High Predictive Value In Patients Research Articles

Role of dynamic ctDNA monitoring in cervical and anal epidermoid carcinomas under curative chemoradiation.

3141 Background: Cervical and anal canal squamous cell carcinoma (SSC) are a significant health problem in underdevelopment countries. Definitive chemoradiation (CRT) is the standard-of-care (SOC) approach for curative treatment in locally advanced disease. Due to the common substantial local inflammation during CRT, the conventional clinical image cannot identify non-responders early. In this scenario, the evaluation of circulating tumor DNA (ctDNA) is a promising tool for real-time tumor response monitoring. Methods: We performed a prospective multicentric cohort study of patients treated between 2020 and 2023 in tertiary oncologic centers in Brazil to evaluate the role of ctDNA dynamic monitoring in epidermoid cervical (CC) and anal cancer (AC) T1-4, N0-1, M0 by AJCC 8th edition and candidates to complete curative CRT. The cDNA was assessed by Signatera test at D1, D29, immediately post-treatment, 8 weeks (w) post-CRT, 24w post-CRT, every 6 months (m) in the first 1-2 years(y), and yearly at 3-5y of follow-up (FUP). The primary endpoint was to estimate the correlation of ctDNA with a tumoral response assessed by conventional routine image and clinical evaluation at 8w. Secondary endpoints included a correlation between ctDNA results at different time points with progression-free survival (PFS) and overall survival (OS). The predictive potential of the biomarker was evaluated using receiving operating characteristic (ROC) curve analysis. Results: We included 33 patients, and 27 were evaluable with ctDNA, with a median FUP of 10m. The majority were female (n=23, 85.1%), and 3 (11%) were HIV-positive(+). Most patients presented with positive nodes and stage III disease (n=18, 66.6%). In the AC group (n=15), the majority received CRT with capecitabine and cisplatin (n=12, 55.5%); in the CC group (n=12), all pts received cisplatin. All pts tested expressed ctDNA+ before treatment. At 8w, images had a sensitivity of 42.8% and specificity of 100% for disease progression (area under the curve [AUC] 0.714), while ctDNA yielded a sensitivity of 85.7% and specificity of 89.4% (AUC 0.875). The ctDNA+ immediately after CRT ended (32%) was consistent with ctDNA+ at 8w (30.7%) and 24w (30%). Pts with ctDNA+ immediately post CRT have a higher risk of disease progression with PFS of 8.2m in ctDNA+ and not reached in ctDNA- group (HR:17.5; IC95%:1.9-157.3; p=0.01). Data are immature for OS analysis. Conclusions: CtDNA immediately post-CRT has a high predictive value in patients with anal and cervical tumors in early access CRT non-responders, who are at a high risk of disease progression. This biomarker should be considered for tailoring strategies of treatment escalation in this population.

Risk factors and prediction model for mortality in HIV/Talaromyces marneffei co-infection: A retrospective cohort study

BackgroundThis study aimed to identify the risk factors associated with mortality among patients co-infected with human immunodeficiency virus (HIV) and Talaromyces marneffei (TM) in China, and develop a risk prediction model. MethodsIn this retrospective cohort analysis conducted from 2013 to 2024, comprehensive clinical data from 160 patients were analyzed using a logistic regression model to identify mortality predictors and construct a predictive model. An additional 36 patients constituted the validation cohort, which was specifically designed to evaluate the predictive value of the model. Model performance was assessed using the area under the curve (AUC). ResultsThe overall mortality rate for hospitalized patients with HIV/TM co-infection was 17.35 %. The median age was 35.0 years, and 89.30 % were male. Additionally, 89.80 % of the patients reported fever and 87.76 % presented with lymphadenopathy. Key independent risk factors associated with mortality included age (odds ratio (OR): 1.103, 95 % confidence interval (CI) = 1.033–1.178, P = 0.003), procalcitonin (PCT) levels (OR: 1.270, 95 % CI = 1.052–1.534, P = 0.013), and urea to albumin ratio (UAR) (OR: 1.491, 95 % CI = 1.175–1.892, P < 0.001). Advanced age, elevated PCT levels, and increased UAR were identified as independent risk factors of mortality. Furthermore, the mortality prediction probability combining age, PCT, and UAR exhibited a high predictive value in patients with HIV/TM co-infection. Additionally, the AUC showed a good discrimination ability in the validation group (AUC, 0.898). ConclusionsAdvanced age, elevated PCT levels, and increased UAR significantly determine mortality in patients with HIV/TM co-infection. These findings underscore the potential of using laboratory parameters as predictive indicators of mortality, facilitating the early identification of HIV/TM co-infection cases in clinical practice.

