Risk Scores For Outcomes Research Articles

Predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Predicting who will or will not benefit from AF ablation is challenging. Although various risk scores have been designed to predict outcomes after AF ablation, comparative data are sparse and external risk score validation is often lacking. Purpose In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. Methods A total of 482 AF patients (37% non-paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (RF-PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography and either cardiac computed tomography imaging or cardiac magnetic resonance imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. The predictive performance of the risk scores for AF recurrence and complications were assessed separately by receiver operating characteristic (ROC) curves. Results Median follow-up was 16 (12-31) months. AF recurrence after the 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days after ablation. Overall procedural adverse event rate was 6%. The HATCH score was the only score without predictive value for recurrent AF after ablation (area under curve [AUC] 0.545). All other investigated scores demonstrated statistically significant but poor predictive value for recurrent AF after ablation (AUC 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). ROC curve analyses of the studied risk scores for the prediction of AF recurrence and complications are shown in Figure. Conclusion Currently available risk scores perform poorly in predicting outcomes after RF-PVI. These data suggest that the utility of these scores for clinical decision-making is limited. Abstract Figure. ROC curve analyses of risk scores

Pre-Conditioning Serum Leptin Levels Predict Early Relapse Rates of High Risk AML after Allogeneic Stem Cell Transplantation

Background: Allogeneic stem cell transplantation (alloSCT) is an effective treatment for many hematologic diseases including intermediate- and high-risk acute myeloid leukemia (AML). Relapse of the original disease continues to be the most common cause of treatment failure following alloSCT for AML. The factors governing relapse and non-relapse mortality (NRM) following alloSCT are poorly understood. We have previously reported that weight loss prior to conditioning therapy is a risk factor for relapse of myeloid diseases following alloSCT (1). The peptide hormone Leptin is a key regulator of food intake and body weight (2). Moreover, it has known roles in regulation of metabolism and immune homeostasis (3). This retrospective study evaluates Leptin as a predictor of survival, relapse and NRM following alloSCT for hematologic malignancies.Methods: Clinical data and Leptin serum levels measured prior to start of conditioning were collected retrospectively in a cohort of patients transplanted for acute leukemias (AML and ALL, n=206). Findings from this cohort were validated in an independent validation cohort of AML patients transplanted in another institution (n=367). Distribution of serum Leptin levels was highly skewed and thus log2-transformation was applied.Results: We identified low serum Leptin as an independent predictor for early relapse following alloSCT for intermediate and advanced stage acute leukemia (AML and ALL) as defined by the EBMT score (4). Multivariate analysis of Leptin and known covariables (age at transplantation, HLA mismatch, conditioning intensity, in-vivo T cell depletion with ATG, recipient and donor sex) revealed a hazard ratio (HR) for relapse of 0.75 per log2 increase (0.59-0.96, p=0.020) for Leptin. We observed an increased risk of NRM with higher leptin serum levels with an HR of 1.63 (1.15-2.31, p=0.006) while no statistically significant effect on OS was found. In order to visualize the effect of the continuous variable on the distribution of survival times, the quartiles of serum Leptin levels with regards to relapse, NRM and OS are shown in Figure 1. This effect on relapse was similar in intermediate and advanced stage AML patients from an independent cohort with an HR of 0.84 (0.72-0.97, p=0.020) while no statistically significant effects on NRM and OS were found. Pre-conditioning serum Leptin was confirmed as a predictor for early relapse by fitting the Cox model to the validation data.Conclusion: Low pre-conditioning serum Leptin levels appear to be an independent risk factor for early relapse following alloSCT for intermediate and advanced stage AML. Pre-conditioning serum Leptin should be explored to guide nutritional intervention in AML patients undergoing alloSCT in order to improve transplant success.ReferencesDietrich S, Radujkovic A, Stolzel F, Falk CS, Benner A, Schaich M, et al. Pretransplant metabolic distress predicts relapse of acute myeloid leukemia after allogeneic stem cell transplantation. Transplantation. 2015;99(5):1065-71.Elmquist JK, Elias CF, Saper CB. From lesions to leptin: hypothalamic control of food intake and body weight. Neuron. 1999;22(2):221-32.Procaccini C, La Rocca C, Carbone F, De Rosa V, Galgani M, Matarese G. Leptin as immune mediator: Interaction between neuroendocrine and immune system. Developmental and comparative immunology. 2017;66:120-9.Gratwohl A, Stern M, Brand R, Apperley J, Baldomero H, de Witte T, et al. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009;115(20):4715-26. [Display omitted] DisclosuresBeelen:Medac: Consultancy, Other: Travel Support.

