Novel Scoring System For Predicting Research Articles

Accuracy of a Novel Scoring System for Prediction of Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer Patients

Background: Neoadjuvant chemotherapy (NAC) has become a widely accepted treatment option for locally advanced breast cancer (LABC). Furthermore, response to NAC is considered to be a predictor of favorable outcomes. It is known that some predictors are associated with NAC response. 
 Objectives: To assess the accuracy of scoring system for prediction of response to neoadjuvant chemotherapy in LABC.
 Methods: Medical record of 50 patients received NAC at Mohammad Hoesin Hospital were retrospectively analysed between July 2019 to July 2020. Response of NAC in LABC was determined with Response Evaluation Criteria in Solid Tumours (RECIST). Variables of the scoring system are risk factors of breast cancer, immunohistochemical subtype, CD4+, CD8+, CD4+/CD8+ ratio, and neutrophil to lymphocyte ratio.
 Results: A total of 50 patients with LABC received and completed NAC. The mean age was 48.2 ± 11.0 at the time of diagnosis. Good response to NAC was achieved in 38 patients (76.0%). This scoring system shows a sensitivity of 77.8%, a specificity of 83.3%, a positive predictive value of 18.4%, and a negative predictive value of 24.4% with the Youden index of 66.1. The combination between less than three parity and positive estrogen receptor demonstrated better accuracy with a sensitivity of 96.3% and specificity of 77.7% and Youden index 74.
 Conclusion: This pilot study suggests that this scoring system is potentially useful for predicting response to neoadjuvant chemotherapy in LABC patients and warrants further investigation in a larger population to validate this finding.

A Novel Scoring System for Prediction of Disease Severity in COVID-19.

Background: A novel enveloped RNA beta coronavirus, Corona Virus Disease 2019 (COVID-19) caused severe and even fetal pneumonia in China and other countries from December 2019. Early detection of severe patients with COVID-19 is of great significance to shorten the disease course and reduce mortality.Methods: We assembled a retrospective cohort of 80 patients (including 56 mild and 24 severe) with COVID-19 infection treated at Beijing You'an Hospital. We used univariable and multivariable logistic regression analyses to select the risk factors of severe and even fetal pneumonia and build scoring system for prediction, which was validated later on in a group of 22 COVID-19 patients.Results: Age, white blood cell count, neutrophil, glomerular filtration rate, and myoglobin were selected by multivariate analysis as candidates of scoring system for prediction of disease severity in COVID-19. The scoring system was applied to calculate the predictive value and found that the percentage of ICU admission (20%, 6/30) and ventilation (16.7%, 5/30) in patients with high risk was much higher than those (2%, 1/50; 2%, 1/50) in patients with low risk (p = 0.009; p = 0.026). The AUC of scoring system was 0.906, sensitivity of prediction is 70.8%, and the specificity is 89.3%. According to scoring system, the probability of patients in high risk group developing severe disease was 20.24 times than that in low risk group.Conclusions: The possibility of severity in COVID-19 infection predicted by scoring system could help patients to receiving different therapy strategies at a very early stage.Topic: COVID-19, severe and fetal pneumonia, logistic regression, scoring system, prediction.

A Novel Scoring System for Prediction of Prostate Cancer Based on Shear Wave Elastography and Clinical Parameters

To develop a novel scoring system for the prediction of prostate cancer (PCa). We assessed 127 patients who underwent a prostate biopsy. Prior to biopsy, we performed shear wave elastography (SWE), transrectal ultrasound, digital rectal exam, total prostatic specific antigen, PSA density (PSAD), and free PSA/total PSA ratio (F/T). We developed an 11-point scoring system based on SWE and these clinical parameters. PCa was diagnosed in 51 (40.2%) of 127 patients and 192 (25.2%) of 762 sextants on initial biopsy. ROC curve analyses showed that the cutoff value (COV) for SWE was 40.8 kpa at the sextant level. The AUC of score system based on the SWE and clinical parameters (0.911) was significantly different from scoring systems based on SWE alone (0.842) or clinical parameters alone (0.868). For this 11-point scoring system, the optimal COV, Youden index, sensitivity, specificity, PPV, NPV, and AUC were 3 points, 0.66, 76.5% 89.5%, 82.98%, 85.00%, and 0.911, respectively. There were 68 negative biopsy results in patients with 0-3 points, and the detection rate of PCa was 100% in patients with scores exceeding 6 points. This 11-point scoring system based on SWE and clinical parameters has the good diagnostic performance for predicting PCa. It may be useful in selecting patients for biopsy, substantially reducing the number of unnecessary biopsies while ensuring that few cancers are missed.

