Multivariate Stepwise Logistic Regression Analysis Research Articles

Predictive value of triglyceride glucose index combined with neutrophil-to-lymphocyte ratio for major adverse cardiac events after PCI for acute ST-segment elevation myocardial infarction

Acute ST-segment elevation myocardial infarction (STEMI) is a severe cardiovascular disease that poses a significant threat to the life and health of patients. This study aimed to investigate the predictive value of triglyceride glucose index (TyG) combined with neutrophil-to-lymphocyte ratio (NLR) for in-hospital cardiac adverse event (MACE) after PCI in STEMI patients. From October 2019 to June 2023, 398 STEMI patients underwent emergency PCI in the Second People's Hospital of Hefei. Stepwise regression backward method and multivariate logistic regression analysis were used to screen the independent risk factors of MACE in STEMI patients. To construct the prediction model of in-hospital MACE after PCI in STEMI patients: Grace score model is the old model (model A); TyG combined with NLR model (model B); Grace score combined with TyG and NLR model is the new model (model C). We assessed the clinical usefulness of the predictive model by comparing Integrated Discrimination Improvement (IDI), Net Reclassification Index (NRI), Receiver Operating Characteristic Curve (ROC), and Decision Curve Analysis (DCA). Stepwise regression and multivariate logistic regression analysis showed that TyG and NLR were independent risk factors for in-hospital MACE after PCI in STEMI patients. The constructed Model C was compared to Model A. Results showed NRI 0.5973; NRI + 0.3036, NRI − 0.2937, IDI 0.3583. These results show that the newly developed model C predicts the results better than model A, indicating that the model is more accurate. The ROC analysis results showed that the AUC of Model A for predicting MACE in STEMI was 0.749. Model B predicted MACE in STEMI with an AUC of 0.685. Model C predicted MACE in STEMI with an AUC of 0.839. For DCA, Model C has a better net return between threshold probability 0.1 and 0.78, which is better than Model A and Model B. In this study, by combining TyG, NLR, and Grace score, it was shown that TyG combined with NLR could reasonably predict the occurrence of MACE after PCI in STEMI patients and the clinical utility of the prediction model.

Impact Exploration of Spatiotemporal Feature Derivation and Selection on Machine Learning-Based Predictive Models for Post-Embolization Cerebral Aneurysm Recanalization.

To enhance the performance of machine learning (ML) models for the post-embolization recanalization of cerebral aneurysms, we evaluated the impact of hemodynamic feature derivation and selection method on six ML algorithms. We utilized computational fluid dynamics (CFD) to simulate hemodynamics in 66 cerebral aneurysms from 65 patients, including 57 stable and nine recanalized aneurysms. We derived a total of 107 features for each aneurysm, encompassing four clinical features, 12 morphological features, and 91 hemodynamic features. To investigate the influence of feature derivation and selection methods on the ML models, we employed two derivation methods, simplified and fully derived, in combination with four selection methods: all features, statistically significant analysis, stepwise multivariate logistic regression analysis (stepwise-LR), and recursive feature elimination (RFE). Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC) on both the training and testing datasets. The AUROC values on the testing dataset exhibited a wide-ranging spectrum, spanning from 0.373 to 0.863. Fully derived features and the RFE selection method demonstrated superior performance in intra-model comparisons. The multi-layer perceptron (MLP) model, trained with RFE-selected fully derived features, achieved the best performance on the testing dataset, with an AUROC value of 0.863 (95% CI: 0.684- 1.000). Our study demonstrated the importance of feature derivation and selection in determining the performance of ML models. This enabled the development of accurate decision-making models without the need to invade the patient.

#550 Characteristics of patients with aHUS who discontinued dialysis after eculizumab treatment: sub-analysis of post-marketing surveillance in Japan

