Simple Prediction Score Research Articles

A Preoperative Scoring System for Adnexal Mass in Children and Adolescents to Preserve Their Future Fertility.

To develop a predictive score for ovarian malignancy to avoid unnecessary adnexectomy in cases of adnexal mass in pediatric and adolescent girls. A population-based retrospective study on girls who underwent surgery for an ovarian mass with normal levels of human chorionic gonadotrophin and alpha fetoprotein between 1996 and2016. Rennes University Hospital, Rennes, France. Eighty-one patients who received surgery for ovarian tumor. The main outcome measure was the rate of malignant and borderline tumor. A preoperative scoring system was constructed after multivariate analysis. The rate of malignant ovarian tumor was 6/81 (7%), borderline tumor was 7/81 (9%) (ie, outcome measure: 16%), and benign tumor was 84%. In a univariate analysis, the characteristics significantly associated with malignancy were early puberty, palpable mass, size and content of the tumor, and positive epithelial tumor markers (carcinoma antigen 125, carcinoembryonic antigen, and carcinoma antigen 19-9). The predictive malignancy score was on the basis of 2 variables obtained after multivariate analysis: tumor size and cystic content. The score defined 3 groups at risk for malignancy: low risk, middle-risk, and high-risk. The sensitivity for detecting malignancy was 1.3% (95% confidence interval [CI], 0.1-18.4), 26.2% (95% CI, 11.6-49.0), and 53.1% (95% CI, 29.1-75.8), respectively. We set up a simple predictive score of malignancy on the basis of objective criteria to help decision-making on whether or not ovarian-sparing surgery is feasible in case of children and adolescents with ovarian tumors and normal human chorionic gonadotrophin and alpha fetoprotein levels while ensuring oncologic safety.

The JAGUAR Score Predicts 1-Month Disability/Death in Ischemic Stroke Patient Ineligible for Recanalization Therapy

Background and PurposeMost available scoring system to predict outcome after acute ischemic stroke (AIS) were established in Western countries. We aimed to develop a simple prediction score of 1-month severe disability/death after onset in AIS patients ineligible for recanalization therapy based on readily and widely obtainable on-admission clinical, laboratory and radiological examinations in Asian developing countries. MethodsUsing the Shiga Stroke Registry, a large population-based registry in Japan, multivariable logistic regression analysis was conducted in 1617 AIS patients ineligible for recanalization therapy to yield ß-coefficients of significant predictors of 1-month modified Rankin Scale score of 5-6, which were then multiplied by a specific constant and rounded to nearest integer to develop 0-10 points system. Model discrimination and calibration were evaluated in the original and bootstrapped population. ResultsJapan Coma Scale score (J), age (A), random glucose (G), untimely onset-to-arrival time (U), atrial fibrillation (A), and preadmission dependency status according to the modified Rankin Scale score (R), were recognized as independent predictors of outcome. Each of their β-coefficients was multiplied by 1.3 creating the JAGUAR score. Its area under the curve (95% confidence interval) was .901 (.880- .922) and .901 (.900- .901) in the original and bootstrapped population, respectively. It was found to have good calibration in both study population (P = .27). ConclusionsThe JAGUAR score can be an important prediction tool of severe disability/death in AIS patients ineligible for recanalization therapy that can be applied on admission with no complicated calculation and multimodal neuroimaging necessary, thus suitable for Asian developing countries.

The new bedside ROCky score to predict the complications in patients with intermediate-risk pulmonary embolism

