Risk Stratification Assessment Research Articles

A rare rectal gastrointestinal stromal tumor with indolent biological behavior: A case study.

The overall incidence of rectal gastrointestinal stromal tumor (RGIST) has risen, but it remains a rare disease. Furthermore, tumor rupture is associated with poor prognosis. The present study reported a rare case of RGIST with indolent biological behavior. The biological behavior of this RGIST was analyzed and its malignant potential was evaluated using a guideline-based risk stratification assessment. The patient was diagnosed with a rectal tumor at the Third Affiliated Hospital of Qiqihar Medical University (Qiqihar, China) in April 2020 and a partial resection biopsy was then performed. This resection counts as a rupture. The biopsy confirmed RGIST and the patient refused further examination and treatment due to economic concerns. However, the patient survives with no tumor progression and metastasis until now, May 2022. In conclusion, based on the present case, tumor rupture in indolent RGIST is not necessarily associated with poor outcome.

Ultrasound radiomics in personalized breast management: Current status and future prospects.

Breast cancer is the most common cancer in women worldwide. Providing accurate and efficient diagnosis, risk stratification and timely adjustment of treatment strategies are essential steps in achieving precision medicine before, during and after treatment. Radiomics provides image information that cannot be recognized by the naked eye through deep mining of medical images. Several studies have shown that radiomics, as a second reader of medical images, can assist physicians not only in the detection and diagnosis of breast lesions but also in the assessment of risk stratification and prediction of treatment response. Recently, more and more studies have focused on the application of ultrasound radiomics in breast management. We summarized recent research advances in ultrasound radiomics for the diagnosis of benign and malignant breast lesions, prediction of molecular subtype, assessment of lymph node status, prediction of neoadjuvant chemotherapy response, and prediction of survival. In addition, we discuss the current challenges and future prospects of ultrasound radiomics.

Epitope detection in monocytes (EDIM) for liquid biopsy including identification of GD2 in childhood neuroblastoma—a pilot study

BackgroundNeuroblastoma (NB) is the most common paediatric extracranial solid malignancy. We analysed the role of the epitope detection in monocytes (EDIM) technique for liquid biopsy in NB patients.MethodsTumour epitopes transketolase-like 1 (TKTL1), Apo10 (DNaseX) and GD2 were assessed: expression levels in seven NB tumour samples and five NB cell lines were analysed using RT-PCR and flow cytometry. LAN-1 cells were co-cultured with blood and assessed using EDIM. Peripheral blood macrophages of patients with neuroblastoma (n = 38) and healthy individuals (control group, n = 37) were labelled (CD14+/CD16+) and assessed for TKTL1, Apo10 and GD2 using the EDIM technology.ResultsmRNA expression of TKTL1 and DNaseX/Apo10 was elevated in 6/7 NB samples. Spike experiments showed upregulation of TKTL1, Apo10 and GD2 in LAN-1 cells following co-culturing with blood. TKTL1 and Apo10 were present in macrophages of 36/38 patients, and GD2 in 15/19 patients. The 37 control samples were all negative. EDIM expression scores of the three epitopes allowed differentiation between NB patients and healthy individuals.ConclusionsThe EDIM test might serve as a non-invasive tool for liquid biopsy in children suffering from NB. Future studies are necessary for assessing risk stratification, tumour biology, treatment monitoring, and early detection of tumour relapses.

Unsupervised Machine Learning for Assessment of Left Ventricular Diastolic Function and Risk Stratification