Abstract Background and Aims Atypical haemolytic uraemic syndrome (aHUS), a type of thrombotic microangiopathy (TMA), is a disease accompanied by acute kidney injury which typically requires dialysis in half of the patients. Eculizumab is the first complement C5 inhibitor approved for aHUS in Japan. Early treatment initiation with eculizumab is associated with better renal outcomes, and dialysis withdrawal has been observed in some of patients on dialysis after treatment with eculizumab. However, patient characteristics relating to dialysis continuation or withdrawal after treatment with C5 inhibitors have not been investigated. Method Paediatric and adult patients with aHUS who were enrolled in Japanese post-marketing surveillance (PMS) for eculizumab and who were on dialysis at the initiation of eculizumab treatment were included in this analysis. Characteristics and clinical courses were compared in two groups: patients who discontinued dialysis within 26 weeks from initiation of eculizumab (Group A) and those who stayed on dialysis for 26 weeks (Group B). Results Among 38 patients included in this analysis, 21 patients (55%) discontinued dialysis (Group A) and 17 patients (45%) stayed on dialysis (Group B). The proportion of paediatrics/adults (7/14 vs. 2/15, P = 0.148), median age (6 vs. 8 years old, P = 0.88 and 54.5 vs. 62 years old, P = 0.47), and the proportion of patients with/without complement-related gene variants or anti-CFH antibody (9/8 vs. 6/5, P = 1.000) were comparable between the two groups. Meanwhile, the proportion of patients with hypertension at baseline was significantly lower in Group A than in Group B (6/21 vs. 11/17, P = 0.022). The median duration of dialysis before initiation of eculizumab (6.0 days vs. 17.0 days, P = 0.011) and the median time from TMA onset to eculizumab initiation (9.0 days vs. 25.0 days, P = 0.008) were significantly shorter in Group A than in Group B, respectively. In contrast, there was no significant difference in the median time from TMA onset to initiation of plasma therapy between the two groups (3.5 days vs. 8.0 days, P = 0.154). No significant difference was also observed in the median (range) duration of eculizumab treatment [75 (13-241) weeks vs. 40 (12-256) weeks, P = 0.167]. Stepwise multivariate logistic regression analysis showed that the time from TMA onset to eculizumab initiation (<15 days/≥15 days) was an independent factor associated with the withdrawal of dialysis (P = 0.013), but the existence of hypertension at baseline as a complication and patients age (paediatrics/adults) were not (P = 0.157 and P = 0.869). No patients in Group A restarted dialysis after dialysis discontinuation. Five out of 17 patients in Group B discontinued dialysis after 27 weeks; their median (range) time to dialysis withdrawal was 63 (27-184) weeks. Conclusion These results demonstrate that early initiation of C5 inhibitors can offer the chance of renal recovery and no further need for dialysis. Continuing treatment with C5 inhibitor beyond 26 weeks may also offer the chance to discontinue dialysis for some patients.

Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States

ObjectivesDirect care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. DesignAn observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. Setting and ParticipantsThe sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. MethodsWe used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. ResultsThe sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. Conclusions and ImplicationsGiven the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.

Abstract PO4-11-04: Early Discontinuation of Adjuvant Chemotherapy in Older Adults with Early Breast Cancer: Results from the Prospective Multicenter HOPE Study

