Predictive Value For Adverse Outcome Research Articles

Long-Term Neurodevelopmental Outcome of Children With Mild Traumatic Brain Injury

BackgroundTo investigate the long-term outcome of pediatric mild traumatic brain injury (mTBI) in terms of neurocognitive, behavioral, and school functioning and to identify clinical risk factors for adverse outcomes. MethodsThis study describes the follow-up of a prospective multicenter sample of 89 children with mTBI 3.6 years postinjury and 89 neurologically healthy children matched for sex, age, and socioeconomic status. Neurodevelopmental outcomes were assessed using an intelligence test, behavioral questionnaires, computerized neurocognitive tests, and longitudinal (pre- and postinjury) standardized school performance data. ResultsChildren with mTBI exhibited intelligence in the average range but had more behavioral problems related to inattentiveness (P = 0.004, d = 0.47) and hyperactive impulsivity (P = 0.01, d = 0.40) and showed poorer neurocognitive performance in information processing stability (P = 0.003, d = −0.55) and Visual Working Memory (P = 0.04, d = −0.39) compared with matched peers. Longitudinal school performance data revealed poorer performance in Technical Reading up to two years postinjury (P = 0.005, d = −0.42) when compared with normative data. Clinical risk factors did not reveal predictive value for adverse outcomes in children with mTBI. ConclusionsThis study indicates that children with mTBI are at risk of long-term deficits in neurocognitive and behavioral functioning, with longitudinal evidence suggesting shortfalls in school performance up to two years postinjury. Clinical risk factors do not provide a solid basis for long-term neurodevelopmental prognosis. Findings emphasize the importance of, and challenges for, early identification of children at risk for adverse neurodevelopmental outcome after mTBI.

Prognostic value of the echocardiographic ratio tricuspid annular plane systolic excursion / pulmonary arterial systolic pressure in acute pulmonary embolism.

The occurrence of death from acute pulmonary embolism (PE) is often linked to right ventricular (RV) failure, arising from an imbalance between RV systolic function and heightened RV afterload. In our study, we posited that an echocardiographic ratio derived from this disparity [RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] could offer superior predictive value for adverse outcomes compared to individual measurements of TAPSE and PASP alone. We conducted a retrospective analysis using data from a University Hospital Centre spanning from 2017 to 2023. All individuals with confirmed PE and a formal transthoracic echocardiogram within 7 days of diagnosis were included. The primary endpoint was a composite outcome of death, hemodynamic deterioration needing introduction of inotropes or thrombolysis within 30 days. Secondary endpoints included 6 months all-cause mortality and onset of right-sided heart failure. Thirty-eight patients were included. Mean age was 58 ±15 years old. A male predominance was noted: 23 male patients (60.5%) and 15 female patients (39.5%). Eight patients met the primary composite endpoint while nine patients met the secondary composite endpoint. In multivariate analysis, the TAPSE/PASP ratio was independently associated with the primary outcome (OR=2.77, 95% CI 1.101-10.23, P=0.042). A TAPSE/PASP ratio <0.3 was independently associated with the secondary outcome (OR=3.07, 95% CI 1.185-10.18, P=0.034). This study suggests that a combined echocardiographic ratio of RV function to afterload is effective in predicting adverse outcomes in acute PE.

The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy.

MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE. Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70). Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h. A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure. A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.

Comparative analysis of four nutritional scores in predicting adverse outcomes in biopsy-confirmed diabetic kidney Disease.

Malnutrition is associated with adverse outcomes in patients with diabetic kidney disease (DKD). However, it is uncertain which nutritional assessment tools are most effective in predicting the adverse outcomes of DKD. This retrospective study was conducted at a single center and included 367 patients diagnosed with DKD based on biopsy results between August 2009 and December 2018. Four nutritional assessment indices, namely the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI), and Controlling Nutritional Status (CONUT) score, were selected and calculated. We aimed to assess the association between these nutritional scores and adverse outcomes, including progression to end-stage kidney disease (ESKD), cardiovascular diseases events (CVD), and all-cause mortality. Univariate and multivariate Cox regression analyses, Kaplan-Meier analysis, along with Restricted cubic spline analysis were used to examine the relationship between nutritional scores and adverse outcomes. Furthermore, the area under the curve (AUC) was calculated using time-dependent receiver operating characteristics to determine the predictive value of the four nutritional scores alone and some combinations. Lastly, ordered logistic regression analysis was conducted to explore the correlation between the four nutritional scores and different renal histologic changes. The incidence of ESKD, CVD, and all-cause mortality was significantly higher in patients with DKD who had a lower PNI, lower GNRI, and higher CONUT score. Additionally, The TCBI performed the worst in terms of grading and risk assessment. The PNI offer the highest predictive value for adverse outcomes and a stronger correlation with renal histologic changes compared to other nutritional scores. Patients diagnosed with DKD who have a worse nutritional status are more likely to experience higher rates of adverse outcomes. The PNI might offer more valuable predictive values and a stronger correlation with different renal histologic changes compared to other nutritional scores.

