Predictor Of Clinical Outcome Research Articles

Adjustment of the ACEF score by the triglyceride glucose index improves the prediction of clinical outcomes in patients undergoing percutaneous coronary intervention

BackgroundThe ACEF score (age, creatinine, and left ventricular ejection fraction) and the triglyceride-glucose (TyG) index have been identified as robust risk prediction models for adverse outcomes post-percutaneous coronary intervention (PCI) in coronary atherosclerotic heart disease (CHD) patients. This study aimed to assess whether incorporating the TyG index enhances the predictive ability of the ACEF score and enhances risk stratification for CHD patients undergoing PCI.MethodsThis observational cohort study enrolled 1248 patients diagnosed with CHD who underwent PCI at the Third People’s Hospital of Chengdu, China, between May 2018 and December 2022. Receiver operating characteristic (ROC) curves were employed to establish the optimal cutoff values for the TyG index and ACEF score. The primary endpoint event was defined as major adverse cardiac and cerebrovascular events (MACCEs). Cumulative survival curves were plotted using the Kaplan–Meier method. Univariable and multivariable Cox regression analyses were conducted to identify predictors of MACCEs. The predictive ability of the ACEF score and the TyG index was assessed using the area under the ROC curve, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsOver a median follow-up period of 30.60 months, 214 patients experienced MACCEs. Kaplan-Meier survival analysis demonstrated a significant association between elevated ACEF score (> 1.27) and TyG index levels (> 8.82) with a heightened incidence of MACCEs (HR = 2.018, 95%CI 1.593–2.789; HR = 2.057, 95%CI 1.572–2.691; Log-Rank test, both P < 0.001). Multivariable Cox regression analysis revealed that even after adjusting for multiple confounders, both the ACEF score and TyG index remained as predictors of MACCEs (HR = 1.702, 95%CI 1.210–2.394, P = 0.002; HR = 1.575, 95%CI 1.296–1.916, P < 0.001). Additionally, the addition of the ACEF score and TyG index into the conventional risk model significantly improved the ability to predict MACCEs, as evidenced by the increase in the C-statistic value from 0.664 to 0.703, along with notable improvements in continuous NRI (0.391), categorical NRI (0.107), and IDI (0.033) (all P < 0.001).ConclusionThe combination of the TyG index and the ACEF score enhances the predictive ability for long-term MACCEs in patients with CHD undergoing PCI.

Irisin Predicts Poor Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction and Low Levels of N-Terminal Pro-B-Type Natriuretic Peptide

Background: Despite existing evidence of the high predictive value of natriuretic peptides (NPs) in patients with heart failure (HF), patients treated with guideline-directed therapy who have low or near-normal NP levels are unlikely to be correctly stratified for risk of clinical outcomes. The aim of this study is to detect plausible predictors for poor one-year clinical outcomes in patients with HFpEF and low NT-proBNP treated with in accordance with conventional guidelines. Methods: A total of 337 patients with HF with preserved ejection fraction (HFpEF) who had low levels of N-terminal natriuretic pro-peptide (NT-proBNP) at discharge due to optimal guideline-based therapy were enrolled in the study. The course of the observation was 3 years. Echocardiography and the assessment of conventional hematological and biochemical parameters, including NT-proBNP, tumor necrosis factor-alpha, high-sensitivity C-reactive protein (hs-CRP), adropin, irisin, visfatin, and fetuin-A, were performed at baseline and at the end of the study. Results: Three-year cumulative clinical endpoints (cardiovascular death, myocardial infarction or unstable angina or acute coronary syndrome, worsening HF, sudden cardiac death, or cardiac-related surgery or all-cause death) were detected in 104 patients, whereas 233 did not meet the endpoint. After adjusting for an age ≥ 64 years and a presence of atrial fibrillation, diabetes mellitus, chronic kidney disease (CKD) stages 1–3 and dilated cardiomyopathy, the multivariable Cox regression analysis showed that an irisin level of ≤7.2 ng/mL was an independent predictor of cumulative clinical endpoint. Moreover, patients with levels of irisin &gt; 7.2 ng/mL had a better Kaplan–Meier survival rate than those with a lower serum irisin level (≤7.2 ng/mL). Conclusions: Multivariable analysis showed that an age ≥ 64 years; the presence of atrial fibrillation, diabetes mellitus, CKD stages 1–3 and dilated cardiomyopathy; an LAVI ≥ 39 mL/m2; and serum levels of hs-CRP ≥ 6.10 mg/L, irisin ≤ 7.2 ng/mL, and visfatin ≤ 1.1 ng/mL were predictors of poor clinical outcomes in HFpEF with low levels of NT-proBNP. A serum level of irisin ≤ 7.2 ng/mL could emerge as valuable biomarker for predicting long-term prognosis among HFpEF patients with low or near-normal levels of NT-proBNP.

