Hosmer-Lemeshow Goodness Of Fit Test Research Articles

PRISM-III and SNAPPE-II to Predict Outcome in Neonates undergoing Surgery under General AnaesthesiaA Prospective Cohort Study

Introduction: Score for Neonatal Acute Physiology Perinatal Extension-II (SNAPPE-II) and Paediatric Risk of Mortality-III (PRISM-III) are scores which have been used in the Paediatric Intensive Care Unit (PICU) setting for quite some time now. However, these have never been utilised in a preoperative setting to predict outcome. Aim: To study the risk scores PRISM-III and SNAPPE-II to predict outcome in neonates undergoing surgery under general anaesthesia. Materials and Methods: This was a prospective observational cohort study conducted in Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India on 100 neonates. The PRISM-III and SNAPPE-II scores were calculated preoperatively to predict the postoperative outcome. Statistical Package for Social Sciences (SPSS) version 15.0 was used for analysis. Discriminatory capacity of scores was assessed using Receiver Operating Characteristic (ROC) curves. Specificity and sensitivity were calculated to identify the cut-off value of the scoring system that would predict outcome. The calibration of both the scoring systems was established by using HosmerLemeshow goodness of fit test. Results: The mean age of population was 8.23±7.93 days, with 69% males and 31% females. The mortality rate was 12%. The maximum sensitivity (91.67%) and specificity (93.18%) for PRISMIII score was found at score 23, whereas best sensitivity (100%) and specificity (81.82%) for SNAPPE-II was at 26.5. The area under ROC for PRISM-III and SNAPPE-II was 0.946 and 0.944 respectively showing excellent discriminatory power. The HosmerLemeshow test showed a good calibration for the study model. Conclusion: Both the scoring systems PRISM-III and SNAPPEII are excellent predictors of postoperative outcomes. PRISMIII is marginally better than SNAPPE-II for diagnostic accuracy. Both scores are well calibrated for Indian population.

Development of a Nomogram Model for Predicting the Risk of In-Hospital Death in Patients with Acute Kidney Injury.

ObjectiveTo analyze the risk factors of in-hospital death in patients with acute kidney injury (AKI) in the intensive care unit (ICU), and to develop a personalized risk prediction model.MethodsThe clinical data of 137 AKI patients hospitalized in the ICU of Anhui provincial hospital from January 2018 to December 2020 were retrospectively analyzed. Patients were divided into two groups: those that survived to discharge (“survival” group, 100 cases) and those that died while in hospital (“death” group, 37 cases), and risk factors for in-hospital death analyzed.ResultsThe in-hospital mortality of AKI patients in the ICU was 27.01% (37/137). A multivariate logistic regression analysis indicated age, mechanical ventilation and vasoactive drugs were significant risk factors for in-hospital death in AKI patients, and a nomogram risk prediction model was developed. The Harrell’s C-index of the nomogram model was 0.891 (95% CI: 0.837–0.945), and the area under the receiver operating characteristic (ROC) curve was 0.886 (95% CI: 0.823–0.936) after internal validation, indicating that the nomogram model had good discrimination. The Hosmer–Lemeshow goodness of fit test and calibration curve indicated the predicted probability of the nomogram model was consistent with the actual frequency of death in ICU patients with AKI. The decision curve analysis (DCA) showed that the clinical net benefit level of the nomogram model is highest when the probability threshold of AKI is between 0.01 and 0.75.ConclusionPatients in the ICU with AKI had high in-hospital mortality and were affected by a variety of risk factors. The nomogram prediction model based on the risk factors of AKI showed good prediction efficiency and clinical applicability, which could help medical staff in the ICU to identify AKI patients with high-risk, allowing early prevention, detection and intervention, and reducing the risk of in-hospital deaths in ICU patients with AKI.

