Scoring System For Prediction Research Articles

A Predictive Scoring System for Therapy Failure in Persons with Chronic Myeloid Leukemia Receiving Initial a Second-Generation Tyrosine Kinase Inhibitor Therapy

Purposes Develop and validate a predictive scoring system for therapy failure in persons with chronic phase chronic myeloid leukemia (CML) receiving initial a second-generation tyrosine kinase inhibitor (2G-TKI). Methods Data from 329 consecutive subjects with CML receiving initial 2G-TKI therapy at one centre (Beijing, China) in a training dataset were interrogated to develop a predictive model which was then validated in 1,083 subjects from 65 other centers in China. Therapy-failure was defined using the 2020 ELN criteria including progression to accelerated or blast phases or CML-related death. Fine-Gray model was used for uni- and multi-variable analyses (UVA and MVA) to identify co-variates significantly-associated with therapy-failure. Akaike information criterion (AIC) was used to select prognostic co-variate and determine the best model. 1000 bootstrap re-samplings, Fine-Gray test, the minimal p-value approach, Bonferroni correction and kernel density estimator were used to determine optimal cut-offs to classify subjects into risk cohorts. Time-dependent receiver-operator characteristic curves (ROC) were used to estimate prediction accuracy and calibration plots used to determine concordance between predicted and observed cumulative incidences. Decision curve analysis (DCA) was used to calculate the net benefit using the model. Results In the training dataset, 279 subjects (85%) initially received nilotinib; and 50 (15%), dasatinib. Median 2G-TKI therapy-duration was 36 months (interquartile range [IQR], 24-68 months). 75 subjects (23%) had therapy-failure at a median of 9 months (IQR 3-12 months) after therapy start. In MVA, increasing splenomegaly and a higher percentage blood blasts were significantly-associated with the higher cumulative incidences of therapy-failure. We used these data to develop a predictive scoring system: "2G-TKI failure risk score= 0.6405×[(spleen size below the costal margin in cm + 0.2)/10] + 0.1348×(blood blasts + 0.2)" which divided subjects into low- (score ≤ 0.3021; n = 89; 31%), intermediate- (0.3021 < score < 1.4508; n = 155; 54%) and high-risk (score ≥ 1.4508; n = 43; 15%) cohorts with 5-year cumulative incidences of therapy-failure of 3% (95% Confidence Interval [CI], 0, 5%), 26% (20, 32%) and 72% (56, 88%; p-value for trend < 0.001; Figure 1A). Hazard ratios (HRs) for therapy-failure (low-risk cohort as reference) were 4.8 (1.7, 13.6; p = 0.002) and 16.5 (5.7, 47.6; p < 0.001; p for trend < 0.001) for the intermediate- and high-risk cohorts. In the external validation dataset, subjects were classified into the low- (n = 433; 40%), intermediate- (n = 583; 54%) and high-risk (n = 67; 6%) cohorts using our scoring system. 5-year cumulative incidences of therapy failure were 8% (3, 13%), 18% (12, 25%) and 44% (29, 60%; p for trend < 0.001; Figure 1B). HRs (low-risk cohort as reference) were 2.7 (1.9, 3.6; p < 0.001) and 10.6 (5.8, 15.4; p < 0.001; p for trend < 0.001) for the intermediate- and high-risk cohorts. In the training dataset cohort time-dependent AUROC curves for therapy-failure at 1-, 3-, and 5-years in the model were 0.73-0.82 and 0.68-0.75 in the validation dataset. Calibration plots for the 1-, 3- and 5-years cumulative incidences of therapy-failure indicated good concordance between predicted and observed outcomes. DCA curves indicated net benefit from using the predictive scoring system in clinical settings. Conclusions We developed and externally validated a therapy-failure scoring system in persons with chronic phase CML receiving initial 2G-TKI. The model had high AUROCs and performed well in calibration plots and DCAs. Our model may help physicians decide appropriateness of initial the 2G-TKI therapy including possible selection of appropriate haematopoietic cell transplant candidates. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Development of a New Risk Scoring System Based on Spleen Involvement and the Lymphocyte/Monocyte Ratio for Follicular Lymphoma Patients

