Multivariate Cox Regression Analysis Research Articles

Impact of osteosarcopenia on short- and long-term outcomes in patients with gastric cancer

Abstract Backgrounds Osteopenia and sarcopenia are associated with adverse clinical outcomes. This study investigated the impact of osteosarcopenia on short- and long-term outcomes after gastrectomy for gastric cancer. Methods The present study included patients who underwent gastrectomy for gastric cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross-sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We investigated the relationship of preoperative osteosarcopenia with short- and long-term outcomes after gastrectomy for gastric cancer. Results Of all 122 patients, 38 (31%) patients were diagnosed with osteosarcopenia. Multivariate logistic regression analysis revealed that osteosarcopenia (P = .008) was an independent risk factor for postoperative complications. Furthermore, multivariate Cox regression analysis revealed that male sex (P = .007), and osteosarcopenia (P = .038) were independent predictors of disease-free survival, while osteosarcopenia (P = .045) and pathological T stage ≥3 (P = .033) were independent predictors of overall survival. Conclusions Osteosarcopenia was a strong predictor of short- and long-term outcomes after gastrectomy for gastric cancer. Preoperative screening of osteosarcopenia may be helpful for better management of patients with gastric cancer.

Clinical outcomes and treatment patterns of maintenance avelumab in locally advanced or metastatic urothelial carcinoma: a multicenter collaborative study.

The JAVELIN Bladder 100 trial demonstrated improved overall survival (OS) with maintenance avelumab in patients with locally advanced or metastatic urothelial carcinoma UC (la/mUC) who achieved disease control following first-line platinum-based chemotherapy (1L-PBC). However, real-world data on eligibility, utilization, and outcomes of maintenance avelumab therapy remain limited. This retrospective study included patients with la/mUC who received 1L-PBC. Eligibility for maintenance avelumab therapy was determined based on the best overall response to 1L-PBC, with patients who achieved stable disease or a partial or complete response considered eligible. Survival outcomes were analyzed using the Kaplan-Meier method. Multivariate Cox regression analysis was used to identify prognostic factors among patients with la/mUC who received maintenance avelumab. Of 161 prospective patients, 67.1% were eligible for maintenance avelumab therapy, and 46.3% of eligible patients received the treatment. The median progression-free survival (PFS) following avelumab initiation was 10.2months, whereas the median OS was not reached. Prognostic factors associated with PFS included the presence of liver metastases, elevated C-reactive protein (> 1.0g/dL), and administration of more than five cycles of 1L-PBC. Adverse events occurred in 60% of patients treated with avelumab, with 16% experiencing grade 3-4 adverse events. We emphasize the real-world applicability of maintenance avelumab for Japanese patients with la/mUC. Maintenance avelumab demonstrated favorable survival outcomes, consistent with clinical trial data. Identifying prognostic factors and optimizing treatment sequencing are essential strategies for improving outcomes in this patient population.

Prognostic value of systemic immune-inflammation index in older patients with acute coronary syndrome.

Contemporary studies assessing the importance of the systemic immune-inflammation index (SII) in older patients presenting with acute coronary syndrome (ACS) are scarce. This study investigated the impact and prognostic value of the SII regarding long-term mortality in older patients with ACS. The study included 401 older patients aged 75 years and above admitted with ACS between May 2015 and December 2022. Predictors of mortality were determined using multivariate Cox regression analysis. Survival curves were generated using the Kaplan-Meier method. The patients' median age was 81 (77-85) years, and 197 (49.1%) were male. The median follow-up was 23 months (Q1-Q3 : 4-43, maximum: 102). All short- and long-term deaths, including in-hospital deaths, were significantly high in patients with high SII (P = 0.001). Inflammatory variables, including C-reactive protein, SII, the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, were positively correlated with the SYNTAX score (for SII; R = 0.492, P = 0.001). Multivariate Cox regression analysis revealed that age [hazard ratio (HR): 1.082, 95% confidence interval (CI): 1.051-1.114, P = 0.001], estimated glomerular filtration rate (HR: 0.988, 95% CI: 0.982-0.994, P = 0.001), SII (HR: 1.004, 95% CI: 1.001-1.006, P = 0.001), and left ventricular ejection fraction (HR: 0.959, 95% CI: 0.947-0.97, P = 0.001) were independent predictors of mortality in older patients with ACS. Kaplan-Meier analysis also showed that patients with high SII had a significantly higher mortality rate (P = 0.001). A high SII is an independent predictor of long-term mortality in older patients with ACS.