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study.

Despite its correlation with skeletal muscle mass and its predictive value for adverse outcomes in clinical settings, calf circumference is a metric underexplored in intensive care. We aimed to determine whether adjusting low calf circumference for adiposity provides prognostic value superior to its unadjusted measurement for intensive care unit (ICU) mortality and other clinical outcomes in critically ill patients. In a secondary analysis of a cohort study across five ICUs, we assessed critically ill patients within 24 h of ICU admission. We adjusted calf circumference for body mass index (BMI) (25-29.9, 30-39.9, and ≥40) by subtracting 3, 7, or 12 cm from it, respectively. Values ≤34 cm for men and ≤33 cm for women identified low calf circumference. We analyzed 325 patients. In the primary risk-adjusted analysis, the ICU death risk was similar between the low and preserved calf circumference (BMI-adjusted) groups (hazard ratio, 0.90; 95% CI, 0.47-1.73). Low calf circumference (unadjusted) increased the odds of ICU readmission 2.91 times (95% CI, 1.40-6.05). Every 1-cm increase in calf circumference as a continuous variable reduced ICU readmission odds by 12%. Calf circumference showed no significant association with other clinical outcomes. BMI-adjusted calf circumference did not exhibit independent associations with ICU and in-hospital death, nor with ICU and in-hospital length of stay, compared with its unadjusted measurement. However, low calf circumference (unadjusted and BMI-adjusted) was independently associated with ICU readmission, mainly when analyzed as a continuous variable.

Evaluation of left ventricular stiffness with echocardiography.

Half of patients with heart failure are presented with preserved ejection fraction (HFpEF). The pathophysiology of these patients is complex, but increased left ventricular (LV) stiffness has been proven to play a key role. However, the application of this parameter is limited due to the requirement for invasive catheterization for its measurement. With advances in ultrasound technology, significant progress has been made in the noninvasive assessment of LV chamber or myocardial stiffness using echocardiography. Therefore, this review aims to summarize the pathophysiological mechanisms, correlations with invasive LV stiffness constants, applications in different populations, as well as the limitations of echocardiography-derived indices for the assessment of both LV chamber and myocardial stiffness. Indices of LV chamber stiffness, such as the ratio of E/e' divided by left ventricular end-diastolic volume (E/e'/LVEDV), the ratio of E/SRe (early diastolic strain rates)/LVEDV, and diastolic pressure-volume quotient (DPVQ), are derived from the relationship between echocardiographic parameters of LV filling pressure (LVFP) and LV size. However, these methods are surrogate and lumped measurements, relying on E/e' or E/SRe for evaluating LVFP. The limitations of E/e' or E/SRe in the assessment of LVFP may contribute to the moderate correlation between E/e'/LVEDV or E/SRe/LVEDV and LV stiffness constants. Even the most validated measurement (DPVQ) is considered unreliable in individual patients. In comparison to E/e'/LVEDV and E/SRe/LVEDV, indices like time-velocity integral (TVI) measurements of pulmonary venous and transmitral flows may demonstrate better performance in assessing LV chamber stiffness, as evidenced by their higher correlation with LV stiffness constants. However, only one study has been conducted on the exploration and application of TVI in the literature, and the accuracy of assessing LV chamber stiffness remains to be confirmed. Regarding echocardiographic indices for LV myocardial stiffness evaluation, parameters such as epicardial movement index (EMI)/ diastolic wall strain (DWS), intrinsic velocity propagation of myocardial stretch (iVP), and shear wave imaging (SWI) have been proposed. While the alteration of DWS and its predictive value for adverse outcomes in various populations have been widely validated, it has been found that DWS may be better considered as an overall marker of cardiac function performance rather than pure myocardial stiffness. Although the effectiveness of iVP and SWI in assessing left ventricular myocardial stiffness has been demonstrated in animal models and clinical studies, both indices have their limitations. Overall, it seems that currently no echocardiography-derived indices can reliably and accurately assess LV stiffness, despite the development of several parameters. Therefore, a comprehensive evaluation of LV stiffness using all available parameters may be more accurate and enable earlier detection of alterations in LV stiffness.