Background: This study aimed to retrospectively evaluate a large Chinses cohort's baseline characters and develop a new predictive scoring system. Methods: A total of 530 FL patients were reviewed, and 376 newly diagnosed 1-3a FL patients from January 2000 to October 2020 were enrolled in our retrospective cohort. Results: Progression-free survival (PFS) was assessed as the first endpoint; the 2-year and 5-year PFS were 79.6% and 66.8%, respectively. A new risk scoring system (SLMR) was established after the univariable and multivariable analyses, and four independent factors such as β2-MG, LDH, LMR, and spleen involvement were detected by FDG-PET imaging were included. The SLMR was compared with the existing models using discrimination and calibration, and k-fold cross-validation was performed for internal validation. Our cohort classified patients into three groups (low-, intermediate- and high) according to the SLMR and showed the best model performance. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Validation and Use of Predictive Scoring Systems for Molecular Responses in 5,203 Persons with Chronic Myeloid Leukemia

Validation and Use of Predictive Scoring Systems for Molecular Responses in 5,203 Persons with Chronic Myeloid Leukemia

Sternal bone marrow cell morphology evaluation utility for diagnostic categorization in patients with acquired hypocellular bone marrow failure syndromes

Objective: Diagnostic value assessment of sternal bone marrow cell morphology in patients with acquired hypocellular bone marrow failure syndromes (BMFS) characterized by normal cytogenetics. Methods: A total of 194 eligible patients with an acquired hypocellular BMFS pre-sternum diagnosis in Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science & Peking Union Medical College from June 2014 to January 2019 were reviewed. Sternal bone marrow evaluation was performed, and a post-sternum diagnosis was made. Clinical characteristics and overall survival (OS) were then compared among patients with different post-sternum diagnosis. Binary logistic regression was used to develop a predictive scoring system. Results: In 152 patients with pre-sternum AA diagnosis, 29 patients with a pre-sternum idiopathic cytopenia of undetermined significance (ICUS) diagnosis, and 13 patients with a pre-sternum clonal cytopenia of undetermined significance (CCUS) diagnosis, sternal bone marrow evaluation resulted in a change of diagnosis to hypocellular myelodysplastic syndrome (hypo-MDS) in 42.8% (65/152) , 24.1% (7/29) , and 30.8% (4/13) , respectively. Patients with a post-sternum hypo-MDS diagnosis showed a significant difference in OS compared with patients with a post-sternum AA diagnosis (P=0.005) . Patients with ICUS/CCUS showed no difference in OS compared with AA and hypo-MDS (P=0.095 and P=0.480, respectively) . A 4-item predictive scoring system to identify hypocellular BMFS patients that need sternal bone marrow evaluation was developed, including age > 60 years old (OR=6.647, 95% CI 1.954-22.611, P=0.002, 2 points) , neutrophil alkaline phosphatase score ≤ 160 (OR=2.654, 95% CI 1.214-5.804, P=0.014, 1 point) , abnormal erythroid markers evaluated by flow cytometry on iliac bone marrow (OR=6.200, 95% CI 1.165-32.988, P=0.032, 2 points) , and DAT (DNMT3A, ASXL1, TET2) genes mutation (OR=4.809, 95% CI 1.587-14.572, P=0.005, 1 point) . The Akaike information criterin (AIC) was 186.1. Conclusion: Patients with a pre-sternum acquired hypocellular BMFS diagnosis characterized by normal cytogenetics may not reach accurate diagnostic categorization without sternal bone marrow cell morphology evaluation, which could be considered a diagnostic tool for this patient population. A predictive scoring system was developed, and when the total score is ≥ 2 points, sternal bone marrow evaluation should be performed for accurate diagnostic categorization that is critical to optimal patient care.

Abstract 12339: Aggressive Additional Treatment Strategies to Eliminate Coronary Artery Aneurysms in Treatment-Resistant Kawasaki Disease

