Predictors of adverse outcome in patients with frequent premature ventricular complexes: The ABC-VT risk score

AbstractPatients hospitalised with COVID-19 have a high mortality. Identification of patients at increased risk of adverse outcome would be important, to allow closer observation and earlier medical intervention for those at risk, and to objectively guide prognosis for friends and family of affected individuals. We conducted a single-centre retrospective cohort study in all-comers with COVID-19 admitted to a large general hospital in the United Kingdom. Clinical characteristics and features on admission, including observations, haematological and biochemical characteristics, were used to develop a score to predict 30-day mortality, using multivariable logistic regression. We identified 316 patients, of whom 46% died within 30-days. We developed a mortality score incorporating age, sex, platelet count, international normalised ratio, and observations on admission including the Glasgow Coma Scale, respiratory rate and blood pressure. The score was highly predictive of 30-day mortality with an area under the receiver operating curve of 0.7933 (95% CI 0.745–0.841). The optimal cut-point was a score ≥ 4, which had a sensitivity of 78.36% and a specificity of 67.59%. Patients with a score ≥ 4 had an odds ratio of 7.6 for 30-day mortality compared to those with a score < 4 (95% CI 4.56–12.49, p < 0.001). This simple, easy-to-use risk score calculator for patients admitted to hospital with COVID-19 is a strong predictor of 30-day mortality. Whilst requiring further external validation, it has the potential to guide prognosis for family and friends, and to identify patients at increased risk, who may require closer observation and more intensive early intervention.

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Validation of a risk score identifying patients with acute pulmonary embolism, who are at low risk of clinical adverse outcome

Thrombosis and Haemostasis ◽

10.1160/th04-01-0034 ◽

2004 ◽

Vol 91 (06) ◽

pp. 1232-1236 ◽

Cited By ~ 51

Author(s):

Patrick Bandelier ◽

Drahomir Aujesky ◽

Jacques Cornuz ◽

Pierre-Marie Roy ◽

Henri Bounameaux ◽

...

Keyword(s):

Pulmonary Embolism ◽

Risk Score ◽

Acute Pulmonary Embolism ◽

Predictive Accuracy ◽

Adverse Outcome ◽

Characteristic Curve ◽

Prognostic Score ◽

Adverse Outcomes ◽

Low Risk ◽

Score Distribution

SummaryA clinical predictive model that accurately identifies patients with pulmonary embolism who are at low risk of adverse medical outcomes may be useful for management decisions, such as outpatient treatment. We aimed to externally validate a previously derived prognostic score identifying emergency ward patients with acute pulmonary embolism at low risk of 3- month complications. One hundred and ninety-nine consecutive patients with proven pulmonary embolism were included from the emergency centres of three teaching and general hospitals. Adverse outcomes, such as death, major bleed, or recurrent venous thromboembolism, were recorded during a 3-month follow-up. We retrospectively computed the prognostic score for each patient and determined its predictive accuracy at different threshold values. The overall 3-month risk of adverse event after the diagnosis of pulmonary embolism was 9.5%. At a threshold of 2 points, eight patients with scores at or below the cut-off (5%; 95% CI 2.6–9.6) and 11 patients with scores above this cut-off (27.5%; 95% CI 16.1–42.8) presented a complication. The negative predictive value for an adverse outcome was 95.0% (95% CI 90.4–97.4). The receiver operating characteristic curve derived from the score distribution had an area of 0.77 (95% CI 0.65–0.89). This compared favourably with the characteristics of the derivation study. We conclude that the Geneva risk score has an acceptable predictive accuracy to identify patients with pulmonary embolism at low risk for 3-month adverse outcomes. Whether this score remains accurate and useful in clinical practice should be determined in a prospective multicentre validation study.

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Predicting Adverse Outcome in Patients with Acute Pulmonary Embolism: A Risk Score

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614065 ◽

2000 ◽

Vol 84 (10) ◽

pp. 548-552 ◽

Cited By ~ 230

Author(s):

Jacques Wicki ◽

Thomas Perneger ◽

Henri Bounameaux ◽

Alain Junod ◽

Arnaud Perrier

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Adverse Events ◽

Risk Score ◽

Major Bleeding ◽

Acute Pulmonary Embolism ◽

Adverse Outcome ◽

Vein Thrombosis ◽

Risk Patients ◽

Deep Vein

SummaryReliable prediction of adverse outcomes in acute pulmonary embolism may help choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to generate a simple risk score for use in clinical settings. We prospectively followed 296 consecutive patients with pulmonary embolism admitted through the emergency ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1%) had one or more adverse events during the 3-month follow-up period: 25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome in multivariate analysis were cancer, heart failure, previous deep vein thrombosis, systolic blood pressure <100 mmHg, arterial PaO2 <8 kPa, and presence of deep vein thrombosis on ultrasound. A risk score was calculated by adding 2 points for cancer and hypotension, and 1 point each for the other predictors. A score of 2 best identified patients at risk of an adverse outcome in a receiver operating characteristic curve analysis. Of 180 low-risk patients (67.2%) (score ≤2), only 4 experienced an adverse outcome (2.2%), compared to 23 (26.1%) of 88 high-risk patients (score ≥3). A simple risk score based on easily available variables can accurately identify patients with pulmonary embolism at low risk of an adverse outcome. Such a score may be useful for selecting patients with pulmonary embolism eligible for outpatient care.