The 2016 American Society of Echocardiography guidelines have been widely used to assess left ventricular diastolic function. However, limitations are present in the current classification system. The aim of this study was to develop a data-driven, unsupervised machine learning approach for diastolic function classification and risk stratification using the left ventricular diastolic function parameters recommended in the 2016 American Society of Echocardiography guidelines; the guideline grading was used as the reference standard. Baseline demographics, heart failure hospitalization, and all-cause mortality data were obtained for all adult patients who underwent transthoracic echocardiography at Mayo Clinic Rochester in 2015. Patients with prior mitral valve intervention, congenital heart disease, cardiac transplantation, or cardiac assist device implantation were excluded. Nine left ventricular diastolic function variables (mitral E- and A-wave peak velocities, E/A ratio, deceleration time, medial and lateral annular e' velocities and E/e' ratio, and tricuspid regurgitation peak velocity) were used for an unsupervised machine learning algorithm to identify different phenotype clusters. The cohort average of each variable was used for imputation. Patients were grouped according to the algorithm-determined clusters for Kaplan-Meier survival analysis. Among 24,414 patients (mean age, 63.6±16.2years), all-cause mortality occurred in 4,612 patients (18.9%) during a median follow-up period of 3.1years. The algorithm determined three clusters with echocardiographic measurement characteristics corresponding to normal diastolic function (n=8,312), impaired relaxation (n=11,779), and increased filling pressure (n=4,323), with 3-year cumulative mortality of 11.8%, 19.9%, and 33.4%, respectively (P<.0001). All 10,694 patients (43.8%) classified as indeterminate were reclassified into the three clusters (n=3,324, n=5,353, and n=2,017, respectively), with 3-year mortality of 16.6%, 22.9%, and 34.4%, respectively. The clusters also outperformed guideline-based grade for prognostication (C index=0.607 vs 0.582, P=.013). Unsupervised machine learning identified physiologically and prognostically distinct clusters on the basis of nine diastolic function Doppler variables. The clusters can be potentially applied in echocardiography laboratory practice and future clinical trials for simple, replicable diastolic function-related risk stratification.

Echocardiographic Characteristics of Cardiogenic Shock Patients with and Without Cardiac Arrest.

Cardiac arrest (CA) is associated with worse outcomes in patients with cardiogenic shock (CS). To better understand the contribution of CA on CS, we evaluated transthoracic echocardiography (TTE) parameters in CS patients with and without CA. We retrospectively identified CS patients with a TTE performed near cardiac intensive care unit admission between 2007 to 2018. We compared TTE measurements of left ventricular (LV) and right ventricular (RV) function in patients with and without CA. The primary outcome was all-cause in-hospital mortality, as determined using multivariable logistic regression. We included 1085 patients, 35% of whom had CA. Median age was 70 years and 37% were females. CA patients had higher severity of illness, more invasive mechanical ventilation and greater vasopressor/inotrope use. In-hospital mortality was 31% and was higher in CA patients (45% vs. 23%, p <0.001). Although LV ejection fraction (LVEF) was similar (35% vs. 37%, p = 0.05), CA patients had lower cardiac index, mitral valve E wave peak velocity, E/A ratio and E/e' ratio. TTE variables that were associated with hospital mortality varied, among patients with CA, these included measures of RV pressure and function and among patients without CA, these included parameters reflecting LV systolic function. Doppler assessments of RV systolic dysfunction were the strongest TTE predictors of hospital mortality in CS patients with CA, unlike CS patients without CA in whom LV systolic function was more important. This emphasizes the importance of RV assessment for mortality risk stratification after CA.

Risk Stratification in Noninvasive Respiratory Support Failure: A Narrative Review

The use of noninvasive respiratory support, including noninvasive ventilation and high-flow nasal cannula therapy, has increased over the years. Failure of noninvasive respiratory support, defined as the need for invasive mechanical ventilation, increases the mortality rate. To familiarize critical care nurses with available risk stratification assessments and identify common concepts and limitations. Few risk stratification assessments are available to identify patients at risk of failure of noninvasive respiratory support. Although many studies have analyzed risk, substantial variation in study design, definitions, terminology, and outcomes have led to a wide range of findings, making clinical application difficult. Further study is needed to broaden known assessments to general patient populations, determine diagnostic accuracy during critical periods, and analyze noninvasive ventilation and high-flow nasal cannula therapy. Risk stratification could allow for better implementation of preventive strategies and patient education. Future research opportunities include improving study design for risk stratification and implementing preventive strategies for patients requiring noninvasive respiratory support. Clinically, risk stratification can provide an opportunity to share knowledge and facilitate conversations with patients and families.

Minimal residual disease comparison between Ig/TCR PCR versus NGS assays in children with Philadelphia chromosome-positive acute lymphoblastic leukemia: A report from the COG AALL1631 study.

