Valuable Risk Assessment Tool Research Articles

A higher non-HDL-C/HDL-C ratio was associated with an increased risk of progression of nonculprit coronary lesion in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

The ratio of nonhigh-density lipoproteincholesterol (non-HDL-C) to high-density lipoproteincholesterol (HDL-C) has been shown associated with various metabolic diseases and atherosclerosis in primary prevention. However, there is limited evidence on the relationship between the non-HDL-C/HDL-C ratio and progression of nonculprit coronary lesion (NCCL) after percutaneous coronary intervention (PCI). Our study aimed to investigate the potential association between the non-HDL-C/HDL-C ratio and NCCL progression in patients with acute coronary syndrome (ACS) undergoing PCI. We conducted a retrospective analysis of ACS patients who underwent coronary angiography twice at a single center from 2016 to 2022. Lipid measurements, demographic, clinical, and other laboratory data were collected from electronic medical records. NCCLs were evaluated using quantitative coronary angiography.The primary outcome was the progression of NCCL. Patients were categorized based on NCCL progression and tertiles of the non-HDL-C/HDL-C ratio. Associations were analyzed using univariate and multivariate logistic regression analysis. The study included 329 ACS patients who underwent PCI, with a median follow-up angiography of 1.09 years. We found NCCL progression in 95 (28.9%) patients with acceptablelow-density lipoprotein cholesterol control (median: 1.81 mmol/L). Patients in the top tertile of the non-HDL-C/HDL-C ratio had a higher risk of NCCL progression. After adjusting for potential confounding factors, the non-HDL-C/HDL-C ratio remained a significant predictor for NCCL progression (adjusted odds ratio: 1.45; 95% confidence interval: 1.14-1.86; p < 0.05). The non-HDL-C/HDL-C ratio predicts NCCL progression in ACS patients following PCI, providing a valuable tool for risk assessment and enhancing secondary prevention of atherosclerotic cardiovascular disease.

Prediction of Recidivism and Detection of Risk Factors Under Different Time Windows Using Machine Learning Techniques

Following a comprehensive analysis of the initial three generations of prisoner risk assessment tools, the field has observed a notable prominence in the integration of fourth-generation tools and machine learning techniques. However, limited efforts have been made to address the explainability of data-driven prediction models and their connection with treatment recommendations. Our primary objective was to develop predictive models for assessing the likelihood of recidivism among prisoners released from their index incarceration within 1-year, 2-year, and 5-year timeframes. We aimed to enhance interpretability using SHapley Additive exPlanations (SHAP). We collected data from 20,457 in-prison records from February 10, 2005, to August 25, 2021, sourced from a Southwestern China prison’s data management system. Recidivism records were officially determined through data mining from an official website and combined identification data from neighboring prisons. We employed five machine learning algorithms, considering sociodemographic, physical health, psychological assessments, criminological characteristics, crime history, social support, and in-prison behaviors as factors. For interpretability, SHAP was applied to reveal feature contributions. Findings indicated that young prisoners accused of larceny, previous convictions, lower fines, and limited family support faced higher reoffending risk. Conversely, middle-aged and senior prisoners with no prior convictions, lower monthly supermarket expenses, and positive psychological test results had lower reoffending risk. We also explored interactions between significant predictive features, such as prisoner age at incarceration initiation and primary accusation, and the duration of current incarceration and cumulative prior incarcerations. Notably, our models consistently exhibited high performance, as shown by AUC on the test dataset across time windows. Interpretability results provided insights into evolving risk factors over time, valuable for intervention with high-risk individuals. These insights, with additional validation, could offer dynamic prisoner information for stakeholders. Moreover, interpretability results can be seamlessly integrated into prison and court management systems as a valuable risk assessment tool.

Evaluation of the non-alcoholic fatty liver fibrosis score in predicting short-term outcomes and severe coronary artery disease in patients undergoing coronary computed tomography angiography.

The correlation between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease is well established. The objective of this study was to assess the short-term associations of the non-alcoholic fatty liver disease fibrosis score (NFS) with various outcomes, including mortality, severe coronary artery disease, myocardial infarction, and the need for coronary angiography, among patients who underwent coronary computed tomographic angiography (CCTA). In this study, we assessed 499 patients who underwent 640-slice CCTA and evaluated their liver fibrosis using the NFS. The NFS takes into account factors such as age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase/alanine aminotransferase ratio, platelets, and albumin. Our primary focus was myocardial infarction, the need for coronary angiography, and death. Additionally, we examined the association between NFS and severe coronary artery disease. Patients with a higher NFS had a greater number of coronary angiography procedures and higher Agatston score (p < 0.001), with NFS and Agatston score emerging as independent predictors of severe coronary artery disease and the primary endpoint. An NFS value above -0.92 could predict the primary endpoint with 61% sensitivity and 63% specificity, while an NFS value above -0.88 could predict severe coronary artery disease with 62% sensitivity and 65% specificity. To analyze primary endpoints, the Kaplan-Meier method was used for survival analysis, with NFS groups compared using the log-rank test. During the follow-up period, patients with higher NFS were exposed to primary outcomes at an earlier period (p = 0.009). NFS is an effective predictor of major cardiovascular events such as death, myocardial infarction, severe coronary artery disease, and the need for coronary angiography. These findings underscore the importance of NFS as a valuable tool for risk assessment and early intervention in patients with suspected or confirmed coronary artery disease.