Introduction: Kawasaki disease (KD), which is the most common multisystem vasculitis with unknown causes in childhood, causes coronary artery aneurysms (CAAs) especially in treatment-resistant cases. Even with steroid combination therapy, sometimes the fever may persist or recur and requires several additional treatments, which cause CAAs. We reported previously about the scoring systems to predict non-responders to the initial steroid combination therapy. The aim of this study is to prove whether aggressive additional treatment strategies can prevent CAAs in patients at high risk of resistance to initial steroid combination therapy. Methods: The subjects were 39 KD patients with high scores in the scoring systems to predict non-responders to the initial steroid combination therapy*. *Patients who had high scores in all three predictive scoring systems in Japan, and scored 3 points or more in the following scoring system: Kobayashi scores ≥7, 2 points; Egami scores ≥4, 1 point; Number of neutrophils after initial treatment≥ 12000/μL, 2 points* Group 1 (n=26) received additional treatment after recurrent fever (ordinary strategy), Group 2 (n=13) received additional treatment before recurrent fever (aggressive strategy). We compared the incidence of CAAs (including transient dilatation) in each group. Results: In Group 1, there were 15 non-responders (58%) to the initial steroid combination therapy, compared to 0 in Group 2 (p&lt;0.01). All of them had recurrent fever after resolving the fever once. The median day of recurrent fever was day 6 [5.3-7]. In Group 1, there were 5 patients (19%) who had coronary artery dilation greater than z-score &gt;2.5 by treatment resistance, compared to 0 in Group 2 (p&lt;0.01). Conclusions: The aggressive additional treatment strategies (intervention before recurrent fever) prevent CAAs in patients at high risk of resistance to initial steroid combination therapy. Even if the fever is relieved once in the initial treatment, it seems important to prevent recurrent fever around day 7 when histological changes begin in high-risk patients.

A Study of Preoperative Predictors of Difficult Laparoscopic Cholecystectomy

Introduction : Laparoscopic cholecystectomy is the most commonly performed surgery for various gallbladder disorders nowadays. Difficulty during laparoscopic cholecystectomy is being faced by many surgeons. If the difficulties are detected preoperatively, management can be planed accordingly by the surgeon. In this study, preoperative clinical and radiological evaluation of patient were studied to predict the difficulties during laparoscopic cholecystectomy. Materials and Methods: All patients who are undergoing laparoscopic cholecystectomy are evaluated by their Name, Age, Sex, BMI, clinically palpable gallbladder, ultrasound findings are correlated with the preoperative score for the prediction of difficulty during laparoscopic cholecystectomy in this study. Results: Upon analyzing of risk factors with pre operative risk score, there was a significant association with BMI, palpable gallbladder, GB wall thickness, impacted gall stones and peri cholecystic collection. Conclusion: This study combined the preoperative clinical and radiological parameters for better prediction of difficult Laparoscopic Cholecystectomy. It provides a base for further studies to validate in this aspect, and it also aids in formulating an efficient scoring system for prediction of difficult Laparoscopic Cholecystectomy and reducing the incidence of complications.

Establishment of Difficult Caudal Epidural Blockade Prediction Model.

We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB). From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827-0.952) in the development cohort and 0.862 (95% CI, 0.747-0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group, p < 0.001). This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.

7434 A Nomogram to Predict the Probability of Laparoendoscopic Single-Site Extracorporeal Cystectomy in Patients with Benign Ovarian Cysts

<h3>Study Objective</h3> To develop a nomogram to predict the chances of laparoendoscopic single-site extracorporeal (LESS-E) cystectomy in patients with benign ovarian cysts. <h3>Design</h3> A multivariate logistic regression analysis of preoperative indicators was performed, and a nomogram was developed to predict the probability of LESS-E cystectomy. <h3>Setting</h3> Department of gynecology at a tertiary medical center. <h3>Patients or Participants</h3> 243 patients conducted LESS-E cystectomy (n=105) or laparoendoscopic single-site intracorporeal (LESS-I) cystectomy (n =138) between August 2016 and October 2018 in our institution. <h3>Interventions</h3> Patients were randomly assigned into training (n = 183) and validation sets (n = 60). <h3>Measurements and Main Results</h3> A multivariate logistic regression analysis of preoperative indicators was performed in the training set, age, BMI, height and the diameter of ovarian cysts were considered to be independent predictors of LESS-E cystectomy. A nomogram was developed based on these four factors with the concordance index (C-index) being 0.838, R2=0.415. Both external and internal calibration curves of the nomogram fitted well. Also, the DCA (decision curve analysis) exhibited satisfactory positive net benefits of the nomogram among the majority of threshold probabilities. To simplify the score, the predicted indicators in the regression model were scored by dividing the beta coefficient by the absolute value of the minimum beta coefficient, and the sum of each predictor score established a predictive scoring system (PSS). The areas under the receiver operating characteristic curve of the PSS in the training and validation sets were 0.837 and 0.835, respectively. In the total sets, the selected cut-off value of the PSS according to the maximum point of the Youden index is 8, and a preoperative score ≥8 identified patients undergoing LESS-E cystectomy. <h3>Conclusion</h3> A nomogram was built to predict the chances of LESS-E cystectomy in patients with benign ovarian cysts. And a PSS was established, patients with preoperative score ≥8 were recommended undergoing LESS-E cystectomy.

