Risk Score Tool Research Articles

The value of intrapartum factors in predicting maternal morbidity

The rates of severe maternal morbidity and mortality in the United States exceed those in other high-income nations. To aid providers and hospitals in recognizing the risk factors, there have been multiple attempts to develop stratification systems for morbidity based on maternal comorbidities. However, most women giving birth are healthy and do not have comorbidities to suggest that they are at an increased risk for severe maternal morbidity. There are small but inherent maternal risks to labor, and the events after admission may further influence a woman's risk for morbidity even for those initially at a low risk. To determine if the incorporation of intrapartum factors known at the start of the second stage of labor improves the predictive performance of a comorbidity-based risk tool for severe maternal morbidity. This is a retrospective cohort study of women at 8 hospitals in a single health system between July 1, 2016, and June 30, 2020. The women had term, singleton gestations and were admitted in labor and reached the second stage. The primary outcome was severe maternal morbidity. We compared logistic regression models using a validated risk-scoring tool (the Expanded Obstetric Comorbidity Score, which uses diagnosis codes for maternal comorbidities and pregnancy characteristics to predict maternal morbidity) with a model that included the Expanded Obstetric Comorbidity Score combined with parity and intrapartum factors. The intrapartum factors included labor induction or augmentation, length of labor, prolonged rupture of membranes, the presence of meconium-stained amniotic fluid, and gestational age. The hospitals were divided into a training (n=4) and testing (n=4) set to evaluate the predictive model performance. Discrimination was assessed by calculating the area under the receiver operating curve and calibration via calibration plots. Similar model comparisons were performed in a subgroup of women, who the Expanded Obstetric Comorbidity Score predicted to be at low risk for morbidity. This analysis included 33,770 deliveries from the 8 hospitals; severe maternal morbidity occurred in 498 (1.5%) deliveries. The model performance is reported among the testing set (n=15,350). Using the Expanded Obstetric Comorbidity Score alone, the area under the receiver operating curve was 0.676 (95% confidence interval, 0.636-0.716) and 155 (71%) events occurred among individuals above the median predicted risk. When combining intrapartum factors, the area under the receiver operating curve increased to 0.729, (95% confidence interval, 0.693-0.764) and 171 (78%) events occurred among individuals above the median predicted risk. The significant factors that were associated with severe maternal morbidity in this combined model included the Expanded Obstetric Comorbidity Score, length of labor, and the presence of meconium-stained amniotic fluid. The area under the receiver operating curve for the model with intrapartum factors was significantly higher than the models using the Expanded Obstetric Comorbidity Score alone (P<.001). The incorporation of intrapartum factors along with a validated risk tool (Expanded Obstetric Comorbidity Score) improved the ability to predict severe maternal morbidity at the start of the second stage. These findings emphasize the evolution of a woman's risk during her labor course and suggests that the prediction of maternal risk can be improved by considering intrapartum factors.

A Novel Risk Scoring Tool to Predict Saphenous Vein Graft Occlusion After Cardiac Artery Bypass Graft Surgery.

Objectives: Coronary artery bypass grafting (CABG) success is reduced by graft occlusion. Understanding factors associated with graft occlusion may improve patient outcomes. The aim of this study was to develop a predictive risk score for saphenous vein graft (SVG) occlusion after CABG.Methods: This retrospective cohort study enrolled 3,716 CABG patients from January 2012 to March 2013. The development cohort included 2,477 patients and the validation cohort included 1,239 patients. The baseline clinical data at index CABG was analyzed for their independent impact on graft occlusion in our study using Cox proportional hazards regression. The predictive risk scoring tool was weighted by beta coefficients from the final model. Concordance (c)-statistics and comparison of the predicted and observed probabilities of predicted risk were used for discrimination and calibration.Results: A total of 959 (25.8%) out of 3,716 patients developed at least one late SVG occlusion. Significant risk factors for occlusion were female sex [beta coefficients (β) = 0.52], diabetes (β = 0.21), smoking (currently) (β = 0.32), hyperuricemia (β = 0.22), dyslipidemia (β = 0.52), prior percutaneous coronary intervention (PCI) (β = 0.21), a rising number of SVG (β = 0.12) and lesion vessels (β = 0.45). On-pump surgery (β = −0.46) and the use of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) (β = −0.59) and calcium channel blockers (CCB) (β = −0.23) were protective factors. The risk scoring tool with 11 variables was developed from the derivation cohort, which delineated each patient into risk quartiles. The c-statistic for this model was 0.71 in the validation cohort.Conclusions: An easy-to-use risk scoring tool which included female sex, diabetes, smoking, hyperuricemia, dyslipidemia, prior PCI, a rising number of SVG and lesion vessels, on-pump surgery, the use of ACEI/ ARB and CCB was developed and validated. The scoring tool accurately estimated the risk of late SVG occlusion after CABG (c-statistic = 0.71).

