Clinical Outcomes of Acute Pancreatitis in Patients with Cirrhosis According to Liver Disease Severity Scores

Abstract Many of the tertiary care hospitals in North Carolina (NC) are often frequented by patients who have to travel a long distance, given the rural nature of the state. Nearly one half of the adult sickle cell disease (SCD) patients seen at the Duke Comprehensive Sickle Cell Center (DCSCC) come from areas further than a 1-hr drive. The current study aims to determine whether geographical proximity to a comprehensive medical center is associated with SCD outcomes, as indicated by severity score, hospitalization frequency, and quality of life. Methods: Two hundred and two patients who primarily receive their SCD disease-related care from DCSCC were enrolled in the study. The sample included 101 males and 101 females, aged 20–69 years (mean=35.6), with SCD disease (SS: n=135; SC: n=47; other: n=20), and level of education ranging from 4–18 years (mean=13.1). Patients lived an average of 50.4 miles (median: 38.6, range:0.4 to 383) from DCSCC. Linear regressions, controlling for age and SCD diagnosis, were used to test associations between continuous variables. Severity scores measuring end organ damage were determined as previously described (Afenyi-Annan et al. 2008), and frequency of hospitalizations over the past 2 years was determined by self-report and medical record review. To measure mental and physical quality of life (QoL) domains, patients were administered the SF36 QoL scale. Hydroxyurea (HU) and opiate pain therapies were also recorded. Patients were considered to be on opiates if they had used opiates daily for a period of thirty days in the previous 12 months. Results and Discussion: Living closer to Duke had a statistically significant association with higher disease severity scores (β = −0.17, p=0.01). Moreover, proximity to Duke was associated with higher frequency of hospitalizations (β = −0.23, p=0.002). These associations were not modified by gender, employment status or education. Medication use did not account for the association between proximity and disease severity, or proximity and frequency of hospitalizations. The mental domain scores of self-reported QoL correlated negatively with hospitalizations (r= −0.18, p=0.02), whereas the physical domain score negatively correlated with both disease severity (r= −0.19, p <0.01) and hospitalizations (r = −0.26, p <0.01). However, proximity to DCSCC was not associated with the mental or the physical QoL domain. Therefore, it is unlikely that patients move closer to Duke due to higher perceived severity of illness and related medical needs. Conclusion: Patients who live closer to our tertiary care comprehensive center had higher disease severity scores and more hospitalizations over a two year period than patients who live farther away. Neither age, disease diagnosis, gender, employment status, education, nor HU and/or opiate medication use accounted for the negative association between proximity to DCSCC and disease outcomes. On the other hand, distance from DCSCC did not affect patients’ quality of life. The cross-sectional nature of the current study makes it difficult to determine causality. However, it is possible that patients who live close to a major medical center rely more on health system availability as a means to managing their disease, while those living further away rely on self-care at home or adhere to long-term medical regimens. Health care providers may need to focus on developing practice guidelines that encourage and empower patients to take a more active role in their medical care and be less dependent on their healthcare providers to decrease frequency of hospitalization and, perhaps decrease the progression of their disease.

Download Full-text

Relationship between Pattern of Hepatic Iron Deposition, Disease Severity and Clinical Outcomes in Non-Alcoholic Fatty Liver Disease

Journal of Hepatology ◽

10.1016/s0168-8278(16)00816-3 ◽

2016 ◽

Vol 64 (2) ◽

pp. S480-S481

Author(s):

E. Buzzetti ◽

R. Manguerra ◽

A. Hall ◽

L. De Luca ◽

P. Manousou ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Clinical Outcomes ◽

Disease Severity ◽

Fatty Liver Disease ◽

Iron Deposition ◽

Hepatic Iron ◽

Alcoholic Fatty Liver ◽

Deposition Disease ◽

Alcoholic Fatty Liver Disease

Download Full-text

118. Nasopharyngeal (NP) Bacterial Detection in Infants With Respiratory Syncytial Virus (RSV) Infection: Impact on Clinical Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.009 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S4-S5 ◽

Cited By ~ 1

Author(s):

Alejandro Diaz ◽

Eleonora Bunsow ◽

Cristina Garcia-Maurino ◽

Jeffrey Naples ◽

Alexis Juergensen ◽

...