Novel Scoring System for Prediction of Cardiac Syndrome X in Women with Typical Angina and a Positive Exercise Tolerance Test.

A major diagnostic challenge for cardiologists is to distinguish cardiac syndrome X (CSX) from obstructive coronary artery disease in women with typical angina and a positive exercise tolerance test (ETT). We performed this study to develop a scoring system that more accurately predicts CSX in this patient population. Data on 976 women with typical angina and a positive ETT who underwent coronary angiography at our center were randomly divided into derivation and validation datasets. We developed a backward stepwise logistic regression model that predicted the presence of CSX, and a scoring system was derived from it. The derivation dataset (809 patients) was calibrated by uing a Hosmer-Lemeshow goodness-of-fit test (8 degrees of freedom; χ2=12.9; P=0.115), and the area under the curve was 0.758. The validation dataset (167 patients) was calibrated in the same way (8 degrees of freedom; χ2=9.0; P=0.339), and the area under the curve was 0.782. Independent predictors of CSX were age <55 years; negative histories of smoking, diabetes mellitus, hyperlipidemia, hypertension, or familial premature coronary artery disease; and highly positive ETTs. A total score >9.5 was the optimal cutoff point for differentiating CSX from obstructive coronary artery disease. Our proposed scoring system is a simple, objective, and accurate system for distinguishing CSX from obstructive coronary artery disease in women with typical angina and positive ETTs. It may help determine which of these patients need invasive coronary angiograms or noninvasive tests like computed tomographic coronary angiography.

A novel scoring system for prediction of esophageal varices in critically ill patients.

Background and aimsPatients with advanced systemic illness or critically ill patients may present with upper gastrointestinal tract (GIT) bleeding which may need endoscopic intervention; however, this may expose them to unnecessary endoscopy. The aim was to validate a novel scoring system for risk stratification for urgency of GIT endoscopy in critically ill patients.MethodsThis is an observational study conducted from January 2013 to January 2016 to analyze 300 patients with critical medical conditions and presenting with upper gastrointestinal bleeding. Meticulous clinical, laboratory, and sonographic evaluations were performed to calculate Glasgow Blatchford score (GBS) and variceal metric score for risk stratification and prediction of the presence of esophageal varices (OV). Finally, this score was applied on a validation group (n=100).ResultsThe use of GBS and variceal metric scores in critically ill patients revealed that patients who showed a low risk score value for OV (0–4 points) and GBS <2 can be treated conservatively and discharged safely without urgent endoscopy. In patients with a low risk for varices but GBS >2, none of them had OV on endoscopy. In patients with intermediate risk score value for OV (5–8 points) and with GBS >2, 33.33% of them had varices on endoscopy. In patients with high risk score value for varices (9–13) and GBS >2, endoscopy revealed varices in 94.4% of them. Finally, in patients with very high risk score for varices (14–17), endoscopy revealed varices in 100% of them.ConclusionGBS and variceal metric score were highly efficacious in identifying critically ill patients who will benefit from therapeutic endoscopic intervention.