Rising Trends in the Incidence of Shoulder Dystocia and Development of a Novel Shoulder Dystocia Risk Score Tool: A Nationwide Population-Based Study of 800,484 Finnish Deliveries

(Abstracted from Acta Obstet Gynecol Scand 2021;100:538–547) Shoulder dystocia is an unpredictable, obstetric emergency. Its incidence has been reported to range from 0.1% up to 3.0%.

Development and Validation of a Clinical Prognostic Risk Score to Predict Early Neonatal Mortality, Ethiopia: A Receiver Operating Characteristic Curve Analysis.

BackgroundEarly neonatal death is the death of a live-born baby within the first seven days of life, which is 73% of all postnatal deaths in the globe. This study aimed to develop and validate a prognostic clinical risk tool for the prediction of early neonatal death.MethodsA prospective follow-up study was conducted among 393 neonates at Debre Tabor Referral hospital, Northwest Ethiopia. Multivariable logistic regression model was employed to identify potential prognostic determinants for early neonatal mortality. Area under receiver operating characteristics curve (AUROC) was used to check the model discrimination probability using ‘pROC’ R-package. Model calibration plot was checked using ‘givitiR’ R-package. Finally, a risk score prediction tool was developed for ease of applicability. Decision curve analysis was done for cost-benefit analysis and to check the clinical impact of the model.ResultsOverall, 15.27% (95% CI: 12.03–19.18) of neonates had the event of death during the follow-up period. Maternal undernutrition, antenatal follow-up less than four times, birth asphyxia, low birth weight, and not exclusive breastfeeding were the prognostic predictors of early neonatal mortality. The AUROC for the reduced model was 88.7% (95% CI: 83.8–93.6%), which had good discriminative probability. The AUROC of the simplified risk score algorithm was 87.8% (95% CI, 82.7–92.9%). The sensitivity and specificity of the risk score tool was 70% and 89%, respectively. The true prediction accuracy of the risk score tool to predict early neonatal mortality was 86%, and the false prediction probability was 13%.ConclusionWe developed an early neonatal death prediction tool using easily available maternal and neonatal characteristics for resource-limited settings. This risk prediction using risk score is an easily applicable tool to identify neonates at a higher risk of having early neonatal mortality. This risk score tool would offer an opportunity to reduce early neonatal mortality, thus improving the overall early neonatal death in a resource-limited setting.

Community-Based Screening for Cardiovascular Disease in the Capricorn District of Limpopo Province, South Africa

Background: The number of people who suffer and die from Cardiovascular Disease (CVD) is increasing at an alarming rate in low-and middle-income countries. Objective: The objective of the study was to screen communities using the non-laboratory INTERHEART Risk Score tool (NLIRS) to determine their level of risk for developing CVD. Methods: A community-based quantitative study was conducted in the Capricorn District of Limpopo Province. A total of 3315 participants were screened by 63 community health workers (CHWs) using the NLIRS tool. The tool covers the following items which are allocated different scores: Gender:male ≥55 years or female ≥65years=2; being a smoker or having stopped ≤12 months ago = 2; smoking1-5 cigarettes =2; 6-10=4; 11-15=6;16-20 a day and ≥20=11; indirect smoking last 12 months =2; having diabetes=6 and high blood pressure=5; parental history of heart attack=4; having stress and depression=3 each; consumption of salty and fried food, no vegetables or fruits each scored a 1; eating meat twice a day =2; being inactive =2; waist-to-hip ratio ≥.874-0.963=2 and ≥0.964=4. The scores were added and those who scored 0-9 were classified to be at low risk, 10-15 moderate and 16-48 at high risk. Results: On average 58% and 33% were found to be at low and moderate risk, respectively for developing CVD and 9% at high risk. The majority consumed salty, fried foods and meat and were inactive. Being hypertensive constituted 67% of being at high risk of developing CVD. Conclusion: Envisaged intervention will focus on preventive strategies for risk factors such as diet, exercise and hypertension. More males should be recruited to participate in future research to determine if the same results will be obtained.