Abstract Background: Older adults with early breast cancer (EBC) treated with adjuvant chemotherapy frequently experience severe toxicities. As a result of such toxicities, many older adults do not complete all planned chemotherapy cycles (i.e., discontinue chemotherapy early). Early discontinuation may increase the risk of recurrence and decrease survival. However, aging is heterogeneous and identifying which older adult is at risk of early discontinuation before starting chemotherapy remains a key knowledge gap. To fill this gap, we examined the incidence, reasons, and risk factors for early discontinuation of adjuvant chemotherapy in older adults with EBC. Methods: This is a post-hoc analysis of 501 older adults (age>65) with EBC enrolled in the Hurria Older PatiEnts (HOPE) with Breast Cancer Study (NCT01472094, R01AG037037), a prospective multicenter study. All participants were treated with neo/adjuvant chemotherapy. Prior to initiating chemotherapy, participants completed survey measures on sociodemographic, clinical, and geriatric assessment characteristics. The primary outcome was early discontinuation (yes/no; yes, defined as failure to complete all planned chemotherapy cycles). Multivariable logistic regression with stepwise selection was used to evaluate the association between baseline variables (demographic, clinical, geriatric assessment) and early discontinuation. Results: A total of 501 participants (median [range] age, 70 [65-86] years and mean [SD] physician-rated KPS 93 [9.3]) were included. One hundred and thirteen (23%) had early discontinuation. Among participants with early discontinuation, 69% discontinued treatment within the last 3 cycles. In bivariate analysis, early discontinuation was associated with older age (continuous), higher stage (II/III), use of non-TC regimens (anthracycline-based or trastuzumab-based), lower albumin level (continuous), a history of diabetes, ≥1 fall in the last 6 months, and lower activities of daily living (ADL) score (< 85). Multivariable stepwise logistic regression analysis identified that ≥1 fall in the last 6 months, ADL score < 85, and regimen were associated with early discontinuation at p < 0.05. In the final model, after accounting for clinically meaningful variables including age, stage, and regimen, the results for falls (odds ratio [OR] = 2.04, 95% CI: 1.10-3.78, p=0.02) and ADL (OR=2.10, 95% CI: 1.32-3.34, p=0.002) remained highly significant. Compared to participants with no falls and ADL scores >85, participants with who reported both falls and an ADL score < 85 prior to initiation of chemotherapy had more than 4-fold increased odds of early discontinuation (Table). Conclusion: In this cohort of older adults with EBC, nearly 1 in 4 older patients initiated neo/adjuvant chemotherapy but did not complete all planned chemotherapy cycles. Older patients at risk for early discontinuation should be identified and targeted upfront before initiating chemotherapy. Table. Multivariable associations between falls, ADL score, and early discontinuation. *Adjusted for age (continuous), stage (I vs. II/III), and regimen (anthracycline based + no trastuzumab vs. non-anthracycline based + no trastuzumab vs. anthracycline based + trastuzumab vs. platinum/CMF + trastuzumab vs. taxol only + trastuzumab vs. other). ** Five patients missing fall information. Two patients missing ADL score. Citation Format: Jingran Ji, Canlan Sun, Rachel Freedman, Harvey Cohen, Heidi Klepin, William Tew, Beverly Moy, Andrew Chapman, Tanya Wildes, Efrat Dotan, Allison Magnuson, Tracey O'Connor, Mary Anne Fenton, Heeyoung Kim, Vani Katheria, Cary Gross, Hyman Muss, Mina Sedrak. Early Discontinuation of Adjuvant Chemotherapy in Older Adults with Early Breast Cancer: Results from the Prospective Multicenter HOPE Study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-04.

Mitral Geometry on the Mechanism of Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy

The mechanism of left ventricular outflow tract obstruction (LVOTO) is complex in hypertrophic cardiomyopathy (HCM). We aimed to evaluate the impact of mitral valve geometry on LVOTO by echocardiography. The study population comprised 177 consecutive patients with HCM. Morphological findings of left ventricular hypertrophy and LVOTO-related abnormalities were assessed by comprehensive transthoracic echocardiography. Aortomitral angle, mitral leaflet length, and coaptation height were measured and analyzed at rest. Multivariable stepwise forward logistic regression analysis was performed to identify geometric predictors of LVOTO. One hundred thirty-seven patients had an LVOT gradient ≥30mm Hg. Multivariable logistic regression showed that aortomitral angle (odds ratio [OR], 0.89; 95% CI, 0.83-0.95, P<.001), coaptation height (OR, 1.96; 95% CI, 1.41-2.72, P<.001), and accessory mitral valve chordae tendineae (OR, 13.1; 95% CI, 4.32-39.95; P<.001) were independently associated with LVOTO. Receiver operating characteristic analysis showed that the area under the curve of mitral coaptation height was higher (area under the curve=0.815) than the other 2 indicators (P<.05). Mitral coaptation height, aortomitral angle, and accessory mitral valve chordae tendineae were important predictors of SAM and LVOTO in HCM independent of septal hypertrophy.

A practical nomogram for predicting early death in elderly small cell lung cancer patients: A SEER-based study.

This study aimed to identify risk factors for early death in elderly small cell lung cancer (SCLC) patients and develop nomogram prediction models for all-cause and cancer-specific early death to improve patient management. Data of elderly patients diagnosed with SCLC were extracted from the SEER database, then randomly divided into training and validation cohorts. Univariate and stepwise multivariable Logistic regression analyses were performed on the training cohort to identify independent risk factors for early death in these patients. Nomograms were developed based on these factors to predict the overall risk of early death. The efficacy of the nomograms was validated using various methods, including ROC analysis, calibration curves, DCA, NRI, and IDI. Among 2077 elderly SCLC patients, 773 died within 3 months, 713 due to cancer-specific causes. Older age, higher AJCC staging, brain metastases, and lack of surgery, chemotherapy, or radiotherapy increase the risk of all-cause early death, while higher AJCC staging, brain metastases, lung metastases, and lack of surgery, chemotherapy, or radiotherapy increase the risk of cancer-specific death (P < .05). These identified factors were used to construct 2 nomograms to predict the risk of early death. The ROC indicated that the nomograms performed well in predicting both all-cause early death (AUC = 0.823 in the training cohort and AUC = 0.843 in the validation cohort) and cancer-specific early death (AUC = 0.814 in the training cohort and AUC = 0.841 in the validation cohort). The results of calibration curves, DCAs, NRI and IDI also showed that the 2 sets of nomograms had good predictive power and clinical utility and were superior to the commonly used TNM staging system. The nomogram prediction models constructed in this study can effectively assist clinicians in predicting the risk of early death in elderly SCLC patients, and can also help physicians screen patients at higher risk and develop personalized treatment plans for them.