Prognostic value of adjuvant chemotherapy for hormone receptor-negative T1a and T1bN0M0 breast cancer patients

The benefit of adjuvant chemotherapy (CT) for hormone receptor-negative T1a and T1bN0M0 breast cancer remains uncertain. Our study was to explore prognostic value and identify candidates of adjuvant CT for these patients. The data of hormone receptor-negative T1a and T1bN0M0 breast cancer patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All patients were divided into two groups according to the history of adjuvant CT namely the CT group and the no CT (No CT) group. Univariate and multivariate Cox regression analysis were utilized to identify factors linked with cancer specific survival (CSS) and overall survival (OS) for the patients. Kaplan-Meier method was employed to determine survival benefit of adjuvant CT. A total of 3889 patients were included. After propensity score-matching, 1217 patients were assigned to the CT group and 1217 patients were assigned to the No CT group respectively. Based on multivariate Cox regression analysis of OS, older age, single, T1b stage, triple-negative tumor and absence of adjuvant CT were identified as risk factors related to OS. Besides, multivariable Cox regression analysis of CSS showed significant association between grade III+IV, T1b stage, triple-negative tumor and absence of adjuvant CT and CSS. The results from Kaplan-Meier curves revealed that adjuvant CT could bring OS benefit for these patients with more than two risk factors and could improve CSS for the patients with more than one risk factor. Our study supports the implementation of individualized strategies for hormone receptor-negative T1a and T1bN0M0 breast cancer patients. Adjuvant CT was recommended for potential beneficial patients after undertaking a risk-benefit discussion.

Evaluation of optimal timing and therapeutic efficacy of radium-223 therapy for metastatic castration-resistant prostate cancer: a multicenter collaborative study.

Despite its demonstrated efficacy in prolonging overall survival (OS) and delaying skeletal-related events in the ALSYMPCA trial, the optimal timing of radium-223 initiation remains unclear. This study investigated factors influencing radium-223 treatment outcomes, including completion rates and survival. This retrospective, multi-institutional study included 164 patients with metastatic castration-resistant prostate cancer (CRPC) who received radium-223 therapy. The primary endpoint was OS following radium-223 initiation. Secondary endpoints included factors associated with incomplete radium-223 treatment (< sixcycles) and poor OS. Multivariate Cox regression and multivariate logistic regression analyses were conducted to identify prognostic factors. The median OS times after CRPC diagnosis and radium-223 initiation were 39 and 12.5months, respectively. Kaplan-Meier analysis showed that the OS of patients who completed six cycles of radium-223 treatment was longer than that of those who did not (18 vs. 5months; P<.001). Multivariate Cox analysis identified Eastern Cooperative Oncology Group performance status (ECOG-PS)≥1 (hazard ratio [HR]=1.74, P=.046), PSA>17ng/ml (HR=2.93, P<.001), and radium-223 incompletion (HR=3.23, P<.001) as independent predictors of poor OS. The radium-223 completion rate was 68.3%, and incompletion was significantly associated with prior docetaxel use (odds ratio [OR]=5.97, P=.001), bone pain (OR=2.64, P=.024), and PSA>17ng/ml at the start of radium-223 treatment (OR=3.12, P=.013). Completion of all six cycles of radium-223 treatment were associated with favorable survival outcomes in metastatic CRPC patients. Prior docetaxel use, bone pain, and elevated PSA levels were significant risk factors for radium-223 incompletion. These findings suggest the importance of initiating radium-223 earlier in the treatment course for patients with favorable clinical profiles to maximize the therapeutic benefits.

Validation of the role of apolipoproteins in coronary artery disease patients with impaired kidney function for prognosis: a prospective cohort study in China