Developing a Prognostic Model to Predict Mortality in Patients with Acute Bacterial Meningitis.

Bacterial meningitis is one of the harmful and deadly infectious diseases, and any delay in its treatment will lead to death. In this paper, a prognostic model was developed to predict the risk of death amongst probable cases of bacterial meningitis. Our prognostic model was developed using a decision tree algorithm on the national meningitis registry of the Iranian Center for Disease and Prevention (ICDCP) containing 3,923 records of meningitis suspected cases in 2018-2019. The most important features have been selected for the model construction. This model can predict the mortality risk for the meningitis probable cases with 78% accuracy, 84% sensitivity, and 73% specificity. The identified variables in prognosis the death included age and CSF protein level. CSF protein level (mg/dl) <= 65 versus > 65 provided the first branch of our decision tree. The highest mortality risk (85.8%) was seen in the patients >65 CSF protein level with 30 years < of age. For the patients <=30 year of age with CSF protein level >137 (mg/dl), the mortality risk was 60%. The prognostic factors identified in the present study draw the attention of clinicians to provide early specific measures, such as the admission of patients with a higher risk of death to intensive care units (ICU). It could also provide a helpful risk score tool in decision-making in the early phases of admission in pandemics, decrease mortality rate and improve public health operations efficiently in infectious diseases.

The Comparability of Lipid-based and Body Mass Index-based Cardiovascular Disease Risk Scores: Using the Rwanda 2012-2013 Non-communicable Diseases Risk Factors Survey Data

Background&#x0D; In Rwanda, cardiovascular diseases (CVDs) ranked second of the most common cause of death in 2016. CVD risk score tools have been recommended to identify people at high risk for management.&#x0D; Objective &#x0D; To assess the comparability of body mass index (BMI)-based and lipid-based CVD risk scores in Rwandan population.&#x0D; Methods&#x0D; Secondary analysis was conducted on 4185 study participants extracted from the dataset of Rwanda 2012-2013 non-communicable diseases risk factors survey. Individual CVD risk scores were calculated using both BMI-based and lipid-based algorithms, one at a time. Spearman rank’s coefficient and Cohen’s Kappa coefficient were used to compare the two tools.&#x0D; Results&#x0D; About 63.5% of participants were women. There was a significant positive correlation between BMI-based algorithm and lipid-based algorithm vis-à-vis a 10-year CVD risk prediction (Spearman rank correlation coefficients &gt; 0.90, p&lt;0.001) considering either men, women or overall study participants. There was a moderate agreement between BMI-based and lipid-based algorithms vis-à-vis CVD risk characterization, kappa = 0.52; p-value p&lt;0.001 considering either overall study participants or men and kappa = 0.48; p-value p&lt;0.001 considering women.&#x0D; Conclusion&#x0D; The findings from this study suggest the use of BMI-based algorithm, a cost effective tool compared to lipid-based tool, can be alternatively used in resource-limited settings. &#x0D; Rwanda J Med Health Sci 2021;4(1):166-184

Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

BackgroundIt is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission.MethodsClinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator.ResultsThe 845 eligible patients (420 men, 425 women) had an average age of 60.05 ± 15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI 0.900–0.946, p < 0.001) and 0.900 in the validation cohort (95% CI 0.883–0.948, p < 0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/).ConclusionsWe developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.