Risk prediction model for mortality in microscopic polyangiitis: multicentre REVEAL cohort study

BackgroundTo establish refined risk prediction models for mortality in patients with microscopic polyangiitis (MPA) by using comprehensive clinical characteristics.MethodsData from the multicentre Japanese registry of patients with vasculitis (REVEAL cohort) were used in our analysis. In total, 194 patients with newly diagnosed MPA were included, and baseline demographic, clinical, laboratory, and treatment details were collected. Univariate and multivariate analyses were conducted to identify the significant risk factors predictive of mortality.ResultsOver a median follow-up of 202.5 (84–352) weeks, 60 (30.9%) of 194 patients died. The causes of death included MPA-related vasculitis (18.3%), infection (50.0%), and others (31.7%). Deceased patients were older (median age 76.2 years) than survivors (72.3 years) (P < 0.0001). The death group had shorter observation periods (median 128.5 [35.3–248] weeks) than the survivor group (229 [112–392] weeks). Compared to survivors, the death group exhibited a higher smoking index, lower serum albumin levels, higher serum C-reactive protein levels, higher Birmingham Vasculitis Activity Score (BVAS), higher Five-Factor Score, and a more severe European Vasculitis Study Group (EUVAS) categorization system. Multivariate analysis revealed that higher BVAS and severe EUVAS independently predicted mortality. Kaplan–Meier survival curves demonstrated lower survival rates for BVAS ≥20 and severe EUVAS, and a risk prediction model (RPM) based on these stratified patients into low, moderate, and high-risk mortality groups.ConclusionsThe developed RPM is promising to predict mortality in patients with MPA and provides clinicians with a valuable tool for risk assessment and informed clinical decision-making.

Abstract 14133: Use of Computed Tomography Coronary Angiography in Pre-Operative Risk Assessment in Non-Cardiac Surgeries

Introduction: Computed Tomography Coronary Angiography (CTCA) has emerged as a promising tool for detecting and evaluating coronary artery diseases (CAD). However, the role of CTCA for risk assessment tool for patients undergoing noncardiac surgeries is unknown. Methods: We searched databases like PubMed and Google Scholar to compile the literature including reviews, meta-analyses, scientific articles, and guidelines, describing the use of CTCA in the diagnosis and evaluation of cardiac risk assessment in noncardiac surgeries. Results: Based on our literature review we found that CTCA is a promising adjunctive tool for preoperative assessment in noncardiac surgeries to evaluate cardiac risk with high sensitivity and negative predictive value. VISION-CTA sub study showed that CTCA combined with Myocardial Perfusion Imaging (MPI) predicts major adverse cardiac events within 30 days of surgery with higher accuracy than either test alone. McCarthy KJ et al found an increase in the proportion of CTCAs performed from before 2018, 2018 to post 2018, (3%, 6.3%, and 26.3% respectively; p &lt;0.001) and obstructive CAD diagnosis using CTCA (0%, 30%, and 51.4% respectively; p = 0.04). Hence supporting a shift to non-invasive CTCA for pre-operative assessment of liver transplant candidates. According to Ahn J et al, CTCA shows 100% sensitivity and 99.3% negative predictive value in predicting major adverse cardiac events and can be used to stratify intermediate risk noncardiac surgery patients. Conclusions: CTCA is a valuable risk assessment tool in patients undergoing noncardiac surgery because of its high sensitivity and negative predictive value. There is a need for further research and guidelines for using CTCA as a risk assessment tool in noncardiac surgeries.

Risk factors analysis of surgical site infections in postoperative colorectal cancer: a nine-year retrospective study

BackgroundColorectal cancer (CRC) patients undergoing surgery are at a high risk of developing surgical site infections (SSIs), which contribute to increased morbidity, prolonged hospitalization, and escalated healthcare costs. Understanding the incidence, risk factors, and impact of SSIs is crucial for effective preventive strategies and improved patient outcomes.MethodsThis retrospective study analyzed data from 431 CRC patients who underwent surgery at Huangshan Shoukang Hospital between 2014 and 2022. The clinical characteristics and demographic information were collected. The incidence and impact of SSIs were evaluated, and independent risk factors associated with SSIs were identified using multivariable logistic regresison. A nomogram plot was constructed to predict the likelihood of SSIs occurrence.ResultsThe overall incidence rate of SSIs was 7.65% (33/431). Patients with SSIs had significantly longer hospital stays and higher healthcare costs. Risk factors for SSIs included elevated Body Mass Index (BMI) levels (odds ratio, 1.12; 95% CI, 1.02—1.23; P = 0.017), the presence of diabetes (odds ratio, 3.88; 95% CI, 1.42 – 9.48; P = 0.01), as well as specific surgical factors such as open surgical procedures (odds ratio, 2.39; 95% CI [1.09; 5.02]; P = 0.031), longer surgical duration (odds ratio, 1.36; 95% CI [1.01; 1.84]; P = 0.046), and the presence of a colostomy/ileostomy (odds ratio, 3.17; 95% CI [1.53; 6.62]; P = 0.002). Utilizing multivariable regression analysis, which encompassed factors such as open surgical procedures, the presence of diabetes and colostomy/ileostom, the nomogram plot functions as a visual aid in estimating the individual risk of SSIs for patients.ConclusionsRisk factors for SSIs included higher BMI levels, the presence of diabetes, open surgical procedures, longer surgical duration, and the presence of colostomy/ileostomy. The nomogram plot serves as a valuable tool for risk assessment and clinical decision-making.