ObjectiveThis study aims to evaluate the relationship between apolipoproteins (ApoA1, ApoB, and the ApoB/A1 ratio) and the incidence of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) and impaired kidney function, assessing their potential role in secondary prevention.MethodA prospective cohort of 1,640 patients with impaired kidney function who underwent percutaneous coronary intervention in China was analyzed. Patients were categorized based on the measurements of ApoA1, ApoB, and ApoB/A1 ratio. MACE, defined as a composite of all-cause mortality, cardiovascular death, nonfatal myocardial infarctions, strokes, and unplanned revascularizations, was tracked post-procedure, with statistical analyses including Kaplan–Meier survival curves and Cox regression models to identify associations with apolipoproteins. Subgroup analyses according to kidney function were conducted.ResultDuring a median follow-up of 3.1 years, 324 MACE events were observed. Multivariable Cox regression analyses illustrated higher levels of ApoB and the ApoB/A1 ratio were significantly associated with increased MACE incidence (adjusted HR [95%CI] 1.668[1.044–2.666]; adjusted HR [95%CI] 2.231[1.409–3.533], respectively), while lower ApoA1 levels correlated with a higher risk (adjusted HR [95%CI] 0.505[0.326–0.782]). ROC curve analyses indicated comparable predictive performances to traditional risk factors like LDL cholesterol. Subgroup analysis revealed that the above association was not statistically significant in the moderate-to-severe renal impairment CAD patients (eGFR < 45 mL/min/1.73 m2).ConclusionOur findings illustrate that apolipoproteins, specifically ApoA1 and ApoB, along with their ratio, are significant predictors of major adverse cardiovascular events in CAD patients with impaired kidney function. These results emphasize the need for incorporating apolipoprotein measurements in secondary prevention strategies for this high-risk population.

Impact of Antithrombotic Therapy on Thrombotic and Bleeding Complications after Elective Endovascular Repair of Abdominal Aortic Aneurysms.

To investigate the influence of antithrombotic therapy on occurrence of thrombotic and bleeding complications after endovascular aneurysm repair (EVAR). In this retrospective single-center cohort study, patients who underwent elective endovascular aneurysm repair for abdominal aortic aneurysm were categorized into three antithrombotic groups: single antiplatelet therapy (SAPT), anticoagulants, or dual antiplatelet therapy (DAPT). Outcome measures were the incidence of major adverse cardiovascular events (MACE), prosthetic limb occlusions, and bleeding complications during follow-up. Among 616 patients (SAPT: n = 450, anticoagulants: n = 84, and DAPT: n = 82), Kaplan-Meier analysis showed no significant difference (log-rank p = 0.37) in incidence of MACE between patients receiving SAPT (20.9%), anticoagulants (25.0%), and DAPT (14.6%) during a median follow-up of almost 4years. In multivariable Cox regression analysis, only age (HR = 1.03; 95% CI 1.01-1.06, p = 0.01) and American Society of Anesthesiologists (ASA) classification (HR = 1.46; 95% CI 1.12-1.91; p = 0.01) were significant predictors for MACE. Prosthetic limb occlusion was observed in 38 patients during a median follow-up of 4years; incidence between patients receiving SAPT (5.8%), anticoagulants (10.7%), and DAPT (3.7%) was not significantly different (log-rank p = 0.08). Age (HR = 0.96; 95% CI 0.92-1.00; p = 0.03) and use of anticoagulants (HR = 3.79, 95% CI 1.46-9.83; p < 0.01) were significant predictors for prosthetic limb occlusion. Bleeding complications occurred in 73 patients during median follow-up of almost 4years, without significant difference (log rank p = 0.06) in incidence between patients receiving SAPT (10.7%), anticoagulants (19.0%), and DAPT (11.0%). ASA classification (HR = 1.74; 95% CI 1.23-2.46; p < 0.01) was a significant predictor for bleeding complications. Use of anticoagulants after EVAR appears to be associated with a higher risk of prosthetic limb occlusion compared to the use of single or dual antiplatelet therapy.

Clinical significance and pro-oncogenic function of DBF4 in clear cell renal cell carcinoma

BackgroundClear cell renal cell carcinoma (ccRCC) is the most common malignant urological tumor, and regrettably, and is insensitive to chemotherapy and radiotherapy, resulting in poor patient outcomes. DBF4 plays a critical role in DNA replication and participates in various biological functions, making it an attractive target for cancer treatment. However, its significance in ccRCC has not yet been explored.MethodsWe utilized external datasets and bioinformatics analyses to investigate the significance of DBF4 in ccRCC. We analysed its expression patterns, prognostic and diagnostic value, and potential mechanisms. We subsequently validated our findings through an immunohistochemistry (IHC) assay of ccRCC clinical samples. We further investigated the impact of DBF4 on the progression of ccRCC cells. Various assays, including assessments of cell proliferation, apoptosis, the cell cycle, cell migration and invasion, and colony formation, and xenograft tumor models were subsequently performed following to the knockdown of DBF4 expression via shRNA.ResultsBioinformatics analyses revealed that DBF4 is significantly overexpressed in ccRCC tissues compared with adjacent normal tissues. This overexpression was confirmed by IHC analysis of 75 pairs of clinical ccRCC tumor and adjacent tissues. Kaplan-Meier analysis revealed that high DBF4 expression was associated with a significantly lower five-year overall survival rate. Moreover, DBF4 expression was identified as an independent risk factor in multivariate Cox regression analysis. GO and KEGG pathway enrichment analyses revealed a substantial enrichment of terms associated with cell division, whereas gene set enrichment analysis (GSEA) revealed correlations between increased DBF4 expression and the activation of cell cycle-related pathways. Subsequent in vitro and in vivo experiments demonstrated that DBF4 knockdown in ccRCC cells not only suppressed proliferation and migration in vitro but also significantly inhibited tumor growth in xenograft mice by arresting the cell cycle at the G1/G0 phase, which was mediated by the inhibition of MCM2 phosphorylation and cyclin D1 and CDK4 expression.ConclusionThe current study revealed that DBF4 overexpression is a significant factor associated with malignant features and poor prognosis in patients with ccRCC. Therefore, it was proposed that DBF4 could serve as a novel potential prognostic biomarker and molecular target for ccRCC.Clinical trial numberNot applicable.