ObjectivePulmonary embolism (PE) remains one of the leading causes of mortality among cardiovascular diseases. We aimed at investigating risk factors of PE complications in patients with intermediate risk and integrate them into a simple model for its' bedside prediction. MethodsAmong 173 patients with PE, 136 were classified as high or intermediate risk. Patients were retrospectively divided into groups of complicated (n = 44) or uncomplicated (n = 92) course. Study endpoints: obstructive shock, recurrent PE, needs for resuscitation/thrombolysis/hemodynamic support and death during 30 days. ResultsPredictors of PE complications were: chronic heart failure, diabetes mellitus (DM), atrial fibrillation, permanent risk factor of venous thromboembolism, syncope, positive heart-type fatty acid binding protein (hFABP), positive troponin I, heart rate (HR) ≥ 110 bpm, systolic blood pressure (SBP) ≤ 100 mmHg, creatinine clearance ≤ 70 ml/min. Multivariate logistic regression analysis was used to model a simple predictive score named ROCky (Risk of Complications): HR ≥ 110 bpm (1.5 points), SBP ≤ 100 mmHg (2.5 points), positive hFABP (2 points) and presence of DM (2.5 points). The AUROC of this model was 0.89 to predict any complication, 0.83 for obstructive shock and 0.92 for death from any cause; the optimal cut-off scores for any complication was ≥2.5 points, ≥3.5 for obstructive shock and ≥4.5 points for death within 30 days. ConclusionhFABP, tachycardia, hypotension and DM were identified as the major independent determinants of complications development in patients with pulmonary embolism and may be used in combination as the bedside simple predictive ROCky score for early risk stratification in intermediate-risk group.

Simple risk score for prediction of haemorrhagic complications after a percutaneous renal biopsy.

To derive a simple risk score to predict the individual risk of major complications for patients undergoing a percutaneous renal biopsy procedure of native kidneys. The risk score was derived from a cohort of 1205 adult patients subjected to percutaneous renal biopsy and assigned to training and validation datasets. Factors associated with major complications were derived from univariate analysis and then modelled by stepwise multivariate logistic regression. Based on the odds ratio, independent predictors were assigned a weighted integer. The risk score is calculated from the sum of the integers. The overall incidence of major complications was 3.2%. Independent factors associated with MC were lower pre-biopsy haemoglobin, lower platelets, higher blood urea nitrogen, documented chronic kidney disease features in pre-biopsy ultrasound (US) and the presence of haematoma in the post-biopsy US. A score for pre-biopsy evaluation included the first four predictors and stratified patients in three categories with increasing risk at higher scores (low-risk 0.1%, moderate-risk 3.0% and high-risk 26.1%). The score demonstrated good discriminative power (AUC=0.872). The addition of post-biopsy US findings increased the discriminative power (AUC=0.938). A higher post-biopsy risk score was also associated with a higher incidence of MC (low-risk 0.2%, moderate-risk 2.7%, high-risk 16.9%). The risk of major complications after a percutaneous renal biopsy can be assessed by a simple risk score calculated from readily available information.

Switching from endoscopic submucosal dissection to salvage piecemeal knife-assisted snare resection to remove a lesion: A preoperative risk score from the beginning.

endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting.

A Simple Clinical Predictive Score for Postoperative Myasthenic Crisis

A recent study has shown that thymectomy improves outcomes over a 3-year period in patients with nonthymomatous myasthenia gravis (MG). However,

Contrast Volume to Creatinine Clearance Ratio Can be Used to Predict Contrast-Induced Nephropathy After Cardiac Catheterization

