Combined evaluation of aminotransferases improves risk stratification for overall and cause-specific mortality in older patients

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

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993 PROSTATE TUMOR VOLUME IS INDEPENDENTLY ASSOCIATED WITH CANCER-SPECIFIC MORTALITY FOLLOWING RADICAL PROSTATECTOMY AND ENHANCES PATIENT RISK STRATIFICATION

The Journal of Urology ◽

10.1016/j.juro.2013.02.577 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

John Knoedler ◽

Robert Karnes ◽

Laureano Rangel ◽

Eric Bergstralh ◽

Stephen Boorjian

Keyword(s):

Radical Prostatectomy ◽

Risk Stratification ◽

Tumor Volume ◽

Prostate Tumor ◽

Patient Risk ◽

Specific Mortality ◽

Cancer Specific Mortality

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17 Evidence for Combined Falls and Syncope Assessment in Older Patients

Age and Ageing ◽

10.1093/ageing/afz164.17 ◽

2019 ◽

Vol 48 (Supplement_4) ◽

pp. iv6-iv8

Author(s):

Rose Anne Kenny

Keyword(s):

Risk Stratification ◽

Older Patients ◽

Older Persons ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Transient Loss ◽

Esc Guidelines ◽

Flow Through ◽

The Brain

Abstract Syncope is a transient loss of consciousness due to cerebral hypoperfusion (reduced blood flow through the brain). Thirty percent of older persons who have syncope are unaware of loss of consciousness and the majority of events are not witnessed. In these cases, the patient presents with non-accidental/unexplained falls (Parry SW et al., 2005). Many of these events are not recognised. Given that most causes of syncope can be treated and further events prevented, the new ESC guidelines for syncope recommends inclusion of falls in syncope risk stratification (Brignole M et al., 2018) in older patients. These new risk stratification recommendations will be reviewed coupled with new prevalence and comorbidity information for falls in community samples and the long term consequences of hypotensive syndromes on cerebral function.

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Cardiovascular Risk Stratification in Older Patients

JAMA ◽

10.1001/jama.293.13.1667 ◽

2005 ◽

Vol 293 (13) ◽

pp. 1667 ◽

Cited By ~ 4

Author(s):

Martin Schillinger

Keyword(s):

Cardiovascular Risk ◽

Risk Stratification ◽

Older Patients ◽

Cardiovascular Risk Stratification

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A competing-risks nomogram and recursive partitioning analysis for cause-specific mortality in patients with esophageal neuroendocrine carcinoma

Diseases of the Esophagus ◽

10.1093/dote/doy129 ◽

2019 ◽

Vol 32 (11) ◽

Cited By ~ 3

Author(s):

G Zhang ◽

B Wu ◽

X Wang ◽

J Li

Keyword(s):

Risk Stratification ◽

Competing Risks ◽

Neuroendocrine Carcinoma ◽

Cumulative Incidence ◽

Recursive Partitioning ◽

Curve Analysis ◽

Recursive Partitioning Analysis ◽

Decision Curve Analysis ◽

Increased Risk ◽

Specific Mortality

SUMMARY The objective of this study is to estimate the probability of cause-specific mortality using a competing-risks nomogram and recursive partitioning analysis in a large population-based cohort of patients with esophageal neuroendocrine carcinoma. The surveillance, epidemiology and end results database was used to identify 162 patients diagnosed with esophageal neuroendocrine carcinoma from 1998 to 2014. We estimated a cumulative incidence function for cause-specific mortality. A nomogram was constructed by using a proportional subdistribution hazard model, validated using bootstrap cross-validation, and evaluated with a decision curve analysis to assess its clinical utility. Finally, we performed risk stratification using a recursive partitioning analysis to divide patients with esophageal neuroendocrine carcinoma into clinically useful prognostic groups. Tumor location, distant metastasis, surgery, radiotherapy, and chemotherapy were significantly associated with cause-specific mortality. The calibration plots demonstrated good concordance between the predicted and actual outcomes. The discrimination performance of a Fine–Gray model was evaluated by using the c-index, which was 0.723 for cause-specific mortality. The decision curve analysis ranged from 0.268 to 0.968 for the threshold probability at which the risk model provided net clinical benefits relative to hypothetical all-screening and no-screening scenarios. The risk groups stratified by a recursive partitioning analysis allowed significant distinction between cumulative incidence curves. We determined the probability of cause-specific mortality in patients with esophageal neuroendocrine carcinoma and developed a nomogram and recursive partitioning analysis stratification system based on a competing-risks model. The nomogram and recursive partitioning analysis appear to be suitable for risk stratification of cause-specific mortality in patients with esophageal neuroendocrine carcinoma and will help clinicians to identify patients at increased risk of cause-specific mortality to guide treatment and surveillance decisions.