Correlation and utility of the changes in sST2 level at clinician determined decompensation and recompensation

Abstract Introduction Soluble Suppressor of Tumorigenicity 2 (sST2) biomarker has been shown to demonstrate prognostic capabilities in patients with heart failure (HF), with serial measurements of sST2 at pre-determined time intervals providing additional predictive value for adverse outcomes. We sought to evaluate what level of sST2 level change, at clinician determined decompensation and recompensation during an acute admission for decompensated HF, could provide prognostic information for adverse outcomes. Methods Between January 2020 and February 2022, consecutive patients hospitalized at a secondary care hospital had sST2 measured within 24 hours of decompensated HF admission and following recompensation assessed by qualified clinicians, as part of the INST2ANT-HF study. sST2 samples were batched analysed at the end of recruitment period with a quantitative turbidimetric immunoassay. The primary outcome was the interval change between admission and discharge sST2 in patients admitted with decompensated heart failure. Related-samples Wilcoxon signed rank test was performed to evaluate for difference in sST2 at decompensation and recompensation. Comparison of median sST2 change was made using independent samples median test comparing alive and deceased patients at one year follow up. Results In 162 consecutive patients with paired samples, median age was 71 (IQR 61-80). 23.5% were female and 34% had an ischaemic aetiology. 94.4% presented with NYHA class III and IV and median ejection fraction was 26% (IQR 17-32). Median length of stay in hospital was 8 (IQR 5-13) days. Median levels of sST2 at decompensation and recompensation were 60.5 and 39.5ng/ml respectively (p&amp;lt;0.001) (Fig.1a). In patients who died within the first year, median levels of sST2, at decompensation and following recompensation, were significantly higher than in patients who were alive. (decompensation sST2 83 vs 56ng/ml; p = 0.007 and recompensation sST2 58 vs 34ng/ml; p = 0.036) (Fig. 1b). There was however no significant difference in the absolute or percentage change in sST2 level between those who died and those who survived (19.5 vs 16ng/ml, p= 0.437; 27 vs 35%, p = 0.363). Conclusion Our initial data demonstrates that in a cohort of patients admitted with acute decompensated HF, there was a significant difference in sST2 levels between clinician determined decompensation and recompensation. Higher levels of sST2 at both decompensation and recompensation were associated with a higher risk of mortality at one year. Utilizing newer biomarkers such as sST2 to predict outcomes may allow better risk stratification and identifying patients needing closer follow up. More research is needed however to determine what values would be useful in clinical practice.Figure 1Figure 2

Cardiac imaging and biomarkers for assessing myocardial fibrosis in children with hypertrophic cardiomyopathy

Myocardial fibrosis, as diagnosed on cardiac magnetic resonance imaging (cMRI) by late gadolinium enhancement (LGE), is associated with adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), but its prevalence and magnitude in children with HCM have not been established. We investigated: (1) the prevalence and extent of myocardial fibrosis as detected by LGE cMRI; (2) the agreement between echocardiographic and cMRI measurements of cardiac structure; and (3) whether serum concentrations of N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) and cardiac troponin-T are associated with cMRI measurements. A cross-section of children with HCM from 9 tertiary-care pediatric heart centers in the U.S. and Canada were enrolled in this prospective NHLBI study of cardiac biomarkers in pediatric cardiomyopathy (ClinicalTrials.gov Identifier: NCT01873976). The median age of the 67 participants was 13.8 years (range 1-18 years). Core laboratories analyzed echocardiographic and cMRI measurements, and serum biomarker concentrations. In 52 children with non-obstructive HCM undergoing cMRI, overall low levels of myocardial fibrosis with LGE >2% of left ventricular (LV) mass were detected in 37 (71%) (median %LGE, 9.0%; IQR: 6.0%, 13.0%; range, 0% to 57%). Echocardiographic and cMRI measurements of LV dimensions, LV mass, and interventricular septal thickness showed good agreement using the Bland-Altman method. NT-proBNP concentrations were strongly and positively associated with LV mass and interventricular septal thickness (P < .001), but not LGE. Low levels of myocardial fibrosis are common in pediatric patients with HCM seen at referral centers. Longitudinal studies of myocardial fibrosis and serum biomarkers are warranted to determine their predictive value for adverse outcomes in pediatric patients with HCM.