High Expression of GPR183 Predicts Poor Survival in Cytogenetically Normal Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) with a normal karyotype (CN-AML) constitutes approximately 50% of all AML cases, presenting significant prognostic variability, and highlighting the urgent need for the identification of novel molecular biomarkers. In this study, we systematically assessed GPR183 expression levels using qRT-PCR in our clinical follow-up study which included 283 CN-AML patients. Using Kaplan-Meier analysis, we found that patients with high GPR183 expression levels exhibited significantly worse overall survival (OS) (P = 0.046) and event-free survival (EFS) (P = 0.030) compared to those with low GPR183 expression. Comprehensive univariate and multivariate Cox regression analyses confirmed that GPR183 expression is a prognostic factor for OS and EFS (P < 0.05). To further validate these findings, we analyzed an independent cohort of 104 CN-AML patients from the GSE71014 dataset, corroborating our primary results, and indicating that high GPR183 expression is associated with poorer survival outcomes. Additionally, RNA-seq data from the GSE71014 dataset were analyzed by Gene Set Enrichment Analysis (GSEA). The results suggested that GPR183 may influence disease progression through the activation of the "TNFa Signaling Via NF-κB" pathway. Collectively, these findings suggested that GPR183 could serve as a valuable prognostic biomarker in CN-AML, offering insights into the underlying mechanisms of disease progression.

Leptomeningeal dissemination in H3 K27M- mutant diffuse midline gliomas: clinical characteristics, risk factors, and prognostic insights.

This study aimed to describe the incidence, clinical and pathological features, and outcomes of H3 K27M- mutant Diffuse Midline Glioma (DMG) patients with leptomeningeal dissemination (LMD) and systematically investigate the predictive and prognostic factors to clarify the response to treatment after the onset of LMD. A total of 304 patients diagnosed with DMG from October 17, 2017, to October 17, 2023, were enrolled in this study, of which 32 patients were diagnosed with LMD. Logistic regression analyses were conducted to identify the predictors of LMD, including clinical, molecular, and imaging data. Univariable and multivariable cox regression analyses were used for overall survival (OS) and post-LMD survival (PLS) analysis. The median OS and PLS were 12.5 and 8.0 months respectively. Tumor with contrast-enhanced lesions reaching ependyma (Ventricular contact type I) was the only independent risk factor for LMD. Male sex and ventricular contact type I were independent risk factors for primary LMD. In all LMD patients, Karnofsky Performance Status (KPS) of ≥ 90 and radiotherapy were statistically significantly associated with longer OS, and primary LMD was significantly associated with shorter OS. Supratentorial location and chemotherapy after LMD diagnosis were independent favorable prognostic factors on PLS. In primary LMD subgroup analysis, radiotherapy was the only independent favorable prognostic factor on OS. The association between contrast-enhanced lesions and ventricular involvement is an independent predictive factor for LMD in DMG patients. Radiotherapy and preoperative KPS may contribute to improved overall survival in these patients. Chemotherapy is a potential treatment option following an LMD diagnosis.

