scholarly journals Predictive factors of failure to control bleeding and 6-week mortality after variceal hemorrhage in liver cirrhosis – a tertiary referral center experience

2021 ◽  
Author(s):  
Daniela Matei ◽  
Dana Crisan ◽  
Bogdan Procopet ◽  
Ioana Groza ◽  
Bogdan Furnea ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Creatinine Level ◽  
Predictive Factors ◽  
Variceal Bleeding ◽  
Meld Score ◽  
Charlson Index ◽  
Variceal Hemorrhage ◽  
Tertiary Referral Center ◽  
Factors Associated ◽  
Child Class

IntroductionMortality from variceal bleeding remains high despite the therapeutic progress in severe cirrhosis. Understanding the predictive factors of failure to control bleeding (FTB) and mortality will lead to better future therapies. Comorbidities are thought to be important prognostic factors for variceal bleeding. The aim of the study was to assess the factors associated with FTB and with 42-day mortality and to evaluate the influence of comorbidities on these patients’ prognosis.Material and methodsWe prospectively included in the study all consecutive patients with cirrhosis and variceal bleeding presenting to the emergency room and we followed them up over 6 weeks. CirCom score and Charlson index were used for the assessment of comorbidities.ResultsOf the 138 patients included in the study, 27 (19.5%) were considered to have FTB. Child C class (74.07% vs. 32.43%, p < 0.001), Meld score (20.5 vs. 16.00, p = 0.004) and creatinine level (1.04 vs. 0.81, p = 0.01) were associated with FTB, but only Child class was independently associated with FTB in multivariate analysis (OR = 2.94, p = 0.006). Mortality at 42 days (21.7%) was influenced by the severity of the disease assessed through Child class (76.66% vs. 30.55% – Child C, p < 0.001) and MELD score (21.00 vs. 16.00, p < 0.001). Creatinine level (1.00 vs. 0.7, p = 0.02) and acute kidney injury (26.66% vs. 7.40%, p = 0.009) were also prognostic factors for the 6-week mortality. Comorbidities did not influence the mortality (CirCom > 1 (16.7% vs. 21.3%, p = 0.76) or Charlson index > 4 (36% vs. 47.2%, p = 0.41).ConclusionsThe severity of cirrhosis is an important prognostic factor for FTB and 42-day mortality. Identifying the factors associated with early mortality may help selecting patients needing more than conventional therapy.

scholarly journals Modifiable and Nonmodifiable Predictive Factors Associated with the Outcomes of Total Knee Arthroplasty

Joints ◽  
2019 ◽  
Vol 07 (01) ◽  
pp. 013-018
Author(s):  
Davide E. Bonasia ◽  
Anna Palazzolo ◽  
Umberto Cottino ◽  
Francesco Saccia ◽  
Claudio Mazzola ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Prognostic Factors ◽  
Treatment Option ◽  
Predictive Factors ◽  
Knee Arthroplasty ◽  
Factors Associated ◽  
Modifiable Factors ◽  
Valuable Treatment ◽  
Total Knee ◽  
The Right

AbstractTotal knee arthroplasty (TKA) is a valuable treatment option for advanced osteoarthritis in patients unresponsive to conservative treatments. Despite overall satisfactory results, the rate of unsatisfied patients after TKA remains high, ranging from 5 to 40%. Different modifiable and nonmodifiable prognostic factors associated with TKA outcomes have been described. The correction, whenever possible, of modifiable factors is fundamental in preoperative patients' optimization protocols. Nonmodifiable factors can help in predicting the outcomes and creating the right expectations in the patients undergoing TKA. The goal of this review is to summarize the modifiable and nonmodifiable prognostic factors associated with TKA outcomes.

scholarly journals Prognostic factors associated with mortality in patients with gastric fundal variceal bleeding