Predictive value of elevated neutrophil gelatinase-associated lipocalin levels for assessment of in-hospital adverse outcomes among myocardial infarction patients.

Inflammatory biomarkers are known to rise and have predictive value for adverse outcomes in patients with acute coronary ischemia. One of those biomarkers is neutrophil gelatinase-associated lipocalin (NGAL). To date, only very few studies have assessed the prognostic value of NGAL in this setting. We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST-elevation myocardial infarction patients. High NGAL was defined as values within the 4th quartile. Patients were assessed for major in-hospital adverse clinical events (MACE). Multivariable logistic regression and area under the receiver operating characteristic curve (AUC) were used to further evaluate NGAL association for MACE and discrimination ability. A total of 273 patients were included. patients with high NGAL were at increased risk for MACE (62% vs. 19%; odds ratio 6.88, 95% confidence interval, 3.77-12.54, P < 0.001). After propensity score matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, P = 0.002). In multivariable regression, high NGAL level was independently associated with MACE. The discrimination ability of NGAL to identify MACE (AUC 0.823), is significantly better than that of other inflammatory markers. Among ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.

Predictive value of elevated neutrophil gelatinase-associated lipocalin (NGAL) levels for assessment of in hospital adverse outcomes among myocardial infarction patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Inflammatory biomarkers are known to rise and have significant predictive value for adverse outcomes in patients with acute coronary ischemia .Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein stored in mature neutrophil granules, is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease and healthy subjects. To date, very few studies have assessed the prognostic value of NGAL in this setting. Purpose We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI). Methods Blood samples for plasma NGAL were drawn immediately after admission. High NGAL was defined as values within the 4th quartile (&amp;gt;75percentile). Patients were assessed for major in-hospital adverse clinical events (MACE). These included reduced left ventricular ejection fraction, clinical heart failure findings and 30-day mortality. Multivariable logistic regression was used to evaluate the association between NGAL group and MACE. Receiver operating characteristic curve (AUC) was used to evaluate the discrimination ability of NGAL compared with other inflammatory biomarkers including white blood cell count(WBC), peak troponin level, peak C-reactive protein(CRP) and neutrophil/lymphocyte ratio(NLR) for the prediction of MACE. Results A total of 273 patients were included (mean age 66 ± 14 years, 81% males). Patients with high NGAL were at increased risk for MACE (62% vs. 19%; OR 6.88, 95%CI 3.77-12.54, p&amp;lt;0.001, Figure 1). After propensity score matching, 55 pairs of comparable patients were identified. Following matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, p=0.002; figure 1). In the multivariable logistic regression high NGAL level was independently associated with MACE (OR 9.25, 95%CI 4.33-19.76, P&amp;lt;0.001). The discrimination ability of NGAL to identify MACE (AUC 0.823) was significantly better (figure 2; p&amp;lt;0.001) than that of CRP (AUC 0.627), troponin (AUC 0.588), WBC (AUC 0.583) and NLR (AUC 0.601). Conclusions Among STEMI patients undergoing primary PCI, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.

Serum mAST/ALT ratio had high predictive value for adverse outcome of severe fever with thrombocytopenia syndrome with severe condition