Development and Validation of a Nomogram to Predict Significant Liver Inflammation in Patients with Chronic Hepatitis B.

Noninvasive diagnosis of liver inflammation is important for patients with chronic hepatitis B (CHB). This study aimed to develop a nomogram to predict significant liver inflammation for CHB patients. CHB patients who underwent liver biopsy were retrospectively collected and randomly divided into a development set and a validation set. The least absolute shrinkage and selection operator regression and logistic regression analysis were used to select independent predictors of significant liver inflammation, and a nomogram was developed. The performance of nomogram was assessed by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). A total of 1019 CHB patients with a median age of 39.0 years were included. Alanine aminotransaminase (ALT, P = 0.018), gamma-glutamyl transpeptidase (P = 0.013), prothrombin time (P < 0.001), and HBV DNA level (P = 0.030) were identified as independent predictors of significant liver inflammation in the development set. A model namely AGPD-nomogram was developed based on the above parameters. The area under the ROC curve in predicting significant inflammation was 0.765 (95% CI: 0.727-0.803) and 0.766 (95% CI: 0.711-0.821) in the development and validation sets, which were significantly higher than other indexes. The AGPD-nomogram had a high predictive value in patients with normal ALT. Moreover, the nomogram was proven to be clinically useful by DCA. A visualized AGPD-nomogram which incorporated routine clinical parameters was proposed to facilitate the prediction of significant liver inflammation in CHB patients. This nomogram had high accuracy in the identification of significant liver inflammation and would be a useful tool for the better management of CHB patients, especially for those with normal ALT.

The Predictive Value of Right Ventricular Longitudinal Strain in Pulmonary Hypertension, Heart Failure, and Valvular Diseases.

Right ventricular (RV) systolic function has an important role in the prediction of adverse outcomes, including mortality, in a wide range of cardiovascular (CV) conditions. Because of complex RV geometry and load dependency of the RV functional parameters, conventional echocardiographic parameters such as RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE), have limited prognostic power in a large number of patients. RV longitudinal strain overcame the majority of these limitations, as it is angle-independent, less load-dependent, highly reproducible, and measure regional myocardial deformation. It has a high predictive value in patients with pulmonary hypertension, heart failure, congenital heart disease, ischemic heart disease, pulmonary embolism, cardiomyopathies, and valvular disease. It enables detection of subclinical RV damage even when conventional parameters of RV systolic function are in the normal range. Even though cardiac magnetic resonance-derived RV longitudinal strain showed excellent predictive value, echocardiography-derived RV strain remains the method of choice for evaluation of RV mechanics primarily due to high availability. Despite a constantly growing body of evidence that support RV longitudinal strain evaluation in the majority of CV patients, its assessment has not become the part of the routine echocardiographic examination in the majority of echocardiographic laboratories. The aim of this clinical review was to summarize the current data about the predictive value of RV longitudinal strain in patients with pulmonary hypertension, heart failure and valvular heart diseases.

