Predictors of Maternal Mortality and Prognostic Models in Obstetric Patients

2017 ◽  
Vol 38 (02) ◽  
pp. 191-200 ◽  
Author(s):  
Jezid Miranda ◽  
Jose Rojas-Suarez ◽  
Andrew Levinson
Keyword(s):  
High Risk ◽  
Maternal Morbidity ◽  
Prediction Models ◽  
Severity Of Illness ◽  
Scoring Systems ◽  
Morbidity And Mortality ◽  
Prognostic Models ◽  
High Risk Patients ◽  
Maternal Morbidity And Mortality ◽  
Risk Patients

AbstractThe use of predictive models has been proposed as a potential tool to reduce maternal morbidity and mortality, by aiding in the timely identification of potential high-risk patients. Prognostic models in critical care have been used to characterize the severity of illness of specific diseases. Physiological changes in pregnancy may result in general critical illness prediction models overestimating mortality in obstetric patients. Models that specifically reflect the unique characteristics of obstetric patients may have better prognostic value. Recently developed tools have focused on identifying at-risk patients before they require intensive care unit (ICU) admission to target early interventions and prevent acute clinical decompensation. The aim of the newest scoring systems, specifically designed for groups of obstetric patients receiving non-ICU care, is to reduce maternal morbidity and mortality by identifying early high-risk patients and initiating prompt effective medical responses.

scholarly journals The Impact Prediction Models of Neoplasia for Lung Nodules in High-Risk Patients

2020 ◽  
Vol 3 (3) ◽  
pp. 138-146
Author(s):  
Camilla Matos Pedreira ◽  
José Alves Barros Filho ◽  
Carolina Pereira ◽  
Thamine Lessa Andrade ◽  
Ricardo Mingarini Terra ◽  
...  
Keyword(s):  
High Risk ◽  
Prediction Model ◽  
Prediction Models ◽  
Lung Nodule ◽  
Smoking History ◽  
Predictive Values ◽  
Impact Prediction ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Impact

Objectives: This study aims to evaluate the impact of using three predictive models of lung nodule malignancy in a population of patients at high-risk for neoplasia according to previous analysis by physicians, as well as evaluate the clinical and radiological malignancy-predictors of the images. Material and Methods: This is a retrospective cohort study, with 135 patients, undergone surgical in the period from 01/07/2013 to 10/05/2016. The study included nodules with dimensions between 5mm and 30mm, excluding multiple nodules, alveolar consolidation, pleural effusion, and lymph node enlargement. The main variables analyzed were age, sex, smoking history, extrathoracic cancer, diameter, location, and presence of spiculation. The calculation of the area under the ROC curve assessed the accuracy of each prediction model. Results: The study analyzed 135 individuals, of which 96 (71.1%) had malignant nodules. The areas under the ROC curves for each prediction model were: Swensen 0.657; Brock 0.662; and Herder 0.633. The models Swensen, Brock, and Herder presented positive predictive values in high-risk patients, corresponding to 83.3%, 81.8%, and 82.9%, respectively. Patients with the intermediate and low-risk presented a high malignant nodule rate, ranging from 69.3-72.5% and 42.8-52.6%, respectively. Conclusion: None of the three quantitative models analyzed in this study was considered satisfactory (AUC> 0.7) and should be used with caution after specialized evaluation to avoid underestimation of the risk of neoplasia. The pretest calculations might not contemplate other factors than those predicted in the regressions, that could present a role in the clinical decision of resection.

scholarly journals SURGICAL TREATMENT OF HIGH-RISK PATIENTS IN PATIENTS

2019 ◽  
pp. 6-11
Author(s):  
V. V. Boyko ◽  
Yu. V. Ivanova ◽  
M. E. Tymchtnko
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Morbidity ◽  
Morbidity And Mortality ◽  
High Risk Patients ◽  
Risk Patients ◽  
Surgical Tactics ◽  
Level Of Risk