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) usually demonstrates multi-organ injury with a high mortality rate. This study aimed to investigate associations of serum aspartate/alanine aminotransferase (AST)/ALT, cytosolic AST (cAST)/ALT and mitochondrial AST (mAST)/ALT ratios with the prognosis of SFTS patients.MethodsA total of 355 confirmed SFTS patients were included. Clinical and laboratory data were compared between survivors and nonsurvivors. Logistic regression analysis was used to assess the independent risk factors for fatality in all patients and those admitted to the intensive care unit (ICU). The predictive values of the risk factors and constructed risk models were evaluated.ResultsMean age and biochemical parameters were significantly greater in nonsurvivors than in survivors. In ICU patients, the three ratios, high-sensitivity troponin I (hsTnI), creatine kinase (CK), lactate dehydrogenase (LDH) and α-hydroxybutyrate dehydrogenase (α-HBDH) were elevated markedly in nonsurvivors than in survivors. Multivariate logistic regression analysis showed that age, three ratios and α-HBDH were independent risk factors for mortality in all patients. Only the three ratios were independent risk factors for death in ICU patients. Risk Models (M1, M2 and M3) and simplified models (sMs) containing the three ratios respectively had comparatively high predictive values for fatality in all patients with area under ROC curves (AUCs) > 0.85. In ICU patients, mAST/ALT ratio had the highest predictive value, sensitivity and odds ratio (OR) for mortality among three ratios.ConclusionAST/ALT, cAST/ALT and mAST/ALT ratios were associated with unfavorable clinical outcome of SFTS. The prognostic value of mAST/ALT ratio was higher in severe cases.

Low calf circumference adjusted for body mass index is associated with prolonged hospital stay

BackgroundCalf circumference (CC) is of emerging importance because of its practicality, high correlation with skeletal muscle, and potential predictive value for adverse outcomes. However, the accuracy of CC is influenced by adiposity. CC adjusted for BMI (BMI-adjusted CC) has been proposed to counteract this problem. However, its accuracy to predict outcomes is unknown. ObjectivesTo evaluate the predictive validity of BMI-adjusted CC in hospital settings. MethodsA secondary analysis of a prospective cohort study in hospitalized adult patients was conducted. The CC was adjusted for BMI by reducing 3, 7, or 12 cm for BMI (in kg/m2) of 25–29.9, 30–39.9, and ≥40, respectively. Low CC was defined as ≤34 cm for males and ≤33 cm for females. Primary outcomes included length of hospital stay (LOS) and in-hospital death, and secondary outcomes were hospital readmissions and mortality within 6 mo after discharge. ResultsWe included 554 patients (55.2 ± 14.9 y, 52.9% men). Among them, 25.3% presented with low CC, whereas 60.6% had BMI-adjusted low CC. In-hospital death occurred in 13 patients (2.3%), and median LOS was 10.0 (5.0–18.0) d. Within 6 mo from discharge, 43 patients (8.2%) died, and 178 (34.0%) were readmitted to the hospital. BMI-adjusted low CC was an independent predictor of LOS ≥ 10 d (odds ratio = 1.70; 95% confidence interval: 1.18, 2.43], but it was not associated with the other outcomes. ConclusionsBMI-adjusted low CC was identified in more than 60% of hospitalized patients and was an independent predictor of longer LOS.

Routine third trimester ultrasonography in predicting adverse perinatal outcomes: a prospective cohort study at a tertiary-care hospital in Eastern India.

Fetal growth restriction (FGR) may go undetected in the antenatal period with subjective clinical evaluation, and there is a growing propensity to perform a third-trimester scan, especially in the developed countries. The literature on the importance of the same in developing countries like ours, is scant. Hence, this study was undertaken to evaluate the role of routine third-trimester ultrasonography along with Doppler in predicting adverse perinatal outcome. A prospective cohort study was conducted at a tertiary-care hospital, in which routine third-trimester ultrasonography was performed for 265 antenatal women, and included estimation of amniotic fluid index (AFI), estimated fetal-weight (EFW), and cerebroplacental ratio (CPR). Women were categorized as having normal parameters or having at least one abnormal parameter. Post-natal adverse perinatal outcomes including low birth-weight, hypoglycemia, poor Apgar scores, prolonged hospital stay, need for ventilatory support, neonatal asphyxia, neonatal sepsis and early neonatal death were recorded. Prediction analyses for sensitivity, specificity, positive and negative predictive values were done. Receiver Operating Characteristic (ROC) curves were plotted for threshold for each parameter for adverse outcome. Out of 260 women that were analyzed, 47.5% had no clinically identifiable risk factors, and 52.5% had at least one abnormal parameter. Sensitivity and negative predictive value for adverse outcome were highest for composite ultrasound finding (85.4% and 90.4% respectively). Specificity, positive predictive value and diagnostic accuracy were highest for CPR (97.8%, 86.7% and 76.9% respectively). Routine third trimester ultrasonography, including Doppler, can help in risk-stratification of otherwise clinically low-risk pregnancies.

