scholarly journals Rs895819 inMIR27Aimproves the predictive value ofDPYDvariants to identify patients at risk of severe fluoropyrimidine-associated toxicity

2016 ◽  
Vol 138 (11) ◽  
pp. 2752-2761 ◽  
Author(s):  
Didier Meulendijks ◽  
Linda M. Henricks ◽  
Ursula Amstutz ◽  
Tanja K. Froehlich ◽  
Carlo R. Largiadèr ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Patients At Risk

Non Invasive Assessment of Hepatic Fibrosis by Measurement of Liver Stiffness in Post Transfusional Iron Overload: Preliminary Results in 15 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3740-3740
Author(s):  
T. Mirault ◽  
D. Lucidarme ◽  
B. Turlin ◽  
Y. Deugnier ◽  
P. Brissot ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Fibrosis ◽  
Iron Overload ◽  
Predictive Value ◽  
Liver Stiffness ◽  
Liver Iron ◽  
Preliminary Results ◽  
Non Invasive ◽  
Patients At Risk ◽  
Severe Fibrosis

Abstract Background: The prognosis of liver iron overload is highly dependent on liver iron content (LIC) and the extent of liver fibrosis. Liver biopsy is the invasive reference method for fibrosis evaluation but with several limitations. Non-invasive biological methods (FibroTest, APRI) are not applicable in blood diseases. Transient elastography (TE) is a new non-invasive and rapid bedside method used to measure liver stiffness.This technique has been extensively studied with success in evaluation of liver fibrosis in HCV infection (Ziol, Hepatology 2005; Castera, Gastroenterology 2005). Until now, no data are available on evaluation of liver fibrosis by TE in highly transfused patients with iron overload. Methods: We assessed liver stiffness (kPa) by elastography measurement (Fibroscan; Echosens, Paris, France). Ishak’s and Metavir’s scales were used to stage fibrosis and hepatitis activity; LIC was measured by atomic absorption spectometry in a central laboratory (Rennes, France) and by MRI procedure according to Gandon (Lancet 2004). Cardiac MRI T2* (indirect estimation of iron heart content) was also measured by MRI according to Anderson (Eur Heart J 2001). Serum ferritin level and HCV serology were assayed in all cases. Correlation statistical analysis used Spearman’s Rho and Pearson tests and mean comparisons were done by a non-parametric Mann-Whitney test. Results: 15 liver samples (weight >1mg except 1) from monthly transfused patients (13 major beta Thalassemia, 1 sickle cell disease, 1 myelodysplastic syndrome) were analyzed. Median age was 37 years (7–75). Histological results were: 3 cirrhosis (METAVIR F=4 (F4), or Ishak’s Staging =6 (IS6)) among 5 patients with severe fibrosis (F3,F4) or (IS4-6) and 10 patients with no or mild fibrosis (F0-2) or (IS0-3). Mean ferritin was 2579 ng/ml CI 95% [1372–3786]. 2 patients were HCV positive. Correlation between LIC and ferritin was 0.82 (p<0,05); between LIC and MRI LIC: 0.88 (p<0,05); LIC and MRI Heart T2*: 0.72(p<0,05); METAVIR F score and Ishak’s grading score: 0.86 (p<0,05). A correlation was also observed between METAVIR F and elastography: 0.60(p<0,05); and mean values of elastography were significally different in patients with severe fibrosis: 9.1kPa CI95% [4.5–13.7] vs 5.9kPa CI95% [4.6–7.2] in those without sever fibrosis (p<0,05) (fig). A value of elastography above 6.25kPa (Se=80%; Sp=70%; AUROC=0.820) identified patients at risk for severe fibrosis (F3,F4 or IS 4–6) (Negative Predictive Value = 88%; Positive Predictive Value = 57%). Conclusion: A significant correlation between Metavir Fibrosis scale and elastography values was found. This new non-invasive method would be helpful to evaluate liver fibrosis and to determine patients who could avoid invasive procedures in particular in regularly transfused low risk myelodysplastic patients at risk of bleeding due to abnormal platelet function. These preliminary results will have to be confirmed in a larger population. Figure Figure

Predictive Value of Cardiac Troponin T in Pediatric Patients at Risk for Myocardial Injury