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Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MBmass

European Heart Journal ◽

10.1053/euhj.1999.1760 ◽

2000 ◽

Vol 21 (5) ◽

pp. 382-389 ◽

Cited By ~ 34

Author(s):

B Jurlander

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Creatine Kinase ◽

Early Diagnosis ◽

Risk Stratification ◽

Cardiac Troponin ◽

Troponin T ◽

Cardiac Troponin T ◽

Combined Evaluation ◽

Suspected Acute Myocardial Infarction

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Is Additional Gastrectomy Required for Elderly Patients after Endoscopic Submucosal Dissection with Endoscopic Curability C-2 for Early Gastric Cancer?

Digestion ◽

10.1159/000519514 ◽

2021 ◽

pp. 1-9

Author(s):

Waku Hatta ◽

Takuji Gotoda ◽

Tomoyuki Koike ◽

Kaname Uno ◽

Naoki Asano ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Risk Stratification ◽

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Submucosal Dissection ◽

All Cause Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Additional Gastrectomy

Background: With the ongoing growth of the aged population, the number of elderly patients suffering from gastric cancer has increased in Japan. Since the frequency of lymph node metastasis (LNM) in patients after endoscopic submucosal dissection (ESD) with endoscopic curability (eCura) C-2 for early gastric cancer (EGC) is relative low, the following question can be raised: “Is additional gastrectomy required for elderly patients with such criteria for ESD?” Summary: For therapeutic decision-making after ESD with eCura C-2, the risk of all-cause mortality and impaired quality of life (QoL) should thus be evaluated. Risk stratification of LNM and gastric cancer-specific mortality was established by the eCura system; however, it remains unclear how much these categories and treatment selection affect all-cause mortality. The contribution of prognostic tools for predicting all-cause mortality was noted to vary across the studies of patients with EGC; thus, further studies that investigate comprehensive geriatric assessment (CGA) may be required. Regarding the QoL, studies on elderly patients remain to be lacking. Furthermore, one of the issues with CGA and QoL tools is that they are time consuming. Key Messages: Combined evaluation of risk stratification of gastric cancer-specific mortality by the eCura system and risk of nongastric cancer-related mortality and impaired QoL may be the current optimal method to decide treatment strategy after ESD with eCura C-2 for EGC among elderly patients. A large-scale prospective study that investigates CGA domains is required to identify predictors of all-cause mortality and impaired QoL, and a more easily usable tool should be developed.

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Comparison of different risk stratification rules to predict short-term adverse outcomes after syncope in older Chinese adults

10.21203/rs.3.rs-1104280/v1 ◽

2021 ◽

Author(s):

Hong Mu ◽

Jiexin Liu ◽

Hefei Tang ◽

Cheng Huang ◽

Limin Liu ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Risk Stratification ◽

Older Patients ◽

Adverse Outcomes ◽

Chronic Obstructive Pulmonary Disorder ◽

Likelihood Ratios ◽

Short Term ◽

Predictive Values ◽

Older Chinese

Abstract Background: Older adults with syncope are commonly treated in the emergency department. Clinical decision rules have been developed to assess syncope patients, but there have been no application or comparative studies in older Chinese cohorts until now. This study aimed to compare the values of five existing rules in predicting the short-term adverse outcomes of older patients. Methods: From September 2018 to February 2021, older Chinese patients (≥60 yr) with syncope admitted to our hospital were investigated and evaluated by the Risk Stratification of Syncope in the Emergency Department (ROSE) rule, the San Francisco Syncope Rule (SFSR), the FAINT rule, the Canadian Syncope Risk Score (CSRS) and the Boston Syncope Criteria (BSC). After a one-month follow-up, the sensitivity, specificity, accuracy, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (PLR), and negative likelihood ratios (NLR) of each aforementioned rule were calculated and compared. Results: A total of 171 patients, with a mean age of 75.65±8.26 years and 48.54% male, were analysed in the study. Fifty-eight patients were reported to have experienced short-term adverse incidents during the month. The neurally mediated syncope group showed a significant sex-specific difference in adverse incidences but the cardiac syncope group did not. There were some factors associated with significant differences in adverse incidences, such as a history of hypertension, congestive heart failure, and chronic obstructive pulmonary disorder, as well as the levels of SpO2, B-type natriuretic peptide (BNP) and troponin T (TnT), while the levels of haemoglobin and creatinine suggested potential significance. In order of the ROSE, SFSR, FAINT, CSRS and BSC rules in the analysis, the sensitivities were 81.03%, 77.59%, 93.10%, 74.14% and 94.83%, the specificities were 86.73%, 84.96%, 38.94%, 60.18% and 56.64%, the NPVs were 89.91%, 88.07%, 91.67%, 81.93% and 95.52%, and the NLRs were 0.22, 0.26, 0.18, 0.43 and 0.09, respectively. Conclusions: This study revealed that the five mentioned rules for syncope risk stratification, with their own characteristics, all showed crucial significance for screening older adults. Therefore, physicians in the emergency department should flexibly understand and judge older patients’ potential risks according to the actual clinical situations.

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