Invited Perspective: The Potential of Potential Outcomes in Air Pollution Epidemiology.

Invited Perspective: The Potential of Potential Outcomes in Air Pollution Epidemiology.

Assessment of Remnant Lipoprotein Cholesterol and Oxidized Low density Lipoprotein Associated with Low-grade Inflammation in Coronary Heart Disease Subjects of Young South Indian Population.

Coronary heart disease (CHD) is a major disease entity responsible for significant mortality and morbidity in the Indian population. The prevalence of CHD is increasing day by day in India. The hardening of arteries is linked to oxidative variations in low-density lipoproteins (LDLs). Modification of LDL to oxidized LDL (ox-LDL) is a crucial step in the oxidation hypothesis of atherogenesis. Oxidized LDL and remnant lipoprotein cholesterol (RLP-C) stimulate the immune and inflammatory reactions and promote atherosclerosis. Because of its lesser size along with high cholesterol content, and increased residence period in blood the remnant lipoproteins are highly atherogenic. Remnant lipoproteins transport more cholesterol to macrophages compared to LDL particles. Remnant lipoproteins enter into the arterial wall easily and are taken up directly by macrophages. This leads to the formation of foam cells, thus initiating the lipid-laden plaque. High sensitive C-reactive protein acts as a nonspecific inflammatory marker. Oxidized LDL along with RLP-C and high-sensitivity C-reactive protein (hs-CRP) play crucial role in progression of CHD. The aim of the study is to assess ox-LDL and RLP-C associated with hs-CRP as potential biomarkers in the development of CHD. This cross-sectional study was conducted in Sri Ramaswamy Memorial Medical College Hospital and Research Centre on subjects appearing for master health check-up and medicine. This cross-sectional study was conducted on 273 subjects who were age and sex match in the age group of ≤45 years. 91 Non-Diabetic subjects with CHD, 91 Diabetic subjects with CHD, and 91 normal healthy subjects were selected as control. After overnight fasting, body fluid samples were collected for analysis for lipid profile, ox-LDL, and hs-CRP. Oxidized LDL and hs-CRP were measured by enzyme-linked immunosorbent assay (ELISA) method and lipid profile was measured using Auto Analyser AU480. Statistical analysis was done using Student's t-test and Pearson's correlation analysis for the comparison between two groups. The mean level of ox-LDL, RLP-C, and hs-CRP was significantly elevated in CHD group. A significantly positive correlation was observed between plasma ox-LDL, RLP-C, and hs-CRP. These results suggest that the link between high ox-LDL, RLP-C, and hs-CRP levels might be interrelated to atherogenesis in subjects with CHD. In addition to conventional parameters, ox-LDL, RLP-C, and hs-CRP can prove to be a valuable tool in risk assessment of CHD. Journal of the Association of Physicians of India (2022): 10.5005/japi-11001-0009.

Unified hazard models for risk assessment of transportation networks in a multi-hazard environment

Transportation networks play a vital role in the economic prosperity of modern societies. Recent hazardous events in Greece, for instance, the 2021 Crete earthquake, the 2021 Thessaly earthquakes and floods, and the heavy 2019 rainfall in Crete, have revealed the vulnerability of roadway networks to natural hazards, resulting in severe physical damage and important economic and societal losses. Severe damage on bridges and tunnels of roadway networks is commonly related to the effects of multiple hazards that may act independently during their life span. However, the literature on risk assessment of the above elements commonly focuses on the effects of a single hazard, disregarding the effects of various hazards in a multi-hazard environment. In this context, there is an increasing need for a reasonable and practical evaluation of the multi-hazard risk of transportation infrastructure. Research project INFRARES (https://www.infrares.gr/) aspires to gain further insight into the risk and resilience assessment of bridges and tunnels subjected to independent and/or multiple subsequent natural hazards, proposing a comprehensive framework toward a more efficient risk assessment of the above critical transportation infrastructure components. This paper presents the first part of the framework. More specifically, a unified methodology for the development and graphic presentation of single seismic- and flood-hazard scenarios, as well as of novel multi-seismic-flood hazard scenarios, are presented, providing a valuable tool for risk assessment of roadway networks for separate, combined (triggered), or subsequent hazards. The unified approach followed to develop single seismic and flood hazard scenarios is initially presented. The data required to develop such scenarios are derived from recently published and freely available data accessible via European databases; hence, allowing for a straightforward application of the proposed methodology throughout Europe. The unified approach in developing single hazard scenarios is further exploited to develop integrated seismic-flood hazard scenarios. Single and multi-hazard scenarios are graphically displayed in the form of GIS format maps, with the methodology being applied to the Greek terrain for various hazard scenarios. Recent hazard events that caused significant damage to the Greek road network are also presented to emphasize the importance of proper evaluation of natural hazards and their effects on roadway networks in multi-hazard environments. The methodology developed within this study contributes toward the generation of uniform multi-hazard scenarios for the risk assessment of various structures and networks in a multi-hazard environment.