Circulation ◽  
1997 ◽  
Vol 96 (8) ◽  
pp. 2641-2648 ◽  
Author(s):  
Steven E. Lipshultz ◽  
Nader Rifai ◽  
Stephen E. Sallan ◽  
Stuart R. Lipsitz ◽  
Virginia Dalton ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Pediatric Patients ◽  
Troponin T ◽  
Cardiac Troponin T ◽  
Patients At Risk

Analysis of Metastatic Regional Lymph Node Locations and Predictors of Para-aortic Lymph Node Involvement in Endometrial Cancer Patients at Risk for Lymphatic Dissemination

2015 ◽  
Vol 25 (4) ◽  
pp. 657-664 ◽  
Author(s):  
Ayse Altay ◽  
Tayfun Toptas ◽  
Selen Dogan ◽  
Tayup Simsek ◽  
Elif Pestereli
Keyword(s):  
At Risk ◽  
Endometrial Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Predictive Value ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Renal Vessels ◽  
Patients At Risk ◽  
The Impact

ObjectiveThe aim of this study was to provide detailed knowledge of the metastatic lymph node (LN) locations and to determine factors predicting para-aortic LN metastasis in endometrial cancer patients at risk (intermediate/high) for LN involvement.MethodsA prospective case series with planned data collection was conducted in a total of 173 patients who treated with systematic pelvic para-aortic lymphadenectomy up to the renal vessels. All the LNs removed from pelvic and para-aortic basins—low or high according to the level of the inferior mesenteric artery—were evaluated separately. Logistic regression analyses were performed to determine the impact of variables on para-aortic metastasis.ResultsLymph node metastasis was observed in 21.9% of the patients, pelvic LN involvement in 17.9%, para-aortic LN involvement in 15.0%, both pelvic and para-aortic LN involvement in 10.9%, and isolated para-aortic LN involvement in 4.0%. The most common metastatic LN locations were the external iliac (50.0%), obturator (50.0%), and low precaval regions (36.8%). The least common location of metastasis was the high precaval region (5.3%). Among patients with para-aortic LN metastasis, 42.3% had metastasis above the inferior mesenteric artery. The number of metastatic pelvic LNs greater than or equal to 2 was the only independent predictor of para-aortic metastasis in multivariate analysis (odds ratio, 23.38; 95% confidence interval, 1.35-403.99; P = 0.030), with 96.94% sensitivity, 95.87% specificity, 98.6% positive predictive value, and 97.0% negative predictive value.ConclusionsThe current study supports the idea that in patients at risk of LN involvement, the systematic lymphadenectomy should be performed up to the renal vessels due to the high rate of upper level involvement.

The Effect of Rapid Screening for Methicillin-ResistantStaphylococcus aureus(MRSA) on the Identification and Earlier Isolation of MRSA-Positive Patients

2010 ◽  
Vol 31 (4) ◽  
pp. 374-381 ◽  
Author(s):  
Eilish Creamer ◽  
Anthony Dolan ◽  
Orla Sherlock ◽  
Toney Thomas ◽  
John Walsh ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Tertiary Care ◽  
Turnaround Time ◽  
Rapid Screening ◽  
Pcr Assay ◽  
Period 2 ◽  
Before And After ◽  
Patients At Risk ◽  
Risk Patients

Objectives.(1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistantStaphylococcus aureus(MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results.Design.Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued.Results.Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P< .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389;P< .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140;P< .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours.Conclusions.Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive Patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.

Role of Routine Laboratory Tests in Assessing Risk of Recurrent Venous Thrombosis: Results from the MEGA Follow-Up Study

2018 ◽  
Vol 118 (11) ◽  
pp. 1918-1929
Author(s):  
Vânia Morelli ◽  
Willem Lijfering ◽  
Suely Rezende ◽  
Astrid Vlieg ◽  
Frits Rosendaal ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thrombosis ◽  
Renal Dysfunction ◽  
Kidney Function ◽  
Predictive Value ◽  
Hazard Ratio ◽  
Risk Of Recurrence ◽  
Glucose Levels ◽  
Increased Risk ◽  
Patients At Risk