Lactate Is a Strong Predictor of Poor Outcomes in Patients with Severe Traumatic Brain Injury

Background: Lactate is a byproduct of glycolysis, often linked to oxygen deprivation. This study aimed to examine how lactate levels (LLs) affect clinical outcomes in patients with severe TBI, hypothesizing that higher LLs would correlate with worse outcomes. Methods: This is a level 1 single-center, retrospective study of patients with severe TBI between 1 January 2020 and 31 December 2023, inclusive. Results: Single-factor ANOVA indicated a significant decrease in LLs with increasing age. Linear regression models showed the same for hospital admission, Intensive Care Unit (ICU) admission LLs, and death LLs. Prognostic scores such as Injury Severity Scores (ISS) and Glasgow Coma Score (GCS) showed a strong correlation with both Hospital admission and ICU admission LLs. ANOVA indicated higher LLs with increasing ISS and increasing LLs with decreasing GCS. Linear regressions revealed a strong positive correlation between ISS and LLs. On linear regression, the LL measured at hospital admission and ICU admission was positively associated with the length of stay (LOS) in the hospital, LOS in the ICU, ventilator days, and mortality. Linear regression models showed that a decreased delta LL during ICU admission led to an increased LOS at the hospital and the ICU, as well as a higher number of days on a ventilator. Discussion: We discovered that high LLs were linked to higher AIS and GCS scores, longer stays in the hospital and ICU, more days requiring a ventilator, and higher mortality rates in patients with severe TBI. Conclusions: LLs can be considered a strong predictor of poor clinical outcomes in patients with severe TBI.

Plasma brain-derived tau correlates with cerebral infarct volume.

A blood-based biomarker that accurately reflects neuronal injury in acute ischemic stroke could be an easily accessible and cost-effective complement to clinical and radiological evaluation. Here, we investigate whether plasma levels of the novel biomarker brain-derived tau (BD-tau) reflect cerebral infarct volumes and whether BD-tau can improve clinical outcome prediction. The present study included 713 consecutive cases from two different hospital-based cohorts, the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) and SAHLSIS phase 2 (SAHLSIS2). Acute stroke severity was determined by the Scandinavian Stroke Scale converted to the National Institutes of Health stroke scale (NIHSS) in SAHLSIS and by the NIHSS in SAHLSIS2. All participants were assessed for functional outcome 3 months after stroke by the modified Rankin Scale, and 254 participants in SAHLSIS had quantitative neuroimaging available. Plasma BD-tau concentrations and cerebral infarct volumes were highly correlated (ρ 0.72, p<0.001). BD-tau improved the prognostic accuracy of suffering an unfavorable outcome over age and stroke severity in the whole cohort. However, the gain in predictive power was dependent on stroke severity and infarct location. The largest improvement was observed for mild ischemic strokes (NIHSS <5; area under the curve [AUC]=0.73 for age+NIHSS versus AUC=0.84 with addition of BD-tau; DeLong p 0.02), posterior circulation stroke (AUC=0.75 vs. AUC=0.84; DeLong p 0.06) and more specifically for infarcts in the brainstem/cerebellum (AUC=0.74 vs. 0.87; DeLong p 0.009). Plasma BD-tau can provide information on the extent of acute neuronal damage in ischemic stroke and adds prognostic value for outcome, especially for mild and posterior circulation strokes.