Development and temporal external validation of a simple risk score tool for prediction of outcomes after severe head injury based on admission characteristics from level-1 trauma centre of India using retrospectively collected data

ObjectiveTo develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).DesignRetrospective.SettingLevel-1, government-funded trauma centre, India.ParticipantsPatients with severe HI...

EFFECTIVE PREVENTION OF HIGH-RISK CERVICAL CANCER AMONG WOMEN IN DEVELOPING COUNTRIES: A CASE-STUDY IN NIGERIA

There is a surge of morbidity and mortality among women as a result of untreated cases of Cervical Cancer (CC) which is common among women living in underdeveloped and developing countries. The epidemiology of CC revealed that the application of certain combat and operational risk factors of some germane associated with the formation/development of CC can help avoid being infected by the neoplastic disease or the early discovery at an early stage can help mitigate the spread. Hence, some germane high-risk and low-risk factors of the formation of CC in this study were considered to help differentiate infected women from those that are not infected and to create awareness about HPV for effective prevention of CC formation. This study is aimed at predicting and differentiating the group of women with ‘low-risk’ CC from ‘high-risk’ CC among Nigerian women; identification of ‘high-risk’ population. Therefore, some germane and prevalent risk factors such as having sexual intercourse at an early age (early age at sexual debut/first coitus) and the number of sex partners had over a lifetime, and other known low-risk germane such as poor diet and inadequate knowledge about Human Papillomavirus (HPV) and CC were considered; wherewith HPV is considered a predominant risk factor for the occurrence/possibility of CC among the population. A risk-score assessment Human Papillomavirus (HPV) Assessment Test (HAT) tool was used for data collection. Hence, this study is the first to develop a risk-score assessment test tool for HPV and CC awareness in Nigeria

Rising trends in the incidence of shoulder dystocia and development of a novel shoulder dystocia risk score tool: a nationwide population-based study of 800484 Finnish deliveries.

Shoulder dystocia has remained an unpredictable and feared emergency in obstetrics. Some risk factors have been identified but nevertheless there is a lack of risk evaluation tools in clinical practice. The aim of this study was to evaluate the incidence and risk factors of shoulder dystocia in the Finnish population and to develop a shoulder dystocia risk score tool. This retrospective, population-based study included all deliveries in Finland between 2004 and 2017 (n=800484). The annual numbers of shoulder dystocia diagnoses were gathered from nationwide Finnish Medical Birth Register and Hospital Discharge Register. The incidence of shoulder dystocia was calculated in subgroups according to the mode of delivery, maternal diabetes status, body mass index (BMI), age, parity and gestational age. Based on these numbers, a shoulder dystocia risk score tool was created. The overall incidence of shoulder dystocia was 0.18%. It increased significantly during the study period from 0.10% to 0.32% (P<.001). More specifically, the incidence increased significantly in all analyzed subgroups except for women with BMI <18.5 or age <20years. To evaluate the importance of risk factors, practical and simple shoulder dystocia risk score tool was created. Instrumental vaginal delivery, maternal diabetes of any kind, BMI ≥25, age ≥40years and gestational age ≥41weeks were associated with higher shoulder dystocia risk compared with non-diabetic, non-obese and younger women with spontaneous deliveries before 41weeks of gestation. In our risk score tool, cases with shoulder dystocia had a significantly higher number of risk points than those without it (15.2 vs 10.4, P<.001). The risk was significantly high when the scores were ≥18 points (relative risk 9.54, 95% confidence interval 8.61-10.57). The incidence of shoulder dystocia in Finland increased during the study period but it is still low compared with previous studies from other countries. In clinical daily practice, the new shoulder dystocia risk score tool helps to evaluate the individual risk profile of the parturient. According to this risk score tool, the highest risk was found with the combination of instrumental vaginal delivery, maternal diabetes, BMI ≥25, age ≥40years and gestational age ≥41weeks.

