Assessment Of Clinical Risk Factors Research Articles

Placenta Accreta Spectrum Diagnosis Challenges and Controversies in Current Obstetrics: A Review.

Placenta accreta spectrum (PAS) is the most common obstetric complication in current obstetrics in which the placenta is fully or partially attached to the uterine myometrial layer at delivery. This is commonly due to the deficiency of the uterine interface between the uterine endometrial and myometrial layers leading to abnormal decidualization at the uterine scar area, which permits the abnormally placental anchoring villous and trophoblasts, deeply invade the myometrium. The prevalence of PAS is globally at rising trends every day in modern obstetrics originally due to the high increasing rate of cesarean sections, placenta previa, and assisted reproductive technology (ART). Thus, the early and precise diagnosis of PAS is imperative to prevent maternal intrapartum or postpartum bleeding complications. The main aim of this review is to debate the current challenges and controversies in the routine diagnosis of PAS diseases in obstetrics. We retrospectively reviewed the recent articles on different methods of diagnosing PAS in PubMed, Google Scholar, Web of Science, Medline, Embase, and other website databases. Despite that, the standard ultrasound is a reliable and key tool for the diagnosis of PAS, the lack of ultrasound features does not exclude the diagnosis of PAS. Therefore, clinical assessment of risk factors, MRI tests, serological markers, and placental histopathological tests are also indispensable for the prediction of PAS. Previously, limited studies reached a high sensitivity rate of diagnosis PAS in appropriate cases, while many studies recommended the inclusion of different diagnosis methods to improve the diagnosis accuracy. A multidisciplinary squad with well-experienced obstetricians, radiologists, and histopathologists should be involved in the establishment of the early and conclusive diagnosis of PAS.

Approaches to organization of Fracture Liaison Services at the regional level with the involvement of primary care physicians

To prevent fractures which the elderly and the very old might deal with is a strategic task for preserving the life quality of the elderly and their independence from outside help, as well as reduce the health care and social support economic costs. The most effective and cost-effective organizational structure for reducing fractures frequency is the Fracture Liaison Service (FLS). The foundation of FLS at the regional level includes various models of these services, which is associated with a multi-level system of trauma care, different numbers of attached population and different number of specialists. Firstly, these are identification, assessment of clinical risk factors for osteoporosis, investigation for secondary osteoporosis causes and treatment initiation in the FLS with follow-up in the primary health care in 12–18 months’ time. Secondly, these are identification, risks assessment, patients’ investigation in the FLS during 3 months with the follow-up treatment initiating by the primary health care physician. And thirdly, these are assessment, investigation and treatment initiation by a primary care doctor immediately after trauma care. In any case of the FLS organization, a patient who has had a fragility fracture in any period after the fracture will be under the supervision of a primary care physician, and therefore additional efforts should be made by healthcare organizers, heads of a medical organization and other specialists in order to increase the identification of the patients with osteoporosis, their examination and treatment with anti-osteoporotic drugs in the primary health care. The article presents the results of the studies confirming the effectiveness of FLS with a coordinator, educational activities for patients and doctors, the role of a traumatologist in motivating a patient for examination and treatment, and other options to help a primary care physician with identifying, diagnosing and treating patients after fragility fractures.

Nurse-led vascular risk assessment in a regional Victorian Indigenous primary care diabetes clinic: An integrated Diabetes Education and Eye disease Screening [iDEES] study.

The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse-led diabetes clinic. This was a cross-sectional descriptive single-site study. Vascular risk factor data were extracted from the electronic health records of participants in the nurse-led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health-care clinic between January 2018 and March 2020. Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46-67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2-12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2 , 7.0 mg/L and 32.4 kg/m2 . Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3-5) for women and 3 (2-5) for men, pχ2 =0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. A nurse-led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. A nurse-led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse-managed iDEES primary-care model of care can assist. This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235).