10023 Background: Minimal residual disease (MRD) assessment by immunoglobulin/T-cell receptor (Ig/TCR) polymerase chain reaction (PCR) is currently being used in the international pediatric Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) trial EsPhALL2017/AALL1631 for risk stratification. MRD concordance has previously been demonstrated between Ig/TCR PCR and flow cytometry in Ph+ALL. We sought to assess concordance of MRD assessment between conventional Ig/TCR PCR and next-generation sequencing (NGS) assays. Methods: MRD was assessed in all pts on AALL1631 by Ig/TCR PCR at end-induction IB; those with MRD &lt;5x10-4 were classified as standard-risk (SR) and randomized to treatment with imatinib and one of two chemotherapy regimens without hematopoietic stem cell transplant (HSCT), whereas pts with end-induction 1B MRD ≥ 5x10-4 were considered high-risk (HR) and assigned to HSCT after consolidation chemotherapy. Residual diagnostic and end-induction IB samples from consenting pts were assessed for NGS MRD by the clonoSEQ assay (Adaptive Biotechnologies) in blinded fashion and subsequently compared to Ig/TCR MRD to determine concordance as related to MRD-based HSCT recommendations ( ie, MRD ≥ 5x10-4 consistent with HR group assignment). MRD values were calculated using the kappa statistic for agreement above chance. Results: Sixty-seven pts had matched samples available for MRD assessment at end-induction 1B by both Ig/TCR PCR and NGS (Table). NGS MRD was evaluable for all 67 pts and stratified as 62 SR (&lt;5x10-4) and 5 HR (≥5x10-4). In contrast, Ig/TCR PCR results were inevaluable for 3 pts (unsatisfactory sample quality) and indeterminate (positive, but not quantifiable) in 4 pts. Of the remaining 60 pts, 55 met SR and 5 HR criteria using Ig/TCR PCR. There was only 1 discordant case between the two methods for MRD-based HSCT recommendation among these 60 pts with a kappa statistic for agreement above chance of 0.88. Conclusions: NGS and Ig/TCR PCR assays were highly concordant in MRD assessment for risk stratification at a threshold of 5x10-4 in pediatric pts with Ph+ALL enrolled on AALL1631. Of note, the NGS assay yielded MRD results amenable for risk stratification in 100% pts compared to 89.6% for the Ig/TCR PCR methodology. These data support the use of NGS MRD testing for risk stratification in pediatric Ph+ALL.[Table: see text]

How and When to Use Lung Ultrasound in Patients with Heart Failure?

Pulmonary congestion is a critical finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS) through B-line quantification, the latter of which can be easily measured by all commercially-available probes/ultrasound equipment. As such, LUS represents a useful tool for the assessment of patients with both acute and chronic HF. Several imaging protocols have been described in the literature according to different clinical settings. While most studies have been performed with either the 8 or 28 chest zone protocol, the 28-zone protocol is more time-consuming while the 8-zone protocol offers the best trade-off with no sizeable loss of information. In the acute setting, LUS has excellent value in diagnosing acute HF, which is superior to physical examination and chest X-ray, particularly in instances of diagnostic uncertainty. In addition to its diagnostic value, accumulating evidence over the last decade (mainly derived from ambulatory settings or at discharge from an acute HF hospitalisation) suggests that LUS can also represent a useful prognostic tool for predicting adverse outcome in both HF with reduced (HFrEF) and preserved ejection fraction (HFpEF). It also allows real-time monitoring of pulmonary decongestion during treatment of acute HF. Additionally, LUS-guided therapy, when compared with usual care, has been shown to reduce the risk of HF hospitalisations at short- and mid-term follow-up. In addition, studies have shown good correlation between B-lines during exercise stress echocardiography and invasive, bio-humoral and echocardiographic indices of haemodynamic congestion; B-lines during exercise are also associated with worse prognosis in both HFrEF and HFpEF. Altogether, LUS represents a reliable and useful tool in the assessment of pulmonary congestion and risk stratification of HF patients throughout their entire journey (i.e., emergency department/acute settings, in-hospital management, discharge from acute HF hospitalisation, monitoring in the outpatient setting), with considerable diagnostic and prognostic implications.

The impact of frailty on postoperative complications in geriatric patients undergoing multi-level lumbar fusion surgery.