SESSION TITLE: Cardio-Pulmonary Interactions SESSION TYPE: Original Investigation Slide PRESENTED ON: Monday, October 30, 2017 at 01:30 PM - 02:30 PM PURPOSE: We sought to develop a simple risk prediction score to identify patients at risk of contrast-induced nephropathy (CIN) after cardiac catheterization. METHODS: A retrospective chart review of 513 patients who underwent cardiac catheterization from June to December 2014 was performed. Patients with end-stage renal disease (n=38) & without pre-procedural serum creatinine (n=57) were excluded. Serum creatinine before the procedure & each day for three days after the procedure was recorded. CIN was defined as an increase in serum creatinine by >25% or 0.5mg/dl from a pre-procedural value within 72 hours of contrast exposure. Pre-procedural creatinine clearance (CCr) was calculated using modification of diet in renal disease (MDRD) equation. Mehran score & Contrast Volume: Creatinine clearance ratio (CV/CCr ratio) were calculated for each patient. Receiver operating characteristic (ROC) curve was obtained & area under the curve (AUC) was calculated for both scores to see the predictive ability for CIN. RESULTS: A total of 418 patients (mean age 69.1 ± 13.8, 55% male & 45% female) were included in the study. Percutaneous coronary intervention (PCI) was performed in 29% (n=121) patients. 81% (n=98) were primary PCI. 16 patients developed CIN with a mean incidence of 3.8%. Contrast volume in CIN group was 150 ml, [95% confidence interval (CI)=36-400ml] Vs. 109.5 ml (95% CI=25ml-160 ml) in the non-CIN group, p=0.06. Mean contrast volume: creatinine clearance ratio (CV:CCr ratio) in CIN group was 3.25, (95% CI=0.70-10.60) Vs. 1.4, (95% CI 0.2-5.4), p=0.03. AUC for CV:CCr ratio was 0.735 (95% CI= 0.602- 0.867), P=0.001, optimal cut-off was 2.25, sensitivity 72.2 % & specificity 72.7%. AUC Mehran score was 0.793 (95% CI 0.646- 0.940), P=0.01, optimal cut-off was 9.5, sensitivity 85.7 % & specificity 71.0%. When compared to Mehran score, CV:Ccr ratio had similar AUC & speicificity. Mehran score had a superior sensitivity. CONCLUSIONS: Contrast volume: Creatinine Clearance ratio (CV:CCr ratio) can be used clinically to identify patients at risk of contrast-induced nephropathy (CIN) after cardiac catheterization. It requires few data, is based on a linear equation & is easy to calculate. CLINICAL IMPLICATIONS: Contrast-induced nephropathy (CIN) is independently associated with higher morbidity and mortality following cardiac catheterization. Identifying patients at risk is an important preventive step. Popular scoring systems like Mehran score uses both patients related and procedural data making it complicated to calculate and use. CV: CCr ratio can be clinically useful as it requires only two variables, easy to calculate and use. DISCLOSURE: The following authors have nothing to disclose: Yub Raj Sedhai, Reshma Golamari, Soney Basnyat, Tawseef Dar, Deepak Acharya, Jose Missri No Product/Research Disclosure Information

Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients.

Prolonged postoperative ileus (PPOI) is a common complication after colorectal resection but data regarding PPOI risk factors after laparoscopic rectal cancer surgery is lacking. This study aimed to identify risk factors for PPOI after laparoscopic sphincter-saving total mesorectal excision (TME) for cancer. All patients who underwent a laparoscopic sphincter-saving TME for cancer from 2005 to 2014 were identified from our prospective database. PPOI was defined as abdominal distension, nausea, and/or vomiting, requiring a nasogastric tube insertion, during the postoperative period. Among 428 consecutive patients, 65 patients (15%) presented with POI. In multivariate analysis, male gender (Odds Ratio (OR) 2.3 [1.1-4.5]; p=0.026, age >70years (OR: 2.0 [1.1-4.0]; p=0.037)], conversion to open approach (OR 4.9 [1.5-15.4]; p=0.007), and intra-abdominal surgical site infection (OR 3.8 [1.9-7.5]; p<0.001) were identified as independent risk factor for PPOI. PPOI risk was 5% in patients without any risk factor but raised to 11, 28, and 54% in patients with 1, 2, or ≥3 risk factors, respectively (p<0.001). PPOI is observed in 15% of the patients after laparoscopic sphincter-saving surgery for rectal cancer. We identified four independent factors for PPOI in multivariate analysis: male, gender, age >70, conversion to open approach, and intra-abdominal surgical site infection, leading to the construction of a simple and pragmatic predictive score. This score might help the surgeon to assess patient at risk of PPOI.

Post-bronchoscopy pneumonia in patients suffering from lung cancer: Development and validation of a risk prediction score.