Risk of osteoporotic fracture in women using the FRAX tool with and without bone mineral density score in patients followed at a tertiary outpatient clinic ‒ An observational study

ObjectivesFragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool might be used to stratify patients in order to rationalize the need for BD and risk classification. The primary objective of this study is to describe and perform comparisons between the estimated risk of fractures in 10 years using the FRAX calculator based on clinical factors with and without BD results for women aged 40 or more with clinical diseases monitored in tertiary care service in internal medicine. MethodsCross-sectional. Women over 40 years with BD in the previous year. After medical chart review, identification of risk factors and risk estimations using FRAX-BRAZIL with (FRAX BDI) and without (FRAX BDNI) the inclusion of T-score. Results239 women. Age 65 ± 10.35 years. BMI 29.68 ± 6.27kg/m2. Risk factors: 32(13.4%) previous fractures; 23 (9.6%) current smoking; 78 (32.6%) corticosteroids use; 44 (18.4%) rheumatoid arthritis; 38 (15.9%) secondary causes; FRAX scores were higher when BD was not included. Spearman correlation coefficients between FRAX BDNI and FRAX BDI for major fractures r = 0.793 (95% CI 0.7388‒0.836). For hip fractures r = 0.6922 (95% CI 0.6174‒0.75446) ConclusionUsing FRAX to estimate 10-year fracture risk without BD data might be a reliable tool for screening, even for patients with a high prevalence of risk factors, improving accessibility and equity in health systems. The present study's data suggest an overestimation of fracture risk with FRAX BDNI, suggesting that it is safe to be widely used as a screening tool.

Application of Machine Learning to Identify Clinically Meaningful Risk Group for Osteoporosis in Individuals Under the Recommended Age for Dual-Energy X-Ray Absorptiometry.

Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis; it is generally recommended in men ≥ 70 and women ≥ 65years old. Therefore, assessment of clinical risk factors for osteoporosis is very important in individuals under the recommended age for DXA. Here, we examine the diagnostic performance of machine learning-based prediction models for osteoporosis in individuals under the recommended age for DXA examination. Data of 2210 men aged 50-69 and 1099 women aged 50-64 obtained from the Korea National Health and Nutrition Examination Survey IV-V were analyzed. Extreme gradient boosting (XGBoost) was used to find relevant clinical features and applied to three machine learning models: XGBoost, logistic regression, and a multilayer perceptron. For the prediction of osteoporosis, the XGBoost model using the top 20 features extracted from XGBoost showed the most reliable performance with area under the receiver operating characteristic curve (AUROC) of 0.73 and 0.79 in men and women, respectively. We compared the diagnostic accuracy of the Shapley additive explanation values based on a risk-score model obtained from XGBoost and conventional osteoporosis risk assessment tools for prediction of osteoporosis using optimal cut-off values for each model. We observed that a cut-off risk score of ≥ 28 in men and ≥ 47 in women was optimal to classify a positive screening for osteoporosis (an AUROC of 0.86 in men and 0.91 in women). The XGBoost-based osteoporosis-prediction model outperformed conventional risk assessment tools. Therefore, machine learning-based prediction models are a more suitable option than conventional risk assessment methods for screening osteoporosis in individuals under the recommended age for DXA examination.

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer Associated Thrombosis. the Observational Roadmap-CAT Study

INTRODUCTION: The aim of this prospective longitudinal study was to identify the most clinically relevant hypercoagulability biomarkers in lung adenocarcinoma patients for elaboration of an improved risk assessment model (RAM) for venous thromboembolism (VTE).METHODS: 150 ambulatory patients with lung adenocarcinoma were prospectively enrolled as well as a control group comprised of 30 healthy age & sex-matched individuals. Thrombin generation parameters, procoagulant phospholipid-dependent clotting time (Procoag-PPL), tissue factor activity (TFa), factor VIIa (FVIIa), factor V (FV), antithrombin (AT), D-Dimers (DDi), P-selectin and heparanase levels were assessed in platelet-poor plasma (PPP) at inclusion (baseline) and at the end of the 3rd chemotherapy cycle (acute phase). Cox regression analysis was used to identify independent VTE predictors.RESULTS: At baseline, patients had significantly attenuated thrombin generation, shorter Procoag-PPL, higher levels of TFa, D-Dimers and heparanase, and lower levels of FVIIa and P-selectin, compared to controls. A significant increase in Procoag-PPL, FV and FVIIa and a decrease of P-selectin levels was observed between baseline and the acute phase. Hospitalization within the last 3 months prior to assessment, time since cancer diagnosis less than 6 months, mean rate index of thrombin generation (MRI) and Procoag-PPL were independently associated with symptomatic VTE. Accordingly, a prediction model including the above parameters had improved discriminating capacity (area under the curve/AUC: 0.84).CONCLUSIONS: Ambulatory patients with lung adenocarcinoma may display pronounced blood hypercoagulability due to decreased Procoag-PPL, increased endothelial cell activation and increased degradation of fibrin. Incorporation of Procoag-PPL and MRI of thrombin generation may improve the accuracy of a VTE RAM in the above setting. DisclosuresNo relevant conflicts of interest to declare.