Validation of risk scores for permanent pacemaker implantation after TAVR

Abstract Background Despite advances in transcatheter aortic valve replacement (TAVR) technology, High grade atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation remains a frequent complication after the procedure. National inpatient sample (NIS) score and the PACeR risk cores have been developed to help identify patients at an increased risk of requiring PPM. Purpose We sort to validate both risk stratification tools developed to predict the need for PPM after TAVR. Methods This is a single center retrospective study using consecutive patients who presented for TAVR at our institution from May 2012 till December 2020. Components from the two-scoring system previously published in literature was applied. Predictive accuracy of the scores were assessed using the C-statistics for discrimination and the Hosmer-Lemeshow goodness of fit test for calibration. Results A total of 663 patients underwent TAVR over the study period. Of those, 101 were excluded. The final cohort included in the analysis were 562 patients. Fifty-seven patients (10.1%) required PPM. In both scoring, higher scores suggested increased risk of PPM implantation (Figure 1). PACeR and NIS scores showed an area under the curve of 0.750 and 0.699 respectively Figure 2. Model calibration showed a P-value of 0.799 over PACER and 0.583 for the NIS score (P>0.5 implying a good fit). Conclusion The PACer risk score and NIS models were both validated in our database with acceptable outcomes. Overall, the PACeR risk scores proved to be more accurate in our database. Further studies in larger patient cohorts are needed to further validate these models. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Establishment and validation of a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders

Objective: To establish a clinical prediction model for infection risk at the placement sites of skin and soft tissue expanders (hereinafter termed as expanders) and to validate the predictive value of the model. Methods: A retrospective observational study was conducted. Totally 2 934 patients who underwent skin and soft tissue dilatation surgery in the Department of Plastic Surgery of the First Affiliated Hospital of Air Force Medical University from January 2009 to December 2018 and met the selection criteria were included. There were 1 867 males and 1 067 females, with a median age of 18 years. Totally 3 053 skin and soft tissue expansion procedures were performed with 4 266 expanders implanted. The following indexes were selected as predictor variables, including patients' age, gender, marital status, ethnicity, hospital admission, surgical indication, disease duration, with/without history of smoking, history of drinking, history of blood transfusion, history of underlying diseases, and inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, water injection rate of expander in the first time, placement site of expander, anesthesia method, duration of operation, and with/without postoperative hematoma evacuation, and infection at the placement site of expander as the outcome variable. Univariate analysis of the data was performed using least absolute shrinkage and selection operator (LASSO) regression to screen the potential risk factors affecting infection at the placement sites of expanders, the factors selected by the univariate analysis were subjected to binary multivariate logistic regression analysis to screen the independent risk factors affecting infection at the placement sites of expanders, and a nomogram prediction model for the occurrence of infection at the placement sites of expanders was established. The C index and Hosmer-Lemeshow goodness of fit test were used to evaluate the discrimination and accuracy of the model, respectively, and the bootstrap resampling was used for internal verification. Results: The results of LASSO regression showed that age, gender, hospital admission, surgical indication, disease duration, history of drinking, history of heart disease, history of viral hepatitis, history of hypertension, inability to use cephalosporin antibiotics due to allergy, number of expander in a single placement, rated volume of expander, placement site of expander, postoperative hematoma evacuation were the potential risk factors for infection at the placement sites of expanders (regression coefficient=-0.005, 0.170, 0.999, 0.054, 0.510, -0.003, 0.395, -0.218, 0.029, 0.848, -0.116, 0.175, 0.085, 0.202). Binary multivariate logistic regression analysis showed that male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volumes of expanders ≥200 mL and <400 mL or ≥400 mL, and expanders placed in the trunk or the limbs were the independent risks factors for infection at the placement sites of expanders (odds ratio=1.37, 3.21, 2.00, 2.47, 1.70, 1.73, 1.67, 2.16, 95% confidence interval=1.04-1.82, 1.09-8.34, 1.38-2.86, 1.29-4.41, 1.07-2.73, 1.02-2.94, 1.09-2.58, 1.07-4.10, P<0.05 or P<0.01). The C index for evaluating the discriminative degree of the model was 0.63, the Hosmer-Lemeshow goodness of fit test for evaluating the accuracy of the model showed P=0.685, and the C index for internal validation by the bootstrap resampling was 0.60. Conclusions: Male, emergency admission, disease duration ≤1 year, inability to use cephalosporin antibiotics due to allergy, rated volume of expander ≥200 mL, and expanders placed in the trunk or the limbs are the independent risk factors for infection at the placement sites of expanders. The clinical prediction model for infection risk at the placement sites of expanders was successfully established based on these factors and showed a certain predictive effect.