The incidence, risk factors, and consequences of pneumonia after flexible bronchoscopy in patients with lung cancer have not been studied in detail. We retrospectively analyzed the data from 237 patients with lung cancer who underwent diagnostic bronchoscopy between April 2012 and July 2013 (derivation sample) and 241 patients diagnosed between August 2013 and July 2014 (validation sample) in a tertiary referral hospital in Japan. A score predictive of post-bronchoscopy pneumonia was developed in the derivation sample and tested in the validation sample. Pneumonia developed after bronchoscopy in 6.3% and 4.1% of patients in the derivation and validation samples, respectively. Patients who developed post-bronchoscopy pneumonia needed to change or cancel their planned cancer therapy more frequently than those without pneumonia (56% vs. 6%, p<0.001). Age ≥70 years, current smoking, and central location of the tumor were independent predictors of pneumonia, which we added to develop our predictive score. The incidence of pneumonia associated with scores=0, 1, and ≥2 was 0, 3.7, and 13.4% respectively in the derivation sample (p=0.003), and 0, 2.9, and 9.7% respectively in the validation sample (p=0.016). The incidence of post-bronchoscopy pneumonia in patients with lung cancer was not rare and associated with adverse effects on the clinical course. A simple 3-point predictive score identified patients with lung cancer at high risk of post-bronchoscopy pneumonia prior to the procedure.

Simple Risk Score for Prediction of Early Recurrence of Hepatocellular Carcinoma within the Milan Criteria after Orthotopic Liver Transplantation

Ten to twenty percent of the hepatocellular carcinoma (HCC) patients fulfilling the Milan criteria (MC) recurred within three years after orthotopic liver transplantation (OLT). We therefore utilize a training cohort to develop an improved prognostic model for predicting the recurrence in these patients. By univariate and multivariate analysis, AFP level [cut-off value: 321 ng/mL, area under the curve (AUC) = 0.724, 95% confidence interval (CI) = 0.604–0.843, P < 0.001] and cytokeratin-19 (CK19) and glypican-3 (GPC3) expression pattern from nine putative prognostic factors were entered in risk factor scoring model to conjecture the tumor recurrence. In the training cohort, the AUC value of the model was 0.767 (95% CI = 0.645–0.890, P < 0.001), which was the highest among all the elements. The model’s performance was then assessed using a validation cohort. In the validation cohort, the AUC value of the model was 0.843 (95% CI = 0.720−0.966, P < 0.001) which was higher than any other elements. The results indicated that model had high performance with good discrimination ability and significantly improved the predictive capacity for the recurrence of HCC patients within MC after OLT.

A simple prediction score system for malignant brain edema progression in large hemispheric infarction

Malignant brain edema (MBE) due to hemispheric infarction can result in brain herniation, poor outcomes, and death; outcome may be improved if certain interventions, such as decompressive craniectomy, are performed early. We sought to generate a prediction score to easily identify those patients at high risk for MBE. 121 patients with large hemispheric infarction (LHI) (2011 to 2014) were included. Patients were divided into two groups: those who developed MBE and those who did not. Independent predictors of MBE were identified by logistic regression and a score was developed. Four factors were independently associated with MBE: baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.048), Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (p = 0.007), collateral score (CS) (p<0.001) and revascularization failure (p = 0.013). Points were assigned for each factor as follows: NIHSS ≤ 8 (= 0), 9–17 (= 1), ≥ 18 (= 2); ASPECTS≤ 7 (= 1), >8 (= 0); CS<2 (= 1), ≥2 (= 0); revascularization failure (= 1),success (= 0). The MBE Score (MBES) represents the sum of these individual points. Of 26 patients with a MBES of 0 to 1, none developed MBE. All patients with a MBES of 6 developed MBE. Both MBE development and functional outcomes were strongly associated with the MBES (p = 0.007 and 0.002, respectively). The MBE score is a simple reliable tool for the prediction of MBE.