Combined diagnosis for Parkinson's disease via gait and eye movement disorders

Background and objectivesWith the discovery of the potential role of gait and eye movement disorders in Parkinson's disease (PD) recognition, we intend to investigate the combined diagnostic value of gait and eye movement disorders for PD. MethodsWe enrolled some Chinese PD patients and healthy controls and separated them into the training and validation sets based on enrollment time. Performance in five oculomotor paradigms and in one gait paradigm was examined using an infrared eye tracking device and a wearable gait analysis device. We developed and validated a combined model for PD diagnosis via multivariate stepwise logistic regression analysis. Furthermore, subgroup comparisons and multi-model comparison were performed to assess its applicability and advantages. ResultsA total of 145 PD patients and 80 healthy controls in China were recruited. The pro-saccade velocity, the trunk-sway max, and the turn mean angular velocity were finally screened out for the model development. Incorporating age factor, the ternary model demonstrated more satisfactory performance on ROC (AUC of 0.953 in the training set and AUC of 0.972 in the validation set), calibration curve, and decision curve. A nomogram was drawn to visualize the model. The combined model outperforms individual models with a broad application and the unique diagnostic value for early detection of PD patients, especially TD-PD patients. ConclusionWe demonstrated the presence of gait and eye movement disorders, as well as the feasibility, applicability, and superiority of employing them together to diagnose PD.

Immunomodulatory Effect of COVID-19 on HLA-Antibody Profile in Renal Transplant Recipients.

Background/Objectives: The novel coronavirus disease 2019 (COVID-19) has led to significant morbidity and mortality among kidney transplant recipients. SARS-CoV-2 has been hypothesized to cause an unusual immunological dysregulation triggering alloimmunity and leading to graft rejection. Methods: This prospective observational cohort study assessed 321 kidney transplant recipients who had COVID-19 infection. After the infection, patients' sera were tested for the presence of anti-HLA de novo DSA and non-DSA specificities. Logistic regression analysis and a stepwise multivariable logistic regression analysis were used to analyze the independent risk factors associated with the development of antibodies, adjusting for known confounders. The variables evaluated were acute COVID-19 characteristics (i.e., presentation, and need for hospitalization), demographic characteristics (i.e., age, gender, and primary renal disease), clinical characteristics (i.e., various comorbidities), and post-COVID-19 sequelae. Results: Anti-HLA de novo DSA developed in 18.7% of patients, while anti-HLA class I and class II non-DSA antibodies developed de novo in 84 (26.3%) and 83 (25.9%) patients, respectively. The development of DSA, HLA-DQ, and HLA-DR antibodies was predicted by the history of graft rejection. Obesity appeared to be protective against the emergence of de novo DSA. De novo DSA and HLA-DR antibody formation was positively linked with intravenous immunoglobulin use, CMV-hyperimmune globulin use, and decreased doses of immunosuppression during acute infection. Better allograft function during the acute disease was a protective factor against the formation of HLA-DQ and HLA-DR antibodies. Positive predictors of de novo DSA development were graft biopsy and the reactivation of EBV after infection. Conclusions: These findings suggest that the SARS-CoV-2 virus has an immunomodulatory effect and may be associated with an increased mortality in this population.

Association between Blood Parameters of Nutritional Status and Functional Status in Extreme Longevity.