Establishment of a predictive model for central cervical lymph node metastasis of papillary thyroid carcinoma based on ACR TI-RADS score and evaluation of its diagnostic efficacy

Objective:To establish a predictive model for central lymph node metastasis（CLNM） of papillary thyroid carcinoma（PTC） based on ACR TI-RADS grades（ATR model） and evaluate its diagnostic efficacy. Methods:A total of 319 patients with PTC diagnosed from January 2019 to May 2020 were included, including 366 nodules were used as the modeling cohort to construct the risk prediction model. A total of 105 PTC patients with 121 nodules from June to August 2020 were included as the external validation cohort. The C-index of the model was calculated and the Hosmer-Lemeshow goodness-of-fit test was performed to compare the diagnostic efficiency of ACR model and those conventional imaging models. Results:The ATR model, Y=-3.719+0.765×gender+1.094×multifocality+0.08×maximum diameter+0.266×ACR TI-RADS score. In the training set, validation set and external validation cohort, the model C-index was 0.758（95%CI: 0.699-0.817）, 0.717（95%CI: 0.619-0.815） and 0.756（95%CI: 0.671-0.840）, respectively. The Hosmer-Lemeshow goodness of fit test showed that the prediction rate of the model was consistent with the actual incidence rate（P=0.918; P=0.581; P=0.366）. With ≥0.434 as the diagnostic threshold, the model had the highest diagnostic efficacy （sensitivity: 86.0%, specificity: 56.3%, Youden index: 0.423）. In the external validation cohort, there was no significant difference between C-US and CT（P>0.05）. Compared with C-US and CT, the sensitivity（66.1% vs 16.1%, P<0.001; 66.1% vs 9.7%, P<0.001） and accuracy（68.6% vs 55.4%, P=0.041; 68.6% vs 52.9%, P=0.012） of ATR model were higher, and the negative predictive value was higher than that of CT（66.7% vs 50.9%, P=0.042）, but there was no difference between ATR model and C-US（66.7% vs 52.3%, P=0.066）; There was no significant difference among the three positive predictive values（70.7% vs 83.3%, P=0.211; 70.7% vs 85.7%, P=0.319）, but the specificity of the model was low （71.2% vs 96.6%, P=0.001; 71.2% vs 98.3%, P<0.001）. Conclusion:The predictive model based on ACR TI-RADS grades can predict CLNM of PTC more accurately and sensitively than traditional imaging examination.

Assessment of dietary diversity and associated factors among lactating mothers in Debub Bench District

ObjectiveTo identify dietary diversity and its associated factors among lactating women in the Debub Bench district. MethodsCross-sectional study design was conducted among 836 lactating women from January 1st to March 31st, 2019, in Debub Bench district. The outcome variable of the study was determined based on the proportion of lactating mothers who fed less than five major food groups to mothers who fed more than five major food groups out of nine (9) food groups. Lactating mothers who fed less than five of the major food groups were categorized under unacceptable dietary diversity. Data were first collected through face-to-face interviews by validated structured questionerers and then entered in Epi-data version 4.6.0.2 software. A bivariate and multivariate logistic regression analysis were later conducted using IBM SPSS version 26 software. During the analysis, multicollinearity was check by using the tolerance test and variance inflation factors (VIF), Hosmer-Lemeshow goodness of fit test was used to see model fitness, and adjusted odds ratios and their 95% confidence interval at P values ≤0.05 were considered to determine statistically significant factors. ResultA total of 836 lactating mothers had participated in the study. The response rate was 91.26%. The mean age of the participants was 29 years (SD ± 6.7). The study found that the magnitude of unacceptable dietary diversity score was 72.4% (95% CI: 69.5–75.5). The study also found that factors such as nutrition information (OR = 4, 95% CI: 2.64–6.08), absence of garden (OR = 2.35, 95% CI: 1.19–4.61), absence of latrine (OR = 6.86, 95% CI: 3.26–14.56) and household food insecurity (OR = 5.23, 95% CI: 3.64–7.46) were significantly associated with unacceptable dietary diversity. ConclusionThe finding of this study showed that information about nutrition, absence of latrine, absence of garden, and household food insecurity were significantly associated with dietary diversity. Based on the finding of the study, the following recommendations are made. First, strategies and programs targeted towards promoting dietary diversity and good health among lactating women should be made at all levels. Second, lactating mothers should be adequately provided with nutritional information. Three, mothers should be empowered to alleviate household food insecurity by leveraging their premises for gardening diversified and nutritious vegetables.

Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study.

The primary aim of this study was to evaluate the 30-day survival of nonagenarian patients who underwent non-traumatic emergency abdominal surgery. Other aims were: 90-day and 12-month survival rates, the postoperative complications rate, the impact of the emergency operation on postoperative functional status, the accuracy of the P-POSSUM in predicting 30-day postoperative mortality and changes in care services after surgery. This was a retrospective cohort study of nonagenarian patients who underwent non-traumatic emergency abdominal surgery between January 2010 and June 2017. Patients were divided in two groups according to the 30-day survival status to compare the distribution of patients' characteristics and postoperative outcomes. Overall survival was estimated using the Kaplan-Meier method. To assess the accuracy of P-POSSUM to predict 30-day mortality, a receiver operating characteristic curve and the Hosmer-Lemeshow goodness of fit test were used. 85 nonagenarian patients were enrolled in this study; of these, 27 (31.8%) died within 30days. The Kaplan-Meier curve showed a rapid decline in survival over the first 30 postoperative days, followed by a more gradual reduction during the rest of the first year. The majority of patients (92.6%) who died within 30days experienced a medical complication, with a preponderance of respiratory failure (48.2%) and multiple organ failure (33.3%). In the surviving patients, the postoperative functional status had worsened, and 64.2% of patients did not return to their original housing situation or were institutionalized. The accuracy of P-POSSUM in predicting 30-day mortality in nonagenarian patients was poor. This study may help doctors convey the postoperative risks of morbidity and mortality, and also to adequately inform relatives about the possible adverse discharge destination of surviving nonagenarian patients with a consequent increase in care needs.

Construction and efficiency analysis of prediction model for venous thromboembolism risk in the elderly after hip fracture.

To screen the risk factors for predicting venous thromboembolism (VTE) risk after hip fracture in the elderly, to establish a prediction model based on these factors, and to analyze its prediction efficacy. A total of 52 hip fracture patients over 60 years old with VTE admitted to the Department of Orthopaedic Trauma, Xiangya Hospital, Central South University from March 2017 to April 2019 were selected as a thrombus group, and another 52 hip fracture patients over 60 years old without VTE were selected as a control group. The differences of hospitalization data and examination results between the 2 groups were compared. Logistic regression model was used to explore the influence of risk factors on VTE risk after hip fracture in the elderly and construct the prediction model based on these factors. The receiver operating characteristic curve was used to analyze the predictive effectiveness of model, Hosmer-lemeshow goodness of fit test was used to evaluate the fitting degree of prediction model. Univariate analysis showed that injury-admission interval, Caprini score, WBC count, platelet count, neutrophil count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammatory index (SII), and fibrinogen in the thrombus group were higher than those in the control group (all P<0.05). Logistic regression analysis showed that injury-admission interval, Caprini score, and SII were independent predictors of VTE risk after hip fracture in the elderly. The AUC was 0.949 (95% CI 0.901 to 0.996) when the sensitivity and specificity were 82.70% and 96.20%, respectively, which were significantly higher than each single index, and the prediction model had perfect fitting degree (Hosmer-lemeshow χ2=14.078, P>0.05). SII, Caprini score, and injury-admission interval are independent predictors of VTE after hip fracture in the elderly. The prediction model based on these 3 factors has a good efficacy on the prediction of VTE risk, and could provide important reference for the prevention, management, and treatment of VTE after hip fracture in the elderly.

Inguinal hernia repair among men: development and validation of a preoperative risk score for persistent postoperative pain.