Exploring lymphocyte subsets in COVID-19 patients: insights from a tertiary academic medical center with a high proportion of patients on immunosuppression.

Severe COVID-19 is associated with reduced absolute lymphocyte counts, suggesting that lymphocyte subsets may serve as predictors of clinical outcomes in affected patients. Early identification of patients at risk for severe disease is crucial for optimizing care, accurately informing patients and their families, guiding therapeutic interventions, and improving patient flow in the ED. Given that immunosuppressive drugs significantly impact lymphocyte profiles, we aimed to determine the association between prior use of immunosuppressive drugs, lymphocyte subsets, and COVID-19 severity in our population with a high prevalence of immunosuppression. In 2021, suspected COVID-19 patients were included in the ED. Lymphocyte subsets were determined in peripheral blood within 24 hours after presentation and comparative analyses was performed between SARS-CoV-2 negative and positive patients, mild versus severe disease and patients with and without prior immunosuppressive drug use. Mild cases were patients discharged home or admitted to a general ward, severe cases were patients with COVID-19-related mortality or necessitating ICU admission. Logistic regression analysis was performed to assess the association between lymphocyte subsets and COVID-19 severity, and between prior immunosuppressive drug use and COVID-19 severity. Twenty-five SARS-CoV-2 negative and 77 SARS-CoV-2 positive patients were included, whereof 57 (74%) had mild and 20 (26%) severe COVID-19. No significant differences were observed in the absolute counts of CD3+, CD4+, and CD8+ T-lymphocytes, B-lymphocytes, and NK-cells between SARS-CoV-2 negative and positive patients or between mild and severe cases. The 36 patients with prior use of immunosuppressive drugs had significantly lower CD4+ T-lymphocytes (p<0.01). Prior use of immunosuppressive drugs was not associated with COVID-19 severity (adjusted OR 1.074, 0.355-3.194). Lymphocyte subsets were not significantly different between SARS-CoV-2 negative and positive patients and between mild versus severe cases. Neither lymphocyte subsets nor prior immunosuppressive drug use were associated with COVID-19 severity.

Wilms’ Tumor 1 Gene Expression as a Predictive Marker for Clinical Outcome of Acute Myeloid Leukemia in Iraqi Population: A Prospective Study

Background: Wilms' tumor gene 1 (WT1), a tumor-associated antigen (TAA), is expressed in many types of cancer. Most acute leukemia patients have a quantitatively detectable and strong expression of it. Objectives: To analyze WT1 expression levels as a predictor of clinical outcomes at the time of diagnosis of de novo leukemia and to monitor tumor progression during treatment. Methods: A total of 71 patients with acute myeloid leukemia (AML) were separated into two groups: twenty-nine de novo AML patients upon presentation and 25 with AML at the time of initial induction. The second induction included 17 AML patients and ten healthy volunteers who served as controls in this study. The WT1 gene was tested using a real-time PCR with the Cyber Green assay. Results: Patients with acute myeloid leukemia had considerably greater levels of WT1 gene expression than controls (27.3 vs. 5.5). In terms of clinical outcomes, WT1 gene overexpression was substantially related to non-responsive AML patients compared to complete response at diagnosis (27.3 vs. 22.15). However, there is no substantial difference between instances following induction. Conclusions: The WT1 tumor antigen may serve as an early diagnostic for acute leukemia prognosis. Improved clinical outcomes have been linked to reduced WT1 levels. A high amount, on the other hand, was linked to a poor prognosis for people with AML, although more research is needed.

CineECG Repolarization Gradients Predict Acute Hemodynamic Response in CRT Patients.