Probability of successful inhaled corticosteroids cessation in preschool wheezers: a predictive score.

Predictors of less successful ICS cessation were the following: perinatal oxygen use, allergic rhinitis, blood eosinophil count > 500 cell/mm3, and previous ICS use > 6months. A simple predictive score developed in this study may help general practitioners to be more confident in making a decision regarding the discontinuation of ICS after initial therapeutic trials. • Early allergic sensitization is associated with reduced chances of inhaled corticosteroid cessation at school age. • Prolonged ICS is associated with the emergence of adverse effect and discontinuing too early can result in recurrence symptoms. • Requirement of oxygen support within 7 days after birth in term neonate is a postnatal factor associated with less successful ICS cessation. • We propose a simple predictive tool with easily available clinical parameters (perinatal oxygen use, allergic rhinitis, blood eosinophil count, parental asthma history, and duration of previous ICS use) to determine the timing of inhalational corticosteroid cessation in preschool wheezers.

Comparison of predictive scoring systems in patients hospitalized in the internal medicine intensive care unit

Aim: Various scoring systems have been developed to predict mortality, disease severity, and length of stay of patients in intensive care units. It is important to demonstrate the validity of these scores in the society in which they are used. This study aims to evaluate the effects of The Acute Physiologic and Chronic Evaluation (APACHE)-II, APACHE-IV, The Simplified Acute Physiologic Score (SAPS), and Mortality Prediction Model (MPM0) scores on mortality in the internal medicine intensive care unit. &#x0D; Material and Method: The patients who were followed up in an internal medicine intensive care unit between June 2021 and December 2021 in a tertiary hospital in Turkey were included in this study. The scores were calculated at the time they were admitted to the intensive care unit. 115 patients who were followed up in the internal medicine intensive care unit for 6 months were included. The patients were divided into two groups alive or deceased. 52 (45.2%) patients in the survivor group and 63 (54.8%) patients in the deceased group were included. Patients received no study-related medical intervention. &#x0D; Results: When all four prognostic scoring systems were analyzed according to the median cut-off values, rising values ​​were related to mortality with statistical significance (p

An MRI-based Scoring System for Preoperative Prediction of Axillary Response to Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: A Multicenter Retrospective Study

To develop and validate a simplified scoring system by integrating MRI and clinicopathologic features for preoperative prediction of axillary pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in clinically node-positive breast cancer. A total of 389 patients from three hospitals were retrospectively analyzed. To identify independent predictors for axillary pCR, univariable and multivariable logistic regression analyses were performed on pre- and post-NAC MRI and clinicopathologic features. Then, a simplified scoring system was constructed based on regression coefficients of predictors in the multivariable model, and its predictive performance was assessed with the receiver operating characteristic curve and calibration curve. The added value of the scoring system for reducing false-negative rate (FNR) of the sentinel lymph node biopsy (SLNB) was also evaluated. The simplified scoring system including seven predictors: progesterone receptor-negative (Three points), HER2-positive (Two points), post-NAC clinical T0-1 stage (Two points), pre-NAC higher ADC value of breast tumor (One point), absence of perinodal infiltration at pre-NAC (One point) and post-NAC MRI (Two points), and absence of enhancement in the tumor bed at post-NAC MRI (Two points), showed good calibration and discrimination, with AUCs of 0.835, 0.828 and 0.798 in the training, internal and external validation cohorts, respectively. The axillary pCR rates were increased with the total points of the scoring system, and patients with a score of ≥11 points had a pCR rate of 86%-100%. In test cohorts for simulating clinical application, the diagnostic accuracy for axillary pCR was 80%-90% among four different radiologists. Compared to standalone SLNB, combining the scoring system with SLNB reduced the FNR from 14.5% to 4.8%. The clinicopathologic-image scoring system with good predictive performance for axillary pCR in clinically node-positive breast cancer, may guide axillary management after NAC and improve patient selection for de-escalating axillary surgery to reduce morbidity.