Risk scores for outcome in bacterial meningitis: Systematic review and external validation study

To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis. MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer-Lemeshow test, and the distribution of calculated risks. Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57-0.61) and 0.74 (0.71-0.76) in bacterial meningitis, 0.67 (0.64-0.70) in pneumococcal meningitis, and 0.81 (0.73-0.90), 0.82 (0.74-0.91), 0.84 (0.75-0.93), 0.84 (0.76-0.93), 0.85 (0.75-0.95), and 0.90 (0.83-0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores. One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management.

Development and Validation of a Scoring System to Predict Outcomes of Patients With Primary Biliary Cirrhosis Receiving Ursodeoxycholic Acid Therapy

Approaches to risk stratification for patients with primary biliary cirrhosis (PBC) are limited, single-center based, and often dichotomous. We aimed to develop and validate a better model for determining prognoses of patients with PBC. We performed an international, multicenter meta-analysis of 4119 patients with PBC treated with ursodeoxycholic acid at liver centers in 8 European and North American countries. Patients were randomly assigned to derivation (n= 2488 [60%]) and validation cohorts (n= 1631 [40%]). A risk score (GLOBE score) to predict transplantation-free survival was developed and validated with univariate and multivariable Cox regression analyses using clinical and biochemical variables obtained after 1 year of ursodeoxycholic acid therapy. Risk score outcomes were compared with the survival of age-, sex-, and calendar time-matched members of the general population. The prognostic ability of the GLOBE score was evaluated alongside those of the Barcelona, Paris-1, Rotterdam, Toronto, and Paris-2 criteria. Age (hazard ratio= 1.05; 95% confidence interval [CI]: 1.04-1.06; P < .0001); levels of bilirubin (hazard ratio= 2.56; 95% CI: 2.22-2.95; P < .0001), albumin (hazard ratio= 0.10; 95% CI: 0.05-0.24; P < .0001), and alkaline phosphatase (hazard ratio= 1.40; 95% CI: 1.18-1.67; P= .0002); and platelet count (hazard ratio/10 units decrease = 0.97; 95% CI: 0.96-0.99; P < .0001) were all independently associated with death or liver transplantation (C-statistic derivation, 0.81; 95% CI: 0.79-0.83, and validation cohort, 0.82; 95% CI: 0.79-0.84). Patients with risk scores >0.30 had significantly shorter times of transplant-free survival than matched healthy individuals (P<.0001). The GLOBE score identified patients who would survive for 5 years and 10 years (responders) with positive predictive values of 98% and 88%, respectively. Up to 22% and 21%of events and nonevents, respectively, 10 years after initiation of treatment were correctly reclassified in comparison with earlier proposed criteria. In subgroups of patients aged <45, 45-52, 52-58, 58-66, and ≥66 years, age-specific GLOBE-score thresholds beyond which survivalsignificantly deviated from matched healthy individuals were-0.52, 0.01, 0.60, 1.01 and 1.69, respectively. Transplant-free survival could still be accurately calculated by the GLOBE score withlaboratory values collected at 2-5 years after treatment. We developed and validated scoring system (the GLOBE score) to predict transplant-free survival of ursodeoxycholic acid-treated patients with PBC. This score might be used to select strategies for treatment and care.

Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients

Hip fracture surgery is associated with high post-operative mortality and poor functional results: the excess mortality is 20% in the first year; of those patients who survive, only 50% recover their previous ability to walk. The purpose of this study was to assess the predictive value of six functional status and/or surgical risk scoring systems with regard to serious complications after hip fracture surgery in the elderly. We performed a prospective study of a consecutive series of 232 patients (aged 65 years or older) undergoing hip fracture surgery. We pre-operatively applied: The American Society of Anesthesiologists classification, the Barthel index, the Goldman index, the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system, the Charlson index and the Visual Analogue Scale for Risk (RISK-VAS) scale. These scales were evaluated with respect to three variables: incidence of serious complications, the ability to walk after a 3-month period and 90-day survival. The predictive value of the different scales was assessed by the calculated area under a receiver operating characteristic curve. The RISK-VAS scale, the POSSUM scoring system and the Charlson index reached a sufficient predictive value with regard to serious post-operative complications. The Barthel index and the RISK-VAS scale were those most useful for predicting ambulation at 3 months. None of the scales proved to be capable of predicting 90-day mortality. A simple index such as the RISK-VAS scale was the best predictor of serious post-operative complications. The functional level before the fracture, measured with the Barthel index, had a major influence on the ambulation recovery.