Prediction of placenta accreta spectrum in patients with placenta previa using clinical risk factors, ultrasound and magnetic resonance imaging findings.

To predict placental accreta spectrum (PAS) in patients with placenta previa (PP) evaluating clinical risk factors (CRF), ultrasound (US) and magnetic resonance imaging (MRI) findings. Seventy patients with PP were retrospectively selected. CRF were retrieved from medical records. US and MRI images were evaluated to detect imaging signs suggestive of PAS. Univariable analysis was performed to identify CRF, US and MRI signs associated with PAS considering histology as standard of reference. Receiver operating characteristic curve (ROC) analysis was performed, and the area under the curve (AUC) was calculated. Multivariable analysis was also performed. At univariable analysis, the number of previous cesarean section, smoking, loss of the retroplacental clear space, myometrial thinning < 1mm, placental lacunae, intraplacental dark bands (IDB), focal interruption of myometrial border (FIMB) and abnormal vascularity were statistically significant. The AUC in predicting PAS progressively increased using CRF, US and MRI signs (0.69, 0.79 and 0.94, respectively; p < 0.05); the accuracy of MRI alone was similar to that obtained combining CRF, US and MRI variables (AUC = 0.97) and was significantly higher (p < 0.05) than that combining CRF and US (AUC = 0.83). Multivariable analysis showed that only IDB (p = 0.012) and FIMB (p = 0.029) were independently associated with PAS. MRI is the best modality to predict PAS in patients with PP independently from CRF and/or US finding. It is reasonable to propose the combined assessment of CRF and US as the first diagnostic level to predict PAS, sparing MRI for selected cases in which US findings are uncertain for PAS.

Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patient Smokers Treated with Thrombolytic Therapy

BackgroundPatients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common. MethodsBetween 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression. ResultsOf 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60–69 years, aOR, 0.30, 95% C.I, 0.108–0.850, p < 0.05), (70–79 years aOR, 0.27, 95% C.I, 0.096–0.734, p < 0.05), (80+ years aOR, 0.16, 95% C.I, 0.057–0.430, P < 0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score > 7 (reference <7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055–0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027–0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356–0.928 P < 0.05). ConclusionOur findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.

Radiofrequency ablation for management of thyroid nodules: a case report

Background: Thyroid nodules constitute a frequently seen clinical problem and the incidence of thyroid nodules has increased with the recently increased use of thyroid ultrasonography. Radiofrequency ablation (RFA) is an effective and safe method for treating benign thyroid nodules and recurrent thyroid cancers.Case Presentation: A 48 years old woman came to the surgical oncology clinic with the presence of a getting bigger, moves when the patient swallows, and painless mass on her neck since 20 years ago. The physical examination measured 5x5 cm mass, mobile on swallowing, no pain on palpation, and the laboratory examination shows a euthyroid state.  The ultrasound result has revealed an enlargement of the right and left thyroid with increased echo intensity of parenchyma and increased vascularisation. This mass was concluded as struma nodus bilateral. The FNAB was follicular neoplasm, Bethesda system class 4. The patient underwent a single session RFA. RFA was performed employing transisthmic access using a 7 cm 18 gauge electrode-needle with a 1 cm active needle tip. The patient well tolerated the procedure and no adverse events were noted. Conclusion: Radiofrequency ablation for thyroid lesions is a safe and effective method for treating benign thyroid nodules and even recurrent thyroid cancers. Therefore, various factors, including serum TSH, clinical risk factor assessment, size of the nodule, ultrasound characteristics, patient preferences, and results of the FNA biopsy, should be considered to manage thyroid nodule.

Is the assessment of clinical risk factors for vitamin D deficiency sufficient?

Is the assessment of clinical risk factors for vitamin D deficiency sufficient?

Clinical assessment of risk factors for infection in inflammatory bowel disease patients.