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Which Patients Discharged to Home-Based Outpatient Parenteral Antimicrobial Therapy Are at High Risk of Adverse Outcomes?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa178 ◽

2020 ◽

Vol 7 (6) ◽

Cited By ~ 1

Author(s):

Sara C Keller ◽

Nae-Yuh Wang ◽

Alejandra Salinas ◽

Deborah Williams ◽

Jennifer Townsend ◽

...

Keyword(s):

High Risk ◽

Risk Score ◽

Antimicrobial Therapy ◽

Adverse Outcome ◽

Adverse Outcomes ◽

Drug Event ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Derivation Cohort ◽

Home Based ◽

Academic Medical

Abstract Background Patients increasingly receive home-based outpatient parenteral antimicrobial therapy (OPAT). Understanding which patients might be at higher risk of complications is critical in effectively triaging resources upon and after hospital discharge. Methods A prospective cohort of patients discharged from 1 of 2 academic medical centers in Baltimore, Maryland, between March 2015 and December 2018 were consented and randomly divided into derivation and validation cohorts for development of a risk score for adverse OPAT outcomes. Data from the derivation cohort with the primary outcome of a serious adverse outcome (infection relapse, serious adverse drug event, serious catheter complication, readmission, or death) were analyzed to derive the risk score equation using logistic regression, which was then validated in the validation cohort for performance of predicting a serious adverse outcome. Results Of 664 patients in the total cohort, half (332) experienced a serious adverse outcome. The model predicting having a serious adverse outcome included type of catheter, time on OPAT, using a catheter for chemotherapy, using a catheter for home parenteral nutrition, being treated for septic arthritis, being on vancomycin, being treated for Enterococcus, being treated for a fungal infection, and being treated empirically. A score ≥2 on the serious adverse outcome score had a 94.0% and 90.9% sensitivity for having a serious adverse outcome in the derivation and validation cohorts, respectively. Conclusions A risk score can be implemented to detect who may be at high risk of serious adverse outcomes, but all patients on OPAT may require monitoring to prevent or detect adverse events.

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Decreased Endotoxin Immunity Is Associated with Greater Mortality and/or Prolonged Hospitalization after Surgery

Anesthesiology ◽

10.1097/00000542-200106000-00012 ◽

2001 ◽

Vol 94 (6) ◽

pp. 992-998 ◽

Cited By ~ 31

Author(s):

Elliott Bennett-Guerrero ◽

Michael H. Panah ◽

G. Robin Barclay ◽

Carol A. Bodian ◽

Wanda J. Winfree ◽

...

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Postoperative Complication ◽

Risk Score ◽

Immunoglobulin G ◽

Postoperative Morbidity ◽

Adverse Outcome ◽

Noncardiac Surgery ◽

Immunoglobulin M ◽

Total Immunoglobulin

Background Patients undergoing noncardiac surgery often develop postoperative morbidity, potentially attributable to endotoxemia and the systemic inflammatory response syndrome. Endogenous antibodies to endotoxin may confer protection from endotoxin-mediated toxicity. The authors sought to determine the association of preoperative antiendotoxin immunity and death or prolonged hospitalization in a broad population of general surgical patients undergoing major surgery. Methods To test the hypothesis that low preoperative serum antiendotoxin core antibody (EndoCAb) concentration is an independent predictor of adverse outcome after general surgery, 1,056 patients undergoing routine noncardiac surgery were enrolled into a prospective, blinded, cohort study. Immunoglobulin M EndoCAb, immunoglobulin G EndoCAb, total inmunoglobulin M, and immunoglobulin G concentrations were measured in serum obtained preoperatively. A physiologic risk score using the established POSSUM criteria was assigned preoperatively to each patient. The primary predefined composite end point (postoperative complication) was either in-hospital death or postoperative length of stay greater than 10 days. Multivariate logistic regression was used to test the study hypothesis. Results Overall, postoperative complication occurred in 234 of the 1,056 patients (22.1%). Lower immunoglobulin M EndoCAb concentration (P = 0.006) predicted increased risk of postoperative complication independent of POSSUM physiologic risk score (P < 0.001). In contrast, total immunoglobulin M and total immunoglobulin G concentrations did not predict adverse outcome. Complications involved multiple organ systems and were generally unrelated to the type or site of surgery, consistent with the systemic inflammatory response syndrome. Conclusions Adverse outcome after routine noncardiac surgery is common and is predicted in part by low concentrations of EndoCAb. The authors' findings suggest that endotoxemia may be a cause of postoperative morbidity after routine noncardiac surgery.

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