Background Kidney function, measured as estimated glomerular filtration rate (eGFR), glucose levels and haematologic variables (blood cell count) are easily obtainable tests, and have been associated with increased risk of first venous thrombosis (VT). Whether these routine tests can identify patients at risk of recurrence is unclear. Aim Our aim was to investigate the predictive value of serum glucose levels, eGFR and haematologic variables in patients at risk of recurrent VT. Methods Patients with a first VT were followed from discontinuation of anticoagulant treatment. Percentile categories of eGFR, glucose levels and haematologic variables were established. Crude incidence rates with 95% confidence intervals (CIs) of recurrence were estimated in each percentile category. Cox regression models were used to compare groups, adjusted for age and sex. Results Of 2,106 patients followed for a median of 6.9 years, 326 developed recurrence (incidence rate, 2.7/100 patient-years; 95% CI, 2.5–3.1). The adjusted hazard ratio for recurrence was 1.5 (95% CI, 0.9–2.4) in the lowest eGFR percentile category (< 59 mL/min/1.73 m2) versus the reference (≥86 mL/min/1.73 m2). Stratification by unprovoked or provoked first events yielded similar results. The combination of a first unprovoked VT with renal dysfunction was associated with a threefold increased risk of recurrence compared with those with first provoked VT and normal kidney function (hazard ratio, 3.1, 95% CI, 1.6–5.9). Glucose levels and haematologic variables were not associated with increased recurrence risk. Conclusion Testing glucose levels and haematologic variables did not identify patients at increased risk of recurrent VT. Renal dysfunction tests may have some predictive value, particularly in combination with other variables.

scholarly journals Who should undergo a comprehensive cognitive assessment after a stroke?

Neurology ◽  
2018 ◽  
Vol 91 (21) ◽  
pp. e1979-e1987 ◽  
Author(s):  
Olivier Godefroy ◽  
Hugo Yaïche ◽  
Hervé Taillia ◽  
Flavie Bompaire ◽  
Claudine Nédélec-Ciceri ◽  
...  
Keyword(s):  
At Risk ◽  
Logistic Regression ◽  
Scale Score ◽  
Risk Score ◽  
Predictive Value ◽  
Cognitive Assessment ◽  
Comprehensive Assessment ◽  
Screening Tests ◽  
Cognitive Risk ◽  
Patients At Risk

ObjectiveTo validate the ability of a specifically developed cognitive risk score to identify patients at risk of poststroke neurocognitive disorders (NCDs) who are eligible for a comprehensive cognitive assessment.MethodsAfter assessing 404 patients (infarct 91.3%) in the Groupe de Réflexion pour l'Evaluation Cognitive VASCulaire (GRECogVASC) cross-sectional study with the National Institute of Neurological Disorders and Stroke–Canadian Stroke Network battery 6 months after stroke, we used multivariable logistic regression and bootstrap analyses to determine factors associated with NCDs. Independent, internally validated factors were included in a cognitive risk score.ResultsCognitive impairment was present in 170 of the 320 patients with a Rankin Scale score ≥1. The backward logistic regression selected 4 factors (≥73% of the permutations): NIH Stroke Scale score on admission ≥7 (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.29–4.3, p = 0.005), multiple strokes (OR 3.78, 95% CI 1.6–8, p = 0.002), adjusted Mini-Mental State Examination (MMSEadj) score ≤27 (OR 6.69, 95% CI 3.9–11.6, p = 0.0001), and Fazekas score ≥2 (OR 2.34, 95% CI 1.3–4.2, p = 0.004). The cognitive risk score computed with these 4 factors provided good calibration, discrimination (overoptimism-corrected C = 0.793), and goodness of fit (Hosmer-Lemeshow test p = 0.99). A combination of Rankin Scale score ≥1, cognitive risk score ≥1, and MMSEadj score ≥21 selected 230 (56.9%) of the 404 patients for a comprehensive assessment. This procedure yielded good sensitivity (96.5%) and moderate specificity (43%; positive predictive value 0.66, negative predictive value 0.91) and was more accurate (p ≤ 0.03 for all) than the sole use of screening tests (MMSE or Montréal Cognitive Assessment).ConclusionThe GRECogVASC cognitive risk score comprises 4 easily documented factors; this procedure helps to identify patients at risk of poststroke NCDs who must therefore undergo a comprehensive assessment.ClinicalTrials.gov identifier:NCT01339195.

scholarly journals Deep learning detects heart failure with preserved ejection fraction using a baseline electrocardiogram