Summary. Due to analysis of the factors that lead to incompetence of bowels` anastomosis and sutures the levels of risk of the development of this complication were created. The surgical tactics depending on the level of risk of the development of bowels` sutures and anastomosis incompetence was created. The method of forming of late bowels` anstomosis in patients with high and moderate levels of risk of  the development of bowels` sutures and anastomosis incompetence were created. This method excludes performing of multistaged  intraabdominal operations. The using of developed algorithm allows to decrease postoperative morbidity and mortality.

scholarly journals APACHE IV system helps to determine cholecystostomy role in elderly patients with acute cholecystitis

2020 ◽  
Author(s):  
Hua Jiang ◽  
Guo Guo ◽  
Zhimin Yao ◽  
Yuehua Wang
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Therapeutic Effect ◽  
Scoring System ◽  
Scoring Systems ◽  
Percutaneous Cholecystostomy ◽  
High Risk Patients ◽  
Before And After ◽  
Risk Patients ◽  
Apache Iv

Abstract Background Cholecystostomy offers an alternative method for patients unfit to undergo immediate cholecystectomy. Nevertheless, the role of cholecystostomy in the clinical management of high-risk surgical patients remains unclear. One of the main problems concerning the therapeutic effect in critically ill patients with acute cholecystitis is the lack of validated, well-established scoring systems to stratify the severity of patient disease states. APACHE IV scoring system was useful to estimate the hospital mortality for high-risk patients. We try to evaluate the performance of the APACHE IV scoring system in patients over 65 years of age with acute cholecystitis and the therapeutic effect of percutaneous cholecystostomy. Methods 597 patients over 65 years of age with acute cholecystitis between January 2011 and December 2018 were retrospectively analyzed with the APACHE IV scores. Results Among the 597 patients, 52 successfully underwent cholecystectomy (2 died, 3.85%), 65 underwent percutaneous cholecystostomy (1 died, 1.54%), and 480 received conservative therapy (27 died, 5.63%). The fitness of the APACHE IV score prediction is good with the area under the ROC curve of 0.894. The APACHE IV models were well-calibrated (with the Hosmer-Lemeshow statistic). Using the method of binary regression analysis, for the patients whose estimated mortality rate was more than 10%, cholecystostomy was an important factor for prognosis (P = 0.048). The estimated mortality of PC patients before and after operation was compared, which indicated that the estimated mortality after puncture was significantly decreased, either in the whole patient group (P = 0.004) or in the group with an estimated mortality greater than 10% (P = 0.008). Conclusion The APACHE IV scoring system showed that cholecystostomy was a safe and effective treatment for elderly high-risk patients with acute cholecystitis.

scholarly journals Decisions to operate: the ASA grade 5 dilemma

2011 ◽  
Vol 93 (5) ◽  
pp. 365-369 ◽  
Author(s):  
J Horwood ◽  
S Ratnam ◽  
A Maw
Keyword(s):  
High Risk ◽  
Scoring Systems ◽  
Apache Ii ◽  
Ageing Population ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Operative Severity Score ◽  
Grade 5 ◽  
Number Of Patients ◽  
Risk Patients

INTRODUCTION Deciding to operate on high risk patients suffering catastrophic surgical emergencies can be problematic. Patients are frequently classed as American Society of Anesthesiologists (ASA) grade 5 and, as a result, aggressive but potentially lifesaving intervention is withheld. The aim of our study was to review the short-term outcomes in patients who were classed as ASA grade 5 but subsequently underwent surgery despite this and to compare the ASA scoring model to other predictors of surgical outcome. METHODS All patients undergoing emergency surgery with an ASA grade of 5 were identified. Patient demographics, indications for surgery, intraoperative findings and outcomes were recorded. In addition to the ASA scores, retrospective Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P POSSUM) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated and compared to the observed outcomes. RESULTS Nine patients (39%) survived to discharge. ASA grade was a poor predictor of outcome. P POSSUM and APACHE II scores correlated significantly with each other and with observed outcomes when predicting surgical mortality. The median stay for survivors in the intensive care unit was nine days. CONCLUSIONS In times of an ageing population, the number of patients suffering catastrophic surgical events will increase. Intervention, with little hope of a cure, a return to independent living or an acceptable quality of life, leads to unnecessary end-of-life suffering for patients and their relatives, and consumes sparse resources. The accuracy and reliability of ASA grade 5 as an outcome predictor has been questioned. P POSSUM and APACHE II scoring systems are significantly better predictors of outcome and should be used more frequently to aid surgical decision-making in high risk patients.