The relationship between functional and nutritional status in the geriatric population remains an issue of debate and there is a gap in the knowledge regarding this field in long-lived individuals. The main aim of this study was to assess the association between selected blood parameters of nutritional status and functional status in extreme longevity. The inclusion criteria were centenarians above 100 years of age who were examined at their homes, and blood samples were collected. The study group consisted of 170 individuals (25 men and 145 women, median age 100.75 years [100.29-101.58]). Total protein and albumin serum concentration was significantly lower in long-lived individuals with severe functional decline compared to individuals with preserved functional status, p = 0.000001 and p = 0.0000, respectively. Iron serum level was significantly higher in the group with preserved functional status, p = 0.04. Preserved functional status was positively correlated with total protein serum concentration (p = 0.000), albumin concentration (p = 0.000), and iron serum level (p = 0.029). A negative correlation was stated between c-reactive protein (CRP) and functional status (p = 0.032). Univariable logistic regression analysis showed that the functional status of long-lived individuals depends on total protein (OR 2.89, CI 95% [1.67-5.0]) and albumin concentrations (OR 2.34, CI 95% [1.39-3.92]). Multivariable backward stepwise logistic regression analysis showed that a total protein concentration was the only variable independently related to the preserved functional status (OR 3.2, 95% Cl [1.8-5.67]). In long-lived individuals, the total serum protein and albumin levels are lower in centenarians with severe functional decline, and they correlate with functional status. Total protein serum concentration is the only factor independently related to the preserved functional status in extreme longevity.

Rising Cardiovascular Mortality Despite Increased Resource Utilization: Insights From the Nationwide Inpatient Sample Database.

Introduction The global burden of cardiovascular disease (CVD) has risen over the past decade, potentially escalating resource utilization, morbidity, and mortality. We analyzed trends in hospitalization for CVDs, outcomes of hospitalizations, and the impact of the COVID-19 pandemic on CVDhospitalizations between 2016 and 2020. Methods Adult CVD hospitalizations recorded in the2016-2020 nationwide inpatient sample (NIS) were identified using major diagnostic categories (MDC- class 5). The NIS is the largest all-payer repository of all hospitalizations in the USA within a calendar year. We compared sociodemographic factors andoutcomes (mortality, length of stay, and hospital charges) of CVD hospitalization before and during the pandemic using Pearson's χ2 tests.We used Stata ranking commands and ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify the most recurring diagnoses associated with CVD mortality during the study period.Trends in mortality and resource use were assessed using theJonckheere-Terpstra trend test. Hospital charges wereadjusted for inflationusing the Medical Expenditure Panel Survey index. We used stepwise multivariate logistic regression analyses(P ≤ 0.05 for entry; P > 0.10 for removal) to identify covariates associated with cardiovascular mortality during the study period. Results Hospitalizations for CVDs rose from 4,283,502 in 2016 to 4,635,246 in 2019 (Ptrend< 0.001) and declined to 3,865,399 in 2020. 452,930 mortalities were recorded during the study period. In-hospital mortality rose from 111,090 (2.6%) in 2016 to 118,825 (2.8%) in 2020 (Ptrend< 0.001). Compared with the prepandemic years, mortality rates were higher during the pandemic (108,231 [2.8%] vs. 445,373 [2.5%]; P<0.001), and increased in hospitalizations for hypertensive heart disease with chronic kidney disease (CKD) (15,585[14.4%] vs. 45,873 [10.3%]; P<0.001), hypertensive heart disease with heart failure (7,468 [6.9%] vs. 21,378 [4.8%]), ventricular tachycardia (2,056 [1.9%] vs. 7,571 [1.7%]; P=0.022), and peripheral angiopathy with gangrene (1,191 [1.1%] vs. 3,118 [0.7%]; P<0.001). CVD hospitalizations totaled 80.3 million hospital days and 39.7 million hospital procedures during the period. The mean number of procedures (3 vs. 2) and mean length of hospital stay (5.6 vs. 4.5 days) increased during the pandemic (P<0.001). The mean hospital cost for CVD increased from US$ 69,394 in 2016 to US$ 89,728 in 2020 (Ptrend< 0.001). Conclusion CVD mortality increased despite increased resource use over the study period. Hospitalizations during the pandemic had poorer mortality and resource use outcomes than those in the preceding years.