Keyword(s):

Clinical Outcomes ◽

Disease Severity ◽

Pathogenic Bacteria ◽

Bacterial Colonization ◽

Antibiotic Use ◽

Clinical Disease ◽

Outcomes Of Care ◽

Severity Scores ◽

Rsv Infection ◽

Syncytial Virus

Abstract Background Previous studies suggest that RSV increases NP bacterial colonization and may facilitate infection. However, the role of NP colonization with potentially pathogenic bacteria (PPB) in the pathogenesis of RSV bronchiolitis is not well understood. We sought to determine the frequency, type, and density of NP PPB detection in infants with RSV infection compared with healthy controls (HC), and its association with clinical outcomes. Methods Single-center, prospective study of previously healthy infants with RSV infection and age-matched HC. Inpatients (IP) were enrolled within 24 hours of hospitalization, outpatients (OP) at the ED or primary clinics and HC at well-child visits. RSV infection and the following PPB: [S. pneumoniae, M. catarrhalis, H. influenzae, and S. aureus] were detected and quantified by PCR. We compared demographic, clinical characteristics, and outcomes of care according to NP PPB detection. Results From 2010 to 2018, we enrolled 815 infants: 664 with RSV infection [IP, 560; OP, 104] and 151 HC. RSV+ OP (6.1 [3.7–10.7] months) and HC (6.9 [3.8–10.8] months) were older than IP (2.5 [1.4–5.4] months; P < 0.001). Identification of ≥1 PPB was 89% in RSV+ infants [IP, 88%; OP, 90%] versus 63% of HC (P < 0.0001). While H. influenzae or >1 PPB detection was higher in RSV infection (P < 0.001), S. aureus detection predominated in HC (P < 0.05; Figure 1). Frequency of S. pneumoniae detection was comparable between groups; however, S. pneumoniae loads were one log higher in RSV+ infants versus HC (P = 0.001) adjusted for antibiotic use. Differences in colonization rates remained different in RSV+ infants versus HC across age ranges (<3, 3–6, >6–12, and >12–24 months; Figure 2). Last, RSV patients (both IP and OP) with S. pneumoniae or H. influenzae detection had fever more frequently (70%–74% vs. 25%–47%; P < 0.0001), higher clinical disease severity scores (P = 0.01), and higher blood neutrophil counts (34%–36% vs. 16%–19%; P < 0.001), versus those with M. catarrhalis, S. aureus detection or PCR negative. In addition, NP detection of H. influenzae in RSV children was associated with higher frequency of atelectasis/consolidation by chest X-ray (P < 0.005). Conclusion These data suggest that NP colonization with PPB is high in infants with RSV infection independent of age, and that specific bacteria, namely S. pneumoniae and H. influenzae, are associated with enhanced clinical disease severity. Disclosures A. Leber, Nationwide Children’s Hospital: Research Contractor, Research support. O. Ramilo, Janssen Scientific Affairs, LLC: Consultant, Consulting fee. A. Mejias, Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Abbvie: CME talks, Speaker honorarium.

Download Full-text

Machine Learning Model to Predict Hypotension After Starting Continuous Renal Replacement Therapy

10.21203/rs.3.rs-125446/v1 ◽

2020 ◽

Author(s):

Min Woo Kang ◽

Seonmi Kim ◽

Yong Chul Kim ◽

Dong Ki Kim ◽

Kook-Hwan Oh ◽

...