Development of a new risk scoring system based on spleen involvement and the lymphocyte/monocyte ratio for follicular lymphoma patients

BackgroundThis study aimed to retrospectively evaluate a large Chinese cohort's baseline characters and develop a new predictive scoring system. Methods: A total of 491 FL patients were reviewed, and 337newly diagnosed 1–3a FL patients from January 2010 to October 2020 were enrolled in our retrospective cohort. Results: Progression-free survival (PFS) was assessed as the first endpoint; the 2-year and 5-year PFS were 81.4% and 67.8%, respectively. A new risk scoring system (SLMR) was established after the univariable and multivariable analyses, and four independent factors such as β2-MG, LDH, LMR, the number of nodal areas ≥ 5, and spleen involvement were detected by FDG-PET imaging were included. The SLMR was compared with the existing models using discrimination and calibration, and k-fold cross-validation was performed for internal validation. Our cohort classified patients into three groups (low-, intermediate- and high) according to the SLMR and showed the best model performance, especially for FL3a and received rituximab maintenance after induction therapy patients.

Application of the ALBI Scoring System for Mortality Outcome Prediction in Patients with Hypertrophic Cardiomyopathy.

There is no information about the clinical significance of the albumin-bilirubin (ALBI) score in patients with hypertrophic cardiomyopathy (HCM). We retrospectively performed clinical evaluations in 462 patients with HCM to estimate whether the ALBI score could be a new tool to predict mortality in HCM. During a median follow-up of 4.7 years, HCM-related death occurred in 52 (11.3%) patients. Overall, there was a significant positive association between ALBI score and HCM-related death (adjusted hazard ratio [HR]: 1.79 per one standard deviation [SD] increment, 95% confidence interval [CI]: 1.36-2.35). When the score was assessed as tertiles, the adjusted HRs of HCM-related death were 1.30 (95% CI: 0.42-3.99) for the tertile 2 and 4.43 (95% CI: 1.65-11.89) for the tertile 3, compared with the tertile 1. Stratified analysis and E-value analysis suggested the robustness of the above-mentioned results. Meanwhile, time-dependent ROC analysis showed ALBI score could discriminate HCM-related death at various time points (AUC ranges: 0.725-0.850). Furthermore, exploratory analysis indicated the dynamic changes of ALBI score also could predict HCM-related death. Finally, multiple linear regression analysis suggested some pathogenetic pathways associated with HCM-related adverse outcomes significantly correlated with ALBI score, and the pathways included inflammation, myocardial injury, nutritional status and some clinical characteristics, but not abnormal cardiac structure and function itself. Higher ALBI score is a strong independent predictor of HCM-related death in patients with HCM.

Early identification of delayed extubation following cardiac surgery: Development and validation of a risk prediction model

BackgroundSuccessful weaning and extubation after cardiac surgery is an important step of postoperative recovery. Delayed extubation is associated with poor prognosis and high mortality, thereby contributing to a substantial economic burden. The aim of this study was to develop and validate a prediction model estimate the risk of delayed extubation after cardiac surgery based on perioperative risk factors.MethodsWe performed a retrospective cohort study of adult patients undergoing cardiac surgery from 2014 to 2019. Eligible participants were randomly assigned into the development and validation cohorts, with a ratio of 7:3. Variables were selected using least absolute shrinkage and selection operator (LASSO) logistic regression model with 10-fold cross-validation. Multivariable logistic regression was applied to develop a predictive model by introducing the predictors selected from the LASSO regression. Receiver operating characteristic (ROC) curve, calibration plot, decision curve analysis (DCA) and clinical impact curve were used to evaluate the performance of the predictive risk score model.ResultsAmong the 3,919 adults included in our study, 533 patients (13.6%) experienced delayed extubation. The median ventilation time was 68 h in the group with delayed extubation and 21 h in the group without delayed extubation. A predictive scoring system was derived based on 10 identified risk factors based on 10 identified risk factors including age, BMI ≥ 28 kg/m2, EF < 50%, history of cardiac surgery, type of operation, emergency surgery, CPB ≥ 120 min, duration of surgery, IABP and eGFR < 60 mL/min/1.73 m2. According to the scoring system, the patients were classified into three risk intervals: low, medium and high risk. The model performed well in the validation set with AUC of 0.782 and a non-significant p-value of 0.901 in the Hosmer-Lemeshow test. The DCA curve and clinical impact curve showed a good clinical utility of this model.ConclusionsWe developed and validated a prediction score model to predict the risk of delayed extubation after cardiac surgery, which may help identify high-risk patients to target with potential preventive measures.