Prediction of false-positive PI-RADS 5 lesions on prostate multiparametric MRI: development and internal validation of a clinical-radiological characteristics based nomogram

BackgroundTo develop a risk model including clinical and radiological characteristics to predict false-positive The Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions.MethodsData of 612 biopsy-naïve patients who had undergone multiparametric magnetic resonance imaging (mpMRI) before prostate biopsy were collected. Clinical variables and radiological variables on mpMRI were adopted. Lesions were divided into the training and validation cohort randomly. Stepwise multivariate logistic regression analysis with backward elimination was performed to screen out variables with significant difference. A diagnostic nomogram was developed in the training cohort and further validated in the validation cohort. Calibration curve and receiver operating characteristic (ROC) analysis were also performed.Results296 PI-RADS 5 lesions in 294 patients were randomly divided into the training and validation cohort (208 : 88). 132 and 56 lesions were confirmed to be clinically significant prostate cancer in the training and validation cohort respectively. The diagnostic nomogram was developed based on prostate specific antigen density, the maximum diameter of lesion, zonality of lesion, apparent diffusion coefficient minimum value and apparent diffusion coefficient minimum value ratio. The C-index of the model was 0.821 in the training cohort and 0.871 in the validation cohort. The calibration curve showed good agreement between the estimation and observation in the two cohorts. When the optimal cutoff values of ROC were 0.288 in the validation cohort, the sensitivity, specificity, PPV, and NPV were 90.6%, 67.9%, 61.7%, and 92.7% in the validation cohort, potentially avoiding 9.7% unnecessary prostate biopsies.ConclusionsWe developed and validated a diagnostic nomogram by including 5 factors. False positive PI-RADS 5 lesions could be distinguished from clinically significant ones, thus avoiding unnecessary prostate biopsy.

Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Vision and refractive error results

ABSTRACT Clinical relevance Optometrists can play a key role in providing access to eye care in underserved populations by organising community-based eye health screenings that include optometric exams to detect vision impairment and uncorrected refractive error. Background Community-based eye health screenings and optometric exams were conducted in the NYC-SIGHT Study. Methods A sub-analysis of vision impairment and refractive error results within a 5-year prospective, cluster-randomised clinical trial. Eligible individuals (age ≥40 years) were recruited from 10 affordable housing developments in Upper Manhattan. Developments were randomised into usual care (received glasses prescription only) and intervention (free glasses) groups. Participants with 6/12 visual acuity or worse, intraocular pressure 23–29 mmHg, or an unreadable fundus image were scheduled with the study optometrist for refraction and a non-dilated exam. Visual improvement data were obtained by comparing the presenting acuity at screening compared to the best corrected acuity after refraction by the optometrist. Chi-square, two-sample t-tests, and a stepwise multivariate logistic regression model were used to determined factors associated with improvable visual impairment. Results Seven hundred and eight participants completed screening, 308 received an optometric exam. Those with improvable vision impairment (n = 251), mean age: 69.8 years, 70.5% female, 53% African American, 39.8% Hispanic, >95% had health insurance. Refractive error diagnosed in 87.8% of the participants; lines of improvement: 2 lines (n = 59), 3 to 5 lines (n = 120), and ≥6 lines (n = 72). Stepwise multivariate logistic regression analysis showed that participants with visual acuity 6/12 or worse (odds ratio 16.041, 95% confidence interval 6.009 to 42.822, p = 0.000) or a normal fundus image (odds ratio 2.783, 95% confidence interval 1.001 to 7.740, p = 0.05) had significantly higher odds of improvable vision impairment. Conclusion This innovative, targeted community-based study included an optometrist who detected high rates of refractive error and improvable vision impairment in an underserved population living in New York City.

Atrial fibrillation post CABG and the risk of arrhythmia recurrence: the AFRODITE study

BackgroundNew-onset postoperative atrial fibrillation (POAF) after coronary artery bypass surgery (CABG) occurs with an incidence of 20–40%. The clinical relevance of POAF remains a concern, and the need for further studies regarding the clinical management of POAF is necessary. AimThe AFRODITE study, a prospective multicenter cohort study, had as its primary endpoint the evaluation of AF recurrence in patients post CABG over a one-year period. MethodsTwo hundred twenty-eight patients aged >50 years who underwent isolated CABG were included in the study. Patients were stratified into two groups, POAF and non-POAF, and followed for 12 months for AF recurrence, hospitalizations, and death. ResultsTwo hundred twenty-eight patients (mean age 67 years, 88.6% male) were included in the study. 28.5% of patients experienced at least one episode of POAF during index hospitalization (POAF group) and were compared with the non-POAF group (n = 163). Multivariate stepwise logistic regression analysis showed that the strongest prognostic parameter for POAF was the CHA2DS2-VASc score (odds ratio = 1.61, p < 0.001). POAF patients had a worse in-hospital outcome, but the incidence of long-term AF recurrence was not statistically different (3.6% vs. 4.8%, p = 0.9). ConclusionInterestingly, a one-year prospective follow-up of patients in the study did not reveal significant differences between POAF and non-POAF patients. A notable finding was that patients with a higher CHA2DS2-VASc score were more likely to develop POAF.