Recognizing patients with inflammatory bowel disease who are prone to infection would enable the adjustment of the type and intensity of immunosuppressive treatment. The aim of this study was to identify a clinical profile of risk for infections in IBD patients, based on the interaction of immunosuppressive treatment with factors inherent to the patient. A case-control study was performed among patients older than 18years. Patients with any significant infection (any kind of severe or recurrent infection according to standard clinical criteria or a critical enough infection according to the patient) were defined as cases. Both cases and controls were randomly selected in a 1:3 ratio. All the period from diagnosis to the end of recruitment (June 2016) was analyzed. Risk factors for infection were identified by logistic regression analysis; the strength of association was reported by odds ratio (OR) with 95% confidence interval (95%CI). A total of 112 cases and 270 controls were included. The independent risk factors for significant infection are the number of immunosuppressants (one drug: OR 1.28, 95% CI 0.53-3.11, two drugs: OR 2.37, 95% CI 1.01-5,56, and three drugs: OR 5.84, 95% CI 1.57-21.72), body mass index (OR 1.08; 95 %CI 1,01-1,16), the degree of comorbidity (OR 1.52; 95% CI 1.04-2.21), and the intensity of inflammatory activity (OR 1.43; 95% CI 1.19-1.71). Regardless of immunosuppression, several patient factors such as comorbidity, body mass index, or the inflammatory activity of the disease determine the individual risk of infectious complications and should be considered for an adequate risk assessment.

Clinical and Bacterial Risk Factors for Development of Post-Prostate Biopsy Infections.

To research on clinical and bacterial risk factors and their relationship with post-prostate biopsy infection (PBI). In this prospective cohort study, rectal swabs were collected from 158 men prior to prostate biopsy and cultured selectively for identify ciprofloxacin-resistant (FQ-R) gram-negative bacteria. The patient characteristics, phylogenetic background, sequence typing and pulsed field gel electrophoresis (PFGE) pattern were compared in two groups of FQ-R E. coli rectal and clinical isolates. In total, PBI was observed in 20 (12.5%) cases; the most of these subjects were FQ-R-colonized. (17/73 [24%] vs 3/85 [3.5%]; P < 0.001). FQ-R colonization, diabetes, hospitalization and UTI were independent risk factors (95% CI: 1.1-20.1, OR = 4.73; 95% CI: 1.7-25.3, OR = 6.57; 95% CI: 1.9-27.5, OR = 7.22; and 95% CI: 1.2-14.3, OR = 4.05; respectively), that increased the rate of PBI (All P < 0.05). Despite the increase in infections among patients colonized with strains of E. coli ST131, its prevalence was near significance between colonized and infected groups (P = 0.07). The PFGE patterns and antimicrobial susceptibility profiles of rectal and clinical isolates in 13 patients were similar which is remarkably important and informative. The most PBIs originate from FQ-R E. coli rectal colonization. Rectal culture screening and assessment of clinical risk factors can predict the incidence of PBI in patients.

Radiomorphological changes of the coronary artery in patients with coronary artery disease with recurrent angina in the first year after angioplasty and stenting of multi-vessel lesions

Aim . To study the radiomorphological changes in coronary arteries (CA) and their contribution to the recurrence of angina pectoris in patients in the first year after angioplasty and stenting of multi-vessel lesions of CA; to identify factors contributing to the progression of atherosclerosis in poorly modified segments of CA after percutaneous coronary intervention (PCI). Material and methods. The study included 102 patients. Multivariate analysis with assessment of clinical risk factors, radiomorphology of the CA before and after PCI, analysis of the technique of the operation to identify factors contributing to the progression of atherosclerosis in the slightly altered segments of CA. Results. Restenosis of the coronary arteries was observed in 43 cases when the stent was implanted BMS (bare-metal stent). Diabetes mellitus, hypertension, dyslipidemia, chronic heart failure, obesity, smoking did not affect the development of restenosis. Hypertension increased the risk of progression of atherosclerosis in the source hemodynamically insignificant stenosis of the right coronary artery (RCA) and left circumflex artery (LCX), peripheral atherosclerosis was associated with progression of atherosclerosis of the left anterior descending artery (LAD). The diabetes mellitus, obesity, smoking did not significantly affect the progression of atherosclerosis in the proximal segments. Performing techniques of “deep intubation” of guide catheters to the left coronary artery (LCA) led to the progression of stenosis growth in the proximal segments of permanent residence. The use of more than one wire and angulation of LCX divergence of more than 90 degrees significantly leads to the progression of atherosclerosis in the proximal segments of LCX. Performing pre-dilatation of proximal segments without subsequent stent coating led to the development of stenosis in LAD, RCA and LCX. Extended calcined lesions are associated with the progression of atherosclerosis in the proximal segments. The use of an extension cord catheter did not affect the progression of atherosclerosis in the proximal segments. Conclusion. Along with stent restenosis, provoking factors of the “iatrogenic” process in the proximal segments may be a combination of aggressive manipulations during PCI, the complexity of the radiomorphology of coronary arteries. The analysis of the use of new endovascular less traumatic technologies (the use of an extension cord catheter) reduces the risk of “iatrogenic” damage to the intima and the progression of atherosclerosis.