Prognostic impact of coronary microvascular dysfunction assessed by caIMR in overweight with chronic coronary syndrome patients

ObjectiveCoronary microvascular dysfunction (CMD) may associate with adverse cardiovascular events in obese patients. Coronary angiography-derived index of microcirculatory resistance (caIMR) is proposed as a less-invasive and pressure-wire-free index to assess CMD. We aimed to investigate the impact of coronary microvascular function assessed by caIMR in patients with overweight and chronic coronary syndrome (CCS).MethodsCCS patients who underwent coronary angiography between 2015 to 2018 were included. Overweight was defined as BMI≥24.0kg/m². Impaired coronary microvascular function was defined as caIMR≥25U. The patients were classified according to BMI and caIMR. The primary endpoint was major adverse cardiac events (MACE). Kaplan-Meier and Cox regression analyses evaluated the association between caIMR and MACE.ResultsTwo hundred and eighty-two CCS patients were enrolled. Among these, 169 (59.93%) were overweight. Impaired coronary microvascular function was higher in overweight patients than in patients with normal weight (49.70% vs. 38.05%; P=0.035). During 35 months of follow-up, 33 MACE had occurred. Among the total CCS population, MACE was higher in patients with high caIMR than in low caIMR (18.11% vs. 6.45%, P=0.003). In subgroups analysis, MACE was higher in overweight patients with high caIMR than low caIMR (20.24% vs. 7.06%, P=0.014), while there were no significant differences in normal-weight patients. Multivariate Cox analysis demonstrated that caIMR≥25 was independently associated with MACE in overweight patients (HR, 2.87; 95% CI, 1.12-7.30; P=0.027) but not in the normal-weight patients. In addition, caIMR showed a significant predictive value for adverse outcomes in overweight patients and provided an incremental prediction when added to a prediction model with BMI.ConclusionsImpaired coronary microvascular function assessed by caIMR was common and is an independent predictor of MACE in overweight patients with CCS.

Modified Frailty Index Combined with a Prognostic Nutritional Index for Predicting Postoperative Complications of Hip Fracture Surgery in Elderly

Aim: There is currently no consensus on the best risk assessment technique for predicting complications after hip surgery in the elderly, which is hindering the accuracy of surgical risk assessment. The goal of this study was to build a risk assessment model and evaluate its predictive value using the modified frailty index (5-mFI) and the prognostic nutritional index (PNI). Methods: A retrospective investigation was undertaken on 150 patients (aged ≥60 years) who had hip fracture surgery. Using univariate and multivariate logistic regression models, the relationship between combined 5-mFI and PNI and the evaluation of postoperative unfavorable outcomes such as infection and unscheduled intensive care unit (ICU) admission was investigated. Finally, utilizing receiver operating characteristic (ROC) curve analysis, the model’s predictive value for adverse outcomes following hip fracture surgery in elderly patients was assessed. Results: Univariate and multivariate logistic analyses revealed that preoperative PNI, 5-mFI, ASA, and gender acted as independent predictors of adverse outcomes after hip fracture surgery in the elderly. According to the ROC curve analysis, the predictive model demonstrated a high predictive value for total postoperative complications (AUC: 0.788; 95%CI: 0.715–0.860; p<0.01), infectious complications (AUC: 0.798; 95% CI: 0.727–0.868; P<0.001), and unplanned ICU admission (AUC: 0.783; 95% CI: 0.705–0.861; P<0.001). Conclusions: The multivariable evaluation model, which included 5-mFI and PNI, showed a high predictive value and can hence be applied to predict the adverse outcomes in elderly patients undergoing hip fracture surgery.