Retrospective Cohort Study. This study evaluates the impact of patient frailty status on postoperative complications in those undergoing multi-level lumbar fusion surgery. The Nationwide Readmission Database (NRD) was retrospectively queried between 2016 and 2017 for patients receiving multi-level lumbar fusion surgery. Demographics, frailty status, and relevant complications were queried at index admission and readmission intervals. Primary outcome measures included perioperative complications and 30-, 90-, and 180-day complication and readmission rates. Perioperative complications of interest were infection, urinary tract infection (UTI), and posthemorrhagic anemia. Secondary outcome measures included inpatient length of stay (LOS), adjusted all-payer costs, and discharge disposition. Nearest-neighbor propensity score matching for demographics was implemented to identify non-frail patients with similar diagnoses and procedures. Subgroup analysis of minimally invasive surgery (MIS) versus open surgery within frail and non-frail cohorts was conducted to evaluate differences in surgical and medical complication rates. The analysis used nonparametric Mann-Whitney U testing and odds ratios. Frail patients encountered higher rates perioperative complications including posthemorrhagic anemia (OR: 1.73, 95%CI 1.50-2.00, p < 0.0001), infection (OR: 2.94, 95%CI 2.04-4.36, p < 0.0001), UTI (OR: 2.57, 95%CI 2.04-3.26, p < 0.0001), and higher rates of non-routine discharge (OR: 2.07, 95%CI 1.80-2.38, p < 0.0001). Frail patients had significantly greater LOS and total all-payer inpatient costs compared to non-frail patients (p < 0.0001). Frailty was associated with significantly higher rates of 90- (OR: 1.43, 95%CI 1.18-1.74, p = 0.0003) and 180-day (OR: 1.28, 95%CI 1.03-1.60, p = 0.02) readmissions along with higher rates of wound dehiscence (OR: 2.21, 95%CI 1.17-4.44, p = 0.02) at 90days. Subgroup analysis revealed that frail patients were at significantly higher risk for surgical complications with open surgery (16%) compared to MIS (0%, p < 0.0001). No significant differences were found between surgical approaches with respect to medical complications in both cohorts, nor surgical complications in non-frail patients. Frailty was associated with higher odds of all perioperative complications, LOS, and all-payer costs following multi-level lumbar fusion. Frail patients had significantly higher rates of 90 and 180-day readmission and higher rates of wound disruption at 90-days. On subgroup analysis, MIS was associated with significantly reduced rates of surgical complications specifically in frail patients. Our results suggest frailty status to be an important predictor of perioperative complications and long-term readmissions in geriatric patients receiving multi-level lumbar fusions. Frail patients should undergo surgery utilizing minimally invasive techniques to minimize risk of surgical complications. Future studies should explore the utility of implementing frailty in risk stratification assessments for patients undergoing spine surgery.

Association of serum sclerostin and osteoprotegerin levels with the presence, severity and prognosis in patients with acute myocardial infarction

BackgroundBone-related proteins (such as sclerostin and osteoprotegerin [OPG]) are involved in the development of atherosclerosis. However, the relationship between bone-related proteins and acute myocardial infarction (AMI) has not been extensively evaluated. The purpose of this study was to assess the association of serum sclerostin and OPG with the presence, severity and prognosis in patients with AMI.MethodsThis study prospectively enrolled 152 patients attacked by acute chest pain. Serum sclerostin and OPG were detected within the first 24 h after AMI diagnosis by ELISA kits. The AMI predictive efficacy of sclerostin and OPG were analyzed by receiver operating characteristics (ROC) curve. Univariable and multivariable linear regression analyses were performed to determine the association between bone-related proteins and scores indicating the severity of coronary artery occlusion. Moreover, prognostic values were assessed by Kaplan–Meier curves and Cox regression analysis.ResultsThere were 92 patients in AMI group, 60 in non-AMI group. Serum levels of sclerostin and OPG were significantly higher in AMI group than in non-AMI group (all p < 0.001), which showed predictive value for the presence of AMI (all p < 0.001). The area under the ROC curve values of sclerostin and OPG were 0.744 and 0.897, respectively. A multivariable linear regression analysis demonstrated that Ln-transformed sclerostin (β = 0.288, p = 0.009) and Ln-transformed OPG (Ln-OPG: β = 0.295, p = 0.019) levels were associated with GENISINI score, independently of conventional clinical parameters. In addition, Ln-OPG levels were still positively associated with GRACE score after adjustments (β = 0.320, p = 0.001). During a 1-year follow-up, patients above the median of sclerostin levels had higher incidence of major adverse cardiac events (MACE) than those below the median (p = 0.028). It was also observed that the MACE rates were higher in patients above the median of OPG levels, though no statistic importance (p = 0.060). After adjusting conventional risk factors by multivariate Cox regression, Ln-OPG was associated with incident MACE (hazard ratio = 2.188 [95% confidence intervals 1.102–4.344], p = 0.025).ConclusionsBone-related proteins could exert a potential role in early risk stratification and prognosis assessment in patients with AMI.

