scholarly journals The Problems with Risk Prediction during an Emergency Medical Admission Using Laboratory Data – Evidence from Potassium

2019 ◽  
Vol 18 (1) ◽  
pp. 16-22
Author(s):  
Richard Conway ◽  
◽  
Declan Byrne ◽  
Seán Cournane ◽  
Deirdre O’Riordan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Risk Prediction ◽  
Biochemical Markers ◽  
Laboratory Data ◽  
Progressive Increase ◽  
Medical Admission ◽  
Emergency Admissions ◽  
Fractional Polynomial ◽  
Relationship Of ◽  
Over Time

Background: The prediction of clinical outcomes using biochemical markers is an important tool. Methods: We calculated a risk score for all emergency admissions 2002-2017. We related potassium and mortality in a multivariable fractional polynomial model. We investigated the potassium distribution and relationship of potassium to mortality over time. Results: There were 106,586 admissions in 54,928 patients. Mortality was higher for those with an admission potassium above the median – 6.1% vs 4.6% (p<0.001), OR 1.07 (95%CI: 1.06, 1.09). There was a progressive increase in mortality from the lowest – 8.9% (95%CI: 8.3%, 9.4%) to highest potassium decile – 14.2% (95%CI: 13.5%, 14.8%). The frequency of admission hypokalaemia and the mortality at any given potassium decreased over time. Conclusion: Admission potassium predicts mortality.

scholarly journals Predicting outcomes in emergency medical admissions – role of laboratory data and co-morbidity

2012 ◽  
Vol 11 (2) ◽  
pp. 59-65
Author(s):  
Esther O’Sullivan ◽  
◽  
Elizabeth Callely ◽  
Kathleen Bennett ◽  
Deirdre O’Riordan ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Laboratory Data ◽  
Medical Admission ◽  
Emergency Admissions ◽  
Fractional Polynomial ◽  
Emergency Medical ◽  
Co Morbidity ◽  
Validation Set ◽  
Patient Administration System

Background: The utility of risk stratification following an emergency medical admission has been debated. We have examined the predictability of outcomes, from a database of all emergency admissions to St James’ Hospital, Dublin, over a six year period (2005-2010). Methods: Analysis was performed using the hospital in-patient enquiry system, linked to the patient administration system and laboratory data. The utility of a fractional polynomial laboratory only model to predict 30-day in-hospital mortality was determined. Results: The AUROC for the laboratory parameters to predict a 30 day death was 0.90 (95% CI 0.89, 0.90) in the 2002 – 2010 derivation dataset and was 0.88 (95% CI 0.86, 0.90) in the 2011 validation set. The addition of co-morbidity measures did not improve the model prediction (0.89 : 95% CI 0.88 – 0.89). Conclusion: A fractional polynomial laboratory only model can reliably predict 30-day hospital mortality following an emergency medical admission, potentially allowing resources to be risk focused and patients to be prioritised.

Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 89-95
Author(s):  
Jianfeng Zheng ◽  
Rui Xu ◽  
Zongduo Guo ◽  
Xiaochuan Sun
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Laboratory Data ◽  
Cardiac Complications ◽  
World Population ◽  
Systemic Complications ◽  
Poor Outcome ◽  
Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

scholarly journals Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19

2021 ◽  
Vol 14 ◽  
pp. 175628482110356
Author(s):  
Lina Zhang ◽  
Huanqin Han ◽  
Xuan Li ◽  
Caozhen Chen ◽  
Xiaobing Xie ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Standard Care ◽  
Cox Model ◽  
Improvement Rate ◽  
Viral Shedding ◽  
Microbial Dysbiosis ◽  
Relationship Of

Background and aims: Currently, there are no definitive therapies for coronavirus disease 2019 (COVID-19). Gut microbial dysbiosis has been proved to be associated with COVID-19 severity and probiotics is an adjunctive therapy for COIVD-19. However, the potential benefit of probiotics in COVID-19 has not been studied. We aimed to assess the relationship of probiotics use with clinical outcomes in patients with COVID-19. Methods: We conducted a propensity-score matched retrospective cohort study of adult patients with COVID-19. Eligible patients received either probiotics plus standard care (probiotics group) or standard care alone (non-probiotics group). The primary outcome was the clinical improvement rate, which was compared among propensity-score matched groups and in the unmatched cohort. Secondary outcomes included the duration of viral shedding, fever, and hospital stay. Results: Among the propensity-score matched groups, probiotics use was related to clinical improvement rates (log-rank p = 0.028). This relationship was driven primarily by a shorter (days) time to clinical improvement [difference, −3 (−4 to −1), p = 0.022], reduction in duration of fever [−1.0 (−2.0 to 0.0), p = 0.025], viral shedding [−3 (−6 to −1), p < 0.001], and hospital stay [−3 (−5 to −1), p = 0.009]. Using the Cox model with time-varying exposure, use of probiotics remained independently related to better clinical improvement rate in the unmatched cohort. Conclusion: Our study suggested that probiotics use was related to improved clinical outcomes in patients with COVID-19. Further studies are required to validate the effect of probiotics in combating the COVID-19 pandemic.