2021 ◽  
Author(s):  
Matthias Unterhuber ◽  
Karl-Philipp Rommel ◽  
Karl-Patrik Kresoja ◽  
Julia Lurz ◽  
Jelena Kornej ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Deep Learning ◽  
Ejection Fraction ◽  
Predictive Value ◽  
Validation Cohort ◽  
External Validation ◽  
Preserved Ejection Fraction ◽  
Derivation Cohort ◽  
Patients At Risk

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a rapidly growing global health problem. To date, diagnosis of HFpEF is based on clinical, invasive and laboratory examinations. Electrocardiographic findings may vary, and there are no known typical ECG features for HFpEF. Methods This study included two patient cohorts. In the derivation cohort, we included n = 1884 patients who presented with exertional dyspnea or equivalent and preserved ejection fraction (≥50%) and clinical suspicion for coronary artery disease. The ECGs were divided in segments, yielding a total of 77.558 samples. We trained a convolutional neural network (CNN) to classify HFpEF and control patients according to ESC criteria. An external group of 203 volunteers in a prospective heart failure screening program served as validation cohort of the CNN. Results The external validation of the CNN yielded an AUC of 0.80 (95% CI 0.74–0.86) for detection of HFpEF according to ESC criteria, with a sensitivity of 0.99 (CI 0.98–0.99) and a specificity of 0.60 (95% CI 0.56–0.64), with a positive predictive value of 0.68 (95%CI 0.64–0.72) and a negative predictive value of 0.98 (95% CI 0.95–0.99). Conclusion In this study, we report the first deep learning-enabled CNN for identifying patients with HFpEF according to ESC criteria including NT-proBNP measurements in the diagnostic algorithm among patients at risk. The suitability of the CNN was validated on an external validation cohort of patients at risk for developing heart failure, showing a convincing screening performance.

Prospective Identification of Patients at Risk for Massive Transfusion: An Imprecise Endeavor

2011 ◽  
Vol 77 (2) ◽  
pp. 155-161 ◽  
Author(s):  
Marianne J. Vandromme ◽  
Russell L. Griffin ◽  
Gerald Mcgwin ◽  
Jordan A. Weinberg ◽  
Loring W. Rue ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Model ◽  
Predictive Value ◽  
Massive Transfusion ◽  
International Normalized Ratio ◽  
Trauma Patients ◽  
Civilian Trauma ◽  
Patients At Risk ◽  
Clinical Measurements ◽  
Clinical Measures

Most retrospective studies evaluating fresh-frozen plasma:packed red blood cell ratios in trauma patients requiring massive transfusion (MT) are limited by survival bias. As prospective resource-intensive studies are being designed to better evaluate resuscitation strategies, it is imperative that patients with a high likelihood of MT are identified early. The objective of this study was to develop a predictive model for MT in civilian trauma patients. Patients admitted to the University of Alabama at Birmingham Trauma Center from January 2005 to December 2007 were selected. Admission clinical measurements, including blood lactate 5 mMol/L or greater, heart rate greater than 105 beats/min, international normalized ratio greater than 1.5, hemoglobin 11g/dL or less, and systolic blood pressure less than 110 mmHg, were used to create a predictive model. Sensitivity (Sens), specificity (Spec), positive predictive value (PPV), and negative predictive value (NPV) were calculated for all possible combinations of clinical measurements as well as each measure individually. A total of 6638 patients were identified, of whom 158 (2.4%) received MT. The best-fit predictive model included three or more positive clinical measures (Sens: 53%, Spec: 98%, PPV: 33%, NPV: 99%). There was increased PPV when all clinical measurements were positive (Sens: 9%, Spec: 100%, PPV: 86%, NPV: 98%). All combinations or clinical measures alone yielded lower predictive probability. Using these emergency department clinical measures, a predictive model to successfully identify civilian trauma patients at risk for MT was not able to be constructed. Given prospective identification of patients at risk for MT remains an imprecise undertaking, appropriate resources to support these efforts will need to be allocated for the completion of these studies.

Predictive value of sFlt, PIGF versus sFlt/PIGF ratio test in patients at risk of preeclampsia

2019 ◽  
Vol 3 (25) ◽  
pp. 14
Author(s):  
Amira-Livia Moldoveanu ◽  
D. Oprescu ◽  
Liliana Novac
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Ratio Test ◽  
Patients At Risk ◽  
Risk Of Preeclampsia
Sign in / Sign up

Export Citation Format

Share Document