INTEGRATION OF APACHE II AND III SCORING SYSTEMS IN EXTREMELY HIGH RISK PATIENTS WITH ACUTE RENAL FAILURE TREATED BY DIALYSIS

Renal Failure ◽  
2002 ◽  
Vol 24 (3) ◽  
pp. 285-296 ◽  
Author(s):  
Yung-Chang Chen ◽  
Hsiang-Hao Hsu ◽  
Chen-Yin Chen ◽  
Ji-Tseng Fang ◽  
Chiu-Ching Huang
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
High Risk ◽  
Scoring Systems ◽  
Apache Ii ◽  
High Risk Patients ◽  
Risk Patients

Percutaneous Cholecystostomy is a Definitive Treatment for Acute Cholecystitis in Elderly High-risk Patients

2013 ◽  
Vol 79 (5) ◽  
pp. 524-527 ◽  
Author(s):  
Min Li ◽  
Ning Li ◽  
Wu Ji ◽  
Zhufu Quan ◽  
Xinbo Wan ◽  
...  
Keyword(s):  
Survival Rate ◽  
High Risk ◽  
Acute Cholecystitis ◽  
Recurrence Rate ◽  
Morbidity And Mortality ◽  
Definitive Treatment ◽  
Percutaneous Cholecystostomy ◽  
Long Term Outcome ◽  
High Risk Patients ◽  
Risk Patients

Percutaneous cholecystostomy (PC) is an alternative treatment for acute cholecystitis (AC) in elderly patients with high surgical risk and has lower morbidity and mortality than emergency cholecystectomy. There is controversy about whether cholecystectomy should be performed after PC in elderly high-risk patients. Medical records of patients with AC admitted to the Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, China, between January 2004 and July 2009 were reviewed retrospectively. The elderly high-risk patients with AC who underwent PC were selected for further study. The safety, efficacy, and long-term outcome of PC without cholecystectomy were evaluated in these patients. The symptoms of AC resolved in 98.6 per cent of patients; drainage-related morbidity and mortality rates were 4.1 and 1.4 per cent, respectively. No patient underwent cholecystectomy after PC. The recurrence rate of cholecystitis was 4.1 per cent. The one-year survival rate was 82.2 per cent, and the three-year survival rate was 39.6 per cent. No death was related to cholecystitis, but one patient died of septic shock on the second day after PC. Considering limited survival and a low recurrence rate of cholecystitis in elderly high-risk patients with AC, we propose that PC is a definitive treatment and cholecystectomy is not necessary after resolution of AC symptoms.

scholarly journals 318 Management of Incidental Pancreatic Cysts –Are We Adhering to Guidelines?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Sharmin ◽  
R Ahmed ◽  
T Singhal ◽  
M Kumar
Keyword(s):  
High Risk ◽  
Morbidity And Mortality ◽  
Pancreatic Cysts ◽  
Adherence To Guidelines ◽  
High Risk Patients ◽  
Risk Patients ◽  
Malignant Transformations ◽  
Second Period ◽  
Incidental Pancreatic Cysts

