Early Risk Stratification Of Patients Research Articles

Construction and validation of a predictive model for major adverse cardiovascular events in the long term after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.

Construction of a prediction model to predict the risk of major adverse cardiovascular events (MACE) in the long term after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Retrospective analysis of STEMI patients treated with PCI from April 2018 to April 2021 in Fuyang People's Hospital. Lasso regression was used to screen the risk factors for the first occurrence of MACE in patients, and multifactorial logistic regression analysis was used to construct a prediction model. The efficacy was evaluated by area under the ROC curve (AUC), Hosmer-Lemeshow deviance test, calibration curve, clinical decision curve (DCA) and clinical impact curve (CIC). Logistic regression results showed that hypertension, diabetes mellitus, left main plus three branches lesion, estimated glomerular filtration rate and medication adherence were influential factors in the occurrence of distant MACE after PCI in STEMI patients ( P < 0.05). The AUC was 0.849 in the modeling group and 0.724 in the validation group; the calibration curve had a good fit to the standard curve, and the result of the Hosmer-Lemeshow test of deviance was x 2 = 7.742 ( P = 0. 459); the DCA and the CIC indicated that the predictive model could provide a better net clinical benefit for STEMI patients. A prediction model constructed from a total of five predictor variables, namely hypertension, diabetes, left main + three branches lesions, eGFR and medication adherence, can be used to assess the long-term prognosis after PCI in STEMI patients and help in early risk stratification of patients.

Screening, risk stratification and CT imaging for assessment of coronary artery disease

Early treatment of cardiovascular risk factors and characterization of coronary plaques is essential to collect prognostic information about coronary artery disease (CAD) and prevent cardiovascular events. Discussion of the most important risk factors of CAD, basic diagnostic of CAD, prevention, and prognostic factors of CAD with focus on cardiac computed tomography (CT). Prevalence and prognostic impact of CAD risk factors; description of specific assessment of risk profiles; estimation of pretest probability; conventional prevention of CAD; prognostic assessment of CAD using the Calcium Scoring and coronary CT angiography. Assessment of risk profiles and estimation of pretest probability for obstructive coronary stenosis necessitates athorough evaluation of medical history and laboratory values. The composition and extent of calcified and noncalcified plaques in CT exams based on the criteria of the Coronary Artery Disease-Reporting and Data System give important prognostic information about the risk of cardiovascular events, which increases with high plaque burden and vice versa. Initial imaging with CT for evaluation of CAD leads to areduction of invasive coronary angiographies and catheter-associated complications. Besides early detection of cardiovascular risk factors, the additional assessment of plaque burden and significant stenosis in CT gives further prognostic information to facilitate effective therapies to prevent cardiovascular events and in the case of low plaque burden avoid invasive coronary angiography. However, systmatic screening using Calcium Scoring is not established yet due to insufficient data, although it could potentially be used for an early risk stratification in patients with multiple risk factors.

IMPACT OF PROLONGED NOCTURNAL HYPOXEMIA ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH PRE-CAPILLARY PULMONARY HYPERTENSION

Objective: Obstructive sleep apnea (OSA) and/or nocturnal hypoxemia is prevalent in patients with pulmonary hypertension (PH). However, the pathophysiological determinants of adverse outcomes remain ambiguous. We aimed to investigate the prognostic significance of various sleep parameters for long-term prognosis in patients with pre-capillary PH. Design and method: Consecutive patients diagnosed with precapillary pulmonary hypertension (PH) by right heart catheterization who underwent overnight cardiorespiratory polygraphy for the assessment of OSA were enrolled. Time-to-event analysis was performed investigating cardiorespiratory indices (apnea-hypopnea index [AHI] and percentage total recording time &lt;90% [T90]) and clinical worsening using the log-rank test and multivariable Cox proportional hazard models adjusted for multiple confounders. Results: Of 440 eligible Chinese patients with PH, 134 (30.5%) had OSA and 147 (33.4%) had nocturnal hypoxemia (T90 greater than 10%). Over a median follow-up of 12.1 months, 72 (16.4%) patients experienced clinical worsening. AHI did not predict a higher risk of incident CW (hazard ratio [HR]: 0.98, 95% confidence interval [CI]: 0.932-1.001, P = 0.225), whereas T90 was associated with an increased risk of CW (HR: 1.01, 95% CI 1.00-1.01, P = 0.018). The likelihood of CW increased by 8% per 10-unit increase in T90 (HR: 1.08, 95% CI 1.020-1.14, P = 0.018). Patients with nocturnal hypoxemia carried an HR of 1.89 for CW events (HR: 1.89, 95% CI 1.19-3.00, P = 0.007) and these associations persisted after covariates adjustments. Clinical worsening-free survival probability over two-year follow-up periods for patients with nocturnal normoxemia and hypoxemia were 87% and 76.9%, respectively (Log-rank P = 0.006), while the trend towards a non-statistical significance of patients with and without OSA. The association of nocturnal hypoxemia reflected by T90 and CW remained robust across different subgroups and did not potentially interact with potential effect modifiers including age, gender, BMI, and pulmonary hemodynamic parameters (P for interaction &gt;0.05). Conclusions: In patients with precapillary PH, nocturnal hypoxemia defined by T90 was a robust risk predictor of long-term clinical worsening. Investigation of nocturnal hypoxemic burden in PH may aid in the early risk-stratification in patients with precapillary PH.