GRACE score - is it good for all NSTEMI patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with a non-ST elevation myocardial infarction (NSTEMI) have a heterogenous prognosis and early risk stratification at admission is essential. GRACE score is validated to estimate in-hospital outcomes, as well as long term prognosis. Objective Evaluation of discriminatory capacity of GRACE score in P &amp;lt;65 years versus ≥65 presenting with NSTEMI. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/2016 and 11/12/2019. Patients with cardiac arrest or hemodynamically unstable patients at admission were excluded. GRACE score was calculated using Killip-Kimball classification as a surrogate of heart failure. P were divided in 2 groups (G): G1 if &amp;lt;65 years old, G2 if ≥65 years. We evaluated the discriminatory capacity of GRACE score in predicting in-hospital MACE in both groups through ROC-curve analysis. Results We identified 405 patients with NSTEMI, 62.7% were males with an average age of 68.4±12.3 years old. Mean GRACE in global population was 118±28.3 points, lower in G1 P (G1 92.6±22.6, G2 130±21.2, p&amp;lt;0.001). At univariate analysis, GRACE score was predictor of MACE in G1 (p=0.05, OR 1.05) and G2 p=0.026, OR 1.03). Its discriminatory capacity was acceptable: for G1 the area under the curve (AUC) was 0.687 and in G2 AUC 0.785. Given the lower discriminatory capacity in G2, the authors determined other predictor factors (excluding GRACE) to accurate risk stratification in this G. At univariate analysis, predictor factors for MACE were diabetes (p=0.006, OR 5.4), left ventricle branch block (p=0.011, OR 2.2) and haemoglobin at admission (p=0.003, OR 0.63). At multivariate analysis, both diabetes (p=0.002) and haemoglobin (p=0.031) were independent predictor factors for MACE. Conclusion In our center, GRACE score was a better predictor for younger patients, while for other patients other factors, such as diabetes and haemoglobin at admission must be taken into account to assess risk stratification.

Assessing Chest Pain.

Revised guidelines by a joint committee of the American College of Cardiology and the American Heart Association have been released to improve early identification and management of chest pain. Clinical goals of the guidelines are to identify life-threatening causes of chest pain, determine a patient's clinical stability, and assess whether the patient needs to be hospitalized or can safely be treated on an outpatient basis. For patients who don't require immediate intervention, risk stratification assessment and following clinical decision pathways are recommended.

PD12-10 URINE COMPREHENSIVE GENOMIC PROFILING OF UROTHELIAL CARCINOMA PATIENTS UNDERGOING INTRAVESICAL THERAPY ENABLES DETECTION OF ACTIONABLE DNA MUTATIONS ASSOCIATED WITH DRUG RESPONSE AND RISK STRATIFICATION