P0193 : A novel scoring system for prediction of Contrast Induced Nephropathy In Cirrhosis - The ’CINIC score’

Background and Aims: Contrast induced nephropathy (CIN) is described in patients undergoing interventional cardiac procedures and a grading system for the same has been in use. The predictors of development of CIN in cirrhotics (CP) has not been studied adequately. It is well known that CP have low creatinine (Cr) clearance and renal reserve and maybe at risk, to develop CIN. We devised a novel scoring system (Contrast Induced Nephropathy In Cirrhosis, CINIC score) to predict CIN in CP using a derivative group (DG) which was validated in a separate cohort (VG). Methods: DG of 350 CP [M=281, F = 69; alcohol = 86, HBV=190, others = 74] with or without decompensation undergoing contrast enhanced computed tomography [CECT, Omnipaque 300 (Iohexol, 1ml/kg; 300mg/ml Iodine)], of abdomen were prospectively studied for development of CIN. CIN was defined as an absolute increase of 0.5mg/dL Cr from baseline or increase in Cr >25% within 48 to 72hrs. Independent risk factors were identified on multivariate analysis, a score derived, based on regression coefficient values rounded for each variable, providing a total score. This was validated in independent VG of 150 CP undergoing CECT. Results: 39 (11.1%) patients developed CIN. On univariate analysis severity of ascites (p 6.2mg/dL, Sen 60%), DM & HTN, 2 each, and CTP 4 (>11, Sen 93%), for a total score of 9. Prediction of CIN was made at a total score of ≥4.5, rounded off to 5 [sensitivity 84%, specificity 76%, AUROC 0.889 (95%CI 0.845–0.933), p < 0.001]. Patients in DG and VG were comparable. In VG, CINIC score predicted CIN with AUROC 96.3 (Sen 80%, Spe 90.4%, PPV 48%, NPV 97.6%). Coordinates of the ROC curve

The Predictive Value of Kidney Allograft Baseline Biopsies for Long-Term Graft Survival

The effect of baseline histology and individual histologic lesions at the time of transplantation on long-term graft survival has been evaluated using different scoring systems, but the predictive capacity of these systems has not been adequately validated. All kidney recipients transplanted in a single institution between 1991 and 2009 who underwent a baseline kidney allograft biopsy at transplantation were included in this prospective study (N=548). All baseline biopsies were rescored according to the updated Banff classification, and the relationship between the individual histologic lesions and donor demographics was assessed using hierarchical clustering and principal component analysis. Survival analysis was performed using Cox proportional hazards analysis and log-rank testing. Mean follow-up time was 6.7 years after transplantation. Interstitial fibrosis, tubular atrophy, and glomerulosclerosis associated significantly with death-censored graft survival, whereas arteriolar hyalinosis and vascular intimal thickening did not. Notably, donor age correlated significantly with interstitial fibrosis, tubular atrophy, and glomerulosclerosis and associated independently with graft survival. On the basis of these findings, a novel scoring system for prediction of 5-year graft survival was constructed by logistic regression analysis. Although the predictive performance of previously published histologic scoring systems was insufficient to guide kidney allocation in our cohort (receiver operating characteristic area under the curve ≤0.62 for each system), the new system based on histologic data and donor age was satisfactory for prediction of allograft loss (receiver operating characteristic area under the curve = 0.81) and may be valuable in the assessment of kidney quality before transplantation.

Not All Histological Damage in Baseline Biopsies Is Deleterious for Renal Allograft Survival

Introduction: The impact of baseline histology and of the individual histological lesions at time of transplantation on long-term graft survival is not well known. Methods: All kidney recipients who were transplanted between 1991 and 2009, and who underwent a baseline biopsy at time of transplantation, were included in this prospective study (N=548). These biopsies were not used to guide kidney allocation. All baseline biopsies were rescored according to the current updated Banff classification. The relationship between the individual histological lesions was assessed using hierarchical clustering and principal component analysis. Survival analysis was performed using Cox proportional hazards analysis and log-rank testing. Mean follow-up time was 6.7±3.3 years. Results: Interstitial fibrosis (ci; p=0.0001), tubular atrophy (ct; p=0.05) and glomerulosclerosis (gs; p< 0.0001) predict death-censored graft survival, while arteriolar hyalinosis (ah; p=0.4) and vascular intimal thickening (cv; p=0.9) did not. Donor age proved to be a highly significant explanatory factor for ci, ct and gs (p=0.0001) and is independently associated with graft survival. Donor age did not correlate with ah (p=0.08) and cv (p= 0.1). In principal component analysis, we confirmed the dichotomy in the histological lesions at baseline, and the association with donor age (Figure A). Based on these findings, a novel scoring system for prediction of 10-year graft survival was calculated by using logistic regression analysis. This score predicted death-censored graft survival (p=0.0004) better than previously proposed and often used scoring systems (Remuzzi score p=0.03); Pirani score p=0.01).Figure: [Graphs]Conclusion: There is a clear dichotomy between the histological lesions in baseline biopsies. While age-associated lesions are highly significantly associated with graft survival, arteriolar hyalinosis and atherosclerosis in donor biopsies are not associated with survival. This dichotomy should be taken into account when evaluating baseline biopsies for kidney allocation and in algorithms to predict transplantation outcome.