The role of body muscle mass as an indicator of activity in inflammatory bowel disease patients

Malnutrition is an objective disease activity parameter for patients with inflammatory bowel disease (IBD), particularly Crohn's Disease (CD), and is an indicator of lesion expansion or inflammatory activity. Active disease is correlated with the systemic response of the body's immune system, activating a hypermetabolic state and protein degradation (Argiles JM, 2015). These conditions lead to malnutrition, which significantly increases the risk of impaired clinical outcomes, such as delayed recovery or increased mortality (Landi F, 2019). Our aim was to identify malnutrition parameters associated with more pronounced metabolic status changes in IBD patients (i.e., classified as by low and high clinical activity) as an indicator of disease activity. This prospective pilot study included hospitalised patients aged ≥18 years, with an established diagnosis of IBD, with no medical history of surgical interventions. IBD patients were divided into those with low clinical activity indexes (CD activity index [CDAI] <150 for CD and Mayo <4 for ulcerative colitis [UC]) and those with high clinical activity indexes (CDAI >150 for CD and Mayo >4 for UC). Patients were assessed twice using the Nutritional Risk Score (NRS2002) and Malnutrition Universal Screening Tool (MUST) and 48 body bioelectrical impedance analysis (BIA) measurements were taken. A control group consisting of heathy age- and sex-matched individuals was used for comparison. Fifty hospitalised patients (median age, 36.5 IQR: 28.5-51.5 years) were enrolled, of which 44% (n=21) were female and 56% (n=27) were male. Of these, 48% (n=23) patients were diagnosed with CD and 52% (n=25) with UC. The median CDAI was 128 (IQR=6.0-207.0) and Mayo score was >4 (IQR=1.0-8.0). The study group comprised 48% (n=23) patients with low IBD activity and 52% (n=25) of patients with high IBD activity. According to the NRS2002, 31% (n=15) patients were nutritionally at risk and in need of nutritional support and an additional 24% (n=12) had low-risk requiring observation, without necessity for additional nutritional care. According to the MUST score, 40% (n=19) of patients had a high-risk of malnutrition requiring a nutritional care plan and 19% (n=9) were of low-risk. Overall, 31% (n=17) of patients received enteral oral feeding and 10% (n=4) required additional parenteral feeding. The group with low IBD activity showed a considerably lower score on both screening tools (NRS2002 p=0.007; MUST p<0.001). Comparing BIA results between IBD patients and the control group, the median BMI was lower for the CD (21.10 [IQR=19.2-23.3]) than for the control group (23.4 [IQR=21.5-25.8]) (p=0.014). In addition, visceral fat mass was lower in CD (-4,00 [IQR=-12.1 to 5.6]) than in the control group (7.85 [IQR=-0.9-18.2]) (p=0.003). In terms of deviation from standard weight, 39% (n=9) of CD patients showed reduced %body fat, while this was observed in only 19% (n=5) of UC patients. Reduced muscle mass was observed in 48% (n=11) of CD patients and in 19% (n=4) of UC patients, while only 13% (n=6) of all IBD patients had reduced BMI. IBD patients with high disease activity indices had a noticeably increased risk for malnutrition (according to NRS2002 scores), taking into consideration not only IBD activity, but also increased weight loss and loss of appetite. Most CD patients in both the low and high disease activity groups had reduction in muscle mass, which was not evaluated in UC patients. Identification of the reduction in soft lean muscle mass in CD patients can be used as an anticipatory indicator of disease activity.

Hypertension Prevalence and Determinants among Black South African Adults in Semi-Urban and Rural Areas.

The burden of hypertension is reported to be on the rise in developing countries, such as South Africa, despite increased efforts to address it. Using a cross-sectional study design, we assessed and compared the prevalence of and risk factors associated with hypertension amongst adults aged ≥18 years in semi-urban and rural communities (1187 semi-urban and 1106 rural). Trained community health workers administered the INTERHEART Risk Score tool and performed blood pressure assessments using the MEDIC Pharmacists Choice Blood Pressure Monitor. Hypertension was defined to be a systolic blood pressure (BP) ≥ 140 mmHg and diastolic BP ≥ 90 mmHg. A multivariate logistic regression model was used to identify factors and determine their relationship with hypertension. The prevalence of hypertension amongst semi-urban and rural communities was 21% with no gender difference. In the semi-urban area, physical activity, family history, fruit intake, salty food, and eating meat were significantly associated with the odds of hypertension among women, whereas only the waist-to-hip ratio (WHR), diabetic status, and salty food were the predictors for rural women. Factors such as fried food and low fruit intake were significantly associated with the odds of hypertension among men in the semi-urban area, whereas only the WHR was significant among men in the rural area. Hypertension was found to be prevalent among semi-urban and rural adults in Limpopo Province, South Africa.

