A novel cardiovascular death prediction model for Chinese individuals: A prospective cohort study of 381,963 study participants

Abstract Background A vast number of patients with chronic critical illness (CCI) have died of delayed organ failure in the intensive care unit (ICU). The weak organ function of patients needed appropriate tool to evaluate, which could provide reference for clinical decisions and communication with family members. The objective of this study was to develope and validate a prediction model for accurate, timely, simple, and objective identification of the critical degree of the patients' condition. Methods This study used a retrospective case–control and a prospective cohort study, with no interventions. Patients identified as CCI from a comprehensive ICU of a large metropolitan public hospital were selected. A total of 344 (case 172; control 172) patients were included to develop the Prognosis Prediction Model of Chronic Critical Illness (PPCCI Model) in this case-control study; 88 (case, 44; control 44) patients were included for the validation cohort in a prospective cohort study. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC). Results The model comprised 9 predictors: age, prolonged mechanical ventilation (PMV), sepsis/other serious infections, Glasgow Coma Scale (GCS), mean artery pressure (MAP), heart rate (HR), respiratory rate (RR), oxygenation index (OI), and active bleeding.In both cohorts, the PPCCI Model could better identify the dead CCI patients (development cohort: AUC, 0.934; 95% CI, 0.908–0.960; validation cohort: AUC, 0.965; 95% CI, 0.931–0.999), and showed better discrimination than the Acute Physiology And Chronic Health Evaluation II (APACHE II), Modified Early Warning Score (MEWS), and Sequential Organ Failure Assessment (SOFA). Conclusions The PPCCI Model can provide a standardized measurement tool for ICU medical staff to evaluate the condition of CCI patients, to facilitate rational allocation of ward-monitoring resources or communicate with family members.

Download Full-text

Metabolic syndrome and the risk of cardiovascular and all-cause mortality: data of 14-year prospective cohort study in Siberia

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-3821 ◽

2020 ◽

Vol 25 (6) ◽

pp. 3821

Author(s):

G I Simonova ◽

S V Mustafina ◽

O D Rymar ◽

L V Scherbacova ◽

T I Nikitenko ◽

...

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cardiovascular Mortality ◽

Prospective Cohort ◽

Cardiovascular Death ◽

Mortality Data ◽

Risk Of Death ◽

All Cause Mortality

Aim. To study the risk of cardiovascular and all-cause mortality in patients with metabolic syndrome (MS) according to a 14-year prospective cohort study in Siberia.Material and methods. Based on the data from the Russian arm of the HAPIEE project, we assessed all-cause deaths occurred by 2017 in the population cohort examined at baseline in 2003-2005 (n=9273). The baseline examination included the assessment of blood pressure (BP), anthropometry, levels of fasting triglycerides, high density lipoprotein cholesterol (HDL-C), and blood glucose. The fatal cases in the studied cohort were identified from “Medical death certificates” for the period from February 1, 2003 to December 31, 2017, based on data from the Department of Civil Registration of Death Acts. Cardiovascular death was established using the International Classification of Diseases, the 10th revision (ICD-10): I (0-99).Results. The mortality rate in subjects with MS was 16,6% — 751 deaths (25,1% in men and 11,5% in women), and it was 20-30% higher than in those without MS. Cardiovascular mortality in subjects with MS was 12,6% — 572 deaths (20,5% in men and 8,9% in women), and it was nearly 30% higher than in those without MS. Multivariable Cox regression revealed that among the components of MS, the elevated BP level even with BP ≥135/80 mm Hg had the major impact on increasing the risk of all-cause mortality (HR=1,7 (1,4; 2,1) in men; HR=2,2 (1,7; 2,8) in women) and increasing the risk of cardiovascular mortality (HR=2,2 (1,5; 3,0) in men and HR=2,8 (1,8; 4.3) in women). Among men, already 1 component of MS increased the risk of cardiovascular and all-cause mortality by 2,0 or more times; among women, 2-4 components of MS increased the risk of death by 3 times, and 5 components — by 4.Conclusion. In the studied population sample, cardiovascular and all-cause mortality during the 14-year follow-up in individuals with MS was about 25-30% higher compared to those without MS. The risk of cardiovascular and all-cause deaths in subjects with MS is comparable to the risk in case of blood pressure ≥135/80 mm Hg. With an increase in the number of MS components from 1 to 5, the risk of all-cause and cardiovascular death increases.

Download Full-text

Development of an early prediction model for postoperative delirium in neurosurgical patients admitted to the ICU after elective craniotomy (E-PREPOD-NS): A secondary analysis of a prospective cohort study

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2021.06.004 ◽

2021 ◽

Vol 90 ◽

pp. 217-224

Author(s):

Hua-Wei Huang ◽

Guo-Bin Zhang ◽

Hao-Yi Li ◽

Chun-Mei Wang ◽

Yu-Mei Wang ◽

...