A radiomics and deep learning nomogram developed and validated for predicting no-collapse survival in patients with osteonecrosis after multiple drilling

PurposeIdentifying patients who may benefit from multiple drilling are crucial. Hence, the purpose of the study is to utilize radiomics and deep learning for predicting no-collapse survival in patients with femoral head osteonecrosis.MethodsPatients who underwent multiple drilling were enrolled. Radiomics and deep learning features were extracted from pelvic radiographs and selected by LASSO-COX regression, radiomics and DL signature were then built. The clinical variables were selected through univariate and multivariate Cox regression analysis, and the clinical, radiomics, DL and DLRC model were constructed. Model performance was evaluated using the concordance index (C-index), area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), calibration curves, and Decision Curve Analysis (DCA).ResultsA total of 144 patients (212 hips) were included in the study. ARCO classification, bone marrow edema, and combined necrotic angle were identified as independent risk factors for collapse. The DLRC model exhibited superior discrimination ability with higher C-index of 0.78 (95%CI: 0.73–0.84) and AUC values (0.83 and 0.87) than other models. The DLRC model demonstrated superior predictive performance with a higher C-index of 0.78 (95% CI: 0.73–0.84) and area under the curve (AUC) values of 0.83 for 3-year survival and 0.87 for 5-year survival, outperforming other models. The DLRC model also exhibited favorable calibration and clinical utility, with Kaplan–Meier survival curves revealing significant differences in survival rates between high-risk and low-risk cohorts.ConclusionThis study introduces a novel approach that integrates radiomics and deep learning techniques and demonstrates superior predictive performance for no-collapse survival after multiple drilling. It offers enhanced discrimination ability, favorable calibration, and strong clinical utility, making it a valuable tool for stratifying patients into high-risk and low-risk groups. The model has the potential to provide personalized risk assessment, guiding treatment decisions and improving outcomes in patients with osteonecrosis of the femoral head.

Correlation of intracranial and extracranial carotid atherosclerotic plaque characteristics with ischemic stroke recurrence: a high-resolution vessel wall imaging study

ObjectivesTo evaluate the ability of the plaque characteristics of extracranial carotid and intracranial arteries to predict large atherosclerotic ischemic stroke recurrence via head and neck combined high-resolution vessel wall imaging (HR-VWI).MethodsThis prospective cohort study included 169 patients with large atherosclerotic ischemic stroke who underwent head and neck combined HR-VWI from April 2022 to May 2023. The baseline clinical data and atherosclerotic plaque characteristics of the intracranial and extracranial carotid arteries were collected, and the patients were followed up for 1 year, with the endpoint event defined as recurrent ischemic stroke. Clinical and imaging data were compared between the recurrent and nonrecurrent groups. Independent risk factors associated with stroke recurrence were assessed via multivariate Cox regression analysis. The receiver operating characteristic (ROC) curves of the relevant variables were also plotted, and the area under the curve (AUC) was calculated to assess their ability to predict stroke recurrence. Kaplan–Meier survival curves were used to compare the probability of stroke recurrence.ResultsDuring the 12-month follow-up, stroke recurrence occurred in 35 of the 169 patients. Multivariate Cox regression analysis revealed that the total number of intracranial and extracranial carotid plaques (p = 0.010) and coexisting extracranial carotid plaques and intracranial significantly enhanced plaques (p = 0.047) were independent risk factors for recurrent ischemic stroke. The AUCs for predicting stroke recurrence were 0.787 and 0.710, respectively. The Kaplan–Meier survival curve revealed that the risk of stroke recurrence was significantly greater in patients whose total number of intracranial and extracranial carotid plaques was &amp;gt;4.5 than in patients whose total number of plaques was &amp;lt;4.5 (p &amp;lt; 0.001) and was significantly greater in patients with coexisting extracranial carotid plaques and intracranial significantly enhanced plaques than in patients without coexisting plaques (p &amp;lt; 0.001).ConclusionA greater total number of intracranial and extracranial carotid plaques and the coexistence of extracranial carotid plaques and intracranially significantly enhanced plaques are independent risk factors associated with recurrent ischemic stroke. Head and neck combined HR-VWI may provide new indicators for the prediction of stroke recurrence, thus helping clinicians identify high-risk patients and target therapy to reduce the recurrence of ischemic events.

Development of a nomogram for overall survival in patients with esophageal carcinoma: A prospective cohort study in China.