Utilização do Finnish Diabetes Risk Score (FINDRISC) como ferramenta para identificação, prevenção e conscientização da diabetes mellitus em adultos da cidade de Santos

Avaliar a funcionalidade da ferramenta Finnish Diabetes Risk Score (FINDRISC) na identificação, prevenção e conscientização da Diabetes mellitus tipo2 (DM2) na cidade de Santos. Trata-se de um estudo transversal, analítico e descritivo. Foram avaliadas 96 pessoas e os participantes foram entrevistados, realizou-se a aferição da pressão arterial (PA), medições antropométricas, glicemia capilar de jejum (GCJ) e analisados os resultados obtidos no FINDRISC. Para análise estatística, aplicaram-se nos dados a análise de variância e teste do qui-quadrado. A prevalência de DM2 foi de 17%. Entre os fatores de risco modificáveis as maiores prevalências foram: Circunferência abdominal alterada (86%), IMC&gt;25kg/m² (75%), PA alterada (57%) e GCJ&gt;100mg/dL (48%). A maior associação para ocorrência de DM2 foi “antecedentes familiares” com aumento de risco em 3,3 vezes (P&lt;0,02). Dos entrevistados que afirmaram não ter diagnóstico de DM2, 40% estava com o valor de GCJ acima de 100 mg/dL e 7,5% da amostra com valores acima de 126mg/dL sendo que destes, 85% apresentavam risco elevado em desenvolver DM2 pela pontuação FINDRISC. Os resultados demonstram a eficácia da ferramenta FINDRISC em identificar DM2 e a necessidade da realização das campanhas preventivas ou de promoção de saúde para o rastreamento e orientação de pessoas com elevado risco.

Simple Risk Index Score and Hospitalization Mortality in Patients with ST-Elevation Myocardial Infarction

Introduction: Hospitalization mortality in ST-elevation Myocardial Infarction (STEMI) patients areaffected by several factors, including initial identification of the risks at hospital admission. Riskscore tools as a predictor of STEMI complication and death event in STEMI patients is a simple riskindex score. The aim of this study was to determine the association between simple risk index scoreand hospitalization mortality in STEMI patients.Methods: We retrospectively enrolled 60 consecutive patients who were admitted to our hospitaldiagnosed with STEMI. The simple risk index score was calculated for each patient using equation:heart rate x [age/10]2/systolic blood pressure. The patients were assigned into 2 groups according tothis score, high score and low score group. Incidence of death during hospitalization in STEMIpatients was recorded.Results: The total subjects were 60 people. The subjects consisted of 30 patients with low score and30 subjects with high score. The incidence of death during hospitalization in the group of high simplerisk index score were 26 patients, and in the group of low simple risk index score were 13 patients.The association between the simple risk index score and the deaths during hospitalization in STEMIpatients based on statistical analysis was significant (p= 0.00) and value of risk relative (RR) is 2.167;95% CI: 1.368-3.433; (p=0.000).Conclusion: Simple risk index score is associated with hospitalization mortality in ST-elevationmyocardial Infarction (STEMI) patients.

Predictive Value of the Get With The Guidelines Heart Failure Risk Score in Unselected Cardiac Intensive Care Unit Patients.