Abstract Background The majority of pancreatic cysts (PC) are incidentally diagnosed. Most NHS Trusts do not have pathways to manage them. We reviewed the management of incidental PC and adherence to guidelines. Method Data was collected across three hospitals in our Trust between January 2018-January 2019 when there were no guidelines. Reaudit was performed between July 2019-February 2020 following the introduction of trust guidelines that recommend all PC be discussed in MDT meetings. Results The first audit identified 79 patients and 28 in the second. 53% (42) and 64% (18) patients were referred to HPB/GI MDT during the two periods. There was an 11% increase in MDT referrals, however, 35.71% of patients were still not referred. During the initial audit, 62 % (23/37) of patients in the Non-MDT group had no surveillance scans, potentially missing high-risk patients and 38% of patients (14/37) still underwent surveillance scans from non-GI specialists which could be unnecessary. 44% of patients underwent surveillance following MDT in the second period as compared to 83% prior to guidelines (p = 0.002). Conclusions Robust guidelines for incidental PC identify high risk cysts that warrant future surveillance/treatment and avoid unnecessary scans releasing radiology capacity.MDT referral ensures malignant transformations are identified early and reduce morbidity and mortality.

scholarly journals “Invasive Klebsiella Pneumoniae Syndrome in Qatar”

2021 ◽  
Author(s):  
Muhammad Jamshaid ◽  
Aamir Shahzad ◽  
Huma Munir ◽  
Muhammad Tayyab ◽  
Abdul Aziz Zafar. ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Morbidity And Mortality ◽  
Metastatic Spread ◽  
Hospital Acquired Infection ◽  
High Risk Patients ◽  
Risk Patients ◽  
Hospital Acquired

Klebsiella pneumoniae can cause community-acquired and hospital-acquired infection. It increases morbidity and mortality in high-risk patients. We present a case of invasive Klebsiella pneumoniae in poorly controlled diabetes mellitus, who ended up having a metastatic spread of Klebsiella pneumoniae involving the liver, lungs, kidneys, brain, and muscle.

scholarly journals The value of a new prognostic model developed by lymphocyte-monocyte ratio and platelet-monocyte ratio in peripheral T-cell lymphoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Zhang ◽  
Yuanfei Shi ◽  
Huafei Shen ◽  
Lihong Shou ◽  
Qiu Fang ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Prognostic Model ◽  
Cell Lymphoma ◽  
Optimal Strategies ◽  
T Cell Lymphoma ◽  
Prognostic Models ◽  
Peripheral T Cell Lymphoma ◽  
High Risk Patients ◽  
Risk Patients

AbstractPeripheral T-cell lymphoma(PTCL) is a group of lymphoproliferative tumors originated from post-thymic T cells or mature natural killer (NK) cells. It shows highly aggressive clinical behaviour, resistance to conventional chemotherapy, and a poor prognosis. Although a few prognostic models of PTCL have been established in retrospective studies, some high-risk patients still can not be screened out. Therefor we retrospectively studied 347 newly diagnosed PTCL patients and assessed the prognostic role of lymphocyte-monocyte ratio (LMR) and platelet-monocyte ratio (PMR) in the complete response (CR) and survival of PTCL patients. Patients with LMR ≤ 1.68 and PMR ≤ 300 achieved a lower CR rate and a poor survival. In multivariate analysis, LMR ≤ 1.68 (HR = 1.751, 95% CI 1.158–2.647, p < 0.05) and PMR ≤ 300 (HR = 1.762, 95% CI 1.201–2.586, p < 0.05) were independently associated with short survival. On this basis, a new prognostic model of PTCL was established to screen out high-risk patients. In our "Peripheral Blood Score (PBS)" model, three groups were identified at low risk (178 patients, 51.3%, score 0), intermediate risk (85 patients, 24.5%, score 1), and high risk (84 patients, 24.2%, score 2), having a 1-year OS of 86%, 55.3% and 22.6% (p < 0.05), and a 3-year OS of 43.4%, 20% and 13.1% (p < 0.05), respectively. Optimal strategies for identifying high-risk patients with PTCL are urgently needed. Our new PBS model is simple, inexpensive and widely available to screen out the high risk patients.

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