Blood lactate levels, base excess values and lactic acidosis predict short-term and long-term survival in patients admitted to the ICU after and out-of-hospital cardiac arrest

Abstract Funding Acknowledgements Type of funding sources: None. Background Global hypoperfusion causes tissue hypoxia, resulting in overproduction of lactate because of impaired mitochondrial oxidation, causing lactic acidosis (LA). Base excess (BE) is defined as the amount of acid or base required to return the pH to 7.4 in the setting of a normal Paco2 and is therefore related to the degree of acid production following injury. Purpose Our hypothesis was that lactate levels, BE levels and occurrence of LA on admission could help in early risk stratification in patients admitted to the ICU after an out-of-hospital cardiac arrest (OHCA). Methods we enrolled 171 consecutive patients resuscitated from an OHCA and admitted to ICU at our center from September 2017 to April 2021. Blood gas analysis on admission was available for 140 patients [77%male, mean age 60 (18-90) years, 54% with first shockable rhythm, median number of shocks delivered 1 (0-14), median dose of adrenaline administered 3 mg (0-12), 26% received amiodarone, median cardiac arrest duration 38 min (IQR 22-74 min)]. Patients with low lactate levels were compared with patients with high lactate levels (cutoff 2 mmol/l as per standard practice), patients with low BE levels were compared with patients with high BE levels (cutoff -8.5 mmol/l, median value) and patients with LA were compared with patients without LA (defined as pH &amp;lt;7.36 and lactate&amp;gt;2mmol/). Survival with good neurological outcome (CPC 1-2) at ICU discharge and 30-day survival were investigated for each group with chi-squared test. Then, one-year survival was investigated for each group with Kaplan-Meier analysis. Results Patients with low BE (&amp;lt; -8.5 mmol/l) had a significantly lower survival with good neurological outcome at ICU discharge (p=0.0017), lower survival at 30 days (p &amp;lt; 0.0001) and 365 days (p&amp;lt;0.0001) compared to patients with high BE (&amp;gt; - 8.5 mmol/l). Low lactate levels (&amp;lt; 2 mmol/L) were associated with higher survival with good neurological outcome at ICU discharge (p&amp;lt; 0.0001), higher survival at 30 days (p &amp;lt; 0.0001) and 365 days (p = 0.0002) compared to higher lactate levels (&amp;gt; 2 mmol/l). The occurrence of LA on admission was significantly associated with lower survival with good neurological outcome at ICU discharge (p=0.001), lower 30-days survival (p=0.001) and 365-days survival (p&amp;lt;0.0001). Conclusion high blood lactate levels, low base excess and lactic acidosis predict short-term and long-term survival in patients admitted to the ICU after an OHCA. These results could help clinician in the identification of populations with different risk profile with the first blood gas analysis obtained at ICU admission.

Multidimensional Oncological Frailty Scale (MOFS): A New Quick-To-Use Tool for Detecting Frailty and Stratifying Risk in Older Patients with Cancer—Development and Validation Pilot Study