A risk assessment framework considering uncertainty for corrosion-induced natural gas pipeline accidents

Corrosion degradation is one of the main causations of natural gas pipeline failure, which poses a severe threat to human life, assets, and the environment. This paper develops a methodology to assess the risk of corrosion-induced natural gas pipeline accidents considering the uncertainties in incident escalations. This approach can capture both the uncertainties in corrosion failure likelihood and the impact of pipeline leak accidents. A pair of limit state functions are established to estimate the corrosion failure probability of the pipeline. The pipeline accident from gas release to vapor cloud explosion (VCE) is modelled using empirical models. Subsequently, the uncertainties in gas pipeline corrosion failure accidents, reflected by some uncertain parameters, e.g., basic pipeline parameters, corrosion defect and environmental conditions et al., are identified. These identified parameters are discretized and described using a set of probability density functions. Eventually, Monte Carlo (MC) method is utilized to solve the established models. Besides, sensitivity analysis is conducted to study the effect of uncertain parameters on the likelihood and impact of a pipeline accident. A practical case is used to test the methodology, proving a valuable tool for risk assessment of corrosion-induced natural gas pipeline accidents.

O015 Upper airway collapsibility measurement under anaesthesia in children: feasibility and utility in predicting perioperative respiratory adverse events

Abstract Background Perioperative respiratory adverse events (PRAE) pose significant risk in paediatric anaesthesia, and identifying risk is vital. Perioperative measurement of pharyngeal closing pressure (PCLOSE) is a quick, objective method of assessing upper airway collapsibility that may identify PRAE risk. Aim To investigate if PCLOSE measurement is feasible and predictive of PRAE in children. Method Fifty-six children (1-8years, 34 male, without significant co-morbidities) underwent PCLOSE measurements immediately preceding (pre-PCLOSE) and following (post-PCLOSE) adenotonsillectomy. Measurement was performed under anaesthesia while breathing spontaneously in supine posture with head/jaw neutral. After application of a face mask, inspiratory flow was occluded with an associated decrease in mask/nasal pressure seen with each inspiratory effort. With airway collapse, a plateau developed in minimum pressure observed (= PCLOSE): less collapsible airways occluded at more negative pressures. PCLOSE was averaged over 5–6 sequential efforts, at least 3 times on each occasion. Results Both pre-and post-PCLOSE were successfully measured in 94.6% children without affecting procedure. Pre-PCLOSE and change in PCLOSE from pre- to post- were associated with an increased incidence of PRAE (Poisson regression coefficient 0.083(0.03) (mean, SE); p=0.0054 and 0.03(0.01); p=0.018, respectively). There was no significant association between post-PCLOSE and PRAE. The odd of PRAE occurrence during recovery was 1.5 times higher than in other phases. Conclusion This study demonstrated the feasibility of obtaining PCLOSE. A more collapsible airway before surgery and an increase in collapsibility with surgery were both associated with increased PRAE. PCLOSE measurement could be a valuable risk assessment tool for PRAE in children undergoing surgery.

Validation and comparison of prognostic scales in Chinese patients with ischemic stroke: a prospective study from CATIS

ABSTRACT Background : Various tools are currently available to quantify the risks of adverse clinical outcomes after an ischemic stroke. This study aimed to validate and compare prognostic scales among Chinese patients with ischemic stroke. Methods : We compared three stroke prognostic scales (Stroke Prognostication using Age and the National Institutes of Health Stroke Scale-100 [SPAN-100], Totaled Health Risks in Vascular Events [THRIVE], and Acute Stroke Registry and Analysis of Lausanne [ASTRAL]) in 3870 Chinese patients with ischemic stroke from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The 2-year primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3). Results : Among all the scales, the ASTRAL score had the best accuracy for predicting 2-year prognosis in Chinese patients with ischemic stroke. The C-statistic of the ASTRAL score for the 2-year primary outcome was 0.79 (95% confidence interval [CI]: 0.78–0.80), and the Hosmer–Lemeshow goodness-of-fit test showed that the ASTRAL score fitted Chinese patients with ischemic stroke well (χ2 = 9.83, P = 0.277). The incidences of the primary outcome in the <5%, 5%–9.9%, 10%–19.9%, and ≥20% risk groups based on the ASTRAL scores were 3.93%, 7.55%, 14.29%, and 41.81%, respectively (odds ratio: 1.23; 95% CI: 1.21–1.26; P < 0.001). Conclusion : The ASTRAL score had higher efficacy than the SPAN-100 and THRIVE scores in predicting 2-year adverse outcomes among Chinese patients with ischemic stroke, suggesting that it could be a valuable risk assessment tool for the 2-year prognosis of such patients.