You have accessJournal of UrologyCME1 May 2022PD12-10 URINE COMPREHENSIVE GENOMIC PROFILING OF UROTHELIAL CARCINOMA PATIENTS UNDERGOING INTRAVESICAL THERAPY ENABLES DETECTION OF ACTIONABLE DNA MUTATIONS ASSOCIATED WITH DRUG RESPONSE AND RISK STRATIFICATION Goran Rac, Shalin Desai, Hiten D. Patel, Chirag Doshi, Ryan Dornbier, Vincent Caruso, Peter Lentz, Brian C. Mazzarella, Kevin G. Phillips, Trevor Levin, Alan J. Wolfe, and Gopal N. Gupta Goran RacGoran Rac More articles by this author , Shalin DesaiShalin Desai More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Chirag DoshiChirag Doshi More articles by this author , Ryan DornbierRyan Dornbier More articles by this author , Vincent CarusoVincent Caruso More articles by this author , Peter LentzPeter Lentz More articles by this author , Brian C. MazzarellaBrian C. Mazzarella More articles by this author , Kevin G. PhillipsKevin G. Phillips More articles by this author , Trevor LevinTrevor Levin More articles by this author , Alan J. WolfeAlan J. Wolfe More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002538.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prediction of intravesical therapy (IVT) response and risk stratification in patients with urothelial carcinoma (UC) remains a challenge. Previous attempts using biomarkers have not gained broad adoption. Urinary comprehensive genomic profiling (uCGP) has significant potential to aid in both quantitative assessment of therapeutic response and risk stratification. METHODS: uCGP was performed on 26 prospectively enrolled patients undergoing IVT induction (BCG=88%, Gemcitabine=12%). Samples were collected after visually complete TURBT immediately prior to IVT instillation. Urine DNA was sequenced and profiled across 60 genes using the CLIA-validated UroAmplitude test (Convergent Genomics). Recurrence predictions were performed using a previously validated algorithm. Subjects were grouped into high, intermediate, and low risk of recurrence. RESULTS: Stage distribution was Tis (15%), Ta (23%), T1 (62%). Mean follow-up after IVT was 22 months. Among samples analyzed, 25% contained no detectable mutations while 75% contained ≥1 high confidence mutation. The high and intermediate risk classification identified 100% of pathologically confirmed recurrence. Among low recurrence risk classifications, no clinical recurrence was identified within follow-up (100% NPV). TP53 mutations were strongly correlated with post-treatment recurrence OR=28, 95%CI (1.99, 394.42), p=0.038. Two subjects had detected aneuploidy post-treatment and had T1 recurrence, supporting earlier observations of aneuploidy correlating with invasive cancer. CONCLUSIONS: uCGP is a quantitative diagnostic with potential to identify therapeutic response. Low risk patients have low mutation burden prior to treatment, intermediate risk have notable disease burden pre-treatment with notable reduction after IVT, and high risk do not respond to treatment. These data suggest that uCGP performed before and after IVT has significant potential to stratify recurrence risk in non-muscle invasive UC patients. Additional studies are underway to further support the generalizability of these findings. Source of Funding: Support for this research is provided by the NCI through a SBIR Grant, 5R44CA200174, provided to Convergent Genomics © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e199 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Goran Rac More articles by this author Shalin Desai More articles by this author Hiten D. Patel More articles by this author Chirag Doshi More articles by this author Ryan Dornbier More articles by this author Vincent Caruso More articles by this author Peter Lentz More articles by this author Brian C. Mazzarella More articles by this author Kevin G. Phillips More articles by this author Trevor Levin More articles by this author Alan J. Wolfe More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement PDF DownloadLoading ...

Nutrition risk assessed by Nutritional Risk Screening 2002 is associated with in-hospital mortality in older patients with COVID-19.

BackgroundAlthough numerous studies have been performed to determine predictors of coronavirus disease 2019 (COVID‐19) mortality, studies that address the geriatric age group are limited. The aim of this study was to investigate the utility of the Nutritional Risk Screening 2002 (NRS‐2002) and the Geriatric 8 (G8) screening tools in predicting clinical outcomes in older adults hospitalized with COVID‐19.MethodsPatients aged ≥60 years who were hospitalized with COVID‐19 in the second wave of the pandemic were included in the study. COVID‐19 infection was demonstrated by a positive real‐time reverse transcriptase–polymerase chain reaction on nasopharyngeal swab or positive radiological findings. Disease severity was determined as defined by the National Institutes of Health. Patient demographics, laboratory values on admission, comorbidities, and medications were recorded. The NRS‐2002 and the G8 screening tools were performed for all patients by the same geriatrician. Primary outcome was in‐hospital mortality.ResultsA total of 121 patients were included. Mean age was 75 ± 9 years, and 51% were female. Mean body mass index was 27 ± 4.5 kg/m2. Sixty‐nine percent of the patients had nutrition risk according to the NRS‐2002. Eighty‐nine percent of the patients had a G8 score ≤14. In‐hospital mortality occurred in 26 (22%) patients. Older age and having nutrition risk as determined by the NRS‐2002 were independently associated with a higher risk of in‐hospital mortality in older patients with COVID‐19.ConclusionThe NRS‐2002 tool provides rapid assessment for risk stratification in hospitalized older patients with COVID‐19.