Frailty detection with comprehensive geriatric assessment (CGA) is of pivotal importance in older patients with cancer to avoid over- or under-treatment and to detect those at increased risk for poor outcomes. Several tools have been developed to capture the complexity of frailty, but only a few were explicitly conceived for older adults with cancer. The study aimed at developing and validating a multidimensional, easy-to-use diagnostic tool for early-risk stratification in patients with cancer, called the Multidimensional Oncological Frailty Scale (MOFS). In this single-center prospective study, we consecutively enrolled 163 older women (age ≥ 75 years) with breast cancer, screened with a G8 score ≤ 14 during the outpatient preoperative evaluation at our breast centre, as the development cohort. Seventy patients with different types of cancer admitted to our OncoGeriatric Clinic served as the validation cohort. Using stepwise linear regression analysis, we evaluated the relationship between Multidimensional Prognostic Index (MPI) and CGA items, and, finally, realized a screening tool based on the combination of the significant variables. The mean age of the study population was 80.4 ± 5.8 years, while the mean age of the validation cohort was 78.6 ± 6.6 years [42 women (60%)]. A composite model of the Clinical Frailty Scale, G8, and hand grip strength test showed a strong correlation with MPI (R= -0.712, p < 0.001). The MOFS accuracy in the prediction of mortality was optimal in both the development and the validation cohorts (AUC 0.82 and 0.87; p < 0.001 and 0.003, respectively). MOFS represents a new, accurate, quick-to-use frailty screening tool for stratifying the risk of mortality in geriatric cancer patients.

Long-term risk stratification for hospitalized patients with acute heart failure at a single rural cardiovascular centre.

Early risk stratification of patients with acute heart failure (AHF) is critical for appropriate triage and outcome improvement. The serum sodium, blood urea nitrogen, age, serum albumin, systolic blood pressure, and natriuretic peptide level (SOB-ASAP) score can predict in-hospital mortality of AHF. However, the relationship between the SOB-ASAP score and long-term prognosis is unknown. This study investigated the determinants of the long-term prognosis of AHF by evaluating the SOB-ASAP score. This retrospective cohort study included all patients with acute decompensated heart failure who were admitted to our hospital between April 2017 and March 2018. And those who discharged were analysed retrospectively. The follow-up period was 3years. Primary end point was all-cause death. Total of 140 patients were analysed. The median SOB-ASAP score of entire cohort on admission was 3 points (interquartile range; 1-5). The Kaplan-Meier curve demonstrated that patients in the higher SOB-ASAP group (score ≥3) had a higher incidence of all-cause death (log-rank test; P<0.001) than those in the lower SOB-ASAP (group score <3). At admission, the SOB-ASAP score may be useful for predicting the long-term prognosis of hospitalized patients with AHF.

Automated tissue Doppler imaging for identification of occluded coronary artery in patients with suspected non-ST-elevation myocardial infarction

PurposeIdentification of regional dysfunction is important for early risk stratification in patients with suspected non-ST-elevation myocardial infarction (NSTEMI). Strain echocardiography enables quantification of segmental myocardial deformation. However, the clinical use is hampered by time-consuming manual measurements. We aimed to evaluate whether an in-house developed software for automated analysis of segmental myocardial deformation based on tissue Doppler imaging (TDI) could predict coronary occlusion in patients with suspected NSTEMI.MethodsEighty-four patients with suspected NSTEMI were included in the analysis. Echocardiography was performed at admission. Strain, strain rate and post-systolic shortening index (PSI) were analyzed by the automated TDI-based tool and the ability to predict coronary occlusion was assessed. For comparison, strain measurements were performed both by manual TDI-based analyses and by semi-automatic speckle tracking echocardiography (STE). All patients underwent coronary angiography.ResultsSeventeen patients had an acute coronary occlusion. Global strain and PSI by STE were able to differentiate occluded from non-occluded culprit lesions (respectively − 15.0% vs. -17.1%, and 8.1% vs. 5.1%, both p-values < 0.05) and identify patients with an acute coronary occlusion (AUC 0.66 for both strain and PSI). Measurements of strain, strain rate and PSI based on TDI were not significantly different between occluded and non-occluded territories.ConclusionAutomated measurements of myocardial deformation based on TDI were not able to identify acute coronary occlusion in patients with suspected NSTEMI. However, this study confirms the potential of strain by STE for early risk stratification in patients with chest pain.