Not All Histological Damage in Baseline Biopsies Is Deleterious for Renal Allograft Survival

Introduction: The impact of baseline histology and of the individual histological lesions at time of transplantation on long-term graft survival is not well known. Methods: All kidney recipients who were transplanted between 1991 and 2009, and who underwent a baseline biopsy at time of transplantation, were included in this prospective study (N=548). These biopsies were not used to guide kidney allocation. All baseline biopsies were rescored according to the current updated Banff classification. The relationship between the individual histological lesions was assessed using hierarchical clustering and principal component analysis. Survival analysis was performed using Cox proportional hazards analysis and log-rank testing. Mean follow-up time was 6.7±3.3 years. Results: Interstitial fibrosis (ci; p=0.0001), tubular atrophy (ct; p=0.05) and glomerulosclerosis (gs; p< 0.0001) predict death-censored graft survival, while arteriolar hyalinosis (ah; p=0.4) and vascular intimal thickening (cv; p=0.9) did not. Donor age proved to be a highly significant explanatory factor for ci, ct and gs (p=0.0001) and is independently associated with graft survival. Donor age did not correlate with ah (p=0.08) and cv (p= 0.1). In principal component analysis, we confirmed the dichotomy in the histological lesions at baseline, and the association with donor age (Figure A). Based on these findings, a novel scoring system for prediction of 10-year graft survival was calculated by using logistic regression analysis. This score predicted death-censored graft survival (p=0.0004) better than previously proposed and often used scoring systems (Remuzzi score p=0.03); Pirani score p=0.01).Figure: [Graphs]Conclusion: There is a clear dichotomy between the histological lesions in baseline biopsies. While age-associated lesions are highly significantly associated with graft survival, arteriolar hyalinosis and atherosclerosis in donor biopsies are not associated with survival. This dichotomy should be taken into account when evaluating baseline biopsies for kidney allocation and in algorithms to predict transplantation outcome.

Identification of factors predictive of malignancy in patients with atypical biliary brushing results obtained via ERCP

Biliary brushings obtained during ERCP can have one of three cellular interpretations: benign, malignant, or "atypical." Atypical interpretations usually result in further testing, and may cause controversy over management and increases in cost. We evaluated a large cohort of patients with atypical biliary brushings for analysis and risk stratification. All biliary brushing specimens collected between January 1, 2001 and December 31, 2010 that had an atypical result were included. Hospital electronic records were reviewed for these patients to include: demographics, indication for ERCP, endoscopist/pathologist impressions, serologic testing, stricture site, and information relating to the final clinical diagnosis. Eighty-six patients were included. Totally, 60/86 patients (70%) had malignancies while 26/86 (30%) had no evidence of malignancy during long term follow up. Univariate analysis showed that the risk of malignant outcomes was significantly associated with older age, suspicious/malignant endoscopic impression, pancreatic mass, indications including jaundice and/or dilated bile ducts, stricture location within the common bile duct, PSC, and CA 19-9 levels >300 U/mL. We created a novel scoring system for prediction of malignancy based on clinical and endoscopic factors. We identified parameters that are typically available to the clinician to categorize patients with an "atypical" bile duct brushing results into "high risk" and "lower risk" classifications. Our proposed scoring system would allow such risk stratification to take place.