Development and validation of a comprehensive early risk prediction model for patients with undifferentiated acute chest pain.

AimsExisting risk scores for undifferentiated chest pain focus on excluding coronary events and do not represent a comprehensive risk assessment if an alternate serious diagnosis is present. This study aimed to develop and validate an all-inclusive risk prediction model among patients with undifferentiated chest pain.MethodsWe developed and validated a multivariable logistic regression model for a composite measure of early all-inclusive risk (defined as hospital admission excluding a discharge diagnosis of non-specific pain, 30-day all-cause mortality, or 30-day myocardial infarction [MI]) among adults assessed by emergency medical services (EMS) for non-traumatic chest pain using a large population-based cohort (January 2015 to June 2019). The cohort was randomly divided into development (146,507 patients [70%]) and validation (62,788 patients [30%]) cohorts.ResultsThe composite outcome occurred in 28.4%, comprising hospital admission in 27.7%, mortality within 30-days in 1.8%, and MI within 30-days in 0.4%. The Early Chest pain Admission, MI, and Mortality (ECAMM) risk model was developed, demonstrating good discrimination in the development (C-statistic 0.775, 95% CI 0.772–0.777) and validation cohorts (C-statistic 0.765, 95% CI 0.761–0.769) with excellent calibration. Discriminatory performance for the composite outcome and individual components was higher than existing scores commonly used in undifferentiated chest pain risk stratification.ConclusionsThe ECAMM risk score model can be used as an all-inclusive risk stratification assessment of patients with non-traumatic chest pain without the limitation of a single diagnostic outcome. This model could be clinically useful to help guide decisions surrounding the need for non-coronary investigations and safety of early discharge.

Electrocardiogram-Based Machine Learning Emulator Model for Predicting Novel Echocardiography-Derived Phenogroups for Cardiac Risk-Stratification: A Prospective Multicenter Cohort Study.

Electrocardiography (ECG)-derived machine learning models can predict echocardiography (echo)-derived indices of systolic or diastolic function. However, systolic and diastolic dysfunction frequently coexists, which necessitates an integrated assessment for optimal risk-stratification. We explored an ECG-derived model that emulates an echo-derived model that combines multiple parameters for identifying patient phenogroups at risk for major adverse cardiac events (MACE). In this substudy of a prospective, multicenter study, patients from 3 institutions (n=727) formed an internal cohort, and the fourth institution was reserved as an external test set (n=518). A previously validated patient similarity analysis model was used for labeling the patients as low-/high-risk phenogroups. These labels were utilized for training an ECG-derived deep neural network model to predict MACE risk per phenogroup. After 5-fold cross-validation training, the model was tested on the reserved external dataset. Our ECG-derived model showed robust classification of patients, with area under the receiver operating characteristic curve of 0.86 (95% CI: 0.79-0.91) and 0.84 (95% CI: 0.80-0.87), sensitivity of 80% and 76%, and specificity of 88% and 75% for the internal and external test sets, respectively. The ECG-derived model demonstrated an increased probability for MACE in high-risk vs low-risk patients (21% vs 3%; P<0.001), which was similar to the echo-trained model (21% vs 5%; P<0.001), suggesting comparable utility. This novel ECG-derived machine learning model provides a cost-effective strategy for predicting patient subgroups in whom an integrated milieu of systolic and diastolic dysfunction is associated with a high risk of MACE.

A Review on Kawasaki Disease

Kawasaki disease is an acute, self-limited vasculitis of unknown etiology, which mainly occurs in infants and children. The target organs of Kawasaki disease are coronary arteries and other cardiovascular structures. The initial manifestations of Kawasaki disease are high fever, inflammation of skin and mucosa, and enlargement of cervical lymph nodes. About 25% of children who are not treated with intravenous immunoglobulin during the acute phase of the disease will develop coronary artery aneurysms. Nowadays, Kawasaki disease has replaced rheumatic fever as the main cause of acquired heart disease in children in developed countries. However, there is still no specific diagnostic test, echocardiography is still the main diagnostic method of coronary artery involvement in children with Kawasaki disease, and risk stratification assessment is carried out according to Z value to assist in the short-term and long-term diagnosis and treatment of Kawasaki disease. In the aspect of treatment, there are reports on the application of corticosteroids, infliximab, cyclosporine, methotrexate, interleukin receptor blockers and so on.&#x0D; This article makes a detailed elaboration on the epidemiology, pathology, diagnostic criteria, differential diagnosis, treatment and prognosis of Kawasaki disease, so as to improve clinicians' understanding of Kawasaki disease and reduce misdiagnosis possible.