Left atrial appendage thrombus in acute stroke: diagnostic accuracy of CT angiography compared to transesophageal echocardiography

ObjectivesTo evaluate the value of an extended emergency computed tomography angiography (CTA) including cardiac imaging in patients with acute ischemic stroke for the detection of left atrial appendage (LAA) thrombus compared to transesophageal echocardiography (TEE) as a reference standard. Materials and MethodsWe conducted a retrospective case-control study of patients with presumed acute ischemic stroke who had undergone non-ECG-gated CTA for the craniocervical vessels with an extended coverage including the heart in the context of emergency stroke evaluation and for whom TEE was available as part of the routine stroke diagnostic. We selected cases with evidence of LAA thrombus in TEE and controls without LAA thrombus in TEE in a 1:3 ratio. Two independent observers analyzed CTA images for presence of LAA thrombus and were blinded to the presence of thrombus in TEE. ResultsTwenty-two patients with LAA thrombus in TEE, and 66 patients without LAA thrombus in TEE were included. The detection of LAA thrombus using CTA showed a sensitivity of 63.6%, a specificity of 81.8%, a positive predictive value of 53.9% and a negative predicted value of 87.1%. Interobserver agreement was only moderate (Cohen´s κ = 0.43). ConclusionsAn extended emergency CTA including cardiac imaging can be helpful in early risk stratification in patients with stroke of cardioembolic origin. However, our data show that a standard CTA of craniocervical vessels with extended coverage of the heart is of limited value when compared to TEE, the standard method of detecting LAA thrombi.

Relationship between QRS duration on ECG and Left Ventricular Systolic Function by Echocardiography in patients with Non-ST elevated Myocardial Infarction

Background: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and enhance outcomes. The present study was therefore undertaken to determine the relationship between QRS duration (QRSd) on admission ECG and left ventricular ejection fraction (LVEF) as a measure of left ventricular function in non-ST elevated myocardial infarction (NSTEMI) patients. Methods: This observational study was carried out from January to December 2020 with total of 120 patients with a history of NSTEMI. Based on the cut-off value of QRS duration 100 msec, the patients were divided into two groups – one group with QRS duration d” 100 msec (normal QRS) and another group with QRS duration &gt; 100 msec (prolonged QRS). Left ventricular systolic function was considered preserved, if it was e” 52% and reduced if it was &lt; 52%. The association and correlation between QRS duration and LVEF was then observed. Results: The prevalence of reduced LVEF in patients with prolonged QRS duration (&gt; 100 msec) was double (38%) than that of preserved (19.5%). The risk of having LV dysfunction in patients with prolonged QRS duration was 2.5 (95% CI = 1.1 – 6.2) times higher than that in patients normal QRS duration (d” 100 msec) (p = 0.039). The QRS duration and LVEF bear a significantly inverse relationship (r = -0.341, p &lt; 0.001). The sensitivity of prolonged QRS duration (&gt; 100 msec) in correctly detecting LV dysfunction was inappreciably low (38%), although its specificity in excluding those who did not have LV dysfunction was optimum (80.5%) with overall diagnostic accuracy being 52.5%. Conclusion: Prolonged QRS duration on a standard 12-lead ECG is associated with reduced echocardiographic LVEF. However, QRS duration in predicting LV dysfunction is much less sensitive, although its specificity is optimum indicating that QRS duration is not a good predictor of LV dysfunction (reduced LVEF), but it can dependably predict those who do not have LV dysfunction (preserved LVEF). Cardiovasc j 2022; 15(1): 36-41

Diagnostic performance of cardiac magnetic resonance segmental myocardial strain for detecting microvascular obstruction and late gadolinium enhancement in patients presenting after a ST-elevation myocardial infarction.

BackgroundMicrovascular obstruction (MVO) and Late Gadolinium Enhancement (LGE) assessed in cardiac magnetic resonance (CMR) are associated with adverse outcome in patients with ST-elevation myocardial infarction (STEMI). Our aim was to analyze the diagnostic performance of segmental strain for the detection of MVO and LGE.MethodsPatients with anterior STEMI, who underwent additional CMR were enrolled in this sub-study of the CARE-AMI trial. Using CMR feature tracking (FT) segmental circumferential peak strain (SCS) was measured and the diagnostic performance of SCS to discriminate MVO and LGE was assessed in a derivation and validation cohort.ResultsForty-eight STEMI patients (62 ± 12 years old), 39 (81%) males, who underwent CMR (i.e., mean 3.0 ± 1.5 days) after primary percutaneous coronary intervention (PCI) were included. All patients presented with LGE and in 40 (83%) patients, MVO was additionally present. Segments in all patients were visually classified and 146 (19%) segments showed MVO (i.e., LGE+/MVO+), 308 (40%) segments showed LGE and no MVO (i.e., LGE+/MVO–), and 314 (41%) segments showed no LGE (i.e., LGE–). Diagnostic performance of SCS for detecting MVO segments (i.e., LGE+/MVO+ vs. LGE+/MVO–, and LGE–) showed an AUC = 0.764 and SCS cut-off value was –11.2%, resulting in a sensitivity of 78% and a specificity of 67% with a positive predictive value (PPV) of 30% and a negative predictive value (NPV) of 94% when tested in the validation group. For LGE segments (i.e., LGE+/MVO+ and LGE+/MVO– vs. LGE–) AUC = 0.848 and SCS with a cut-off value of –13.8% yielded to a sensitivity of 76%, specificity of 74%, PPV of 81%, and NPV of 70%.ConclusionSegmental strain in STEMI patients was associated with good diagnostic performance for detection of MVO+ segments and very good diagnostic performance of LGE+ segments. Segmental strain may be useful as a potential contrast-free surrogate marker to improve early risk stratification in patients after primary PCI.