Clinical significance of bispectral index monitoring in patients with acute severe carbon monoxide poisoning

Objective: To analyze the correlation of bispectral index (BIS) with the prognosis of patients with acute severe carbon monoxide poisoning (ASCMP) and its predictive value of adverse outcomes. Methods: In March 2021, 106 ASCMP patients who were treated in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to December 2020 were taken as research objects. All patients underwent 24-hour BIS monitoring after admission, and were divided into good prognosis group (n=75) and poor prognosis group (n=31) according to the prognosis of the patients' cranial nerve function after 60 d. The general conditions, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Glasgow Coma Scale (GCS) score at admission and 24-hour BIS mean were compared between the two groups. Pearson correlation analysis was used to analyze the correlations between the 24-hour BIS mean and GCS score at admission, APACHEⅡ score and coma time. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of 24-hour BIS mean, GCS score at admission, APACHEⅡ score and coma time on adverse outcome of ASCMP patients. Results: The coma time and APACHEⅡ score of the patients in the poor prognosis group were significantly higher than those in the good prognosis group, the GCS score at admission and 24-hour BIS mean were significantly lower than those in the good prognosis group (P<0.05) . Pearson correlation analysis showed that the 24-hour BIS mean was positively correlated with the GCS score at admission, and negatively correlated with the APACHEⅡ score, coma time (r=0.675, -0.700, -0.565, P<0.001) . The 24-hour BIS mean had the highest predictive value for adverse outcome of ASCMP patients, with a cut-off value of 74, the area under the curve was 0.883 (95%CI: 0.814-0.951, P<0.001) , and the sensitivity and specificity were 73.3% and 87.1%, respectively. Conclusion: The 24-hour BIS mean has a good correlation with the acute brain nerve injury, the severity of the disease and coma time of patients with ASCMP. And it has a high predictive value for the adverse outcome in patients with ASCMP.

Left atrial reservoir strain is an outstanding predictor of adverse cardiovascular outcomes in patients undergoing maintenance hemodialysis: Assessment via three-dimensional speckle tracking echocardiography.

BackgroundThere is a paucity of literature focusing left atrium (LA) in patients undergoing maintenance hemodialysis (MHD).HypothesisWe used three‐dimensional speckle tracking echocardiography (3DSTE) to evaluate LA in MHD patients and to explore its predictive value for adverse outcomes.MethodsEchocardiography was performed on 130 consecutively enrolled MHD patients without previous cardiac diseases. Conventional and 3DSTE parameters of LA were obtained. The MHD cohort was then followed and the end point was major adverse cardiovascular events (MACEs). LA strain indices, including reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct), were measured and compared between patients with and without MACEs.ResultsPatients were prospectively followed up for a median of 40.5 (interquartile range: 26.3–48.0) months. During follow‐up, 43 patients met the end point. These patients had larger LA size and reduced LA strains (LA maximal volume indexed: 45.1 ± 11.9 vs. 33.8 ± 6.9ml/m2; LASr: 20.2 ± 3.5 vs. 27.2 ± 3.3%; LAScd: −12.3 ± 5.2 vs. −14.5±4.0%; LASct: −8.0 ± 4.2 vs. −13.2 ± 3.7%; all p<.05), compared with those without MACEs. Multivariable regression analysis showed LASr was the strongest predictor of MACEs (hazard ratio, 0.69; 95% confidence interval, 0.54–0.89; p=.004). Univarite Kaplan–Meier analysis revealed the incidence of MACEs in the impaired LASr (<24.2%) group was significantly higher than in the normal LASr group (log rank p<.001).ConclusionsLASr derived from 3DSTE is an independent predictor of MACEs and cardiac death in MHD patients, superior to LV parameters and LA volume indices.

Predicting the 30-day Adverse Outcomes of Non-Critical New-Onset COVID-19 Patients in Emergency Departments based on their Lung CT Scan Findings; A Pilot Study for Derivation an Emergency Scoring Tool

Introduction: Coronavirus Disease (COVID‐19) has become the most important global health issue, and chest computed tomography (CT) scan can help determine the severity of the infection. Objectives: This study aimed to provide an emergency scoring tool for predicting 30-day adverse outcomes in non-critical new-onset COVID-19 patients. Methods: This derivation study was conducted on new-onset COVID-19 patients presenting to the emergency department of an urban teaching hospital in Tehran, Iran, between 20 February and 20 March 2020. The total lobe severity score (TSS), age, history of comorbidities, and 30-day adverse outcomes (death, ICU admission or intubation) were taken into account to produce three prediction models. Results: Overall, 137 patients were included in the study. Their mean age was 59.9±16.8 years and 62% were male. The ground glass nodule, patch B/punctate ground-glass opacity, fibrous stripes, and air bronchogram sign with perihilar distribution, bilateral and ≥ 2 affected lobes were the most common findings. The mean TSS (model 1) was significantly higher in patients with an adverse outcome (9.4±3.2) compared to the discharged patients (7.2±3.3) (p&lt;0.001, AUC: 0.703, sensitivity: 64.4% and specificity: 74.1%). The optimal cut-off point of model 2 (TSS and age) had the following parameters: AUC: 0.721, sensitivity: 71.2% and specificity: 67.2%. The optimal cut-off point of model 3 (TSS, age, comorbidities) had: AUC: 0.755, sensitivity: 79.7% and specificity: 65.5%. The discrimination achieved with model 3 based on Bonferroni’s test was significantly better than that achieved with TSS (p&lt;0.001). Conclusion: TSS combined with age and history of at least one comorbidity had a better predictive value for adverse outcomes with a cut-off point above 8.