Time series: pathologic determinants of cytobiochemical urinalysis and urinary infections at the University Clinics in Kinshasa

Introductionl´examen cytobiochimique urinaire est un outil complémentaire le plus demandé au laboratoire à côté de l´hémogramme. Il a une grande valeur prédictive dans les infections urinaires quand il est correctement fait et scrupuleusement interprété. L´objectif de cette étude était d´évaluer l´ampleur, l´évolution, les déterminants, et les comorbidités cytobiochimiques de l´infection urinaire.Méthodesil s´est agi d´une étude documentaire, avec des approches, descriptive, analytique et comparative portant sur des patients référés pour examens cytobiochimiques des urines aux laboratoires de Cliniques Universitaires de Kinshasa (CUK) entre 2011 et 2014.Résultatsau total, 8926 analyses cytobiochimiques ont été demandées avec moins de 2% d´analyses biochimiques. Les femmes étaient plus représentées (6426 femmes vs 2500 hommes) avec un sex ratio 3F: 1H. Il y avait plus de demandes dans la tranche d´âge de 30-39 ans (17%; n=1517). Les analyses ont plus été demandées pendant les saisons de pluies 72% (n=3511) avec le pic pendant les mois de mai. Les infections urinaires estimées à 54,8% [n=4892 ajusté dont E. coli (n=1937), Klebsiella (n= 993)] étaient plus diagnostiqués pendant la période de 2012 à 2014. Il existait une association indépendante et significative entre le sexe féminin (OR aj = 3,5; IC = 95%; 3,1-3,8; P<0,0001, l´admission pendant les saisons de pluies (OR aj = 1,3, IC = 95%; 1,2-1,4; P<0,0001 et l´infection urinaire.Conclusionl´infection urinaire émerge comme une préoccupation majeure pour les patients de sexe féminin et admises pendant les saisons de pluies et les années 2012-2014 de la série de 2011 à 2014 aux CUK. La rareté de l´infection urinaire était observée au cours de l´année La Nina 2011 post-l´année trop chaude EL Nino alors que l´ampleur de l´infection urinaire était coexistante pendant les années 2012-2014 normales relativement chaudes pré-l´année très chaude El Nino 2015. Il existe donc une interaction entre le climat tropical chaud et humide de la ville de Kinshasa et le climat global (mondial) froid dans le cadre de la variabilité climatique/réchauffement climatique, pouvant expliquer la flambée des infections urinaire à Kinshasa.

An Update on Neurofibromatosis Type 1: Not Just Café-au-Lait Spots and Freckling. Part II. Other Skin Manifestations Characteristic of NF1. NF1 and Cancer

In addition to the classic skin manifestations of NF1 (café-au-lait spots, freckling, and neurofibromas), the presence of other manifestations such as nevus anemicus and juvenile xanthogranuloma may be of high predictive value in patients with an uncertain diagnosis. Localized or mosaic NF1, also known as segmental neurofibromatosis, is caused by a postzygotic mutation responsible for the presence of the typical disease manifestations limited to a body segment. Although no follow-up protocols are available for these patients with mosaic NF1, the risk of complications is much lower than in the generalized forms of the disease. Malignant tumors are, probably, the most feared complication of NF1. In decreasing order, the most frequent neoplasms are optic nerve glioma, malignant peripheral nerve sheath tumor, gastrointestinal stromal tumors, and pheochromocytomas. Most malignant peripheral nerve sheath tumors are the result of malignant transformation of plexiform neurofibromas and early diagnosis is a decisive factor in the prognosis. In conclusion, NF1 is a multisystemic disease that requires multidisciplinary follow-up with dermatologists playing an important role.

Long term survival of cirrhotics following admission to a uk intensive care unit - a subgroup of patients with ´resilient´ cirrhosis

Patients with cirrhosis who are admitted to the ICU are considered to have a poor prognosis. Previous studies have sought to identify markers of high predictive value in patients who will not survive their critical care stay including the need for mechanical ventilation, vasopressor support, GI bleeding and APACHE III score. These studies have focused upon early prognosis, rather than long term survival.