Clinical Application of CHA2DS2-VASc versus GRACE Scores for Assessing the Risk of Long-term Ischemic Events in Atrial Fibrillation and Acute Coronary Syndrome or PCI.

Early risk stratification of patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has relevant implication for individualized management strategies. The -VASc and GRACE ACS risk model are well-established risk stratification systems. We aimed to assess their prognostic performance in AF patients with ACS or PCI. Consecutive patients with AF and ACS or referred for PCI were prospectively recruited and followed up for 3 years. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular mortality, myocardial infarction, ischemic stroke, systemic embolism and ischemia-driven revascularization. Higher -VASc (HR [hazard ratio] 1.184, 95% CI 1.091-1.284) and GRACE at discharge score (HR 1.009, 95% CI 1.004-1.014) were independently associated with increased risk of MACCEs. The -VASc (c-statistics: 0.677) and GRACE at discharge (c-statistics: 0.699) demonstrated comparable discriminative capacity for MACCEs (p = 0.281) while GRACE at admission provided relatively lower discrimination (c-statistics: 0.629, p vs. -VASc = 0.041). For predicting all-cause mortality, three models displayed good discriminative capacity (c-statistics: 0.750 for -VASc, 0.775 for GRACE at admission, 0.846 for GRACE at discharge). A significant discrimination improvement of GRACE at discharge compared to -VASc was detected (NRI = 45.13%). In the setting of coexistence of AF and ACS or PCI, -VASc and GRACE at discharge score were independently associated with an increased risk of MACCEs. The GRACE at discharge performed better in predicting all-cause mortality.

Relationship between QRS duration on Admission ECG and Angiographic Severity of Coronary Artery Disease in Patients with Acute Anterior Myocardial Infarction

Background: Early risk stratification of patients with myocardial infarction is critical to determine optimum treatment strategies and improve outcomes. This study was designed to determine the relation between QRS duration on admission ECG and severity of coronary artery disease (CAD) in patients with acute anterior myocardial infarction (AMI). Methods: This observational study was carried out from November 2019 to October 2020 with total of 100 patients with first attack of anterior MI who were treated with thrombolytic therapy. Based on the cut-off value of QRS duration 100, the patients were divided into two groups – one group with QRS duration £100 msec (normal QRS) and another group with QRS duration &gt; 100 msec (prolonged QRS). Severity of CAD was assessed using Gensini score derived from coronary angiographic data. Gensini score &lt; 36 points was regarded as mild coronary artery disease and Gensini score ³36 points as moderate to severe coronary artery disease. Then patients with prolonged and normal QRS durations were compared with severity of CAD to find their association. Results: Acute AMI patients with prolonged QRS duration (&gt; 100 msec) more often tend to be associated with severe CAD. Risk of having severe CAD in patients with prolonged QRS duration were almost 8 (95% of CI = 3.2– 19.3) times higher than those with normal QRS duration (£100 msec) (p &lt; 0.001). Conclusion: The study concluded that three out of four patients of acute anterior MI with prolonged QRS duration are likely to have severe CAD. QRS duration more than 100 msec can be used as a cheap, easily available prognostic factor in patients with acute anterior MI. Cardiovasc j 2022; 14(2): 143-149

Early risk stratification in patients with cardiogenic shock irrespective of the underlying cause – the Cardiogenic Shock Score