A statistical forecast scheme of precipitation in the Upper Bermejo River Basin in Argentina

ABSTRACT The Bermejo River, located in northern Argentina, has a flow regime controlled by precipitation. In an area characterized by its risk of flooding and land-sliding during the summer, seasonal precipitation forecast becomes a valuable tool for risk assessment and better management of hydric resources. This study focuses on identifying remote forcings of precipitation variability for the upper sub-basin of the Bermejo River Basin, and developing multiple linear regression models of areal spring precipitation (September to November), the beginning of the rainy season, considering predictors monitored on the preceding August. Positive rainfall anomalies in spring relate to higher monthly and maximum daily streamflow in the upper and lower sub-basins. Two forecast models arose as the ones with best performance when using leave-one-out-cross-validation. Predictors involved in these models (four and three predictors, respectively) emphasize the influence of the circulation in middle-low levels over the Pacific Ocean, as well as of the sea surface temperature in the El Niño region and the low-level meridional wind in tropical South America. The two models share similar performance metrics, although the model with less predictors has a better skill for the detection of normal and above-normal rainfall seasons.

Heparin versus aspirin thromboprophylaxis adds independent value to IMPEDE-VTE score for venous thrombosis prediction in multiple myeloma.

Multiple myeloma (MM) is associated to an increased incidence of venous thromboembolism (VTE). IMPEDE-VTE score constitutes a valuable risk assessment tool for VTE prediction in first-line MM patients. Nevertheless, refinement of the primary thromboprophylaxis category of this score (which pools aspirin and heparin) seems desirable. To investigate the role of the type of thromboprophylaxis, within IMPEDE-VTE score, for VTE prediction in MM patients. Retrospective analysis of a single-center cohort of 438 MM patients receiving first-line antimyeloma treatment (1991-2020). IMPEDE-VTE score was calculated. Primary thromboprophylaxis was additionally stratified into aspirin- and heparin-based regimen subgroups. VTE risk was analyzed by Cox regression. Median follow-up during first-line antimyeloma treatment was 6.0months (IQR 4.1-9.0months). Twenty-three patients developed VTE (5.3%, 95%CI 3.4-7.8%). IMPEDE-VTE score showed a notable predictive value (area under the ROC curve: 0.70, 95%CI 0.60-0.80). Cox analysis confirmed that 1-point increase in the score resulted in a 1.3-fold increase in VTE risk (HR 1.30, 95%CI 1.13-1.53, p < 0.001). In the multivariable analysis, the type of primary thromboprophylaxis (heparin versus aspirin) was an independent predictive factor (HR 0.15, 95% CI 0.05-0.47, p = 0.001). The combined model showed a higher goodness-of-fit (Akaike Information Criterion [AIC]: 99) than IMPEDE-VTE separately (AIC:235). Our analysis contributes to the external validation of IMPEDE-VTE score for the prediction of VTE in MM. But more interestingly, our results demonstrate that among those patients receiving thromboprophylaxis, the type of regimen (heparin versus aspirin) adds independent predictive value and should be explored for a more accurate risk assessment.

Development and Baseline Characterization of a Thrombosis Risk Alert Tool: A Quality Assessment Project