MRI combined with early clinical variables are excellent outcome predictors for newborn infants undergoing therapeutic hypothermia after perinatal asphyxia.

BackgroundBinary prediction-models for outcome [death, cognition, presence and severity of cerebral palsy (CP)], using MRI and early clinical data applicable for individual outcome prediction have not been developed.MethodsFrom Dec 1st 2006 until Dec 31st 2013, we recruited 178 infants into a population-based cohort with moderate or severe hypoxic-ischaemic encephalopathy (HIE) including postnatal collapse (PNC, n = 12) and additional diagnoses (n = 12) using CoolCap/TOBY-trial entry-criteria including depressed amplitude-integrated EEG (aEEG). Early clinical/biochemical variables and MRI scans (median day 8) were obtained in 168 infants. Injury severity was scored for cortex, basal ganglia/thalami (BGT), white matter (WM) and posterior limb of the internal capsule, summating to a total injury score (TIS, range 0–11). Outcome was categorized as adverse or favourable at 18–24 months from Bayley-III domains (cut-off 85) and neurological examination including CP classification.FindingsHIE and entry-aEEG severity were stable throughout the study. Outcome was favourable in 133/178 infants and adverse in 45/178: 17 died, 28 had low Cognition/Language scores, (including 9 with severe CP and 6 mild); seven had mild CP with favourable cognitive outcome. WMxBGT product scores and TIS were strong outcome predictors, and prediction improved when clinical/biochemical variables were added in binary logistic regression. The Positive Predictive Value for adverse outcome was 88%, increasing to 95% after excluding infants with PNC and additional diagnoses. Using WMxBGT in the regression predicted 8 of the 9 children with severe CP.InterpretationBinary logistic regression with WMxBGT or TIS and clinical variables gave excellent outcome prediction being 12% better than single variable cross-tabulation. Our MRI scoring and regression models are readily accessible and deserve investigation in other cohorts for group and individual prediction.FundingWe thank the National Health Service (NHS) and our Universities and funders in UK and Norway: SPARKS, The Moulton Foundation, The Norwegian Research Council, The Lærdal Foundation for Acute Medicine and charitable donations for their support for cooling therapy.

The Glasgow Prognostic Score and fibrinogen to albumin ratio as prognostic factors in hospitalized patients with COVID-19

ABSTRACT Aim: This study aims to determine the prognostic value of the Glasgow Prognostic Score (GPS) and fibrinogen to albumin ratio (FAR) in patients with COVID-19. Methods: Electronic database records of 400 patients with COVID-19 were retrospectively analyzed and the initial levels of CRP, albumin, fibrinogen values were recorded. The ground-glass opacities (GGO) and consolidations were evaluated on thorax CT. Hospital mortality and the need for intensive care unit (ICU) transfer were determined as adverse outcomes. Results: It was determined that 345 patients (86.25%) were discharged while 31 patients (7.75%) were transferred to ICU in addition to 24 patients who died (6%). The rates of deaths and transfers to ICU were significantly increased in GPS 2 group compared to both GPS 0 and 1 groups. Additionally, increased FAR was observed in patients who died and transferred to ICU compared to the discharged patients. The FAR was significantly increased in patients with diffuse GGO. Logistic regression analysis indicated that FAR ≥144.59 and the presence of GPS 2 were independent predictors of the adverse outcomes in COVID-19 patients. Conclusion: Our results demonstrated that the GPS and FAR could possess a predictive value for adverse outcomes in patients with COVID-19.