The value of OLGA staging system in risk assessment of gastric precancerous states and precancerous lesions

Objective: To investigate the role of operative link on gastritis assessment (OLGA) staging system in risk assessment of gastric precancerous states and precancerous lesions. Methods: A total of 682 patients undergoing gastroscopy from January to July 2016 at the First Hospital of Jiaxing were enrolled. According to the results of gastroscopy and pathology, patients were divided into five groups by OLGA staging system, respectively. The differences of atrophic progression/reversion rate, detection rates of intraepithelial neoplasia and gastric cancer among different OLGA groups during 5-year follow-up were compared. Results: A total of 437 patients completed endoscopic follow-up, including 207 cases in Stage-0, 158 cases in Stage-Ⅰ, 47 cases in Stage-Ⅱ, 18 cases in Stage-Ⅲ and 7 cases in Stage-Ⅳ. There were 24 cases of atrophy progression, 78 cases of atrophy reversion, 5 cases of intraepithelial neoplasia and 2 cases of gastric cancer. The atrophy progression rate correlated with the rising OLGA stages(χ2=19.14, P<0.001);The rate of atrophy reversion in high-risk group was significantly lower than that in low-risk group(χ2=4.96, P=0.026); The detection rate of intraepithelial neoplasia and gastric cancer in high-risk group was significantly higher than that in low-risk group(χ2=29.63, 11.60, both P<0.05). Conclusions: Histological OLGA staging system is helpful to realize the risk stratification assessment of gastric precancerous states and precancerous lesions. It has practical significance to formulate individualized endoscopic/histological follow-up plan for OLGA high-risk group.

Surrogate markers of gut dysfunction are related to heart failure severity and outcome–from the BIOSTAT-CHF consortium

The contribution of gut dysfunction to heart failure (HF) pathophysiology is not routinely assessed. We sought to investigate whether biomarkers of gut dysfunction would be useful in assessment of HF (eg, severity, adverse outcomes) and risk stratification. A panel of gut-related biomarkers including metabolites of the choline/carnitine- pathway (acetyl-L-carnitine, betaine, choline, γ-butyrobetaine, L-carnitine and trimethylamine-N-oxide [TMAO]) and the gut peptide, Trefoil factor-3 (TFF-3), were investigated in 1,783 patients with worsening HF enrolled in the systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF) cohort and associations with HF severity and outcomes, and use in risk stratification were assessed. Metabolites of the carnitine-TMAO pathway (acetyl-L-carnitine, γ-butyrobetaine, L-carnitine, and TMAO) and TFF-3 were associated with the composite outcome of HF hospitalization or all-cause mortality at 3 years (hazards ratio [HR] 2.04-2.93 [95% confidence interval {CI} 1.30-4.71] P≤ .002). Combining the carnitine-TMAO metabolites with TFF-3, as a gut dysfunction panel, showed a graded association; a greater number of elevated markers was associated with higher New York Heart Association class (P< .001), higher plasma concentrations of B-type natriuretic peptide (P< .001), and worse outcome (HR 1.90-4.58 [95% CI 1.19-6.74] P≤ 0.008). Addition of gut dysfunction biomarkers to the contemporary BIOSTAT HF risk model also improved prediction for the aforementioned composite outcome (C-statistics P≤ .011, NRI 13.5-21.1 [95% CI 2.7-31.9] P≤ .014). A panel of biomarkers of gut dysfunction showed graded association with severity of HF and adverse outcomes. Biomarkers as surrogate markers are potentially useful for assessment of gut dysfunction to HF pathophysiology and in risk stratification.

Preoperative polypharmacy assessment for risk stratification and management.

Preoperative polypharmacy assessment for risk stratification and management.