Early risk stratification is essential to guide treatment in cardiogenic shock (CS). Existing CS risk scores were derived in selected cohorts, without accounting for the heterogeneity of CS. The aim of this study was to develop a universal risk score (the Cardiogenic Shock Score, CSS) for all CS patients, irrespective of the underlying cause. Within a registry of 1308 CS unselected patients admitted to a tertiary care hospital between 2009 and 2019, a Cox regression model was fitted to derive the CSS, with 30-day mortality as main outcome. The CSS's predictive ability was compared to the IABP-SHOCK II score, the CardShock score and SCAI classification by C-indices and validated in an external cohort of 934 CS patients. Based on the Cox regression, nine predictors were included in the CSS: age, sex, acute myocardial infarction (AMI-CS), systolic blood pressure, heart rate, pH, lactate, glucose and cardiac arrest. The CSS had the highest C-index in the overall cohort (0.740 vs. 0.677/0.683 for IABP-SHOCK II score/CardShock score), in patients with AMI-CS (0.738 vs. 0.675/0.689 for IABP-SHOCK II score/CardShock score) and in patients with non-AMI-CS (0.734 vs. 0.677/0.669 for IABP-SHOCK II score/CardShock score). In the external validation cohort, the CSS had a C-index of 0.73, which was higher than all other tested scores. The CSS provides improved information on the risk of death in unselected patients with CS compared to existing scores, irrespective of its cause. Because it is based on point-of-care variables which can be obtained even in critical situations, the CSS has the potential to guide treatment decisions in CS.

Prognostic findings for ICU admission in patients with COVID-19 pneumonia: baseline and follow-up chest CT and the added value of artificial intelligence.

Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. Coronavirus disease 19 (COVID-19) causes mild-to-moderate symptoms in most individuals. However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 1–2 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. Computed tomography (CT) is widely available and offers the potential for fast triage, robust, rapid, and minimally invasive diagnosis: Ground glass opacities (GGO), crazy-paving pattern (GGO with superimposed septal thickening), and consolidation are the most common chest CT findings in COVID pneumonia. There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19. Furthermore, developments and progress integrating artificial intelligence (AI) with computer-aided design (CAD) software for diagnostic imaging allow for objective, unbiased, and rapid assessment of CT images.

Association of Inflammatory and Hemostatic Parameters With Values of High Sensitive Troponin in Patients With Acute Coronary Syndrome.

Background:Acute coronary syndrome (ACS) includes a group of different clinical conditions resulting from acute ischemia and/or myocardial necrosis and may manifest as: unstable angina pectoris, acute myocardial infarction without and with ST-segment elevation on electrocardiography (ECG), or as sudden cardiac death. Their mutual differentiation is based, with clinical findings and ECG characteristics, on laboratory confirmation or exclusion of myocardial necrosis on the basis of obtained values of highly sensitive and specific cardiac troponins T or I. Troponin I is a widespread marker in clinical use that possesses almost 100% specificity for myocardial tissue and is used as a highly sensitive marker even in the case of microscopically small lesions of cardiac tissue necrosis.Objective:To investigate the association of inflammatory and hemostatic parameters with values of high sensitive troponin I (hsTnI) in patients with acute coronary syndrome.Methods:The prospective study included 82 patients with a clinical condition of acute coronary heart disease (stable angina pectoris 23, acute coronary syndrome 59, of which 35 had non-STEMI elevation infarction and 24 had ST-segment elevation infarction (STEMI). The values of hsTnI had been measured in all patients and correlated with values of inflammatory (c reactive protein-CRP, leukocytes, neutrophils, lymphocytes, neutrophil/lymphocyte ratio) and hemostatic (platelet counts, mean platelet volume-MPV) parameters.Results:Patients with acute coronary syndrome had significantly higher values of hsTnI, and inflammatory parameters: CRP, leukocytes and neutrophils (absolute number and percentage) as well as the neutrophil /lymphocyte ratio compared to patients with stable angina pectoris. In patients with ACS, hsTnI has significantly correlated with CRP (r=0.5; p=0.00), leukocytes (r=0.3; p=0.020) and absolute neutrophil count (r=0.27; p=0.039). In patients with non-STEMI, a significant correlation was found between hsTnI and MPV (r=0.359; p=0.034), while in the STEMI group a significant correlation existed between hsTnI and CRP (r=0.422; p=0.40), and neutrophil /lymphocyte ratio (r =0.511; p=0.011).Conclusion:Markers of inflammation may help in early risk stratification in patients with acute coronary syndrome.