A variable proportion of non-responders to cardiac resynchronization therapy (CRT) warrants the search for new approaches to optimize the position of the left ventricular (LV) lead and the CRT device programming. CineECG is a novel ECG modality proposed for the spatial visualization and quantification of myocardial depolarization and repolarization sequences. The present study aimed to evaluate CineECG-derived parameters in different pacing modes and to test their associations with acute hemodynamic responses in CRT patients. CineECG was used to construct the average electrical path within the cardiac anatomy from the 12-lead ECG. CineECG and LV dP/dt max were tested in 15 patients with nonischemic dilated cardiomyopathy and left bundle branch block (QRS: 170 ± 17 ms; LVEF: 26 ± 5.5%) under pacing protocols with different LV lead localizations. The CineECG-derived path directions were computed for the QRS and ST-T intervals for the anteroposterior (Xh), interventricular (Yh), and apicobasal (Zh) axes. In a multivariate linear regression analysis with adjustment for the pacing protocol type, the ST-T path direction Yh was independently associated with the increase in dP/dt max during CRT, [regression coefficient 639.4 (95% confidence interval: 187.9-1090.9), p = 0.006]. In ROC curve analysis, the ST-T path direction Yh was associated with the achievement of a 10% increase in dP/dt max (AUC: 0.779, p = 0.002) with the optimal cut-off > 0.084 (left-to-right direction) with sensitivity 0.67 and specificity 0.92. The acute hemodynamic response in CRT patients was associated with specific CineECG repolarization sequence parameters, warranting their further testing as potential predictors of clinical outcomes.

Micronutrient deficiencies in copper, zinc, and vitamin D as predictors of clinical outcomes in critically ill surgical patients in Korea: a retrospective cohort study

Micronutrient deficiencies in copper, zinc, and vitamin D as predictors of clinical outcomes in critically ill surgical patients in Korea: a retrospective cohort study

Factors Predicting Renal Outcomes in Hypertensive Emergencies With Severe Renal Impairment: A Single-Center Retrospective Study.

Hypertensive emergencies, characterized by elevated blood pressure (BP) and multiple organ damage, have poor prognosis. Patients occasionally show gradual improvement in renal function with appropriate antihypertensive treatment despite renal impairment. However, reports analyzing factors predicting prognosis in patients with hypertensive emergencies and severe renal impairment are limited. This retrospective study aimed to investigate clinical features and predictors of renal outcomes in such patients. Patients admitted to our hospital diagnosed with hypertensive emergency with severe renal impairment (serum creatinine [Cr] level > 2.5 mg/dL) between 2007 and 2021, were enrolled and divided into two groups: those who received renal replacement therapy (RRT) after 3 years (RRT group) and those who did not (non-RRT group); clinical characteristics and laboratory data were compared. Fifteen patients were enrolled, with a median age and serum Cr level of 48 years and 5.97 mg/dL, respectively. No significant between-group difference was observed in serum Cr levels or kidney size. However, the non-RRT group exhibited significantly higher levels of serum lactate dehydrogenase (LDH) levels and significantly lower platelet counts (PLT), suggesting development of microangiopathic hemolysis due to severe endothelial damage. Furthermore, the non-RRT group exhibited lower serum potassium levels than the RRT group, accompanied by high plasma renin activity and serum aldosterone levels, suggesting activation of the renin-angiotensin system (RAS). In the non-RRT group, serum Cr, LDH, potassium levels, and PLT improved significantly after treatment. Serum LDH, potassium levels, and PLT are useful predictors of renal prognosis in hypertensive emergencies with extremely poor renal function. In some cases, severe renal damage can be ameliorated by appropriate antihypertensive therapy. A positive response to treatment often signifies a favorable prognosis. Furthermore, early initiation of RAS inhibitors may be beneficial for lowering BP and providing renal protection.