Introduction: The Khorana Score (KS) is a validated tool to assess the risk of thrombosis in cancer patients, prior to initiation of chemotherapy. The AVERT and CASSINI studies evaluated prophylactic anticoagulation with apixaban or rivaroxaban for patients with KS of 2 or higher. Both studies demonstrated that while patients were taking prophylactic anticoagulant, the Hazard Ratio of cancer associated thrombosis was approximately 0.4. The NCCN and other societies are now recommending oral anticoagulant prophylaxis should be considered for up to 6 months, for patients with an intermediate or high-risk score of ≥2. Methods: We have developed a medical record tool, that identifies all MSKCC patients prior to initiation of a new chemotherapy regimen, captures the KS parameters, and generates the KS. Once fully implemented, it is anticipated that this tool and appropriate use of prophylactic anticoagulation, will reduce the burden of cancer associated thrombosis. To accurately document a potential reduction in rates of cancer associated thrombosis, we need to establish current baseline rates of cancer associated thrombosis via a contemporary verification of the KS, reflecting potential changes in oncology in the 12 years since the score was first published. We applied our KS capture tool to a 2-year period (10/17/2017 to 11/29/2019). 13,992 patients were identified with a new chemotherapy order, of whom 13,176 were found to have cancer and had complete parameters for the KS. We tracked all patients for 6 months, to identify possible episodes of Venous Thromboembolism (VTE). VTE episodes were identified by capturing the impressions of all contrast imaging studies, Doppler ultrasounds, and V/Q scans, combined with keyword and phrase computer identification, and manual review. To identify possible VTE events that occurred at an outside emergency department or hospital, we also queried new prescriptions for therapeutic doses of anticoagulants and ICD10 codes. In this analysis we focus on deep vein thrombosis (DVT) and pulmonary embolism (PE). Results: The 6-month rate of VTE (DVT or PE) was 6.4%. The VTE rate was 4.1% in the KS 0 cohort, and &amp;gt;18% for patients with a score of 4 or greater. We assessed the contribution of each parameter of the KS, in univariate analysis. Of the cancers assigned 2 points in the KS, pancreatic cancer had the highest VTE rate of 13.7%, but gastric/esophageal cancer did not have an increased rate. Of the cancers assigned 1 point, germ cell/testis, gynecologic, and lung cancer, also had increased risk of VTE, but bladder and non-Hodgkin lymphoma did not. Renal/urothelial cancers and cholangiocarcinoma/biliary tract cancers were also associated with high rates of VTE, although were not assigned points using the KS. Elevated BMI (≥35 kg/m2) was a weak risk factor. However, baseline anemia (&amp;lt;10 gm/dL), leukocytosis (&amp;gt;11,000/mcL) and thrombocytosis (≥350,000/mcL) were all strong predictors of VTE rate. Conclusions: The purpose of this QA project was to provide contemporary data on baseline cancer associated thrombosis rates, anticipating implementation of a program of targeted primary thrombosis prophylaxis. It remains clear that the KS provides a valuable risk assessment tool, stratifying 6-month VTE risk from 4.1% to &amp;gt;18%. Cancer type is typically the parameter that gets the first consideration. And most of the cancers with 1 or 2 points did predict increased risk. We don't have an explanation as to why, gastric/esophageal cancers and non-Hodgkin lymphoma were not associated with increased risk, but this finding may reflect the stage of their treatment at which patients begin care at MSKCC. Renal/urothelial, and cholangiocarcinoma/biliary tract cancers are associated with a high risk of VTE, and one may choose to include them for consideration of prophylactic anticoagulation. The relative contribution of pre-chemotherapy blood counts has been questioned in the past, but in this cohort, they clearly contributed to appropriate risk assessment. These data will serve as baseline for future assessment of thrombosis risk reduction upon implementation of a program of targeted prophylactic anticoagulation. Table Disclosures Khorana: Leap: Research Funding; BMS: Honoraria, Research Funding; Merck: Research Funding; Array: Other: Research funding (to institution); Janssen: Honoraria; Bayer: Honoraria; Pfizer: Honoraria; Sanofi: Honoraria; Medscape: Honoraria; Leo Pharma: Honoraria; Seattle Genetics: Honoraria; Pharmacyte: Honoraria; Pharmacyclics: Honoraria. Mantha:MJH Associates: Honoraria; Physicians Education Resource: Honoraria. Soff:Amgen: Research Funding; Amgen: Honoraria; Janssen Scientific Affairs: Honoraria; Dova Pharmaceuticals: Honoraria; Bristol-Myers Squibb, Pfizer: Honoraria; Janssen Scientific Affairs: Research Funding; Dova Pharmaceuticals: Research Funding.

P1670GLOMERULAR C4D IN POST-TRANSPLANT IG-A GLOMERULONEPHRITIS IS ASSOCIATED WITH DECREASED ALLOGRAFT SURVIVAL

Abstract Background and Aims Post transplant (pTX) glomerulonephritis (GN) is an important factor contributing to early and late allograft failure. De novo or recurrent IgA GN are the most frequent pTX-GN forms, however little is known about the optimal risk and therapeutic assessment. Recently, immunopathological evidence of glomerular C4d staining has been suggested as a prognostic tool in native glomerular kidney disease, in particular IgA GN. While peritubular capillary C4d is an accepted diagnostic criterion for antibody mediated rejection (ABMR), the role of glomerular C4d in pTX-GN is unkown. The primary hypothesis was that the finding of immunohistochemical glomerular C4d may be associated renal graft survival in post TX IgA GN. Method This large retrospective cohort study included all indication biopsies performed for cause in 885 kidney allografts from 1999-2006. Cases were screened for biopsy verified de novo or recurrent pTX-GN. GN cases were re-assessed by a single nephropathologist (NK). Primary endpoint was death-sensored graft survival followed until 01.01.2017. Results The prevalence of pTX-GN was 9.6% (n=85/885). De novo or recurrent IgA-GN was the most common pTX GN form with 40%. Of the 34 cases with pTX IgA GN, 27 had adequate material for interpretation of immunohistochemical glomerular C4d in the biopsy specimen. Eighteen of the 27 cases (66%) with pTx-IgA GN showed positive immunohistochemical C4d staining along glomerular capillary walls. There was no difference in renal function at biopsy or after one year comparing glomerular C4d positive vs. C4d negative pTX IgA GN. In univariate KM analysis glomerular C4d positive pTX-IgA GN showed significantly worse renal allograft survival rates (28%) compared to glomerular C4d negative pTX IgA GN (50%) or cases without GN (66%), p&amp;lt;0.001, respectively. In a multivariate Cox-Regression analysis including baseline covariates as well C4d+ABMR, Borderline lesion and TCMR, C4d+pTX IgA-GN remained independently associated with death censored graft-loss (HR 2.92, 95% CI 1.51-5.64, p=0.001). Conclusion Glomerular C4d staining in post transplant IgA glomerulonephritis is an independent risk factor for worse allograft survival and may provide a valuable risk assessment tool for prognostic and therapeutic decisions in post transplant glomerulonephritis.