Persistent postoperative pain (PPP) is a prevalent complication after inguinal hernia repair. The aim of this study was to develop and validate a preoperative risk score for PPP. We developed the risk score based on a cohort of 2,508 Danish men, who answered a questionnaire six months after inguinal hernia repair performed 2015-2016. PPP was defined as a numerical rating scale score ≥ 2 during activity six months postoperatively. Logistic regression analyses were undertaken to determine statistically significant predictors of PPP. Univariable analysis selected potential predictors with a p value ≤ 0.20, and a subsequent multivariable model was built using backward elimination with a criterion of p value < 0.10. We created a risk score based on the β coefficients of the multivariable model. The risk score was validated internally using Hosmer-Lemeshow goodness of fit test, calibration belt test, and receiver operating characteristic curve analyses with 95% confidence intervals based on the bootstrap analysis. External validation was performed in a cohort of 293 men recruited preoperatively. Predictors of PPP were age 18-49 and 50-59 (versus ≥ 60) years (p < 0.001), total load lifted > 1,000kg/day (p = 0.001), working in a bent-over position > 1h/day (p < 0.001), leisure-time physical activity < 2h/week (p = 0.009), increasing body mass index (per unit) (p < 0.003), and repair of recurrent hernia (p = 0.001).The preoperative risk score predicted risks of 6-61% in the development population. The model showed good internal and external validity. The results suggest that the risk of PPP after inguinal hernia repair can be predicted using a preoperative risk score.

Validity of Pediatric Index of Mortality 2 score as an Outcome Predictor in Pediatric ICU of a Public Sector Tertiary Care Hospital in Pakistan.

Pediatric Index of Mortality 2 (PIM-2) is one of the leading mortality scores used in intensive care units all around the world. We assessed its validity as an outcome predictor in a pediatric intensive care unit (PICU) of Mayo Hospital/King Edward Medical University Lahore, Pakistan. We enrolled 154 consecutive admissions, aged 1 month to 13 years, requiring intensive care from January to June of 2019. Patient demographics along with PIM-2 data were collected; PIM-2 score and mortality risk was calculated; and the outcome recorded as death or survival. The median age at admission was 0.50 years (interquartile range [IQR]: 0.24-1.78) and the median weight was 5.0 kg (IQR: 3.08-10.0) with females constituting 54%; malnutrition was also common (66%). Observed mortality was 29.9% (46 out of 154) and expected mortality (cut-off ≥ 99.8%) was 27.9% with a standardized mortality ratio of 1.07 (95% confidence interval [CI]: 0.79-1.41). Sepsis was the most common diagnosis at admission (27.9%) with the highest mortality (52.2%). Chi-square analysis revealed a sensitivity of 54.3% and a specificity of 83.3% ( p -value 0.00). PIM-2 score showed acceptable discrimination between survivors and nonsurvivors with an area under the receiver operating characteristic curve of 0.75 (95% CI: 0.67-0.84) ( p -value = 0.00); however, poor calibration according to Hosmer-Lemeshow goodness of fit test (Chi-square = 15.80, df = 7, and p -value of 0.027 [< 0.1]), thus requiring recalibration according to local population characteristics.

Validation of the SORT score in greek patients with pancreatic cancer undergoing surgery and comparison with POSSUM and P-POSSUM

Introduction: The aim of the present study was to validate the Surgical Outcome Risk Tool (SORT) equation for predicting perioperative mortality in Greek adult patients with pancreatic cancer undergoing surgery, and to compare its performance with the POSSUM and Portsmouth (P)-POSSUM models. Methods: Data was prospectively collected from thirty patients undergoing surgery for pancreatic cancer performed by a single hepato-pancreato-biliary surgical team in a Greek tertiary hospital (January-October 2019). Model discrimination was assessed by calculating the Area Under Receiver Operating Characteristic curve (AUC). The calibration was evaluated by calculating the observed to expected (O:E) ratios and by performing the Hosmer-Lemeshow goodness of fit test. Results: Two patients (6.7%) died and 5 patients (16.7%) had a major complication within 30 days of surgery. All models overpredicted mortality. SORT had fair discrimination and calibration (AUC: 0.759, p=0.23; H-L: 3.947, p=0.68). POSSUM had the most reliable discrimination (AUC: 0.982, p=0.02) and calibration (H-L: 0.3169, p>0.99). P-POSSUM had also excellent accuracy (AUC: 0.964, p=0.03; H-L: 0.939, p=0.99). Conclusion: All models overestimated mortality. SORT presented inferior discrimination and calibration compared to POSSUM and P-POSSUM in the context of predicting mortality in Greek patients with pancreatic cancer undergoing surgery.