Effect of hypofibrinolysis on clinical outcomes of patients with septic disseminated intravascular coagulation

BackgroundThis study investigated the utility of thromboelastometry (ROTEM) in assessing hypofibrinolysis among septic patients, specifically the association of hypofibrinolysis, as determined by ROTEM, with septic disseminated intravascular coagulation (DIC), organ dysfunction, and clinical outcomes. MethodsThis single-center, retrospective analysis included adult septic patients admitted to Saga University Hospital from 2013 to 2017, with available ROTEM data. Hypofibrinolysis was assessed using the lysis index at 60 min (LI60) in extrinsic thromboelastometry (EXTEM). Based on their LI60 values, patients were classified into three groups: Hyper (LI60 ≤ 85), Normal (LI60 86–96), and Hypo (LI60 ≥ 97). ResultsAmong the 63 cases analyzed, the Hypo group showed significantly higher APACHEII and SOFA scores than the Normal group, indicating greater disease severity. Similarly, DIC and sepsis-induced coagulopathy (SIC) scores were notably higher in the Hypo group. The diagnostic performance of LI60 for ISTH-overt DIC showed an area under the curve (AUC) of 0.954, with an optimal cutoff value of 97 %, achieving 100 % sensitivity and 83.3 % specificity. The odds ratio for ISTH-overt DIC was 2.894, indicating a strong association between elevated LI60 and occurrence of DIC. Hypofibrinolysis predicted 28-day mortality and high SOFA scores (≥ 10) with high specificity and negative predictive value (NPV). A Kaplan-Meier curve revealed that the Hypo Group showed significantly worse clinical outcomes than the Normal and Hyper groups. ConclusionFor septic patients, fibrinolysis suppression presenting as “hypofibrinolysis” (elevated LI60) is associated with poor prognosis and risk of higher organ dysfunction. Moreover, it is a significant predictor of adverse clinical outcomes in sepsis.

Motor threshold parameters do not predict repetitive Transcranial Magnetic Stimulation and intermittent Theta Burst Stimulation outcomes in major depressive disorder

BackgroundRepetitive Transcranial Magnetic Stimulation (rTMS) and intermittent Theta Burst Stimulation (iTBS) are non-invasive treatments for major depressive disorder (MDD). While effective, variability in outcomes necessitates identifying predictors of therapeutic response. This study examined whether motor threshold (MT), percentage of motor threshold (%MT), and treatment intensity could predict clinical outcomes in MDD patients undergoing rTMS and iTBS. MethodsAdult MDD patients treated with NeuroStar rTMS or iTBS at Mayo Clinic from February 2016 to April 2024 were included. MT, %MT, and treatment intensity were recorded. Clinical outcomes were assessed via Patient Health Questionnaire-9 (PHQ-9) score changes, response (PHQ-9 change ≥50 %), remission (PHQ-9 < 5), and a patient-reported outcome (PRO) on treatment helpfulness. Linear and logistic regression models were used to assess predictors of clinical outcomes. ResultsAmong 149 patients analyzed (mean age 45.7, 67.8 % female), response rate was 43.0 % and remission rate was 16.8 %. MT and %MT did not significantly correlate with clinical outcomes. Treatment intensity and TMS type did not predict PHQ-9 score changes. Higher treatment intensity was associated with decreased odds of positive PRO responses. Linear regression showed that age and gender significantly predicted PHQ-9 score changes, with older patients and females showing greater improvement. MT was significantly lower in men and with iTBS compared to rTMS. ConclusionMT, %MT, and treatment intensity did not reliably predict outcomes. Higher intensity was linked to reduced patient-reported helpfulness, suggesting that patient comfort is crucial. iTBS's lower MT may benefit those needing less stimulation. Future research should identify better predictors to improve TMS outcomes.

Prediction of clinical prognosis and drug sensitivity in hepatocellular carcinoma through the combination of multiple cell death pathways.