Development of a respiratory severity score for hospitalized adults in a high HIV-prevalence setting\u2014South Africa, 2010\u20132011

BackgroundAcute lower respiratory tract infections (LRTI) are a frequent cause of hospitalization and mortality in South Africa; however, existing respiratory severity scores may underestimate mortality risk in HIV-infected adults in resource limited settings. A simple predictive clinical score for low-resource settings could aid healthcare providers in the management of patients hospitalized with LRTI.MethodsWe analyzed 1,356 LRTI hospitalizations in adults aged ≥18 years enrolled in Severe Acute Respiratory Illness (SARI) surveillance in three South African hospitals from January 2010 to December 2011. Using demographic and clinical data at admission, we evaluated potential risk factors for in-hospital mortality. We evaluated three existing respiratory severity scores, CURB-65, CRB-65, and Classification Tree Analysis (CTA) Score assessing for discrimination and calibration. We then developed a new respiratory severity score using a multivariable logistic regression model for in-hospital mortality and assigned points to risk factors based on the coefficients in the multivariable model. Finally we evaluated the model statistically using bootstrap resampling techniques.ResultsOf the 1,356 patients hospitalized with LRTI, 101 (7.4%) died while hospitalized. The CURB-65, CRB-65, and CTA scores had poor calibration and demonstrated low discrimination with c-statistics of 0.594, 0.548, and 0.569 respectively. Significant risk factors for in-hospital mortality included age ≥ 45 years (A), confusion on admission (C), HIV-infection (H), and serum blood urea nitrogen >7 mmol/L (U), which were used to create the seven-point ACHU clinical predictor score. In-hospital mortality, stratified by ACHU score was: score ≤1, 2.4%, score 2, 6.4%, score 3, 11.9%, and score ≥ 4, 29.3%. Final models showed good discrimination (c-statistic 0.789) and calibration (chi-square 1.6, Hosmer-Lemeshow goodness-of-fit p-value = 0.904) and discriminated well in the bootstrap sample (average optimism of 0.003).ConclusionsExisting clinical predictive scores underestimated mortality in a low resource setting with a high HIV burden. The ACHU score incorporates a simple set a risk factors that can accurately stratify patients ≥18 years of age with LRTI by in-hospital mortality risk. This score can quantify in-hospital mortality risk in an HIV-endemic, resource-limited setting with limited clinical information and if used to facilitate timely treatment may improve clinical outcomes.

Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study.

Patients admitted to intensive care units with sepsis are prone to developing cardiac dysrhythmias, most commonly atrial fibrillation. To determine the incidence, risk factors, and outcomes of atrial fibrillation in a cohort of critically ill patients with sepsis. We assessed the association between atrial fibrillation and mortality using time-dependent competing risks survival analysis. Subsequently, for development of a risk score estimating the probability of a first occurrence of atrial fibrillation within the following 24 hours, we performed logistic regression analysis. Among 1,782 patients with sepsis admitted to two tertiary intensive care units in the Netherlands between January 2011 and June 2013, a total of 1,087 episodes of atrial fibrillation occurred in 418 (23%) individuals. The cumulative risk of new-onset atrial fibrillation was 10% (95% confidence interval [CI], 8-12), 22% (95% CI, 18-25), and 40% (95% CI, 36-44) in patients with sepsis, severe sepsis, and septic shock, respectively. New-onset atrial fibrillation was associated with a longer stay (hazard ratio [HR], 0.55; 95% CI, 0.48-0.64), an increased death rate (HR, 1.52; 95% CI, 1.16-2.00), and an overall increased mortality risk (subdistribution HR, 2.10; 95% CI, 1.61-2.73) when considering discharge as a competing event. A simple risk score for daily prediction of atrial fibrillation occurrence yielded good discrimination (C statistic, 0.81; 95% CI, 0.79-0.84) and calibration (chi-square, 9.38; P = 0.31), with similar performance in an independent validation cohort (C statistic, 0.80; 95% CI, 0.76-0.85). Atrial fibrillation is a common complication of sepsis and independently associated with excess mortality. A simple risk score may identify patients at high risk of this complication. Clinical trial registered with www.clinicaltrials.gov (NCT 01905033).