A decade of the twenty-first century of percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis: long-term outcomes and clinical risk score among the AF and non-AF patients

Abstract Backgrounds Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for anatomically suitable severe rheumatic mitral stenosis (MS). Atrial fibrillation (AF) is one of the most common arrhythmic conditions in rheumatic MS and may decrease successful or alter the long-term outcomes of rheumatic MS patients who are undergoing PBMV. Purpose The purpose of this study is to investigate the long-term outcomes of treatment in patients with AF compared to sinus rhythm (SR). Results Post-PBMV median follow-up time was 10.83±5.69 years. The incidence of the primary endpoint was 57.8% (95% confidence interval [CI]: 48.6% to 66.9%) and 20.0% (95% CI: 10.3% to 29.6%), p-valve &amp;lt;0.001 in AF and SR patients respectively. The adjusted hazard ratio (HR) of the primary endpoint in the AF compare with SR group was 2.377 (95% CI: 1.250 to 4.520, p-valve = 0.008). Not only the rate of death that was greater in AF than SR group with 30% (95% CI: 22% to 39%) and 11% (95% CI: 4% to 19%), p-valve &amp;lt;0.001 respectively but also as in MV surgery, the incidence rate was 30% (95% CI: 22% to 39%) and 10% (95% CI: 2% to 18%). Independence predictors of the primary endpoint were age &amp;gt;55 years (hazard ratio [HR]: 1.765; 95% CI: 1.05 to 2.95, p=0.031) and echocardiographic score &amp;gt;8 (HR: 2.94; 95% CI: 1.22 to 7.09, p=0.017). The MiTrAL-55 score has a C-statistic of 0.71±0.036 reflecting the good ability to predict long-term outcomes. Conclusion Severe rheumatic MS patients with AF had a worse long-term prognosis than SR after PBMV. An early decision to PBMV in patients with MS supporting with the predictive scoring system to minimize morbidity and mortality is necessary. Funding Acknowledgement Type of funding sources: None.

A Novel Posterior Compression Score System for Outcome Prediction in Laminoplasty Treated OPLL Patients: A Propensity-Matched Analysis.

A retrospective observational study. To describe a novel outcome indication system, the posterior compression score (PCS), and investigate its clinical value in cervical ossification of the posterior longitudinal ligament (OPLL) patients treated with laminoplasty. A total of 282 OPLL patients who underwent laminoplasty from January 2013 to December 2018 were reviewed. The patients were divided into high-score (HS) or low-score (LS) groups based on whether the PCS was over 8. Propensity score matching analysis with a caliper of .1 was used to attenuate the potential selection bias. Clinical measurements, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), and radiological measurements, including C2-C7 lordotic angle and range of motion (ROM), were compared between the groups. The mean follow-up period was 29.87 ± 9.17months. There were no significant differences between the two groups regarding patients' baseline demographical and clinical characteristics after propensity score matching. No significant differences were found in the operative time, blood loss, postoperative VAS score for neck and arm pain, postoperative C2-C7 lordotic angle, or postoperative ROM (P > .05). However, the postoperative JOA score and recovery rate were significantly higher in the HS group than in the LS group, while the postoperative NDI was significantly lower in the HS group (P < .05). OPLL patients with higher PCS scores displayed better clinical outcomes. The novel PCS system is suggested to be a reliable scoring system for surgical outcome evaluation in patients with cervical OPLL.

A predictive score for detecting vesicoureteral reflux in children with their first Escherichia coli-induced urinary tract infection.

In children with a first Escherichia coli-induced febrile urinary tract infection (fUTI), routine voiding cytourethrography (VCUG) is not recommended for detecting vesicoureteral reflux (VUR). Meanwhile, the sensitivity of renal and bladder ultrasound (RBUS) for detecting VUR is insufficient. Aiming to implement VCUG properly for children with a first E.coli-induced fUTI, we attempted to construct a predictive scoring system for the early screening of VUR. This study enrolled patients aged <2 years of age hospitalized for their first E.coli-induced fUTI during the period when VCUG was implemented for all patients (2007-14, non-selective group [n = 111]) and only for those with VUR-suspected RBUS findings, bacteremia or acute focal bacterial nephritis (2016-19, selective group [n = 102]). We evaluated the accuracy of the current criteria and the VUR predictive score constructed using data from the non-selective group. In the non-selective group, 32 patients had VUR (29%). In the selective group, 20 of 45 VCUG-tested patients had VUR (44%). Among 57 patients not undergoing VCUG in the selective group, 8 had a recurrence of fUTI, 3 of whom were diagnosed with VUR. In the non-selective group, 9 patients with VUR did not fulfill the current criteria and the VUR predictive score consisting of young age, female sex, prolonged fever, hypoproteinemia, hyponatremia and hyperglycemia, showed higher sensitivity, specificity than the current criteria. The current imaging/bacteriological criteria were ineffective in screening for VUR in patients with their first E.coli-induced fUTI. The VUR predictive score can be an accurate indicator for implementing VCUG.