scholarly journals Investigation of the Correlation between Postherpetic Itch and Neuropathic Pain over Time

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Rie Ishikawa ◽  
Masako Iseki ◽  
Rie Koga ◽  
Eiichi Inada
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Pain Intensity ◽  
Visual Analog Scale ◽  
Analog Scale ◽  
Paindetect Questionnaire ◽  
Relationship Of ◽  
The Relationship ◽  
Over Time

Postherpetic itch (PHI), or herpes zoster itch, is an intractable and poorly understood disease. We targeted 94 herpes zoster patients to investigate their pain and itch intensities at three separate stages of the condition (acute, subacute, and chronic). We used painDETECT questionnaire (PDQ) scores to investigate the correlation between PHI and neuropathic pain. Seventy-six patients were able to complete follow-up surveys. The prevalence of PHI was 47/76 (62%), 28/76 (37%), and 34/76 (45%) at the acute, subacute, and chronic stages, respectively. PHI manifestation times and patterns varied. We investigated the relationship of PHI with neuropathic pain using the visual analog scale (VAS), which is a measure of pain intensity, and the PDQ, which is a questionnaire used to evaluate the elements of neuropathic pain. The VAS and PDQ scores did not differ significantly between PHI-positive and PHI-negative patients. A large neuropathic component was not found for herpes zoster itch, suggesting that neuropathic pain treatments may not able to adequately control the itch. Accordingly, we suggest that a more PHI-focused therapy is required to address this condition.

scholarly journals The relationship of oleic acid/albumin molar ratio and clinical outcomes in leptospirosis

Heliyon ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e06420
Author(s):  
Caroline Azevedo Martins ◽  
Maria Conceição B dos Santos ◽  
Cassiano Felippe Gonçalves-de-Albuquerque ◽  
Hugo Caire Castro-Faria-Neto ◽  
Mauro Velho Castro-Faria ◽  
...  
Keyword(s):  
Oleic Acid ◽  
Clinical Outcomes ◽  
Molar Ratio ◽  
Relationship Of ◽  
The Relationship

Relationship of a Quality Measure Composite to Clinical Outcomes for Patients With Heart Failure

2008 ◽  
Vol 23 (3) ◽  
pp. 168-175 ◽  
Author(s):  
Eugene S. Chung ◽  
Lin Guo ◽  
Donald E. Casey ◽  
Cheryl Bartone ◽  
Santosh Menon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Quality Measure ◽  
Patients With Heart Failure ◽  
Relationship Of

scholarly journals RELATIONSHIP OF HEMODYNAMIC VALVE DETERIORATION AND LATE CLINICAL OUTCOMES AFTER TAVR WITH A SELF-EXPANDING BIOPROSTHESIS AND SURGERY

2021 ◽  
Vol 77 (18) ◽  
pp. 904
Author(s):  
Daniel O’Hair ◽  
Michael Reardon ◽  
Steven Yakubov ◽  
Shuzhen Li ◽  
G. Michael Deeb
Keyword(s):  
Clinical Outcomes ◽  
Relationship Of

Narrating The City: spaces Of Urban Change, South London

2008 ◽  
Vol 33 (2) ◽  
pp. 10-17
Author(s):  
Suzanne M. Hall
Keyword(s):  
Inner City ◽  
The Other ◽  
Urban Change ◽  
Spatial Transformation ◽  
Class Culture ◽  
Relationship Of ◽  
The City ◽  
North And South ◽  
Official Data ◽  
Over Time

This paper explores the documentation of social and spatial transformation in the Walworth area, South London. Spatial narratives are the entry point for my exploration, where official and ‘unofficial’ representations of history are aligned to capture the nature of urban change. Looking at the city from street level provides a worldly view of social encounter and spaces that are expressive of how citizens experience and shape the city. A more distanced view of the city accessed from official data reveals different constructs. In overlaying near and far views and data and experience, correlations and contestations emerge. As a method of research, the narrative is the potential palimpsest, incorporating fragments of the immediate and historic without representing a comprehensive whole. In this paper Walworth is documented as a local and Inner City context where remnants and insertions are juxtaposed, where white working class culture and diverse ethnicities experience difference and change. A primary aim is to consider the diverse experiences of groups and individuals over time, through their relationship with their street, neighbourhood and city. In relating the Walworth area to London I use three spatial narratives to articulate the contemporary and historic relationship of people to place: the other side examines the physical discrimination between north and south London, the other half looks at distinctions of class and race and other histories explores the histories displaced from official accounts.

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