patients were enrolled between 2004 and 2019 and were followed until death, end of registration with the physician’s practice, or end of January 2019. We estimated the risk factors for DAH and prognostic factors for mortality using multivariate analysis. Results We included 4744 patients diagnosed with SLE, with 94 cases of DAH, for an incidence rate of 2.0%. DAH may occur in any stage of SLE but mostly in the early phase of disease course. Lupus nephritis (LN) was the most common concomitant involvement at DAH diagnosis. By multivariate analysis, LN, anti-SSA positivity, thrombocytopenia and elevated C-reactive protein (CRP) were significantly associated with DAH in SLE patients. All-cause mortality was increased in SLE with DAH compared with SLE without DAH (adjusted hazard ratio 6.0, 95% confidence interval 2.8–13.0, p < 0.0001). Intravenous cyclophosphamide (CTX) showed an increased tendency for better survival in DAH after adjusting for Systemic Lupus Erythematosus Disease Activity Index 2000, acute kidney injury and mechanical ventilation. Conclusions LN, anti-SSA positivity, thrombocytopenia and elevated CRP were independent risk factors of DAH in lupus patients. Due to a high early death rate of DAH and little long-term damage, DAH patients may benefit from early diagnosis and intensive treatment, and CTX-based therapy can be a preferential choice.

Evaluation Of a Novel 3 Factor Prognostic Score (PS-3) For Patients With Advanced Hodgkin Lymphoma (HL) Treated On US Intergroup E2496

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4277-4277 ◽  
Author(s):  
Catherine S. Diefenbach ◽  
Hailun Li ◽  
Fangxin Hong ◽  
Leo I. Gordon ◽  
Richard I Fisher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Disease Progression ◽  
Proportional Hazards ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Study Entry ◽  
Current Therapy

Abstract Background The international prognostic score (IPS) (Hasenclever et al., NEJM 1988) uses 7 factors (age> 45, male sex, hemoglobin<10.5, stage IV, leukocytosis > 15,000, and lymphopenia< 600) to predict a 5 year freedom from progression (FFP) of 42%-84% and overall survival (OS) of 56%-89% for patients with advanced HL. Constructed from a retrospective analysis of patients treated before 1992, the IPS continues to be the most commonly used risk stratification index for advanced HL. Recent studies suggest that the predictive range of the IPS has narrowed due to improved outcomes of patients treated with current therapy (Moccia et al. JCO 2012). In this report we prospectively evaluated the ability of the individual components of the IPS to predict outcome in patients enrolled on the US Intergroup trial E2496. Methods All seven IPS (IPS-7) variables were recorded for all patients at study entry. FFP was defined as the time from study entry to disease progression or relapse; deaths that occurred during remission that were not preceded by disease progression/relapse were censored. OS was defined as the time from study entry to death from any cause. Kaplan-Meier methodology was used to construct survival curves. Univariate and multivariate analysis (MVA) was performed using Cox proportional-hazards models. We subsequently constructed an alternative prognostic score utilizing the factors which were significant on MVA (PS-3). Results From 1996-2006, 854 patients with advanced HL, were randomized to treatment with either ABVD or Stanford V, with no significant differences in outcome (Gordon et al, JCO 2013). While the IPS-7 remained prognostic it did not stratify the lowest risk patients (0-1 risk factor) or patients with 3-5 risk factors, as its predictive range was narrowed due to improved clinical outcomes (Fig 1a and 2a). Table 1 shows the univariate and multivariate analysis for IPS-7 and outcomes. In contrast to the original IPS-7, on MVA, only two factors, hemoglobin and stage were significant for FFP, and three factors for OS: hemoglobin, stage, and age. We then evaluated a new 3 factor score (PS-3) utilizing variables significant on the MVA. The PS-3 was significant for both FFP (p=0.0001) and OS (p<.0001) and clearly separated patients into 4 distinct risk groups with either: 0, 1, 2 or 3 risk factors. The five year FFP was 83%, 74%, 68%, and 63% and OS was 95%, 85%, 75%, and 52% for patients with 0, 1, 2, and 3 risk factors, respectively (Table 2, Fig 1b and 2b). Conclusion In E2496, for patients with advanced HL, the PS-3 may stratify patients more clearly compared to IPS-7 and provide a simpler model to assess risk. Studies comparing PS-3 with IPS-7, and are ongoing. The incorporation of novel biomarkers and biologic factors into PS-3, as well as validation with other data sets is warranted. Disclosures: No relevant conflicts of interest to declare.