Esophageal carcinoma (EC) presents a significant public health issue in China, with its prognosis impacted by myriad factors. The creation of a reliable prognostic model for the overall survival (OS) of EC patients promises to greatly advance the customization of treatment approaches. To create a more systematic and practical model that incorporates clinically significant indicators to support decision-making in clinical settings. This study utilized data from a prospective longitudinal cohort of 3127 EC patients treated at Chongqing University Cancer Hospital between January 1, 2018, and December 12, 2020. Utilizing the least absolute shrinkage and selection operator regression alongside multivariate Cox regression analyses helped pinpoint pertinent variables for constructing the model. Its efficacy was assessed by concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Nine variables were determined to be significant predictors of OS in EC patients: Body mass index (BMI), Karnofsky performance status, TNM stage, surgery, radiotherapy, chemotherapy, immunotherapy, platelet-to-lymphocyte ratio, and albumin-to-globulin ratio (ALB/GLB). The model demonstrated a C-index of 0.715 (95%CI: 0.701-0.729) in the training cohort and 0.711 (95%CI: 0.689-0.732) in the validation cohort. In the training cohort, AUCs for 1-year, 3-year, and 5-year OS predictions were 0.773, 0.787, and 0.750, respectively; in the validation cohort, they were 0.772, 0.768, and 0.723, respectively, illustrating the model's precision. Calibration curves and DCA verified the model's predictive accuracy and net benefit. A novel prognostic model for determining the OS of EC patients was successfully developed and validated to help clinicians in devising individualized treatment schemes for EC patients.

Clinicopathological significance and prognostic value of serum 25-hydroxyvitamin D3 level in children with IgA vasculitis nephritis

To study the significance of serum 25-hydroxyvitamin D3 [25-(OH)D3] level in the clinicopathological characteristics and prognosis of children with immunoglobulin A vasculitis nephritis (IgAVN). A retrospective analysis was conducted on the clinical data of children with IgAVN who underwent renal biopsy at Suzhou Hospital Affiliated to Anhui Medical University and Jinling Hospital of the Medical School of Nanjing University from June 2015 to June 2020. Based on serum 25-(OH)D3 level, the patients were divided into a normal group and a lower group. The clinicopathological characteristics and follow-up data of the two groups were collected and compared. A total of 359 children with IgAVN were included. Compared to the normal group (62 cases), the lower group (297 cases) exhibited higher incidences of hematochezia and gross hematuria, higher levels of serum creatinine, blood urea nitrogen, urinary retinol protein, urinary N-acetyl-β-D-glucosaminidase, and quantitative urinary protein, and a longer duration from renal biopsy to urinary protein becoming negative, as well as lower estimated glomerular filtration rate and albumin level (P<0.05). Renal pathology in the lower group showed a higher occurrence of tubular interstitial injury, crescent formation, segmental sclerosis in glomeruli, and inflammatory cell infiltration in the renal interstitium compared to the normal group (P<0.05). Survival analysis indicated that the cumulative renal survival rate was lower in the lower group (P<0.05). Multivariate Cox regression analysis revealed that low serum 25-(OH)D3 level is an independent risk factor for poor prognosis in children with IgAVN. Children with IgAVN and low serum 25-(OH)D3 level have relatively severe clinicopathological manifestations. Low serum 25-(OH)D3 level is an independent risk factor for poor prognosis in children with IgAVN.

Incidence and risk of infections in patients with ankylosing spondylitis receiving biologic therapies: A prospective observational study using the KOBIO registry.

This study aimed to assess infection occurrence of infection and risk factors among ankylosing spondylitis (AS) patients treated with biologics in a real-world setting. This prospective observational cohort study included AS patients from the Korean College of Rheumatology BIOlogics (KOBIO) registry who initiated or switched to biologic agent between December 2012 and July 2023. The primary outcome was the first occurrence of any infection, ranging from mild to severe, classified by organ system. The infection rate per 1,000 person-years (PY), with a 95% confidence interval were calculated using the Poisson distribution method. Cox proportional hazard regression models, adjusted for confounders, estimated hazard ratios for infection risk, considering only the first infection event. This analysis included 2,129 patients with a total of 7,107.67 PY of follow-up. The predominant infections observed were of the upper and lower respiratory tract (25.89/1000 PY), followed by herpes zoster (HZ) (6.13/1000 PY). Multivariate Cox regression analysis revealed significant risk factors for infection, including age, ischemic heart disease, complicated diabetes, chronic kidney disease (CKD), and peripheral arthritis. In contrast, male sex was identified as a protective factor against the development of infections. The infection rate was 39 events/1,000 PY with respiratory tract infections being most common, followed by HZ. Significant risk factors included age, female sex, ischemic heart disease, complicated diabetes, CKD and peripheral arthritis for the occurrence of infection in patients with AS treated with biologics.

Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study.