Clinical-radiomics nomogram for the risk prediction of esophageal fistula in patients with esophageal squamous cell carcinoma treated with intensity-modulated radiation therapy or volumetric-modulated arc therapy.

Esophageal fistula (EF) is a serious adverse event as a result of radiotherapy in patients with esophageal cancer (EC). We aimed to identify the predictive factors and establish a prediction model of EF in patients with esophageal squamous cell carcinoma (ESCC) who underwent intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Patients with ESCC treated with IMRT or VMAT from January 2013 to December 2020 at Xijing Hospital were retrospectively analyzed. Ultimately, 43 patients with EF and 129 patients without EF were included in the analysis and propensity-score matched in a 1:3 ratio. The clinical characteristics and radiomics features were extracted. Univariate and multivariate stepwise logistic regression analyses were used to determine the risk factors associated with EF. The median follow-up time was 24.0 months (range, 1.3-104.9 months), and the median overall survival (OS) was 13.1 months in patients with EF. A total of 1,158 radiomics features were extracted, and eight radiomics features were selected for inclusion into a model for predicting EF, with an area under the receiver operating characteristic curve (AUC) value of 0.794. Multivariate analysis showed that tumor length, tumor volume, T stage, lymphocyte rate (LR), and grade IV esophagus stenosis were related to EF, and the AUC value of clinical model for predicting EF was 0.849. The clinical-radiomics model had the best performance in predicting EF with an AUC value of 0.896. The clinical-radiomics nomogram can predict the risk of EF in ESCC patients and is helpful for the individualized treatment of EC.

Predictive Factors for the Formation of Viable Embryos in Subfertile Patients with Diminished Ovarian Reserve: A Clinical Prediction Study

This study aims to construct and validate a nomogram for predicting blastocyst formation in patients with diminished ovarian reserve (DOR) during in vitro fertilization (IVF) procedures. A retrospective analysis was conducted on 445 DOR patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) at the Reproductive Center of Yulin Maternal and Child Health Hospital from January 2019 to January 2023. A total of 1016 embryos were cultured for blastocyst formation, of which 487 were usable blastocysts and 529 did not form usable blastocysts. The embryos were randomly divided into a training set (711 embryos) and a validation set (305 embryos). Relevant factors were initially identified through univariate logistic regression analysis based on the training set, followed by multivariate logistic regression analysis to establish a nomogram model. The prediction model was then calibrated and validated. Multivariate stepwise forward logistic regression analysis showed that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 were independent predictors of blastocyst formation in DOR patients. The Hosmer–Lemeshow test indicated no statistical difference between the predicted probabilities of blastocyst formation and actual blastocyst formation (P > 0.05). These results suggest that female age, normal fertilization status, embryo grade on D2, and embryo grade on D3 are independent predictors of blastocyst formation in DOR patients. The clinical prediction nomogram constructed from these factors has good predictive value and clinical utility and can provide a basis for clinical prognosis, intervention, and the formulation of individualized medical plans.

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis.

Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.

Development and validation a nomogram for predicting new-onset postoperative atrial fibrillation following pulmonary resection

BackgroundThe new-onset postoperative atrial fibrillation (NOPAF) following pulmonary resection is a common clinical concern. The aim of this study was to construct a nomogram to intuitively predict the risk of NOPAF and offered protective treatments.MethodsPatients who underwent pulmonary resection between January 2018 and December 2020 were consecutively enrolled. Forward stepwise multivariable logistic regression analyses were used to screen independent predictors, and a derived nomogram model was built. The model performance was evaluated in terms of calibration, discrimination and clinical utility and validated with bootstrap resampling.ResultsA total of 3583 patients who met the research criteria were recruited for this study. The incidence of NOPAF was 1.507% (54/3583). A nomogram, composed of five independent predictors, namely age, admission heart rate, extent of resection, laterality, percent maximum ventilation volume per minute (%MVV), was constructed. The concordance index (C-index) was 0.811. The nomogram showed substantial discriminative ability, with an area under the receiver operating characteristic curve of 0.811 (95% CI 0.758-0.864). Moreover, the model shows prominent calibration performance and higher net clinical benefits.ConclusionWe developed a novel nomogram that can predict the risk of NOPAF following pulmonary resection, which may assist clinicians predict the individual probability of NOPAF and perform available prophylaxis. By using bootstrap resampling for validation, the optimal discrimination and calibration were demonstrated, indicating that the nomogram may have clinical practicality.