An Epithelial-Mesenchymal Transition (EMT) Preoperative Nomogram for Prediction of Lymph Node Metastasis in Bladder Cancer (BLCA).

Lymph node (LN) metastasis is a lethal independent risk factor for patients with bladder cancer (BLCA). Accurate evaluation of LN metastasis is of vital importance for disease staging, treatment selection, and prognosis prediction. Several histopathologic parameters are available to predict LN metastasis postoperatively. To date, medical imaging techniques have made a great contribution to preoperatively diagnosis of LN metastasis, but it also exhibits substantial false positives. Therefore, a reliable and robust method to preoperatively predict LN metastasis is urgently needed. Here, we selected 19 candidate genes related to epithelial-mesenchymal transition (EMT) across the LN metastasis samples, which was previously reported to be responsible for the subtype transition and correlation with malignancy and prognosis of BLCA, to establish an EMT-LN signature through LASSO logistic regression analysis. The EMT-LN signature could significantly predict LN metastasis with high accuracy in the TCGA-BLCA cohort, as well as several independent cohorts. As integrating with C3orf70 mutation, we developed an individualized prediction nomogram based on the EMT-LN signature. The nomogram exhibited good discrimination on LN metastasis status, with AUC of 71.7% and 75.9% in training and testing datasets of the TCGA-BLCA cohort. Moreover, the EMT-LN nomogram displayed good calibration with p > 0.05 in the Hosmer-Lemeshow goodness of fit test. Decision curve analysis (DCA) revealed that the EMT-LN nomogram was of high potential for clinical utility. In summary, we established an EMT-LN nomogram integrating an EMT-LN signature and C3orf70 mutation status, which acted as an easy-to-use tool to facilitate preoperative prediction of LN metastasis in BLCA individuals.

S0622 Upper Endoscopic Outcomes in High MELD Patients Undergoing Inpatient Transplant Evaluation

INTRODUCTION: Patients with cirrhosis have increased risks of bleeding related to portal hypertension (including esophageal varices, and portal hypertensive gastropathy), as well coagulopathy from hepatic dysfunction, thrombocytopenia, and impaired INR. There is limited data evaluating the upper endoscopy outcomes of interventions in patient with increased MELD scores, or those undergoing transplant evaluation. Our aims were to determine upper endoscopy outcomes of intra-procedure bleeding, post-procedure bleeding, and IR intervention in patients undergoing inpatient liver transplant evaluations at a single high-volume liver transplant center. METHODS: Retrospective review of patients who underwent inpatient liver transplant evaluation at a single high-volume center were evaluated between January 2017 and July 2019, with 235 patients identified. 62 of those required an inpatient upper endoscopy as a part of their transplant evaluation. Univariate analysis with Pearson Chi-squared or ANOVA was performed. Multivariate logistic model selection was performed using AIC. The final logistic model utilized MELD, INR, platelets, and banding to predict the probability of intra or post-procedure bleeding after endoscopies during urgent liver transplant evaluation. The model was tested using the Hosmer-Lemeshow goodness of fit test. A P-value of 0.05 was considered statistically significant. RESULTS: Of sixty-two patients who underwent upper endoscopy, 9 were noted to have intra-procedure or post-procedure bleeding. Of those 9 patients that bled, 6 were related to varices, and 1 patient required an interventional radiology procedure for hemostasis. While not statistically significant, 7 of the patients with procedure-related bleeding had underlying alcoholic cirrhosis (P = 0.089). Univariate MELD differences between the two groups were not significant (P = 0.40) with group means of 23.39 for the outcome group and 20.33 for the non-outcome group. On multivariate analysis (Table 1), a platelet count > 100 demonstrated a statistically significant 0.10 times decreased odds of bleeding (P = 0.035). MELD, INR, and banding were not significant on multivariate analysis. CONCLUSION: Based on our single center results, we have demonstrated that performing upper endoscopies in patients with a high MELD can be done safely. Those with a platelet count below 100 may have a slightly increased risk of bleeding based on multivariate analysis. A larger sample size is needed to evaluate these findings along with external validation.Table 1

