Predictive Power Of Risk Factors Research Articles

Impact of age and tumor size on the development of the Kasabach-Merritt phenomenon in patients with kaposiform hemangioendothelioma: a retrospective cohort study.

The Kasabach-Merritt phenomenon (KMP) is a severe complication of kaposiform hemangioendothelioma (KHE). The risk factors for KMP need further investigation. The medical records of patients with KHE were reviewed. Univariate and multivariate logistic regression models were used for the risk factors for KMP, and the area under the receiver operator characteristic (ROC) curve was used to assess the predictive power of risk factors. A total of 338 patients with KHE were enrolled. The incidence of KMP was 45.9%. Age of onset (P<0.001, odds ratio [OR] 0.939; 95% confidence interval [CI] 0.914-0.966), lesion size (P<0.001, OR 1.944; 95% CI 1.646-2.296), mixed type (P=0.030, OR 2.428; 95% CI 1.092-5.397), deep type (P=0.010, OR 4.006; 95% CI 1.389-11.556), and mediastinal or retroperitoneal lesion location (P=0.019, OR 11.864; 95% CI 1.497-94.003) were correlated with KMP occurrence through multivariate logistic regression. ROC curve analysis revealed that the optimal cutoffs were 4.75 months for the age of onset (P<0.001, OR 7.206, 95% CI 4.073-12.749) and a lesion diameter of 5.35 cm (P<0.001, OR 11.817, 95% CI 7.084-19.714). Bounded by a lesion size of 5.35 cm, we found significant differences in tumor morphology, age of onset, treatments, and hematological parameters. Using an onset age of 4.75 months as a cutoff, we found significant differences in tumor morphology, lesion size, hematological parameters, and prognosis. For KHE patients with an onset age<4.75 months and/or lesion diameter>5.35 cm, clinicians should be wary of the occurrence of KMP. Active management is recommended to improve the prognosis.

Practical Model for Residual/Recurrent Cervical Intraepithelial Lesions in Patients with Negative Margins after Cold-Knife Conization.

Objective: This study aimed to identify reliable risk factors for residual/recurrent cervical intraepithelial lesions in patients with negative margins after cold-knife conization. Methods: A total of 2352 women with HSILs (high-grade squamous intraepithelial lesions) with negative margins who underwent cold-knife conization between January 2014 and December 2020 were included; in total, 1411 women were assigned to the development cohort, and 941 women were assigned to the validation cohort. Multivariate logistic regression was used to build four predictive models based on the different combinations of follow-up data (Model A: preoperative factors; Model B: first-follow-up data; Model C: second-follow-up data; Model D: data from both follow-ups). The accuracy, sensitivity, specificity, false-positive rate (FPR), false-negative rate (FNR), and area under the receiver operating characteristic curve (AUC) were evaluated on the validation cohort. The predictive power of risk factors was further validated using six machine learning algorithms. Results: Model D demonstrated the highest AUC of 0.91 (95% CI, 0.87 to 0.96) in the validation cohort, whereas Models A, B, and C achieved AUCs of 0.69 (95% CI, 0.59 to 0.78), 0.88 (95% CI, 0.80 to 0.95), and 0.89 (95% CI, 0.81 to 0.97) respectively. The six machine learning methods achieved consistent results. Kaplan-Meier (KM) survival curves demonstrated that our models could effectively stratify patients with all models (p < 0.05 for all models). Conclusion: Our model, which is based on preoperative and follow-up factors, can serve as a complementary screening procedure for the early detection or prediction of recurrence after cold-knife conization in HSIL patients.