Development and validation of a simple integer risk score for prediction of in-hospital mortality following Takotsubo syndrome

BackgroundData regarding the characteristics associated with worse outcomes in Takotsubo syndrome (TTS) patients is lacking. Methods and objectivesThe National Inpatient Sample (NIS) 2012 database was utilized to calculate a risk score for in-hospital mortality following TTS that was internally and externally validated in both 2012 and 2013 databases, respectively. ResultsThe incidences of in-hospital mortality in the 2012 development sample were 0.2%, 3.2% and 15.6% in the low risk (≤2), intermediate risk (3–4) and high-risk (≥5) score groups, respectively. The risk score C-statistics were 0.86 and 0.88 in the development and external validation samples, respectively (p < 0.001). Age ≥ 80 year was associated with the highest odds ratio (OR) of mortality (OR 8.07, 95% confidence interval (CI) 5.79–11.25). Other important predictors were acute cerebrovascular accident and acute respiratory failure. ConclusionsThe risk of in-hospital mortality following TTS could be predicted using a simple risk score, which could aid in identifying and proper management of a higher risk group.

External validation of the APPS, a new and simple outcome prediction score in patients with the acute respiratory distress syndrome.

BackgroundA recently developed prediction score based on age, arterial oxygen partial pressure to fractional inspired oxygen ratio (PaO2/FiO2) and plateau pressure (abbreviated as ‘APPS’) was shown to accurately predict mortality in patients diagnosed with the acute respiratory distress syndrome (ARDS). After thorough temporal external validation of the APPS, we tested the spatial external validity in a cohort of ARDS patients recruited during 3 years in two hospitals in the Netherlands.MethodsConsecutive patients with moderate or severe ARDS according to the Berlin definition were included in this observational multicenter cohort study from the mixed medical-surgical ICUs of two university hospitals. The APPS was calculated per patient with the maximal airway pressure instead of the plateau pressure as all patients were ventilated in pressure-controlled mode. The predictive accuracy for hospital mortality was evaluated by calculating the area under the receiver operating characteristics curve (AUC-ROC). Additionally, the score was recalibrated and reassessed.ResultsIn total, 439 patients with moderate or severe ARDS were analyzed. All-cause hospital mortality was 43 %. The APPS predicted all-cause hospital mortality with moderate accuracy, with an AUC-ROC of 0.62 [95 % confidence interval (CI) 0.56–0.67]. Calibration was moderate using the original cutoff values (Hosmer–Lemeshow goodness of fit P < 0.001), and recalibration was performed for the cutoff value for age and plateau pressure. This resulted in good calibration (P = 1.0), but predictive accuracy did not improve (AUC-ROC 0.63, 95 % CI 0.58–0.68).ConclusionsThe predictive accuracy for all-cause hospital mortality of the APPS was moderate, also after recalibration of the score, and thus the APPS does not seem to be fitted for that purpose. The APPS might serve as simple tool for stratification of mortality in patients with moderate or severe ARDS. Without recalibrations, the performance of the APPS was moderate and we should therefore hesitate to blindly apply the score to other cohorts of ARDS patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0190-0) contains supplementary material, which is available to authorized users.

Prognostic Features for Objectively Defined Urinary Continence after Radical Cystectomy and Ileal Orthotopic Neobladder in a Contemporary Cohort

We objectively quantified daytime and nocturnal continence rates, anddefined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation. At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p <0.05. A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p=0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p <0.001). Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.

56-12: Long-term outcome after catheter ablation of atrial fibrillation and predictors of good arrhythmia control