Desarrollo y validación interna de un modelo de predicción clínica del riesgo de infección bacteriana nosocomial en pacientes con lupus eritematoso sistémico

IntroductionPatients with systemic lupus erythematosus (SLE) have an increased risk of developing community-acquired infections, as well as those associated with health care. Bacterial infections are the most common and serious while these patients are in hospital. ObjectiveTo develop, and internally validate, a clinical prediction model for the prognosis of the risk of hospital-acquired bacterial infection in SLE patients using clinical and laboratory data obtained during the first hours of hospital admission. MethodsAn analysis was performed on retrospective cohort of patients with SLE older than 16 years and admitted for reasons other than bacterial infection in 2 highly complex hospitals in Medellín between 2011 and 2016. The characteristics of the patients who developed a bacterial infection were compared between day 3 and day 15 of hospital admission with those who did not develop one. The significant variables in the bivariate analysis were used for the construction of the model using multivariate logistic regression. ResultsA total of 765 episodes were included, of which 98 (12.8%) presented the outcome of interest. Thirty-five candidate predictors were considered. The variables incorporated in the final model were: age, neutrophil count, SLEDAI lupus activity score, use of a bladder catheter, use of a central venous catheter in the first 72h, glucocorticoid doses in the previous month, and use of an antimalarial drug in the 3 previous months. The discrimination capacity of the model was acceptable to good (AUC-ROC 0.74; 95% CI 0.69-0.80). The Hosmer-Lemeshow goodness of fit test (P=.637) suggested adequate calibration. ConclusionA clinical prediction model of prognostic risk of nosocomial bacterial infection in patients with SLE has been developed. This model is made up of simple clinical and laboratory variables available at the time of hospital admission. External validation and clinical impact studies are required before routine implementation.

Validation of the CASUS score in Tunisian patients: a quality management tool in intensive care units

Abstract Background Early prediction of patients at highest risk of a poor outcome after cardiovascular surgery, including death can aid medical decision making, and adapt health care management in order to improve prognosis. In this context, we conducted this study to validate the CASUS severity score after cardiac surgery in the Tunisian population. Methods This is a retrospective cohort study conducted among patients who underwent cardiac surgery under extracorporeal circulation during the year 2018 at the Cardiovascular Surgery Department of La Rabta University Hospital in Tunisia. Data were collected from the patients hospitalization records. The discrimination of the score was assessed using the ROC curve and the calibration using the Hosmer-Lemeshow goodness of fit test and then by constructing the calibration curve. Overall correct classification was also obtained. Results In our study, the observed mortality rate was 10.52% among the 95 included patients. The discriminating power of the CASUS score was estimated by the area under the ROC curve (AUC), this scoring system had a good discrimination with AUC greater than 0.9 from postoperative Day 0 to Day 5.From postoperative day 0 to day 5, the Hosmer-Lemeshow's test gave a value of chi square test statistic ranging from 1.474 to 8.42 and a value of level of significance ranging from 0.39 to 0.99 indicating a good calibration. The overall correct classification rate from postoperative day 0 to day 5 ranged from 84.4% to 92.4%. Conclusions Despite the differences in the profile of the risk factors between the Tunisian population and the population constituting the database used to develop the CASUS score, we can say that this risk model presents acceptable performances in our population, attested by adequate discrimination and calibration. Prospective and especially multicentre studies on larger samples are needed before definitively conclude on the performance of this model in our country. Key messages The casus score seems to be valid to predict mortality among patients undergoing cardiac surgery. Multicenter study on larger sample is needed to derive and validate models able to predict in-hospitals mortality.

A nomogram to predict skip metastasis in papillary thyroid cancer

BackgroundSkip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients.Patients and methodsA total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated.ResultsThe incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342–5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017–1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710–17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736–0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful.ConclusionBased on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.

Determinants of virological failure among adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia: a case–control study

ObjectiveTo identify determinants of virological failure among HIV-infected adults on first-line highly active antiretroviral therapy at public health facilities in Kombolcha town, Northeast, Ethiopia, in 2019.MethodsAn unmatched case–control study was...