Rebleeding after recovery from esophagogastric variceal bleeding (EGVB) is a severe complication that is associated with high rates of both incidence and mortality. Despite its clinical importance, recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking. To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding. This study included 477 EGVB patients across 2 cohorts: The derivation cohort (n = 322) and the validation cohort (n = 155). The primary outcome was rebleeding events within 1 year. The least absolute shrinkage and selection operator was applied for predictor selection, and multivariate Cox regression analysis was used to construct the prognostic model. Internal validation was performed with bootstrap resampling. We assessed the discrimination, calibration and accuracy of the model, and performed patient risk stratification. Six predictors, including albumin and aspartate aminotransferase concentrations, white blood cell count, and the presence of ascites, portal vein thrombosis, and bleeding signs, were selected for the rebleeding event prediction following endoscopic treatment (REPET) model. In predicting rebleeding within 1 year, the REPET model exhibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort, alongside 0.862 and 0.127 in the validation cohort. Furthermore, the REPET model revealed a significant difference in rebleeding rates (P < 0.01) between low-risk patients and intermediate- to high-risk patients in both cohorts. We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive performance, which will improve the clinical management of rebleeding in EGVB patients.

Nationwide cohort study of primary open angle glaucoma risk and cardiovascular factors among in Korean glaucoma suspects

This retrospective study investigated the risk of primary open-angle glaucoma (POAG) among individuals identified as glaucoma suspects and examined associated cardiovascular risk factors. We conducted a longitudinal, nationwide cohort study using data from the Korean National Health Insurance Service (KNHIS) and included 362,285 participants aged ≥ 40 years from the Korean National Health Screening Program (NHSP) without pre-existing POAG in 2009 and 2010. Of these, glaucoma suspects (n = 32,220) were defined as individuals with at least two recorded instances of the KCD code H400 for glaucoma suspect and no prior antiglaucoma medication prescriptions before health screening. The primary outcome was the diagnosis of POAG and the prescription of antiglaucoma medications. Over a 6-year follow-up, 4.92% of glaucoma suspects developed POAG. Through multivariate Cox regression analysis, glaucoma suspects with diabetes, hypertension, dyslipidemia, or coronary heart disease exhibited a greater risk of conversion to POAG than those without these comorbidities ([HR, 1.354; 95%CI, 1.201 to 1.527] for diabetes, [HR, 1.139; 95%CI, 1.019 to 1.273] for systemic hypertension, [HR, 1.128; 95%CI, 1.013 to 1.26] for dyslipidemia, [HR, 1.124, 95%CI, 1.007 to 1.254] for coronary heart disease).This nationwide study observed that among glaucoma suspects, having cardiovascular risk factors/disease was associated with higher risk of developing POAG.

Clinicopathological characteristics and predictors of renal outcomes in diffuse crescentic glomerulonephritis : a retrospective single-center study from Western China

BackgroundThe factors influencing diffuse crescentic glomerulonephritis renal survival and prognosis remain uncertain. Additionally, there’s no literature on the clinical outcomes of IgA nephropathy, lupus nephritis, and IgA vasculitis nephritis in type II patients.MethodsThis study retrospectively examined 107 patients diagnosed with diffuse crescentic glomerulonephritis through biopsy. Analytical methods included Cox regression models and Kaplan-Meier survival analysis to assess the data.ResultsAmong the 107 enrolled patients, 12 patients had Type I diffuse crescentic glomerulonephritis, 70 patients had Type II, and 25 patients had Type III. The respective 5-year kidney survival rates were 0%, 57.5%, and 18.6% for type I, type II, and type III. Furthermore, among Type II patients, IgA nephropathy emerged as the most prevalent condition. The cumulative 5-year kidney survival rates were 50% for patients with IgA nephropathy, 64% for lupus nephritis, and 70% for Henoch-Schönlein purpura nephritis. A significant association between the risk of ESKD development and several factors was revealed by a multivariate Cox regression analysis: estimated glomerular filtration rate (P = 0.004), initial kidney replacement therapy (KRT) at presentation (P = 0.002), global glomerulosclerosis (P<0.001).ConclusionsType II diffuse crescentic glomerulonephritis was the most prevalent type in DCGN, and favors better renal prognosis than type I and III DCGN, in which IgA nephropathy was the most common entity of Type II DCGN. Additionally, estimated glomerular filtration rate, initial KRT at presentation and global glomerulosclerosis were identified as predictors of renal outcomes in diffuse crescentic glomerulonephritis.