BackgroundThe cardiac intensive care unit (CICU) population is no longer composed of only patients with acute coronary syndromes, and includes those with acute heart failure and multiple comorbidities. We hypothesized that the GWTG‐HF (Get With The Guidelines–Heart Failure) risk score that predicts inpatient mortality in hospitalized patients with heart failure would predict mortality in CICU patients.Methods and ResultsWe retrospectively analyzed CICU patients at a tertiary care hospital from 2007 to 2015. The GWTG‐HF risk score was calculated at CICU admission. As a secondary analysis, the EFFECT (Enhanced Feedback for Effective Cardiac Treatment), OPTIMIZE‐HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure), and ADHERE (Acute Decompensated Heart Failure National Registry) risk scores were calculated. Kaplan–Meier survival analysis and the area under the receiver operating characteristic curve value were determined for inpatient and 1‐year mortality. The GWTG‐HF risk score was calculated in 9532 (95%) patients, with a median value of 40 (interquartile range, 35–47). Inpatient mortality occurred in 824 (8.6%) patients, and 2075 (21.8%) patients died by 1 year. Patients who died in hospital had a significantly higher mean GWTG‐HF score (47.7 versus 40.2; P<0.001). Inpatient and 1‐year mortality increased in each GWTG‐HF risk score quartile (P<0.0001). Discrimination of the GWTG‐HF, EFFECT, OPTIMIZE‐HF, and ADHERE risk scores was assessed using area under the receiver operating characteristic curve values for hospital mortality, and were similar for all risk scores (0.72–0.74; P>0.05). The Hosmer–Lemeshow statistic suggested poor calibration for hospital mortality by the GWTG‐HF risk score (P<0.001).ConclusionsThe GWTG‐HF risk score and other heart failure prediction tools demonstrate good discrimination for inpatient and 1‐year mortality in a heterogeneous cohort of CICU patients. Our study emphasizes that prognostic variables overlap in cardiac patients, regardless of the admission diagnosis.

Clinical Validation of the Chinese Version of Patient Completed Caprini Risk Assessment Form.

To create and validate patient-completed Caprini risk score (CRS) tools for Chinese people. We revised Chinese patient-completed CRS form according to previously published studies. We prospectively recruited 70 internal medical patients and 70 surgical patients. The average age of these patients was 54.26 ± 15.29 years, 54.29% of them were male and 80% of them had education beyond high school. The study compared: (1) patient-completed CRS and physician-completed CRS; (2) the final value of physician-completed CRS (physician-completed CRS + body mass index) and CRS in the electronic medical record (EMR) system. Patient-completed CRS was 3.71 ± 3.63, patients spent 3.60 ± 1.24 minutes, 57.14% patients were at high-highest risk; physician-completed CRS was 3.84 ± 3.63, physicians spent 2.11 ± 1.13 minutes, 59.28% patients were at high-highest risk; the final value of physician-completed CRS was 4.12 ± 3.62, 63.58% patients were at high-highest risk; CRS value in the EMR system was 4.07 ± 3.58, 65% patients were at high-highest risk. There were strong positive correlations (P < .0001) between patient-completed CRS and physician-completed CRS (r = 0.978, κ = 0.76) and between the final value of physician-completed CRS and CRS in EMR (r = 0.994, κ = 0.97). This study successfully developed and validated a Chinese patient-completed CRS that we found can replace physician-completed CRS. This results in considerable time saving for physicians and this process should increase the percentage of patients having complete risk assessment when they are admitted to the hospital.

A Novel Integrated Type 2 Diabetes Prediction Model for Indian Population using Data Mining Techniques

Late diagnosis and undiagnosed type 2 diabetes are the two major concerns for India, which is going to be a diabetes capital shortly. Several diabetes risk score (DRS) tools have been proposed and deployed for detecting the persons with high risk. These DRS tools have been developed using the multiple logistic regression model. But this model is both imperfect and subject to misuse. Another major issue with the DRS tools developed for Indian population is that they are based on the very limited urban population that does not represent the population of India. The objective of current research work is to develop a classification model for type 2 diabetes prediction. Along with this, the building of a novel integrated model for type 2 diabetes risk prediction is discussed consisting of the aggregate classification model and Indian weighted diabetes risk score model. The dataset used to develop and validate the model is obtained from the Annual Health Survey comprising of nearly 0.7 million and nearly 75 thousand adult participants respectively from around 400 districts of India. The proposed integrated diabetes risk prediction model predicts diabetes with 69.89% sensitivity, 56.58% specificity. The positive predictive value of the proposed integrated model is 15.88%, which is a significant improvement as the prevalence of diabetes is only 3.68% for the study population. Developing countries such as India, where undiagnosed diabetes and limited financial resources are a significant concern, the proposed integrated model for diabetes risk prediction can be useful as a cheaper tool useful for mass-screening, which can save up to 30% of the total screening cost.