P276 Predictive value of changes in 3D volumetry in perianal fistulas in patients with Crohn’s disease under biologic therapy. A pilot study

Abstract Background Changes in the 3D volumetry of perianal fistulas measured by magnetic resonance (MR) could be an imaging biomarker of interest. The objective of the study is to determine the value of volumetric changes in perianal fistulas in patients with Crohn's disease (CD) after biological treatment to predict subsequent clinical outcomes. Methods Retrospective single-center pilot study. We have included CD patients with perianal fistulas who started biological therapy between 2012-2020 and have 1) both pre- and post-treatment (3-18 months) pelvic MR and 2) follow-up after post-treatment MR of at least 2 to 5 years. According to the last visit, patients were categorized as clinically active (perianal discharge) or in remission (absence of draining). Using an specific software (vEUA, Motilent, London), we calculated the 3D volumetry of the fistulas, the active component (hypersignal on T2) and the fibrotic component (hyposignal on T2). We compared MR volumetric changes between both pre and post treatment MRs and calculated the value of MR volumetric changes in predicting clinical remission using a multivariate stepwise logistic regression analysis. Results Among the 24 patients included, 13 were in perianal clinical remission in the last follow-up. The percentage (%) of volumetric changes in the active component was significantly higher in patients achieving perianal clinical remission compared to non-responder patients (82.5% vs 38.7%, p=0.007). The % of change of the fibrotic component was also significantly higher in patients achieving perianal remission (120% vs 34%, p=0.03). The % of change of the active component was identified as predictor of clinical remission (OR 1.06 [1.02-1.11] P=0.008). A reduction of ≥16% of the active MR component has a sensitivity of 85% and specificity of 82% to predict clinical perianal remission on the long-term. Conclusion Changes in the 3D volumetry on MR of perianal fistulas have value in predicting clinical response. The decrease in the active component could be therefore a good biomarker to define therapeutic targets in fistulizing perianal CD.

The Impact of Cigarette Smoking, Water-Pipe Use on Hearing Loss/Hearing Impairment: A Cross-Sectional Study.

The aim of the present study was to determine the association between cigarette smoking, waterpipe smoking, and co-morbidity diseases on hearing loss. A cross-sectional study was conducted among 1015 patients [386 males (38%) and 629 females (62%)] who were aged are between 25 and 65 years. The study used clinical, physical examinations and Pure-Tone Audiometry (PTA) to assess hearing. Univariate and multivariate stepwise logistic regression analyses were used for the statistical analysis. Out of 1015 patients assessed, 199 were cigarette smokers with hearing loss (21.6%) and 111 waterpipe smokers with hearing loss (12%). There were statistically significant differences between cigarette smokers with hearing loss regarding (p<0.001), gender (p<0.001), BMI (p<0.001), hypertension (p<0.001), tinnitus (p<0.001), vertigo and/or dizziness (p<0.001), and migraine/headaches (p<0.001). Also there were statistically significant differences between waterpipe smokers with hearing loss, none smokers concerning age groups (p<0.001), BMI (p<0.001), using MP3 players (p=0.004), family history of hypertension (p=0.026), ATP III metabolic syndrome (p=0.010), IDF metabolic syndrome (p=0.012), tinnitus (p<0.001), vertigo/dizziness (p<0.001), and migraine/headaches (p=0.025). Multivariate stepwise logistic regression analysis indicated that tinnitus (p<0.001), dizziness (p<0.001), nausea (p=0.001), headaches and migraine (p<=0.003), fatigue (p=0.004), and vertigo (p=0.022) were considered as risk predictors risk hearing loss related cigarette smokers. Also, analysis revealed that tinnitus (p<0.001), nausea (p=0.001), headaches and migraines (p<0.001), Type 2 diabetes mellitus (p<0.001), and vertigo (p=0.021), were considered as risk predictors for hearing loss related waterpipe smokers. The present study suggests cigarette smoking and waterpipe smoking, life-style factors are possible risk factors for hearing loss among smoker participants.