2017 ◽  
Vol 23 (3) ◽  
pp. 496 ◽  
Author(s):  
Keishi Komori ◽  
Masaru Kubokawa ◽  
Eikichi Ihara ◽  
Kazuya Akahoshi ◽  
Kazuhiko Nakamura ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Variceal Bleeding ◽  
Factors Associated

scholarly journals Factors Predicting Mortality of Variceal Bleeding in Liver Cirrhosis

2018 ◽  
Vol 56 (209) ◽  
pp. 493-496
Author(s):  
Amrendra Kumar Mandal ◽  
Mukesh Sharma Paudel ◽  
Sudhamshu KC ◽  
Sitaram Chaudhary ◽  
Bidhan Nidhi Paudel ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Variceal Bleeding ◽  
Meld Score ◽  
High Serum ◽  
Predictors Of Mortality ◽  
Acute Variceal Bleeding ◽  
Ctp Score

Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC. Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding. Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score. Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020 ◽  
Author(s):  
Giancarlo Buitrago ◽  
Jorge R. Ortiz ◽  
Felipe Camacho
Keyword(s):  
Prognostic Factors ◽  
Health System ◽  
Hospital Readmission ◽  
Postoperative Mortality ◽  
Charlson Index ◽  
Day Hospital ◽  
Factors Associated ◽  
Episode Of Care ◽  
Care Costs ◽  
Arthroplasty Revision

AbstractTotal knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

Something new about prognostic factors for lupus nephritis? A systematic review

Lupus ◽  
2021 ◽  
pp. 096120332110614
Author(s):  
Esther Rodríguez-Almaraz ◽  
Elena Gutiérrez-Solís ◽  
Elena Rabadán ◽  
Paola Rodríguez ◽  
Loreto Carmona ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Prognostic Factors ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Predictive Factors ◽  
Cardiovascular Events ◽  
Vascular Lesions ◽  
Histological Findings ◽  
Factors Associated

Background Lupus nephritis (LN) affects 30–45% of patients with systemic lupus erythematosus (SLE) and causes great morbidity and mortality. About 10–25% of patients will develop chronic kidney disease (CKD), and it has been described a mortality of 10–20% at 10 years. The contribution of clinical and biological markers to the prediction of outcome is unclear. Objective To describe the factors, with measures of association, that predict the main outcomes of LN. Material and Methods We have conducted a systematic review. Medline, Embase, and Cochrane Library were systematic searched from inception up to Oct 2019, with a strategy that included synonyms of all targeted outcomes of LN: (kidney failure, response to treatment, cardiovascular events, and mortality). Only studies with longitudinal prospective design or with warranties of unbiased recollection of the prognostic factors, where LN was confirmed by biopsy were included. Risk of bias was assessed with the New Castle Ottawa scale. Predictive factors and their effect measures were collected from each study. Results From 1221 studies identified, 25 studies were included, of which 15 were retrospective, nine prospective, and one was a trial extension study (range from 3 months to 11 years). The main predictive factors of renal response were serum creatinine (SCr) and glomerular filtration rate C3 levels, titer of anti-C1q, and anti-dsDNA antibodies. Renal histological findings such as class type (IV or V), tubulointerstitial or vascular lesions and chronicity index were risk factors for development of chronic kidney disease. The factors associated with persistence of activity were proteinuria, anti-dsDNA, anticardiolipin, anti C1q antibodies, and complement values. The factors associated to cardiovascular events and mortality were age, smoking, amount of proteinuria, and histological findings, such as vascular lesions. Meta-analysis was precluded given the heterogeneity of designs definitions and effect measures. Conclusions Nowadays, we do not have new biomarkers that establish the renal prognosis of patients with LN. Classical clinical, renal, and histological markers are used in most studies. It is worth noting the heterogeneity of studies in the definition of renal outcomes, which complicates risk stratification in these patients.