The rising incidence of Acanthamoeba keratitis: A 7-year nationwide survey and clinical assessment of risk factors and functional outcomes.

PurposeTo evaluate the incidence of Acanthamoeba keratitis in the Netherlands between 2009 and 2015 and to analyse predicting factors for treatment outcome.MethodsPatient characteristics, diagnostic methods, diagnostic delay, therapy prior to and after diagnosis, and visual outcome were obtained from medical files of all patients diagnosed with Acanthamoeba keratitis in the Netherlands between 2009 and 2015. A logistic regression analysis on treatment failure, defined as a best corrected visual acuity of less than 20/40 Snellen decimals (i.e. >0.3 logMAR or an approximate loss of three lines of visual acuity) and/or the need for keratoplasty, was performed to determine predicting factors.ResultsTwo hundred and twenty-four eyes of 224 patients were included. Ninety-five percent of the patients were contact lens wearers, of whom 74% wore soft contact lenses. The number of cases increased from 16 in 2009 to 49 in 2015. This resulted in an estimated incidence of 1 in 21,000 for soft contact lens wearers in 2015. Eighty-seven eyes (39%) met the criteria for treatment failure. In a multivariable regression analysis, higher age at presentation, a higher severity stage and corticosteroid use before diagnosis were positively correlated with treatment failure. Early referral to a cornea specialist was associated with better clinical outcomes.ConclusionsAlthough Acanthamoeba keratitis is still a relatively uncommon disease, the incidence in soft contact lens wearers has increased to reach 1 in 21,000 in 2015. Treatment failure occurred in 39% of cases, with age, higher severity stage, corticosteroid use before diagnosis and indirect referral to a cornea specialist as important risks factors.

Population-Based Assessment of Clinical Risk Factors for Legionnaires' Disease.

We used US population-based surveillance data to characterize clinical risk factors for Legionnaires' disease (LD). The LD incidence increased by age and the risk was elevated for 12 clinical conditions, when compared to healthy adults. This information can be used to guide testing, treatment, and public health prevention efforts.

High rates of indeterminate interferon-gamma release assays for the diagnosis of latent tuberculosis infection in liver transplantation candidates.

Screening for latent tuberculosis infection (LTBI) is recommended prior to solid organ transplantation. Interferon-gamma release assays (IGRAs) are the most widely used test for LTBI screening; however, assessment of IGRA performance in patients with end-stage liver disease is limited. The purpose of this study was to evaluate the prevalence and predictors of indeterminate (INDT) IGRA results in liver transplantation candidates. Between March 2011 and May 2018, we retrospectively analyzed 155 patients undergoing liver transplantation assessment, who underwent IGRA testing (Quantiferon-TB Gold, QFT-G) to exclude LTBI. Characteristics of patients, including age, gender, etiology of liver disease, MELD score, and absolute lymphocyte counts, were compared by QFT-G result (determinate vs INDT). Of the 155 patients screened, the rate of positive, negative, and INDT results were 5.2%, 69.8%, and 25%, respectively. The only variable independently associated with an indeterminate test on multivariate analysis was MELD score (odds ratio=1.07, 95% CI=1.01-1.14 per unit increase; P=0.014). In 95% of INDT tests, both TB antigen tube and the positive control tube were negative and repeat testing gave the same indeterminate result, suggestive of anergy rather than laboratory error. Our study suggests a high rate of INDT IGRA results during screening of liver transplant candidates for LTBI, associated with severity of liver disease and anergy. Because of the high rate of INDT QFT-G testing in this setting, individualized risk assessment is required including a thorough assessment of clinical risk factors and knowledge of local TB prevalence.