Hepatocellular carcinoma (HCC) is the sixth most common malignant tumor, highlighting a significant need for reliable predictive models to assess clinical prognosis, disease progression, and drug sensitivity. Recent studies have highlighted the critical role of various programmed cell death pathways, including apoptosis, necroptosis, pyroptosis, ferroptosis, cuproptosis, entotic cell death, NETotic cell death, parthanatos, lysosome-dependent cell death, autophagy-dependent cell death, alkaliptosis, oxeiptosis, and disulfidptosis, in tumor development. Therefore, by investigating these pathways, we aimed to develop a predictive model for HCC prognosis and drug sensitivity. We analyzed transcriptome, single-cell transcriptome, genomic, and clinical information using data from the TCGA-LIHC, GSE14520, GSE45436, and GSE166635 datasets. Machine learning algorithms were used to establish a cell death index (CDI) with seven gene signatures, which was validated across three independent datasets, showing that high CDI correlates with poorer prognosis. Unsupervised clustering revealed three molecular subtypes of HCC with distinct biological processes. Furthermore, a nomogram integrating CDI and clinical information demonstrated good predictive performance. CDI was associated with immune checkpoint genes and tumor microenvironment components using single-cell transcriptome analysis. Drug sensitivity analysis indicated that patients with high CDI may be resistant to oxaliplatin and cisplatin but sensitive to axitinib and sorafenib. In summary, our model offers a precise prediction of clinical outcomes and drug sensitivity for patients with HCC, providing valuable insights for personalized treatment strategies.

High iASPP (PPP1R13L) expression is an independent predictor of adverse clinical outcome in acute myeloid leukemia (AML)

Apoptosis-stimulating proteins of p53 (ASPPs) are a family of proteins that modulate key tumor suppressor pathways via direct interaction with p53. Deregulation of these proteins promotes cancer development and impairs sensitivity to systemic (chemo)therapy and radiation. In this study, we describe that the inhibitor of ASPP (iASPP) is frequently highly expressed in acute myeloid leukemia (AML) and that overexpression correlates with a poor clinical outcome. Four independent patient cohorts comprising about 1500 patient samples were analysed and consistently confirm an association of high iASPP expression with unfavourable clinical characteristics and shorter survival. Notably, the predictive role of iASPP is independent of, and adds information to, the European LeukemiaNET (ELN) risk classification. iASPP-interference cell models were developed to investigate the underlying functional aspects of iASPP in AML biology. Attenuation of iASPP expression resulted in reduced proliferation rates of leukemic blasts and rendered cells more susceptible towards induction of apoptosis in response to cytotoxic therapy. In line, independent NSG xenograft mouse experiments demonstrate that attenuation of iASPP results in a significant delay of disease onset and tumor burden and this translates to longer overall survival of mice. In conclusion, deregulation of iASPP has direct functional consequences in AML. Determination of iASPP expression levels provides valuable additional information as a predictive marker in AML and may guide treatment decisions.

Krebs von den Lungen-6 (KL-6) as a diagnostic and prognostic biomarker for non-neoplastic lung diseases.

Important advancements have been made in understanding the pathogenetic mechanisms underlying acute and chronic lung disorders. But although a wide variety of innovative biomarkers have and are being investigated, they are not largely employed to evaluate non-neoplastic lung diseases. The current work aims to examine the use of Krebs von den Lungen-6 (KL-6), a mucin-like glycoprotein predominantly expressed on the surface of type II alveolar epithelial cells (AEC2s), to evaluate the stage, response to treatment, and prognosis in patients with non-neoplastic lung disorders. Data analysis suggests that KL-6 can be utilized as an effective diagnostic and prognostic biomarker in individuals with interstitial lung disease and as a predictor of clinical outcomes in subjects with SARS-CoV-2-related pneumonia. Moreover, KL-6 can be reliably used in routine clinical settings to diagnose and predict the outcome of patients with chronic obstructive pulmonary disease (COPD) exacerbation. The optimal cut-off points within the European population should be defined to improve KL-6's diagnostic efficacy.

Circulating YKL-40 levels but not CHI3L1 or TRIB1 gene variants predict long-term outcomes in patients with angiographically confirmed multivessel coronary artery disease