scholarly journals Performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rehab Elsayed Elsafty ◽  
Abdallah Ahmed Elsawy ◽  
Ahmed Fawzy Selim ◽  
Atef Mohamed Taha
Keyword(s):  
Hepatic Encephalopathy ◽  
Variceal Bleeding ◽  
Early Discharge ◽  
Meld Score ◽  
Bleeding Control ◽  
Acute Variceal Bleeding ◽  
Prophylactic Measures ◽  
Significant Performance ◽  
Cirrhotic Patients ◽  
Grade 3

Abstract Background Hepatic encephalopathy exacerbates the morbidity, delays hospital discharge, and increases the rate of readmissions of cirrhotic patients, particularly those are admitted by acute variceal bleeding. We evaluated the performance of albumin-bilirubin score in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding, in comparison to Child-Pugh and MELD scores. This prospective cohort study was conducted on 250 cirrhotic patients who were consecutively presented by acute variceal bleeding in the period from January to December 2020 at Tanta university emergency hospital. Albumin-bilirubin, Child-Pugh, and MELD scores were measured at admission, and then all patients were followed up for 4 weeks after endoscopic bleeding control for possible occurrence of hepatic encephalopathy Results Albumin-bilirubin, Child-Pugh, and MELD scores had significant performances in prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding; in this regard, albumin-bilirubin score had the highest accuracy (AUC 0.858, CI 0.802-0.914, sig 0.000) followed by Child-Pugh score (AUC 0.654, CI 0.574–0.735, sig 0.001) and then MELD score (AUC 0.602, CI 0.519–0.686, sig 0.031). The cumulative incidence of hepatic encephalopathy in cirrhotic patients with albumin-bilirubin grade 3 was found to be significantly more than that present in albumin-bilirubin grade 2; most of these hepatic encephalopathy cases occurred in the first 2 weeks of follow-up period. Conclusions Albumin-bilirubin score has a significant performance in risk prediction of hepatic encephalopathy in cirrhotic patients with acute variceal bleeding better than Child-Pugh and MELD scores. Albumin-bilirubin grades could be used as a risk stratifying tool to triage cirrhotic patients who will benefit from early discharge after bleeding control and those patients who will benefit from prophylactic measures for hepatic encephalopathy.

scholarly journals Application of a second opinion ultrasound in Breast Imaging Reporting and Data System 4A cases: can immediate biopsy be avoided?

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110244
Author(s):  
Yantao Cai ◽  
Chenfang Zhu ◽  
Qianqian Chen ◽  
Feng Zhao ◽  
Shanyu Guo
Keyword(s):  
Minimally Invasive ◽  
Predictive Factors ◽  
Breast Imaging ◽  
Protective Factor ◽  
Multivariate Analyses ◽  
Data System ◽  
Second Opinion ◽  
Factors Associated ◽  
Peripheral Location ◽  
Biopsy Rate

Objective The probability of malignancy in women who are diagnosed with a Breast Imaging Reporting and Data System (BI-RADS) 4A score is low. Application of a second opinion ultrasound (SOUS), which is low in cost and minimally invasive, may lower the biopsy rate for patients who fall into this category. This study aimed to apply SOUS to patients with a BI-RADS score of 4A and predict the pathological results of a biopsy. Methods One hundred seventy-eight patients were analyzed. Univariate and multivariate analyses were performed to screen for predictive factors that are associated with malignancy. Categorical alteration of downgraded, unchanged, or upgraded was made after SOUS results. Changes in category were compared with biopsies to determine their predictive value of benignancy or malignancy. Results Independent factors associated with malignancy were age (>50 years), tumor size (≥20 mm), margin (not circumscribed), orientation (not parallel), and peripheral location, and an upgraded categorical alteration from SOUS. Downgraded categorical alterations were associated with benignancy. Conclusions In BI-RADS 4A cases, a biopsy is recommended when independent factors are associated with malignancy. A downgraded result from an SOUS examination is a protective factor, supporting the likelihood of benignancy in these patients.

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