Keyword(s):

Cohort Study ◽

Prediction Model ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Postoperative Delirium ◽

Secondary Analysis ◽

Early Prediction ◽

Neurosurgical Patients

Download Full-text

Long term impact on lung function of patients with moderate and severe COVID-19. A prospective cohort study

10.1101/2021.01.06.21249312 ◽

2021 ◽

Author(s):

Sonia Qureshi ◽

Nosheen Nasir ◽

Naveed Haroon Rashid ◽

Naveed Ahmed ◽

Zoya Haq ◽

...

Keyword(s):

Cohort Study ◽

Lung Function ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

List Type ◽

Long Term Impact ◽

Study Participants ◽

The Impact

AbstractIntroductionA significant number of patients continue to recover from COVID-19; however, little is known about the lung function capacity among survivors. We aim to determine the long-term impact on lung function capacity in patients who have survived moderate or severe COVID-19 disease in a resource-poor setting.Methods and analysisThis prospective cohort study will include patients aged 15 years and above and have reverse transcriptase-polymerase chain reaction (RT-PCR) positive for COVID 19 (nasopharyngeal or oropharyngeal). Patients with a pre-existing diagnosis of obstructive or interstitial lung disease, lung fibrosis and cancers, connective tissue disorders, autoimmune conditions affecting the lungs, underlying heart disease, history of syncope and refuse to participate will be excluded. Pulmonary function will be assessed using spirometry and diffusion lung capacity for carbon monoxide (DLCO) at three- and six-months interval. A chest X-ray at three and six-month follow-up and CT-chest will be performed if clinically indicated after consultation with the study pulmonologist or Infectious Disease (ID) physician. Echocardiogram (ECHO) to look for pulmonary hypertension at the three months visit and repeated at six months if any abnormality is identified initially. Data analysis will be performed using standard statistical software.Ethics and disseminationThe proposal was reviewed and approved by ethics review committee (ERC) of the institution (ERC reference number 2020-4735-11311). Informed consent will be obtained from each study participant. The results will be disseminated among study participants, institutional, provincial and national level through seminars and presentations. Moreover, the scientific findings will be published in high-impact peer-reviewed medical journals.Strengths and Limitations of this study-The study has the potential to develop context-specific evidence on the long-term impact on lung function among COVID-19 survivors-Findings will play key role in understanding the impact of the disease on vital functions and help devise rehabilitative strategies to best overcome the effects of disease-This is a single-center, study recruiting only a limited number of COVID-19 survivors-The study participants may loss-to-follow up due to uncertain conditions and disease reemergence

Download Full-text

Development and validation of the OUTCoV score to predict the risk of hospitalisation among patients with SARS-CoV-2 infection in ambulatory settings: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-044242 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044242

Author(s):

Frederique Jacquerioz ◽

Stéphanie Baggio ◽

Angele Gayet-Ageron ◽

François Chappuis ◽

Laurent Getaz ◽

...

Keyword(s):

Cohort Study ◽

Prediction Model ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

University Hospital ◽

Ambulatory Setting ◽

Likelihood Ratios ◽

Predictive Values ◽

Rule Out

ObjectivesTo develop and validate a rule-out prediction model for the risk of hospitalisation among patients with SARS-CoV-2 infection in the ambulatory setting to derive a simple score to determine outpatient follow-up.DesignProspective cohort study.SettingSwiss university hospital.Participants1459 individuals with a positive result for SARS-CoV-2 infection between 2 March and 23 April 2020.MethodsWe applied the rule of 10 events per variable to construct our multivariable model and included a maximum of eight covariates. We assessed the model performance in terms of discrimination and calibration and performed internal validation to estimate the statistical optimism of the final model. The final prediction model included age, fever, dyspnoea, hypertension and chronic respiratory disease. To develop the OUTCoV score, we assigned points for each predictor that were proportional to the coefficients of the regression equation. Sensitivity, specificity, positive and negative likelihood ratios were estimated, including positive and negative predictive values in different thresholds.Main outcome measureThe primary outcome was COVID-19-related hospitalisation.ResultsThe OUTCoV score ranged from 0 to 7.5 points. The two threshold parameters with optimal rule-out and rule-in characteristics for the risk of hospitalisation were 3 and 5.5, respectively. Outpatients with a score <3 (997/1459; 68.3%) had no follow-up as at low risk of hospitalisation (1.8%; 95% CI 1.1 to 2.8). For a score ≥5.5 (20/1459; 1.4%), the hospitalisation risk was higher (30%; 95% CI 11.9 to 54.3).ConclusionsThe OUTCoV score allows to rule out two-thirds of outpatients with SARS-CoV-2 infection presenting a low hospitalisation risk and to identify those at high risk that require careful follow-up to assess the need for hospitalisation. The model provides a simple decision-making tool for an effective allocation of resources to maintain quality care for outpatient populations.

Download Full-text