Patient frailty as a risk assessment tool in surgical management of long bone fractures

BackgroundFrailty is an important predictor of surgical outcomes and has been quantified by several models. The modified frailty index (mFI) has recently been adapted from an 11-item index to a 5-item index and has promise to be a valuable risk assessment tool in orthopedic trauma patients. We perform a retrospective analysis of the 5-item mFI and evaluate its effectiveness in predicting outcomes in patients with long bone fractures. MethodsThe National Surgery Quality Improvement Program (NSQIP) 2006–2016 database was queried for surgical procedures in the treatment of long bone fractures by current procedural terminology (CPT) codes, excluding those performed on metacarpals and metatarsals. Cases were excluded if they were missing demographic, frailty, and variable data. The 5-item frailty index was calculated based on the sum of presence of 5 conditions: COPD/pneumonia, congestive heart failure, diabetes, hypertension, and impaired functional status. Chi square was used to determine variables significantly associated with each outcome. The significant variables were included in multivariate logistic regression along with the mFI. Significance was defined as p < 0.05. ResultsOf the 140,249 fixation procedures performed on long bone fractures in NSQIP, 109,423 cases remained after exclusion criteria were applied. The majority of patients were between the ages of 61 and 80 (34.0%), were female (65.6%) and Caucasian (86.3%). Multivariate analysis revealed that mFI scores ≥3 were predictive of unplanned reoperation (OR = 1.57), wound disruption (OR = 2.83), unplanned readmission (OR = 2.12), surgical site infection (OR = 1.90), major complications (OR = 3.04), and discharge destination (OR = 3.06). ConclusionsOur study analyzed the relationship of frailty and postoperative complications in patients with long bone fractures. Patients had increased likelihood of morbidity, independent of other comorbidities and demographic factors. The mFI may have a role as a simple, easy to use risk assessment tool in cases of orthopedic trauma.

Validation of a New Clinical Prediction Model for Outcome in Newly Diagnosed Multiple Myeloma Patients Not Eligible for Autologous Stem-Cell Transplantation; A Population-Based Study from the Danish National Multiple Myeloma Registry