PWE-105 Long term survival of cirrhotics following icu admission – a subgroup of patients with 'resilient' cirrhosis

<h3>Introduction</h3> Patients with cirrhosis who are admitted to the ICU are considered to have a poor prognosis. Previous studies have sought to identify markers of high predictive value in patients who will not survive their critical care stay. These studies have focused upon early prognosis, rather than longer term survival. We sought to validate previously described outcome predictors and review long-term survival in a cohort of cirrhotic patients admitted to ICU. <h3>Method</h3> We performed a retrospective analysis of cirrhotic patients admitted to adult ICU, University Hosptial of Wales (Cardiff, UK) between 2009–14. Admission information was collated from the Intensive Care National Audit and Research Centre database. Child-Pugh, Model for End-stage Liver Disease-Na (MELD-Na) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were derived from data on admission to critical care. Statisical analyses were conducted with SPSS. <h3>Results</h3> One hundred and fifty one cirrhotics (2.8% of all critical care admissions) were admitted to the ICU with a mean age of 54 (range 22–80) and a male preponderance (65.6%). The predominant aetiology was alcoholic liver disease (ALD, 107/151, 70.9%). The reasons for ICU admission were variceal bleed 29.8%; sepsis 25.2%; decompensation 13.9%;non variceal bleed 5.3% and other 26%. ICU mortality was 43.7% for the 151 patients. Mean follow up after ICU discharge was 788 days (range 26–1722). Hyponatraemia (p &lt; 0.001), coagulopathy (p = 0.02), APACHE II (p = 0.004) and MELD-Na scores (p &lt; 0.0001) were significantly associated with mortality. Patients diagnosed as decompensation with no obvious underlining precipitant had a worse prognosis than those with precipitants (e.g. variceal bleeding, sepsis) which was maintained at follow up (p = 0.05). Child’s A, B and C stage patients had a mean overall survival of 1274, 976 and 690 days respectively (p = 0.01). Seventy-eight patients were discharge from hospital. Only 6 of these patients died, all with Child’s B liver disease. Only attending outpatient follow up clinic was associated with increased survival (p = 0.01 1373 v 1668 days). <h3>Conclusion</h3> Nearly half of all cirrhotics admitted to the ICU die before discharge, and two thirds of all patients have alcohol as an aetiological factor, emphasising the burden on our society. As expected, commonly used scoring systems predict short-term outcome, but often do not reflect long-term survival. Cirrhotics who survive the challenge of ICU admission seem to have quite marked physiological resilience and capacity for recovery with a good long term prognosis. Interestingly only patients with Child’s B cirrhosis continued to demonstrate a post-hospital discharge mortality, warranting further investigation for underlying reasons. <h3>Disclosure of interest</h3> None Declared.

Detection of renovascular hypertension. State of the art: 1992.

To review recent advances in detecting renovascular hypertension. Original English-language reports obtained through a MEDLINE search for the years 1987 to 1991. Also, a manual search through Index Medicus as well as bibliographies of original reports and selected review articles. Cited studies were critically reviewed with emphasis on study size, patient sample, methods, diagnostic criteria, and reproducibility of results. Where applicable, reviews that combined the results of smaller studies are cited. A sensitivity of 74% and a specificity of 89% have been reported for the captopril test and of 93% and 95%, respectively, for captopril scintigraphy with diethylenetriaminepentaacetic acid (DTPA). The sensitivity and specificity of renal vein renin determination are 80% and 62%, respectively and may increase with the use of stricter technical criteria and maneuvers to stimulate renin secretion. These tests differentiate renovascular hypertension from essential hypertension more reliably than from asymmetric renal parenchymal disease; however, they do not reliably distinguish unilateral from bilateral stenosis. Other tests are less widely used. Intravenous pyelography (sensitivity, 74.5%; specificity, 86.2%) has the disadvantages of radiation and dye load exposure. Intravenous angiography is expensive and invasive and does not always enable visualization of the origin of the renal artery. The roles of duplex ultrasound and magnetic resonance angiography remain to be clarified. Noninvasive tests are cost effective and have a high predictive value in patients with clinical clues suggestive of renovascular hypertension. These tests are not recommended for use in patients with a low likelihood of disease.