32295 Looking beyond scalp hair loss: Factors influencing dermatologists’ assessment of alopecia areata severity

Background: Severity criteria for AA currently rely on extent of scalp hair loss (HL) without formally assessing other relevant factors that may influence disease severity. Objective: Identify factors beyond extent (percent) of scalp HL that are associated with dermatologist assessed AA severity. Methods: Real-world data from a 2019 cross-sectional survey of US dermatologists and their adult AA patients were analyzed. Dermatologists provided assessments of patients’ clinical characteristics. Two methodologies were used to evaluate the predictive power of risk factors including percent scalp HL: classification and regression tree (CART) and multinomial logistic regression (MLR) models. Seven domains of dermatologist-reported risk factors were sequentially tested: HL percent, patient impairments, disease/treatment history, demographics, dermatologist treatment satisfaction, comorbidities, and dermatologist characteristics. Results: Patients’ (n = 442) mean (SD) age was 39.3 (13.8) years, time since diagnosis was 4.5 (7.5) years, 51% female. Patient’s AA severity as assessed by the dermatologist was 20% mild, 53% moderate and 27% severe. CART identified percent scalp HL as the primary differentiator between Mild (0-10%), Moderate (11-40%) and Severe (≥41%) AA; treatment success was an additional predictor that differentiated between mild and moderate severity. In MLR, scalp HL was the most important risk factor (generalized R-sq = 60% out of 70% in the final model). Additional differentiating factors included fear of recurrence and day-to-day activity impairment. Conclusions: Although dermatologists’ assessment of AA severity primarily relies on extent of scalp HL, it is also influenced by a combination of physician-related (treatment success) and patient-related (fear of recurrence and activity impairment) factors.

The relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes in Iran

AimsThis study aimed to investigate the relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes. MethodsThis descriptive-analytical study was conducted using the merging data from two prospective cohort studies that were carried out from 2015 to 2018 in Ahvaz, southwest of Iran. Logistic regression and ROC curves were used to evaluate the predictive power of risk factors. ResultsOf all 1270 pregnant women studied, 454 (35.75%) had gestational diabetes who were compared with the other 816 (64.25%) healthy women. The area under the curve (AUC) of fasting glucose for the first pregnancy visit was 0.80 (95% CI: 0.76–83), and the optimum fasting glucose cut-off point was 85.5 mg/dL with a sensitivity of 71% and a specificity of 69%. AUC of the combination of fasting glucose at the first visit with body mass index ≥25 kg/m2 and family history of diabetes was calculated to be 0.85 (CI, 0.82–0.88) and 0.84 (CI, 0.79–0.89) respectively. ConclusionFasting plasma glucose in the first trimester of pregnancy is a relatively good predictor of gestational diabetes. If this factor is combined with other risks, its diagnostic value will increase.

Excess weight loss is a vital strategy for controlling hypertension among multi-ethnic population in northwest China: A cross-sectional analysis.

Hypertension is a common global health problem including China. This study aimed to assess the prevalence and awareness of hypertension, and evaluate risk factors associated with hypertension among multi-ethnic population in northwest China using a random sampling cross-sectional data.A cross-sectional survey was conducted between 2014 and 2015 as part of a nationwide survey using stratified four-stage random sampling in Xinjiang. Hypertension was defined as mean systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥140/90 mm Hg and/or taking anti-hypertensive medication. In addition, the prevalence of hypertension (SBP ≥ 130 or DBP ≥ 80 mm Hg) was also estimated according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) High Blood Pressure Guideline. Awareness of hypertension was based on self-report. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on hypertension.Totally 6722 subjects aged ≥18 years were enrolled and prevalence of hypertension was 24.3%, while the prevalence of hypertension based on the 2017 ACC/AHA guideline was approximately twice as high as that based on 2010 Chinese guideline (37.6%). Among individuals with hypertension, 55.5% were aware of their condition. Six potential factors were estimated to be associated with increased risk of hypertension including age, ethnicity, marital status, body mass index (BMI), waistline circumference, and comorbidity. In the analyses of calculated risk score, BMI ≥ 28.0 corresponded to the highest risk score of 23 points. The area under the receiver operation curve for the multivariable prediction model was 0.803 (95%CI: 0.789-0.813).There is a considerable prevalence of hypertension among Xinjiang adults, northwest China; awareness of hypertension is low. Excess weight loss may be a vital strategy for controlling hypertension, particularly if accompanied with other preventive measures in this region.