Background : The UK Myeloma Research Alliance recently introduced a new clinical prediction model for outcome in newly diagnosed multiple myeloma (MM) patients not eligible for autologous hematopoietic stem-cell transplantation (ASCT) (Lancet Haematology 2019; 6: e154-66). The score or Myeloma Risk Profile, MRP, includes WHO performance status (PS), the International Staging System (ISS), age, and C-reactive protein (CRP) as prognostic variables. First a score is calculated by the formula: Score = (PS - 2) * 0.199 + (age - 74.4) * 0.0165 + (ISS - 2) * 0.212 + (log(CRP + 1) - 2.08) * 0.0315, where PS and ISS are defined as numbers between 0-4 and 1-3, respectively, and CRP is in mg/L. Next, three risk groups are defined as 1) low risk: score &lt; -0.256, 2) medium risk: -0.256 ≤ score ≤ -0.0283, or 3) high risk: score &gt; -0.0283. The MRP score was generated based on two prospective clinical trial cohorts, the NRCI-Myeloma XI study (ISRCTN49407852) as training set or internal validation, and the NRCI-Myeloma IX study (Blood 2011; 118, 1231-38) as test set or external validation. Both trials investigated conventional oral alkylating agents, cyclophosphamide or melphalan, in combination with thalidomide, lenalidomide, and/or bortezomib; thus including drugs typically used in treatment of elderly MM patients. Establishment of the model included 1852 patients in the training set, and 520 patients in the test set. All patients were recruited as part of clinical trials and therefore fulfilled defined inclusion and exclusion criteria. To validate the MRP score in a population-based setting we performed a study of the entire cohort of transplant ineligible MM patients in the Danish National MM Registry. Methods : The Danish MM registry started 01 January 2005. It includes registration of all diagnosed MM patients in Denmark and given first- and second-line treatment. A data validation study has been performed (J Clin Epidemiology, 2016; 8: 583-587). At 31 December 2014, 2,926 newly diagnosed treatment demanding MM patients were registered, hereof 1,803 patients were above 65 years and found ineligible for ASCT, and constituted the patient population for this study. Results: Of 1,803 transplant in-eligible but treatment demanding newly diagnosed MM patients above 65 years 426 patients had one or more missing values for calculation of the MRP score, most often this was caused by missing ISS. Thus, 1,377 patients were evaluable with a median follow-up of 40.9 months. Patients were treated according to standard of care in Denmark during the 10-years registration period which included upfront conventional alkylating agent, mostly melphalan in 37.7%, thalidomide-based in 25.6%, bortezomib-based in 26.1%, lenalidomide based in 2.7%, and only palliative, mostly steroid-based in 7.9%. The distribution of the risk groups according to MRP was as follows: low risk 28.5%, medium-risk 25.1%, and high-risk 46.4%. Ccompared to the UK datasets we had a higher proportion of high-risk patients which undoubtedly reflects that our cohort is population based. Median survivals for the 3 risk groups are presented in Table 1 and overall survival curves illustrated in Figure 1. The model performed well in separating the patients into subgroups with different survival risks. In conclusion, our real life population-based data confirm that the MRP score is a robust and valuable risk assessment tool for elderly newly diagnosed MM patients older than 65 and not eligible for ASCT. An important advantage of the MRP score is that it is calculated from simple parameters that should be part of everyday diagnostic work-up. Disclosures Vangsted: Oncopeptides: Membership on an entity's Board of Directors or advisory committees; Sanofi: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria; Jansen: Honoraria. Plesner:Takeda: Consultancy; Oncopeptides: Consultancy; Genmab: Consultancy; AbbVie: Consultancy; Celgene: Consultancy; Janssen: Consultancy, Research Funding. Frederiksen:Novartis: Research Funding; Janssen: Research Funding; Gilead: Research Funding; Alexion: Research Funding; Abbvie: Research Funding. Abildgaard:Amgen: Research Funding; Takeda: Research Funding; Celgene: Research Funding; Janssen: Research Funding.

Do you know your customer? Bank risk assessment based on machine learning

Know Your Customer (KYC) data can serve as a valuable risk assessment tool for banks by providing information that can identify customers who are more likely to default on a loan. This study aims to provide an accurate risk assessment tool using unique KYC data and machine-learning techniques to overcome problems in existing risk detection methods. This study proposes that the bank branch is the best level at which to determine the degree of default risk, and can also provide insight into patterns of suspicious transactions. Bank managers and regulators can focus on suspicious behavior at specific branches to increase overall compliance and reduce the risk of illegal activity.

Review: mine tailings in an African tropical environment-mechanisms for the bioavailability of heavy metals in soils.

Heavy metals are of environmental significance due to their effect on human health and the ecosystem. One of the major exposure pathways of Heavy metals for humans is through food crops. It is postulated in the literature that when crops are grown in soils which have excessive concentrations of heavy metals, they may absorb elevated levels of these elements thereby endangering consumers. However, due to land scarcity, especially in urban areas of Africa, potentially contaminated land around industrial dumps such as tailings is cultivated with food crops. The lack of regulation for land-usage on or near to mine tailings has not helped this situation. Moreover, most countries in tropical Africa have not defined guideline values for heavy metals in soils for various land uses, and even where such limits exist, they are based on total soil concentrations. However, the risk of uptake of heavy metals by crops or any soil organisms is determined by the bioavailable portion and not the total soil concentration. Therefore, defining bioavailable levels of heavy metals becomes very important in HM risk assessment, but methods used must be specific for particular soil types depending on the dominant sorption phases. Geochemical speciation modelling has proved to be a valuable tool in risk assessment of heavy metal-contaminated soils. Among the notable ones is WHAM (Windermere Humic Aqueous Model). But just like most other geochemical models, it was developed and adapted on temperate soils, and because major controlling variables in soils such as SOM, temperature, redox potential and mineralogy differ between temperate and tropical soils, its predictions on tropical soils may be poor. Validation and adaptation of such models for tropical soils are thus imperative before such they can be used. The latest versions (VI and VII) of WHAM are among the few that consider binding to all major binding phases. WHAM VI and VII are assemblages of three sub-models which describe binding to organic matter, (hydr)oxides of Fe, Al and Mn and clays. They predict free ion concentration, total dissolved ion concentration and organic and inorganic metal ion complexes, in soils, which are all important components for bioavailability and leaching to groundwater ways. Both WHAM VI and VII have been applied in a good number of soils studies with reported promising results. However, all these studies have been on temperate soils and have not been tried on any typical tropical soils. Nonetheless, since WHAM VII considers binding to all major binding phases, including those which are dominant in tropical soils, it would be a valuable tool in risk assessment of heavy metals in tropical soils. A discussion of the contamination of soils with heavy metals, their subsequent bioavailability to crops that are grown in these soils and the methods used to determine various bioavailable phases of heavy metals are presented in this review, with an emphasis on prospective modelling techniques for tropical soils.