The prognostic value of systemic immune-inflammation index in patients with unresectable hepatocellular carcinoma treated with immune-based therapy

BackgroundPredicting the efficacy of immune-based therapy in patients with unresectable hepatocellular carcinoma (HCC) remains a clinical challenge. This study aims to evaluate the prognostic value of the systemic immune-inflammation index (SII) in forecasting treatment response and survival outcomes for HCC patients undergoing immune-based therapy.MethodsWe analyzed a cohort of 268 HCC patients treated with immune-based therapy from January 2019 to March 2023. A training cohort of 93 patients received atezolizumab plus bevacizumab (T + A), while a validation cohort of 175 patients underwent treatment with tyrosine kinase inhibitors (TKIs) combined with anti-PD-(L)1 therapy. The SII cutoff value, determined using X-tile analysis based on overall survival (OS) in the training cohort, divided patients into high (> 752*109) and low (≤ 752*109) SII groups. Prognostic factors were identified through univariate and multivariate logistic and Cox regression analyses, and survival outcomes were assessed using Kaplan–Meier methods. The predictive accuracy of SII was evaluated using receiver operating characteristic (ROC) curves.ResultsAn optimal SII cutoff of 752*109 stratified patients into high and low SII groups. Univariate and multivariate logistic regression indicated that SII was a significant predictor of the objective response rate (ORR), which was markedly different between the low and high SII subgroups (34.72% vs. 9.52%, P = 0.019). This finding was consistent in the validation cohort (34.09% vs. 16.28%, P = 0.026). SII also demonstrated prognostic value in Cox regression and Kaplan–Meier analyses. ROC curves confirmed that SII had superior predictive accuracy compared to common clinical indicators, with predictive relevance even in AFP-negative patients. Furthermore, a lower SII was associated with a higher T cell ratio and an increased number of CD8+ T cells and Granzyme B+ CD8+ T cells in peripheral blood.ConclusionSII is a promising predictor of both therapeutic efficacy and prognosis in HCC patients undergoing immune-based treatments. Its application may enhance clinical decision-making, thereby improving patient outcomes from immune-based therapy.

Predictive Factors and the Predictive Scoring System for Falls in Acute Care Inpatients: Retrospective Cohort Study.

Falls in hospitalized patients are a serious problem, resulting in physical injury, secondary complications, impaired activities of daily living, prolonged hospital stays, and increased medical costs. Establishing a fall prediction scoring system to identify patients most likely to fall can help prevent falls among hospitalized patients. This study aimed to identify predictive factors of falls in acute care hospital patients, develop a scoring system, and evaluate its validity. This single-center, retrospective cohort study involved patients aged 20 years or older admitted to Shizuoka General Hospital between April 2019 and September 2020. Demographic data, candidate predictors at admission, and fall occurrence reports were collected from medical records. The outcome was the time from admission to a fall requiring medical resources. Two-thirds of cases were randomly selected as the training set for analysis, and univariable and multivariable Cox regression analyses were used to identify factors affecting fall risk. We scored the fall risk based on the estimated hazard ratios (HRs) and constructed a fall prediction scoring system. The remaining one-third of cases was used as the test set to evaluate the predictive performance of the new scoring system. A total of 13,725 individuals were included. During the study period, 2.4% (326/13,725) of patients experienced a fall. In the training dataset (n=9150), Cox regression analysis identified sex (male: HR 1.60, 95% CI 1.21-2.13), age (65 to <80 years: HR 2.26, 95% CI 1.48-3.44; ≥80 years: HR 2.50, 95% CI 1.60-3.92 vs 20-<65 years), BMI (18.5 to <25 kg/m²: HR 1.36, 95% CI 0.94-1.97; <18.5 kg/m²: HR 1.57, 95% CI 1.01-2.44 vs ≥25 kg/m²), independence degree of daily living for older adults with disabilities (bedriddenness rank A: HR 1.81, 95% CI 1.26-2.60; rank B: HR 2.03, 95% CI 1.31-3.14; rank C: HR 1.23, 95% CI 0.83-1.83 vs rank J), department (internal medicine: HR 1.23, 95% CI 0.92-1.64; emergency department: HR 1.81, 95% CI 1.26-2.60 vs department of surgery), and history of falls within 1 year (yes: HR 1.66, 95% CI 1.21-2.27) as predictors of falls. Using these factors, we developed a fall prediction scoring system categorizing patients into 3 risk groups: low risk (0-4 points), intermediate risk (5-9 points), and high risk (10-15 points). The c-index indicating predictive performance in the test set (n=4575) was 0.733 (95% CI 0.684-0.782). We developed a new fall prediction scoring system for patients admitted to acute care hospitals by identifying predictors of falls in Japan. This system may be useful for preventive interventions in patient populations with a high likelihood of falling in acute care settings.