Predicting Incident Radiographic Knee Osteoarthritis in Middle‐Aged Women Within Four Years: The Importance of Knee‐Level Prognostic Factors

To develop and internally validate risk models and a clinical risk score tool to predict incident radiographic knee osteoarthritis (RKOA) in middle-aged women. We analyzed 649 women in the Chingford 1,000 Women study. The outcome was incident RKOA, defined as Kellgren/Lawrence grade 0-1 at baseline and ≥2 at year 5. We estimated predictors' effects on the outcome using logistic regression models. Two models were generated. The clinical model considered patient characteristics, medication, biomarkers, and knee symptoms. The radiographic model considered the same factors, plus radiographic factors (e.g., angle between the acetabular roof and the ilium's vertical cortex [hip α-angle]). The models were internally validated. Model performance was assessed using calibration and discrimination (area under the receiver characteristic curve [AUC]). The clinical model contained age, quadriceps circumference, and a cartilage degradation marker (C-terminal telopeptide of type II collagen) as predictors (AUC = 0.692). The radiographic model contained older age, greater quadriceps circumference, knee pain, knee baseline Kellgren/Lawrence grade 1 (versus 0), greater hip α-angle, greater spinal bone mineral density, and contralateral RKOA at baseline as predictors (AUC = 0.797). Calibration tests showed good agreement between the observed and predicted incident RKOA. A clinical risk score tool was developed from the clinical model. Two models predicting incident RKOA within 4 years were developed, including radiographic variables that improved model performance. First-time predictor hip α-angle and contralateral RKOA suggest OA origins beyond the knee. The clinical tool has the potential to help physicians identify patients at risk of RKOA in routine practice, but the tool should be externally validated.

Perceived risk versus objectively measured risk of HIV acquisition: a cross-sectional study among HIV-negative individuals in Serodiscordant partnerships with clients attending an Urban Clinic in Uganda

BackgroundAcceptability of Pre-exposure Prophylaxis (PrEP) could be hampered by low self-perceived risk for HIV acquisition. Moreover, discordance between risk perception and actual risk of HIV acquisition is likely to occur. We assessed congruence between the level of self- perceived and that of objectively scored risk of HIV acquisition among HIV-negative individuals in discordant relationships.MethodsThis was a cross-sectional study among a representative sample of HIV-negative adult males and females whose partners were receiving antiretroviral therapy for at least 3 months from the Infectious Diseases Institute Clinic in Kampala, Uganda. Perceived risk was measured based on self-report using a numerical rating scale whereas objective risk was measured using a validated risk score tool. Congruence between perceived risk and objectively scored risk was evaluated using descriptive statistics and validity measures. Incongruence between the two phenomena was further evaluated using univariate and multivariate regression analyses.ResultsHIV-negative partners evaluated in this study were mostly male (64%) with a median age of 41 years (IQR 35 to 50). Majority (76.3%) of the partners perceived themselves as low risk for HIV acquisition. Similarly, most (93.8%) were objectively scored as low risk. However, nearly three quarters (72.7%) of partners who were objectively scored as high risk perceived themselves as being at low risk and all were men. The sensitivity and specificity of perceived risk for detecting the objectively measured risk was 27.3 and 76.5% respectively; area under ROC curve = 0.52; 95%CI (0.38, 0.66). The proportion of participants at high risk of HIV acquisition who perceived their risk as low was greater among those whose partners had detectable viral load compared to participants whose partners had undetectable viral load (PR = 0.51; 95%CI 0.29 to 0.90).ConclusionIncongruence between perceived and objectively measured risk of HIV acquisition does occur especially among individuals whose partners had a detectable viral load. PrEP counselling for serodiscordant couples should focus on explaining the consequence of detectable viral load in the HIV-positive partner on HIV transmission risk.