Keyword(s):

Machine Learning ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Disease Severity ◽

Support Vector ◽

Learning Models ◽

Severity Scores ◽

Disease Severity Scores ◽

Machine Learning Models

Abstract Background: Hypotension after starting continuous renal replacement therapy (CRRT) is associated with worse outcome, but it is difficult to predict because several factors have interactive and complex effects on the risk. The present study applied machine learning algorithms to develop models to predict hypotension after initiating CRRT.Methods: Among 2,349 adult patients who started CRRT due to acute kidney injury, 70% and 30% were randomly assigned into the training and testing sets, respectively. Hypotension was defined as a reduction in mean arterial pressure (MAP) ≥20 mmHg from the initial value within 6 hours. The area under the receiver operating characteristic curves (AUROCs) in machine learning models, such as support vector machine (SVM), deep neural network (DNN), and light gradient boosting machine (LGBM), were compared with those in disease-severity scores such as the Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II.Results: The DNN model showed the highest AUROC (0.822 [0.789–0.856]), and the LGBM and SVM models followed with AUROCs of 0.810 (0.776–0.845) and 0.807 (0.772–0.842), respectively; all machine learning AUROC values were higher than those obtained from disease-severity scores (AUROCs <0.6). Although different definitions of hypotension were used such as a reduction of MAP ≥30 mmHg or a reduction occurring within 1 hour, the AUROCs of machine learning models were higher than those of disease-severity scores. These machine learning models were well calibrated.Conclusion: Machine learning models successfully predict hypotension after starting CRRT and can serve as the basis of systems to predict hypotension before starting CRRT.

Download Full-text

Comparison of six disease severity scores for allergic rhinitis against pollen counts a prospective analysis at population and individual level

Pediatric Allergy and Immunology ◽

10.1111/pai.12562 ◽

2016 ◽

Vol 27 (4) ◽

pp. 382-390 ◽

Cited By ~ 14

Author(s):

Jakob Florack ◽

Maria Antonia Brighetti ◽

Serena Perna ◽

Antonio Pizzulli ◽

Antje Pizzulli ◽

...

Keyword(s):

Allergic Rhinitis ◽

Disease Severity ◽

Prospective Analysis ◽

Pollen Counts ◽

Individual Level ◽

Severity Scores ◽

Disease Severity Scores

Download Full-text

Comparison of Cidofovir and the Measles, Mumps, and Rubella Vaccine in the Treatment of Recurrent Respiratory Papillomatosis

Ear Nose & Throat Journal ◽

10.1177/014556131709600209 ◽

2017 ◽

Vol 96 (2) ◽

pp. 69-74 ◽

Cited By ~ 3

Author(s):

Ryan Kent Meacham ◽

Jerome W. Thompson

Keyword(s):

Disease Severity ◽

Demographic Data ◽

Recurrent Respiratory Papillomatosis ◽

Adjunctive Treatment ◽

Mmr Vaccine ◽

Severity Scores ◽

Remission Rates ◽

Study Population ◽

Group 3 ◽

Disease Severity Scores

We conducted a retrospective study of the use of cidofovir and the measles, mumps, and rubella (MMR) vaccineas adjunctive treatments to lesion debridement in patients with recurrent respiratory papillomatosis (RRP). Our study population was made up of 15 children—7 boys and 8 girls, aged 1 to 16 years at diagnosis (mean: 6.2)—with pathologically confirmed RRP who had been followed for at least 1 year. In addition to demographic data, we compiled information on disease severity, the type of adjunctive treatment administered to each patient, the frequency of debridements, the length of observation, and remission rates. Of the 15 patients, 5 had been treated with cidofovirafter debridement (cidofovir-only group), 6 were treated with MMR vaccine after debridement (MMR-only group), 3 were treated with one and later switched to the other based on parental preference, and 1 received neither treatment, only debridement. The initial mean Derkay disease severity scores were 12.6 for the cidofovir-only group and 11.0 for the MMR-only group (p = 0.61). The cidofovir-only patients underwent an average of 11.8 adjunctive treatments and the MMR-only patients an average of 17.7 (p = 0.33). The average duration of observation was 44.0 months in the cidofovir-only group and 64.7 months in the MMR-only group (p = 0.29). Remission rates were 20% in the cidofovir-only group and 50% in the MMR-only group (p = 0.54). Our study found insufficient evidence of any significant differences between cidofovir and the MMR vaccinein terms of the number and frequency of adjunctive treatments and the rates of remission.

Download Full-text