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Newly Diagnosed Chemotherapy Naïve Patients with Multiple Myeloma at Risk for Cancer-Associated Thrombosis. The Observational ROADMAT-CAT-MM Study

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Newly Diagnosed Chemotherapy Naïve Patients with Multiple Myeloma at Risk for Cancer-Associated Thrombosis. The Observational ROADMAT-CAT-MM Study

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Patients with Lung Adenocarcinoma at Risk for Cancer-Associated Thrombosis: The Observational ROADMAP-CAT Study.

The aim of this prospective study was to identify the most clinically relevant hypercoagulability biomarkers in lung adenocarcinoma patients for elaboration of an improved risk assessment model (RAM) for venous thromboembolism (VTE). One hundred fifty ambulatory patients with lung adenocarcinoma were prospectively enrolled. Thrombin generation, procoagulant phospholipid-dependent clotting time (Procoag-PPL), tissue factor activity (TFa), factor VIIa (FVIIa), factor V (FV), antithrombin, D-Dimers, P-selectin, and heparanase levels were assessed in platelet-poor plasma at inclusion (baseline) and at the end of the third chemotherapy cycle (third chemotherapy). Cox regression analysis was used to identify independent VTE predictors. At baseline, patients had significantly attenuated thrombin generation, shorter Procoag-PPL, higher levels of TFa, D-Dimers, and heparanase, and lower levels of FVIIa and P-selectin, compared with controls. A significant increase in Procoag-PPL, FV, and FVIIa and a decrease of P-selectin levels were observed between baseline and third chemotherapy. Hospitalization within the last 3 months prior to assessment, time since cancer diagnosis less than 6 months, mean rate index (MRI) of thrombin generation, and Procoag-PPL were independently associated with symptomatic VTE. Accordingly, a prediction model including Procoag-PPL and MRI showed significant discriminating capacity (area under the curve: 0.84). Ambulatory patients with lung adenocarcinoma may display pronounced blood hypercoagulability due to decreased Procoag-PPL, increased endothelial cell activation, and increased degradation of fibrin. Incorporation of Procoag-PPL and MRI of thrombin generation may improve the accuracy of a VTE-RAM in the above setting. The prospective ROADMAP-CAT study identified two biomarkers of hypercoagulability, the procoagulant phospholipid-dependent clotting time (Procoag-PPL) and the mean rate index (MRI) of the propagation phase of thrombin generation assessed with the Calibrated Automated Thrombinoscope, as being clinically relevant for the classification of ambulatory patients with lung adenocarcinoma receiving a maximum of one cycle of chemotherapy into high and intermediate/low risk for venous thromboembolism. Measurement of Procoag-PPL and MRI within 1 month after the administration of the first chemotherapy cycle provides significant accuracy of the assessment. Association of the Procoag-PPL and MRI with the clinical risk assessment model for cancer-associated thrombosis in ambulatory patients with solid tumors (COMPASS-CAT RAM) further improved its accuracy.

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Newly diagnosed chemotherapy Naïve Patients with Multiple Myeloma at Risk for Cancer-associated Thrombosis. The Observational ROADMAP-CAT-MM Study

Prospective Assessment of Clinical Risk Factors and Biomarkers of Hypercoagulability for the Identification of Newly diagnosed chemotherapy Naïve Patients with Multiple Myeloma at Risk for Cancer-associated Thrombosis. The Observational ROADMAP-CAT-MM Study

Left ventricular dysfunction in oncological diseases

The article is devoted to cardiotoxicity - development of metabolic, functional and morphological changes in myocardium in anticancer treatment. There are presented the frequency and types of left ventricular systolic dysfunction that develop with the use of different chemotherapy drugs, imaging diagnostic methods of cardiac function, as well as the use of biomarkers for detection of subclinical LV dysfunction. All data are based on recently published expert consensus document of the American Society of echocardiography, the European Association of Cardiovascular imaging and recommendations of the European Society of Cardiology.Therefore, it is of great importance that the cardiologist is involved in the planning and delivery of chemotherapy, follow-up of patients, as well as the need for risk stratification of cardiac toxicity, which must begin with a thorough initial assessment of clinical risk factors for every patient.