Self-reported hypertension in Northern China: a cross-sectional study of a risk prediction model and age trends

BackgroundHypertension is a major risk factor for the global burden of disease, particularly in countries that are not economically developed. This study aimed to evaluate risk factors associated with self-reported hypertension among residents of Inner Mongolia using a cross-sectional study and to explore trends in the rate of self-reported hypertension.MethodsMulti-stage stratified cluster sampling was used to survey 13,554 participants aged more than 15 years residing in Inner Mongolia for the 2013 Fifth Health Service Survey. Hypertension was self-reported based on a past diagnosis of hypertension and current use of antihypertensive medication. Adjusted odds risks (ORs) of self-reported hypertension were derived for each independent risk factor including basic socio-demographic and clinical factors using multivariable logistic regression. An optimized risk score model was used to assess the risk and determine the predictive power of risk factors on self-reported hypertension among Inner Mongolia residents.ResultsDuring study period, self-reported hypertension prevalence was 19.0% (2571/13,554). In multivariable analyses, both female and minority groups were estimated to be associated with increased risk of self-reported hypertension, adjusted ORs (95% CI) were 1.22 (1.08, 1.37) and 1.66 (1.29, 2.13) for other minority compared with Han, increased risk of self-reported hypertension prevalence was associated with age, marital status, drinking, BMI, and comorbidity. In the analyses calculated risk score by regression coefficients, old age (≥71) had a score of 12, which was highest among all examined factors. The predicted probability of self-reported hypertension was positively associated with risk score. Of 13,421 participants with complete data, 284 had a risk score greater than 20, which corresponded to a high estimated probability of self-reported hypertension (≥67%).ConclusionsSelf-reported hypertension was largely related to multiple clinical and socio-demographic factors. An optimized risk score model can effectively predict self-reported hypertension. Understanding these factors and assessing the risk score model can help to identify the high-risk groups, especially in areas with multi-ethnic populations.

Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study

ObjectivesTo evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients. MethodA retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n=90) and a control group without pressure ulcers (n=90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model. ResultsThe risk factors that predicted pressure ulcers were friction (OR=5.97), previous history of pressure ulcers (OR=5.43), prolonged intensive care unit stay (OR=3.92), dehydration (OR=3.18), elevated skin temperature by 1–2°C (OR=3.12) and treatment of other comorbidities (OR=2.79). ConclusionAdult intensive care patients have an increased risk of developing a pressure ulcer. These risk factors are regarded as strong predictors for pressure ulceration. This study advances nursing knowledge in that it investigates additional risk factors for the development of pressure ulcers and it identifies a set of factors that best predict their occurrence, which may contribute to the nurses' diagnostic reasoning in the intensive care unit.

Risk and protective factors for antepartum and postpartum depression: a prospective study

Introduction: Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD.Methods: We conducted a prospective study with three measurement time points: six weeks antepartum (N = 297), as well as six weeks (N = 278) and twelve weeks (N = 266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience.Results: Predictors for APD were high DSC, high concerns about one’s appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD.Discussion: The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.

The role of cumulative risk and protection for violent offending

PurposeRisk and protective factors for antisocial behavior have been shown to act in a cumulative manner. The purpose of this article is to examine the predictive power of risk factors and protective indices predicting violent offending. MethodsWe used longitudinal data across 25years to predict violent offenses for 475 males. Cumulative childhood risk factors (age 10), and cumulative individual, family, peer and school protective factors (ages 13, 15) were analyzed. ResultsThe likelihood for a conviction for violent offenses showed a fivefold increase with an increase in risk factors from 0 to 3. This increase was markedly reduced when controlling for protective factors. Similarly, controlling for risk factors, the likelihood for a conviction was almost ameliorated, showing a tenfold decrease, with an increase in protective factors from 0 to 10. Interactions between cumulative risk and protective factors were also found. Total number of protective factors significantly decreased the likelihood of violent offenses for those with and without childhood behavioral risk factors, however the decrease was significantly greater for those with no childhood risk factors. ConclusionsAnalyses of antisocial behavior should not be restricted to risk factors, but include protective factors, if the purpose is to better tailor interventions.