Rockall score in Upper Gastrointestinal Bleeding: Risk stratification and prognostic outcome

Background: Early risk stratification of patients with upper gastrointestinal bleeding (UGIB) is of utmost importance for a favourable patient outcome. It ensures patient triaging into the appropriate level of care, avoiding unnecessary and prolonged hospitalisations on one end and rapid identification of high-risk patients for emergent management on the other. Methods: This prospective observational study was carried out on 150 patients who met the inclusion criteria. Demographic data, baseline lab parameters, Rockall scores, endoscopic interventions, re-bleeding, duration of hospital stay and mortality were recorded. Based on the Rockall scores, patients were divided as low, moderate and high risk. Results: Variceal bleeding was the most common cause of UGIB (34%). The need for therapeutic endoscopy, risk of re-bleeding and duration of hospital stay were proportional to the severity of the risk as per Rockall score (p-value &lt; 0.01). Among the study subjects, one patient in high-risk category expired. Conclusion: Rockall scoring system helps in the risk stratification of UGIB patients and hence early intervention in high-risk patients. Higher scores are associated with poor patient outcomes.

Early Prediction of Disease Progression in Patients with Severe COVID-19 Using C-Reactive Protein to Albumin Ratio.

Background Early identification of patients with severe coronavirus disease (COVID-19) at an increased risk of progression may promote more individualized treatment schemes and optimize the use of medical resources. This study is aimed at investigating the utility of the C-reactive protein to albumin (CRP/Alb) ratio for early risk stratification of patients. Methods We retrospectively reviewed 557 patients with COVID-19 with confirmed outcomes (discharged or deceased) admitted to the West Court of Union Hospital, Wuhan, China, between January 29, 2020 and April 8, 2020. Patients with severe COVID-19 (n = 465) were divided into stable (n = 409) and progressive (n = 56) groups according to whether they progressed to critical illness or death during hospitalization. To predict disease progression, the CRP/Alb ratio was evaluated on admission. Results The levels of new biomarkers, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, CRP/Alb ratio, and systemic immune-inflammation index, were higher in patients with progressive disease than in those with stable disease. Correlation analysis showed that the CRP/Alb ratio had the strongest positive correlation with the sequential organ failure assessment score and length of hospital stay in survivors. Multivariate logistic regression analysis showed that percutaneous oxygen saturation (SpO2), D-dimer levels, and the CRP/Alb ratio were risk factors for disease progression. To predict clinical progression, the areas under the receiver operating characteristic curves of Alb, CRP, CRP/Alb ratio, SpO2, and D-dimer were 0.769, 0.838, 0.866, 0.107, and 0.748, respectively. Moreover, patients with a high CRP/Alb ratio (≥1.843) had a markedly higher rate of clinical deterioration (log − rank p < 0.001). A higher CRP/Alb ratio (≥1.843) was also closely associated with higher rates of hospital mortality, ICU admission, invasive mechanical ventilation, and a longer hospital stay. Conclusion The CRP/Alb ratio can predict the risk of progression to critical disease or death early, providing a promising prognostic biomarker for risk stratification and clinical management of patients with severe COVID-19.

NIMG-08. A MULTI-CENTER RADIOMICS-BASED MODEL TO DIFFERENTIATE BETWEEN NEUROFIBROMATOSIS TYPE 1-ASSOCIATED PLEXIFORM NEUROFIBROMAS AND MALIGNANT PERIPHERAL NERVE SHEATH TUMORS

Abstract BACKGROUND Several MRI features are proposed to distinguish between plexiform neurofibromas (PNF) and malignant peripheral nerve sheath tumors (MPNST) in neurofibromatosis type 1 (NF1), including tumor size, margins, and degree of heterogeneity. However, most of these features are descriptive in nature, subject to intra-/interrater variability, and based on small single-institution studies. The goal of this study was to identify radiomic features that can differentiate between NF1-associated PNF and MPNST. METHODS 31 MPNSTs and 24 PNFs from five centers were segmented on short TI inversion recovery sequences using a semi-automated segmentation software (3DQI). Standard pre-processing was performed, including N4 bias field correction, intensity normalization (using a mean of 120 SI and standard deviation of 80 SI), and resampling to 1 mm3 voxel resolution. 1688 radiomic features were extracted from the tumor region of interest using PyRadiomics, an open-source Python radiomics package. To classify tumors as PNF or MPNST, we implemented the Boruta algorithm and correlation removal for selection of important features. A Random Forest model was built using the top ten selected features. Five-fold cross-validation was performed and repeated 100 times. Model performance was evaluated using the area under the ROC curve (AUC), sensitivity, specificity, accuracy, and confidence intervals. RESULTS The top ten features included in the model were five intensity features, two shape features, and three texture features. The model demonstrated an AUC of 0.891 (95% CI 0.882-0.899), sensitivity of 0.744, specificity of 0.847, and accuracy of 0.802 (95% CI 0.792-0.813). CONCLUSIONS Our machine learning model demonstrated high performance in classifying tumors as either PNF or MPNST in NF1 individuals. Inclusion of additional tumors for model training and testing on an independent dataset are underway. Ultimately, our model may enable improved differentiation between PNF and MPNST compared to descriptive MRI features, permit early patient risk stratification, and improve patient outcomes.