Introduction: The outcome of catheter ablation of atrial fibrillation (AF) may improve by selecting optimal candidates and/or by continuing previously ineffective antiarrhythmic drugs (AADs) in subjects with risk factors for recurrence. Methods: We analysed a database of patients undergoing radiofrequency ablation of AF at our institution between years 2001–2015. Association of good arrhythmia control (GAC) with baseline clinical factors was investigated by multivariate regression analysis. Simple prediction score of outcome (SCORE) was proposed. Results: A total of 2635 patients (age: 59 ± 10 years; males: 69%; paroxysmal AF: 66%; body-mass index (BMI): 29 ± 5 kg/m2; left atrium diameter (LAD): 42 ± 6 mm; left ventricular ejection fraction: 53 ± 5%; CHA2DS2-VASc score: 1.7 ± 1.3) underwent 3608 ablation procedures (1.4 ± 0.7 per patient) with major complications rate of 3.6% and zero mortality. At the end of a mean follow-up of 29 ± 28 months, GAC was achieved in 56.1% and 83.4% of patients with and without AADs, respectively. Five factors were independently associated with GAC in the patients without AADs: paroxysmal AF (P < 0.0001), male gender (P < 0.0001), age ≤ 60 years (P < 0.0001), BMI ≤ 28 kg/m2 (P = 0.002), and LAD ≤ 42 mm (P = 0.008). Four factors were independently associated with GAC in the patients on AADs: paroxysmal AF (P < 0.0001), male gender (P < 0.0001), age ≤ 60 years (P = 0.002), and LAD ≤42 mm (P = 0.009). Impaired LVEF at baseline was not associated with worse outcome. The SCORE was created by summation of: 4 points for persistent AF, 2 points for female gender, 2 points for age > 60 years, 1 point for BMI > 28 kg/m2, and 1 point for LAD > 42 mm. The mean SCORE in the study population was 4.1 ± 2.6. The Figure shows GAC in the respective SCORE categories.

Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study

ObjectivesTwo objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive...

Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD) (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment). We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days) and 2 (dengue illness >4 days). In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from −2 to +6 points) showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC) of 0.848 (95% confidence interval [CI], 0.771–0.924). The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points), significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756–0.963), with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%). The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825–0.983) and 0.917 (95% CI, 0.833–1.0) in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts) were <3% for patients with a score <1 point, but >50% for those with a score of ≥2 points, irrespective of the day of illness onset, suggesting that our simple risk score can be easily implemented in resource-limited countries for early prediction of dengue patients at risk of SD provided that they have rapid dengue confirmed tests. For patients with other acute febrile illnesses or bacterial infections usually have SD risk score of >1. Thus, these scoring algorithms cannot totally replace good clinical judgement of the physician, and most importantly, early differentiating dengue from other febrile illnesses is critical for appropriate monitoring and management.

A Predictive Model for Selecting Patients with HCV Genotype 3 Chronic Infection with a High Probability of Sustained Virological Response to Peginterferon Alfa-2a/Ribavirin.

BackgroundAccess to direct-acting antiviral agents (DAAs) is restricted in some settings; thus, the European Association for the Study of the Liver recommends dual peginterferon/ribavirin (PegIFN/RBV) therapy wherever DAAs are unavailable. HCV genotype (GT) 3 infection is now the most difficult genotype to eradicate and PegIFN/RBV remains an effective option. The goal of this study was to devise a simple predictive score to identify GT3 patients with a high probability of achieving a sustained virologic response (SVR) with PegIFN alfa-2a/RBV therapy.MethodsRelationships between baseline characteristics and SVR were explored by multiple logistic regression models and used to develop a simple scoring system to predict SVR using data from 1239 treatment-naive GT3 patients who received PegIFN alfa-2a/RBV for 24 weeks in two large observational cohort studies.ResultsThe score was validated using a database of 473 patients. Scores were assigned for six factors as follows: age (years) (≤40: 2 points; >40 but ≤55: 1); bodyweight (kg) (<70: 2; ≥70 but <90: 1); no cirrhosis/transition to cirrhosis (2); ALT ≤2.5 x ULN (1); platelets (109/L) (>200: 2; ≥100 but <200: 1); HCV RNA (<400,000 IU/mL: 1). The points are summed to arrive at a score ranging from 0‒10 where higher scores indicate higher chances of SVR; 141, 123, 203, 249, 232, and 218 patients had total scores of 0‒4, 5, 6, 7, 8, and 9–10, respectively, among whom SVR rates were 45%, 62%, 72%, 76%, 84%, and 89%. Among 622 patients who had scores of 6‒10 and HCV RNA <50 IU/mL by treatment week 4 the SVR rate was 86% (532/622).ConclusionsA simple baseline scoring system involving age, bodyweight, cirrhosis status, ALT level, platelet count and HCV RNA level can be used to identify treatment-naive Caucasian patients with HCV GT3 infection with a high probability of SVR with PegIFN alfa-2a/RBV therapy.