Risk factors and predictive scoring system for twice or more strokes in patients with cerebral small vessel disease

Objectives To explore the independent risk factors of twice or more strokes in patients with cerebral small vessel disease, and to construct a predictive scoring system. Methods A retrospective study was carried out in Tangshan, Hebei Province, China. Patients with cerebral small vessel disease suffered from acute stroke and admitted to Neurology Department of Tangshan Gongren Hospital from January 2020 to June 2021 were collected and grouped according to whether they had a previous stroke history. Binary logistic regression models were used to investigate the independent risks for the occurrence of twice or more strokes in patients with cerebral small vessel disease, assigned scores to each factor, then established and evaluated the predictive efficacy of the predictive scoring system. Results A total of 531 patients were included. Regression analysis showed that age, hypertension, diabetes, intracranial arterial stenosis, and total cerebral small vessel disease burden were independent risk factors. On the basis of each regression coefficient, a 10-point predictive scoring system selected the highest Jordon index as the cut-off value, which was 4 points. And the area under the receiver operating characteristic curve was 0.842 (95 %CI: 0.796~0.893, P＜0.001). Conclusions The predictive scoring system based on age, hypertension, diabetes, intracranial arterial stenosis, and total cerebral small vessel disease burden can effectively predict whether patients with cerebral small vessel disease are tend to be onset with twice or more strokes.

TCT-531 Tricuspid TEER Score: A Novel Scoring System for Procedural Outcome Prediction in Patients Undergoing Transcatheter Tricuspid Valve Edge-to-Edge Repair

TCT-531 Tricuspid TEER Score: A Novel Scoring System for Procedural Outcome Prediction in Patients Undergoing Transcatheter Tricuspid Valve Edge-to-Edge Repair

Poor utility of current nomograms assessing the risk of intraoperative blood transfusion in patients undergoing liver resection for hepatocellular carcinoma and proposal of a new model

BackgroundThe Memorial Sloan Kettering Cancer Center nomogram, the predictive scoring system of Yamamoto et al, and the 3-point transfusion risk score of Lemke et al are models used to determine the probability of receiving intraoperative blood transfusion in patients undergoing liver resection. However, the external validity of these models remains unknown. The objective of this study was to evaluate their predictive performance in an external cohort of patients with hepatocellular carcinoma. We also aimed to identify predictors of blood transfusion and develop a new predictive model for blood transfusion. MethodsPost hoc analysis of our prospective database of 1,081 patients undergoing liver resection for hepatocellular carcinoma from 2001 to 2018. The predictive performance of current prediction models was evaluated using C statistics. Demographic and clinical variables as predictors of blood transfusion were assessed. Using logistic regression, an alternative model was created. ResultsThe Lemke transfusion risk score performed better than the Memorial Sloan Kettering Cancer Center nomogram (0.69, 95% confidence interval 0.66–0.73 vs 0.66, 95% liver resection 0.62–0.69) (P < .001). The model from Yamamoto et al performed comparably with no statistically significant differences found through pairwise comparison. In our alternative model, hemoglobin level, albumin level, liver resection type, and tumor size were independent predictors of blood transfusion. The new HATS model obtained a C statistic of 0.74 (95% confidence interval 0.71–0.78), performing significantly better than the previous 3 models (P ≤ 0.001 for all). ConclusionThe existing Memorial Sloan Kettering Cancer Center, Yamamoto et al, and Lemke et al had nomograms with the suboptimal accuracy of predicting risk of intraoperative blood transfusion in patients undergoing liver resection for hepatocellular carcinoma. The proposed HATS model was more accurate at predicting patients at risk of blood transfusion.