Delta neutrophil index and shock index can stratify risk for the requirement for massive transfusion in patients with primary postpartum hemorrhage in the emergency department.

Postpartum hemorrhage (PPH) constitutes a major risk for maternal mortality and morbidity. Unfortunately, the severity of PPH can be underestimated because it is difficult to accurately measure blood loss by visual estimation. The delta neutrophil index (DNI), which reflects circulating immature granulocytes, is automatically calculated in hematological analyzers. We evaluated the significance of the DNI in predicting hemorrhage severity based on the requirement for massive transfusion (MT) in patients with PPH. We retrospectively analyzed data from a prospective registry to evaluate the association between the DNI and MT. Moreover, we assessed the predictive ability of the combination of DNI and shock index (SI) for the requirement for MT. MT was defined as a transfusion of ≥10 units of red blood cells within 24 h of PPH. In total, 278 patients were enrolled in this study and 60 required MT. Multivariable logistic regression revealed that the DNI and SI were independent predictors of MT. The optimal cut-off values of ≥3.3% and ≥1.0 for the DNI and SI, respectively, were significantly associated with an increased risk of MT (DNI: positive likelihood ratio [PLR] 3.54, 95% confidence interval [CI] 2.5-5.1 and negative likelihood ratio [NLR] 0.48, 95% CI 0.4-0.7; SI: PLR 3.21, 95% CI 2.4-4.2 and NLR 0.31, 95% CI 0.19-0.49). The optimal cut-off point for predicted probability was calculated for combining the DNI value and SI value with the equation derived from logistic regression analysis. Compared with DNI or SI alone, the combination of DNI and SI significantly improved the specificity, accuracy, and positive likelihood ratio of the MT risk. The DNI and SI can be routinely and easily measured in the ED without additional costs or time and can therefore, be considered suitable parameters for the early risk stratification of patients with primary PPH.

The Hidden Treasures of Preoperative Blood Assessment in Oral Cancer: A Potential Source of Biomarkers.

Simple SummaryIn this study, we assess the prognostic potential of immune and inflammatory elements determined preoperatively in the peripheral blood of patients with oral squamous cell carcinoma (OSCC). Preoperative plasma fibrinogen (Fib) and platelet-to-lymphocyte ratio (PLR) show strong correlations with patients’ outcomes. Analyzed together, in a new parameter named Fibrinogen-PLR Algorithm (FiPLA), predictive power increases significantly. Clinicians can use this new, easy, cost-effective, and globally available tool for risk stratification of patients with OSCC, as early as from the moment of diagnosis.(1) Background: Oral squamous cell carcinoma (OSCC) is a common malignancy, and the impact of immune and inflammatory mechanisms in its development and progression are of major interest. The aim of our study is to assess the prognostic potential of circulating immune and inflammatory elements determined preoperatively in patients with OSCC, as well as the development of a new compound parameter with predictive value. (2) Methods: We assessed preoperative fibrinogen (Fib) and the platelet-to-lymphocyte ratio (PLR) in 111 OSCC patients. Using a mathematic algorithm, we determined a composite parameter with cumulative information from Fib and PLR, named Fibrinogen-PLR Algorithm (FiPLA). Survival analysis, followed by bivariate and multivariate analyses, was subsequently conducted. (3) Results: Increased preoperative Fib and PLR levels were associated with poor outcome in OSCC (p = 0.0001 and p = 0.0015, respectively). Preoperative FiPLA values were also associated with poor patient survival (p < 0.0001). Multivariate analysis confirmed the independent prognostic role for FiPLA only (CI95% 1.232–67.770, p = 0.03), showing the superior predictive value of FiPLA compared to its individual components. (4) Conclusions: Preoperative assessments of circulating immune and inflammatory elements can provide high-quality prognostic information, and they represent valuable tools in clinical practice, facilitating the early risk stratification of patients with OSCC.