Determinants Of Subjective Well-Being: Evidence Of Urban Indonesia

Happiness studies on economics have increasingly arisen since the uprising of the Easterlin Paradox phenomenon. Besides its populous side, the urban area has more complicated problems than rural. This research aims to analyze the determinants of happiness in urban Indonesia. We use the latest data from the Happiness Measurement Survey 2017 conducted by the BPS-Statistic Agency of Indonesia. Taking 30,665 observations, we apply the Ordered Logit Estimation technique (including G2-likelihood ratio test, Wald statistical test, and Hosmer-Lemeshow goodness of fit test) to analyze the determinants of happiness. We found that Easterlin Paradox does not exist in urban area Income, education, health, marrying, internal-external relationship, a satisfying job, positive feeling, and a meaningful life have a positive impact on happiness. Generally, these findings support some previous studies' findings.

Development and validation of a risk score for predicting mortality after resection of primary hepatocellular carcinoma.

Background: Primary hepatocellular carcinoma (PHCC) has a poor prognosis and high short-term mortality rate, even after resection. Thus, early diagnosis in PHCC cases can help improve quality of life via personalized management strategies.Results: The risk score system (RSS) were classified as low risk (<5 points), medium risk (5–10 points), or high risk (>10 points). The areas under the receiver operating characteristic curves were 0.80 in the training cohort and 0.69 in the validation cohort, which indicated satisfactory prognostic performance. The Hosmer-Lemeshow goodness of fit test (P>0.05) revealed consistent performance in both groups. The concordance index (C-index: 0.663, 95% CI: 0.618–0.708) revealed excellent discrimination and good calibration in the validation cohort.Conclusions: This simple RSS, which is based on clinical and laboratory data from patients undergoing resection of PHCC, might allow clinicians and medical staff to better manage PHCC.Materials and Methods: A total of 672 PHCC cases were retrospectively obtained from the First Affiliated Hospital of Wenzhou Medical University between January 2007 and February 2015. Cox proportional hazard models were used to identify independent predictors of mortality. Kaplan-Meier curves and the log-rank test were used to examine the relationships between the prognostic factors and overall mortality.

Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser En Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial

BACKGROUND: Ongoing efforts aim at overcoming the challenges of conventional transurethral resection of bladder tumor (TURBT) such as the high recurrence rate, difficulty of pathologic interpretation and complications including wall injury. OBJECTIVE: To prospectively assess the safety and efficacy of Thulium fiber en bloc resection of bladder tumor (Tm-fiber ERBT) compared to TURBT. MATERIALS AND METHODS: The prospective non-randomized study included 129 patients with non-muscle-invasive bladder cancer (NMIBC) divided into two groups: 58 patients underwent conventional TURBT and 71 –Tm-fiber ERBT with FiberLase U1 (NTO IRE-Polus, Russia). Relapse-free survival (RFS), detrusor presence and complication rates were assessed. For multivariable analysis we used the Pearson chi-squared Hosmer-Lemeshow goodness of fit test; to compare survival –Cox regression analysis; for operative data comparison –chi-square test with Fisher’s correction; for survival analysis –the Kaplan–Meier method and logrank test. RESULTS: RFS rates at 3 and 6 months were 84.5% and 67.2% for conventional TURBT versus 97.2% and 91.5% for Tm-fiber ERBT (p = 0.011 and p &lt; 0.001, respectively). Detrusor muscle was present in 58.6% of cases treated with conventional TURBT vs 91.6% for the Tm-fiber ERBT group (p &lt; 0.001). The obturator nerve reflex and bleeding were noted in 17.2% and 10.3% of TURBT cases, respectively; and in none of cases treated with Tm-fiber ERBT. Limitations included the non–randomized nature and the small sample size. CONCLUSIONS: Tm-fiber ERBT seems to be a safe and efficacious treatment option for NMIBC. Tm-fiber ERBT had fewer adverse events, was more likely to secure detrusor muscle in the specimen and resulted in better RFS rates than conventional TURBT. Based on these promising data, we have started a prospective randomized clinical trial comparing en bloc TURBT with conventional TURBT (ClinicalTrials.gov NCT03718754).