Determinants of Social Activity and Work Status after Coronary Bypass Surgery

Despite the occurrence of adverse events after coronary artery bypass, the degree of social integration can be increased following this operation. This study addresses the predictive power of risk factors as well as clinical status in determining long-term social functioning and rate of return to work following isolated bypass surgery. A prospective cohort study was conducted in 178 patients who underwent isolated bypass surgery between 2004 and 2007. Information on work status and social relationships was obtained 1-2 days before surgery and during a mean follow-up of 29.4 ± 1.1 months. The proportion of patients who engaged in social activities at 2, 3, and 4 years of follow-up was 0.3, 0.6, and just over 0.8, respectively, and the proportion who had returned to work at these time points was 0.2, 0.45, and 0.63, respectively. Social activity after surgery was less in patients with left ventricular dysfunction, cerebrovascular disease, and higher New York Heart Association functional class. The rate of return to work was lower for men and for patients with left ventricular dysfunction, diabetes, cerebrovascular disease, and those who were hospitalized for more than 14 days.

Integrating DSM‐IV Factors to Predict Violence in High‐Risk Psychiatric Patients

This study incorporated Axis-II and Axis-IV factors in DSM-IV to test the relationship between predicted risk for violence assessed in the psychiatric emergency room and actual violence during hospitalization. Psychiatric nurses lack an objective instrument to use during the acute psychiatric assessment. The retrospective study comprised consecutive psychiatric admissions (n = 161) in one tertiary veterans' hospital. Statistical testing for the predictive power of risk factors, relationships between variables, and violent events included nonparametric tests, factor analysis, and logistic regression. Of the 32 patients who committed violence during hospitalization, 12 had committed violence in the psychiatric emergency room. Statistical significance was shown for violent incidents and dementia, court-ordered admission, mood disorder, and for three or more risk factors. The 13-item Risk of Violence Assessment (ROVA) scale suggests validity and sensitivity for rating DSM-IV factors and psychosocial stressors to predict risk for violence during hospitalization. Replication studies are recommended to strengthen validity of the ROVA scale.

The NATVNS Scotland 2006 annual general meeting

To evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients.A retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n = 90) and a control group without pressure ulcers (n = 90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model.The risk factors that predicted pressure ulcers were friction (OR = 5.97), previous history of pressure ulcers (OR = 5.43), prolonged intensive care unit stay (OR = 3.92), dehydration (OR = 3.18), elevated skin temperature by 1–2 °C (OR = 3.12) and treatment of other comorbidities (OR = 2.79).Adult intensive care patients have an increased risk of developing a pressure ulcer. These risk factors are regarded as strong predictors for pressure ulceration. This study advances nursing knowledge in that it investigates additional risk factors for the development of pressure ulcers and it identifies a set of factors that best predict their occurrence, which may contribute to the nurses' diagnostic reasoning in the intensive care unit.

Risk factors for the development versus maintenance of posttraumatic stress disorder.

This study examined risk factors for posttraumatic stress disorder (PTSD) in Vietnam veterans: 68 women and 414 men of whom 88 were White, 63 Black, 80 Hispanic, 90 Native Hawaiian, and 93 Japanese American. Continuation ratio logistic regression was used to compare the predictive power of risk factors for the development versus maintenance of full or partial PTSD. The development of PTSD was related to premilitary, military, and postmilitary factors. The maintenance of PTSD was related primarily to military and postmilitary factors. Multivariate analyses identified different models for development and maintenance. We conclude that development of PTSD is related to factors that occur before, during, and after a traumatic event, whereas failure to recover is related primarily to factors that occur during and after the event.

Coronary heart disease epidemiology revisited. Clinical and community aspects.

Epidemiological research relating coronary heart disease risk to risk factors has been reviewed and condensed into simple, diagrammatic form. The predictive power of risk factors for detecting susceptibles in the population is presented. While much is now known about long-term prediction, there is an urgent need for tests to signal impending heart attacks. Against this background, the potential for preventive action is discussed in the light of current knowledge. The "clinical-individual" and "community" approaches to prevention are contrasted. To what extent is prevention on the community level warranted, pending the results of controlled prophylactic trials? The view is presented that advice on preventive measures to the population at large is justified at this time, based on education and planned change but short of an all-out campaign which must await conclusive data from intervention studies.