Risk Factors for Infections in Myelofibrosis: Role of Disease Status and Treatment. A Study on 507 Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1606-1606 ◽  
Author(s):  
Nicola Polverelli ◽  
Massimo Breccia ◽  
Giulia Benevolo ◽  
Bruno Martino ◽  
Alessia Tieghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Prognostic Score ◽  
Smoking Habit ◽  
Infectious Complications ◽  
Costal Margin ◽  
Massive Splenomegaly ◽  
Free Survival ◽  
Infectious Risk ◽  
Severe Infections

Abstract Background: Infectious complications represent one of the main causes of morbidity and mortality in patients (pts) with Primary Myelofibrosis (PMF), Post-Essential Thrombocythemia and post-Polycythemia Vera MF (PET/PPV-MF). Up-to-date, very few data are available on incidence and outcome of infectious complications. Also, risk factors of this potentially fatal complication are still to be investigated and defined. This is particularly relevant in the era of targeted therapy in MF, since an increased infectious risk has been reported in pts treated with ruxolitinib (RUX), a JAK1/2 inhibitor. Aims: To evaluate risk factors for severe infections in a large cohort of MF patients. Methods: Clinical and laboratory data of pts with MF were retrospectively collected from the database of 5 Italian Hematology Centers. Severe infections were defined according to the CTCAE. The study was approved by the Ethic Committee of each participating Centers. Results: Between 1980 and Aug 2014, 507 pts with PMF (362 pts, 71%), or PET-MF (14%) or PPV-MF were diagnosed and followed for a median follow-up of 4.2 yr (0.5-30.1). Baseline characteristics were (median): age, 66 y (range, 26-87); ≥65 y, 54%; male, 59%; hemoglobin (Hb), 11.9 g/dL (4-17.9); Hb <10 g/dL, 25%; PLT, 376×109/L (4-2513); PLT <100×109/L, 8%; spleen enlargement, 71% (spleen length ≥10cm: 20.5%); constitutional symptoms, 20%. International Prognostic Score System (IPSS) was low (21%), intermediate-1 (intm-1, 37%), intermediate-2 (intm-2, 25%), high (17%). Molecular analysis was performed on 321 pts (63%) and was positive in 83% (JAK2V617F), 12% (CALR), 3% (MPLW515K/L); 6 pts (2%) were triple negative. Karyotype was abnormal in 46 (17%) out of 265 evaluable pts (unfavorable in 13 pts; 5%). Three hundred and sixty-five (72%) received cytoreductive therapy (mainly hydroxyurea, 88%) and 71 patients (14%) received corticosteroids (defined as ≥ one cycle of prednisone at the dose of 1mg/Kg/daily for at least a month). Smoking habit was present in 165 patients (37%) and diabetes mellitus in 66 (13%). Overall, 112 pts (22%) experienced 160 infectious events (grade 3-4, 45%), for an incidence rate of 3.9% pt-y. The cumulative incidence was 20%, 33% and 51% at 5, 10 and 20 y, respectively. Infections were: bacterial (143 events, 89%; pneumonia: 80 cases, 56%); VZV reactivations (11 events, 7%), nodal TBC (3 events, 2%), fungal infections (3 events, 2%). Infectious complications represented the causes of death in 10 (7%) out of 134 deceased pts. Among baseline features, age≥65 y (p=0.001), primary vs secondary MF (p=0.009), spleen length>10 cm below left costal margin (p=0.006), high/intm-2 IPSS (p<0.0001) significantly correlated with higher infectious risk; in multivariate analysis, an high/intm-2 IPSS category and massive splenomegaly confirmed their negative impact (p=0.02 and p=0.04, respectively). Overall, 128 pts at intm-2/high IPSS risk were treated with RUX for a median time of 23 mos (1-41). Infection-free survival at 5 years was comparable in RUX-treated pts compared to non RUX-treated intm-2/high risk pts (76% vs 67%, p=0.82). In the RUX-treated cohort, age ≥65 y (p=0.008), JAK2 allele burden ≥75% (p=0.03) and steroids exposure before RUX (0.007) correlated with an increased infectious risk. Multivariate analysis confirmed age and corticosteroids utilization as independent negative prognostic risk factors (p=0.003 and p=0.043, respectively). Also, patients who obtained a spleen reduction higher than 50% during RUX therapy were projected to a better infection-free survival compared to non-responders (89% vs 70% at 12 mos, p=0.001) Summary/Conclusion. This large study confirms severe infections as frequent and potentially fatal events in MF. Also, this study has led to the identification of the main baseline features associated with increased infectious risk, namely baseline IPSS category and massive splenomegaly. Surprisingly, RUX therapy did not seem to significantly increase the risk of infections, despite its immunosuppressant properties. Yet, the successful use of RUX in terms of spleen response was found to correlate with a significant reduction of the probability to develop an infectious complication. Conversely, a combined or sequential use of corticosteroids and RUX may further increase the risk of infectious complications and therefore require a careful evaluation. Disclosures Martinelli: MSD: Consultancy; BMS: Speakers Bureau; Roche: Consultancy; ARIAD: Consultancy; Novartis: Speakers Bureau; Pfizer: Consultancy.

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