YKL-40 is significantly associated with the prevalence and severity of coronary artery disease (CAD). YKL-40 levels are significantly associated with variations in the CHI3L1 and TRIB1 genes. We investigated candidate genes for YKL-40 levels and evaluated the prognostic value of this biomarker and corresponding variants for long-term outcomes in patients with CAD. We included 4664 and 521 participants from the Taiwan Biobank (TWB) and CAD cohorts, respectively. Candidate variants for circulating YKL-40 levels were investigated using genome-wide association study (GWAS) data from the TWB cohort, and the results were validated in the CAD cohort. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac events (MACEs), which included the composite endpoints of all-cause mortality, nonfatal acute coronary syndrome, hospitalization for heart failure, and nonfatal stroke. According to the GWAS data from the TWB cohort, three CHI3L1 variants (rs4950928, rs10399931, and rs872129) and one TRIB1 variant (rs6982502) were independently associated with YKL-40 levels. These findings were validated in the CAD cohort. The combined CHI3L1 and TRIB1 weighted genetic risk scores (WGRSs) were not associated with the long-term outcomes (median follow-up period of 3.7 years) in patients with CAD. Conversely, patients with YKL-40 levels in the upper tertile had the highest rates of all-cause mortality and MACEs (log-rank p = 9.58 × 10−8 for all-cause mortality and 1.34 × 10−7 for MACEs). Furthermore, YKL-40 levels predicted poor clinical outcomes only in patients with multivessel CAD (log-rank p = 3.0 × 10−6 for all-cause mortality and 1.10 × 10−5 for MACEs) and not in patients with single-vessel CAD. This study revealed that YKL-40 levels but not the combined CHI3L1 and TRIB1 WGRSs were found to be independent predictors of poor clinical outcomes in patients with multivessel CAD.

Antibiotic resistance genotype, phenotype, and clinical outcomes in patients with Gram-negative infections at Rabin Medical Center in Israel.

While there have been several studies that attempt to find clinical predictors of outcomes in patients hospitalized with bacterial infections, less has been done to combine clinical data with genomic mechanisms of antibiotic resistance. This study focused on a hospitalized patient population in Israel with infections due to medically important bacterial pathogens as a way to build a framework that would unite clinical data with both bacterial antibiotic susceptibility and genomic data. Merging both clinical and genomic data allowed us to find both bacterial and clinical factors that impact certain clinical outcomes. As genome sequencing of bacteria becomes both rapid and commonplace, near real-time monitoring of resistance determinants could help to optimize clinical care and potentially improve outcomes in these patients.

Advanced KPI framework for IVF pregnancy prediction models in IVF protocols

The utilization of neural networks in assisted reproductive technology is essential due to their ability to process complex and multidimensional data inherent in IVF procedures, offering opportunities for clinical outcome prediction, personalized treatment implementation, and overall advancement in fertility treatment. The aim of this study was to develop a novel approach to IVF laboratory data analysis, employing deep neural networks to predict the likelihood of clinical pregnancy occurrence within an individual treatment cycle, integrating both key performance indicators and clinical data. We conducted a retrospective analysis spanning 11 years, encompassing 8732 treatment cycles, to extract the most relevant features to our goal and train the model. Internal validation was performed on 1600 preimplantation genetic testing for aneuploidy embryo transfers, while external was conducted across two independent clinics (over 10,000 cases). Leveraging recurrent neural networks, our model demonstrates high accuracy in predicting the likelihood of clinical pregnancy within specific IVF treatment cycles (AUC = 0.68–0.86; test accuracy = 0.78, F1 score = 0.71, sensitivity = 0.62; specificity = 0.86) comparable to time-lapse system but with a simpler approach. Our model facilitates both retrospective analysis of outcomes and prospective evaluation of clinical pregnancy chances, thus presenting a promising avenue for quality management programs and promotes their realization in medical centers.

Alternate Sampling Matrices for Therapeutic Drug Monitoring of Immunosuppressants.

Immunosuppressant (IS) therapeutic drug monitoring (TDM) relies on measuring mostly pharmacologically inactive erythrocyte-bound and/or plasma protein-bound drug levels. Variations in hematocrit and plasma protein levels complicate interpretation of blood calcineurin inhibitor (CNI) and inhibitors of themolecular target of rapamycin (mTORi) concentrations. Variable binding of mycophenolic acid (MPA) to albumin similarly complicates its TDM in plasma. A different matrix may improve IS concentration-response relationships and better reflect exposures at sites of action. This review explores the evidence for IS TDM using peripheral blood mononuclear cell (PBMC), graft tissue, and total or unbound plasma concentrations. Tandem mass spectrometry provides the sensitivity for assessing these matrices. But several challenges must be addressed, including minimizing hemolysis during blood collection, preventing IS efflux during PBMC preparation, and determining the need for further purification of the PBMC fraction. Assessing and reducing nonspecific binding during separation of unbound IS are also necessary, especially for lipophilic CNIs/mTORi. Although TDM using PBMC or unbound plasma concentrations may not be feasible due to increased costs, plasma CNI/mTORi levels may be more easily integrated into routine TDM. However, no validated TDM targets currently exist, and published models to adjust blood CNI/mTORi concentrations for hematocrit or to predict PBMC, and total and unbound plasma IS concentrations have yet to be validated in terms of measured concentrations or prediction of clinical outcomes. Even if CNI/mTORi measurements in novel matrices do not become routine, they may help refine pharmacokinetic-pharmacodynamic relationships and improve mathematical models for TDM using whole blood. Notably, there is evidence to support measuring unbound MPA in patients with severe renal dysfunction, hypoalbuminemia, and hyperbilirubinemia, with some proposed TDM targets.

Bedside Utilization of Intestinal Pathology in Preterm Infants with Surgical Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with multi-organ dysfunction, multiple systemic morbidities and mortality. The resected bowel commonly shows evidence of coagulative necrosis, inflammation, interstitial hemorrhages, and reparative changes on the pathology examination. The severity of these pathological abnormalities may correlate with the disease's severity and pace of progression and may assist in the prediction of clinical outcomes. This review presents current evidence about the clinical utility of the intestinal pathology in bedside decision making, accurate diagnosing, prediction of outcomes, and in the prognostication of preterm infants with surgical NEC. Developing refined and validated noninvasive methods to diagnose the extent of bowel injury and monitoring of tissue repair throughout disease progression is paramount to mitigating the long-term morbidities in preterm infants with surgical NEC. Improved imaging methods such as targeted bowel ultrasound capable of assessing the inflammation and necrosis in real time will greatly advance care and provide focus for the temporal framework of surgical interventions.

Prognostic Factors of Recovery and Discharge Outcome in Adults after Moderate Traumatic Brain Injury

Abstract Background Traumatic brain injury (TBI) is a leading cause of mortality and morbidity particularly among young people. Identification of prognostic factors can be considerably helpful for clinical decision-making and prediction of outcome. Objective The aim of this study was to identify prognostic factors supposed to be of value in predicting functional outcome in moderate TBI patients. Materials and Methods This was a prospective case series study conducted from March 2023 to January 2024 involving 72 TBI patients with a Glasgow Coma Scale (GCS) score of 9 to 13. Demographic, clinical, laboratory, and management data were collected, analyzed, and correlated with patient outcomes. Based on the Extended Glasgow Outcome Scale (GOSE), patients were assigned to have either favorable outcome (GOSE score: 5–8) or poor outcome (GOSE score: 1–4). Results The mean age was 38.76 ± 18.30 years. The mean GCS score on admission was 11.68 ± 1.27. Surgical intervention was indicated in 29 patients (40.3%). The average length of hospital stay was 9.01 ± 7.88 days. Sixty-five patients (90.3%) had a favorable outcome and 7 patients (9.7%) had a poor outcome. Prognostic factors with significant impact on outcome included the GCS score on admission (p = 0.002); pupillary responses (p = 0.011); blood pressure (p = 0.005); acute subdural hematoma (ASDH) as a primary lesion (p = 0.049); and time to admission, comorbidities, blood glucose, hemoglobin%, oxygen saturation, coagulation profile, endotracheal intubation, and tracheostomy (p &lt; 0.001). Conclusion In moderate TBI patients, delayed hospital arrival, low GCS score, unequal pupils, pretrauma comorbidities, hypotension, hypoxia, anemia, endotracheal intubation, tracheostomy, and ASDH were associated with unfavorable functional recovery and could be considered as poor prognostic factors.