A Novel Scoring System for Early Assessment of the Risk of the COVID-19-associated Mortality in Hospitalized Patients: COVID-19 BURDEN

Background: Corona Virus Disease 2019 (COVID-19) presentation resembles common flu or can be more severe; it can result in hospitalization with significant morbidity and/or mortality. We made an attempt to develop a predictive model and a scoring system to improve the diagnostic efficiency for COVID-19 mortality via analysis of clinical features and laboratory data on admission. Methods: We retrospectively enrolled 480 consecutive adult patients, aged 21-95, who were admitted to Faghihi Teaching Hospital. Clinical and laboratory features were extracted from the medical records and analyzed using multiple logistic regression analysis. Results: A novel mortality risk score (COVID-19 BURDEN) was calculated, incorporating risk factors from this cohort. CRP (> 73.1 mg/L), O2 saturation variation (greater than 90%, 84-90%, and less than 84%), increased PT (>16.2s), diastolic blood pressure (≤75 mmHg), BUN (>23 mg/dL), and raised LDH (>731 U/L) are the features comprising the scoring system. The patients are triaged to the groups of low- (score <4) and high-risk (score ≥ 4) groups. The area under the curve, sensitivity, and specificity for predicting non-response to medical therapy with scores of ≥ 4 were 0.831, 78.12%, and 70.95%, respectively. Conclusion: Using this scoring system in COVID-19 patients, the severity of the disease will be determined in the early stages of the disease, which will help to reduce hospital care costs and improve its quality and outcome.

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Scoring System for Differentiation of Complicated Appendicitis in Pediatric Patients: Appendicitis Scoring System in Children

Global Pediatric Health ◽

10.1177/2333794x211022268 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110222

Author(s):

Yujin Lee ◽

Hyunjin Cho ◽

Geumhee Gwak ◽

Byungnoe Bae ◽

Keunho Yang

Keyword(s):

Body Temperature ◽

Acute Appendicitis ◽

Scoring System ◽

Multiple Logistic Regression Analysis ◽

Laboratory Data ◽

Area Under The Curve ◽

Perforated Appendicitis ◽

Scoring Systems ◽

Complicated Appendicitis ◽

Free Fluid

Although several scoring systems have been used to differentiate simple acute appendicitis from perforated appendicitis, no particular system has been widely accepted. Therefore, this study aimed to investigate preoperative factors associated with complicated appendicitis and to develop a scoring system that distinguishes complicated appendicitis in children aged <10 years. Patients aged <10 years who underwent surgical treatment for acute appendicitis between 2011 and 2019 were included in this study, after excluding those with insufficient medical records, with other diseases that affect the length of hospitalization, or without formal reports of abdominal computed tomography (CT) or ultrasonography (US). Complicated appendicitis was defined as hospitalization for ≥5 days postoperatively or readmission within 30 days postoperatively. Patient characteristics, symptoms, physical examination, laboratory data, and radiographic results were collected to determine predictors of complicated appendicitis. The mean age of 279 patients was 7.3 years. Among them, 57 patients had complicated appendicitis. A scoring system was developed based on the following 5 independent risk factors derived from multiple logistic regression analysis: body temperature, anorexia, diarrhea, C-reactive protein (CRP) level, and presence of periappendiceal free fluid on CT or US. The scoring system resulted in an area under the curve of .898 ( P < .001). For patients aged <10 years, a new model that includes objective factors, such as body temperature, CRP levels, and radiography results, might help predict complicated appendicitis and determine treatment plans.

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Development of a practical prediction score for acute renal injury after surgery for Stanford type A aortic dissection

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa011 ◽

2020 ◽

Vol 30 (5) ◽

pp. 746-753

Author(s):

Ning Dong ◽

Hulin Piao ◽

Yu Du ◽

Bo Li ◽

Jian Xu ◽

...

Keyword(s):

Aortic Dissection ◽

Risk Score ◽

Scoring System ◽

Characteristic Curve ◽

Area Under The Curve ◽

Kidney Injury ◽

Type A ◽

Postoperative Management ◽

Prediction Score ◽

Improve Patient

Abstract OBJECTIVES Acute kidney injury (AKI) is a common complication of cardiovascular surgery that is associated with increased mortality, especially after surgeries involving the aorta. Early detection and prevention of AKI in patients with aortic dissection may help improve outcomes. The objective of this study was to develop a practical prediction score for AKI after surgery for Stanford type A acute aortic dissection (TAAAD). METHODS This was a retrospective cohort study that included 2 independent hospitals. A larger cohort of 326 patients from The Second Hospital of Jilin University was used to identify the risk factors for AKI and to develop a risk score. The derived risk score was externally validated in a separate cohort of 102 patients from the other hospital. RESULTS The scoring system included the following variables: (i) age >45 years; (ii) body mass index >25 kg/m2; (iii) white blood cell count >13.5 × 109/l; and (iv) lowest perioperative haemoglobin <100 g/l, cardiopulmonary bypass duration >150 min and renal malperfusion. On receiver operating characteristic curve analysis, the score predicted AKI with fair accuracy in both the derivation [area under the curve 0.778, 95% confidence interval (CI) 0.726–0.83] and the validation (area under the curve 0.747, 95% CI 0.657–0.838) cohorts. CONCLUSIONS We developed a convenient scoring system to identify patients at high risk of developing AKI after surgery for TAAAD. This scoring system may help identify patients who require more intensive postoperative management and facilitate appropriate interventions to prevent AKI and improve patient outcomes.

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A novel risk score for prediction of hypersensitivity reactions in cancer patients receiving carboplatin: Retrospective observational analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.e282 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. e282-e282

Author(s):

Orawan Suppramote ◽

Prapatsara Pongpunpisand ◽

Kanlaya Ladkam ◽

Somkiat Rujirawat

Keyword(s):

High Risk ◽

Cancer Patients ◽

Risk Score ◽

Scoring System ◽

Predictive Accuracy ◽

Area Under The Curve ◽

Cancer Type ◽

Hypersensitivity Reactions ◽

Risk Patients ◽

Carboplatin Hypersensitivity

e282 Background: Hypersentitivity reactions (HSRs) from carboplatin are high incidence and most severity in Chulabhorn hospital. These reactions are associated with several causes including patient factors and experience in drug used. A reliable and valid tool for evaluated risk of HSRs before started carboplatin infusion should lead to prevent or decrease severity of the reactions. We innovated risk score to screen patient at high risk of HSRs. Methods: From October 2013 to September 2014, all cancer patients who received carboplatin in Chulabhorn hospital were included. A retrospective study design to developed risk scoring system for prediction of patients at high risk of carboplatin hypersensitivity called “Hypersensitivity risk score”. The hypersensitivity risk score was calculated for all patients receiving carboplatin and data for carboplatin hypersensitivity were obtained from medical records. Expected and observed HSRs were analyzed by using receiver operating characteristic (ROC) curve. Results: Seventy-three cancer patients received carboplatin and five (7%) patients had HSRs. Our scoring algorithm based on cancer type, number of carboplatin retreatment, duration between each retreatment, and number of carboplatin infusions prior to first reaction. All significant predictors were weighted into points and categorized to risk group which ranged from 0 to 8 . The ROC analysis for hypersensitivity risk score indicated good predictive accuracy with an area under the curve of 0.96 (95 %CI: 0.91-1.00). Data showed high sensitivity (80%) and specificity (94.85%) for a risk score cut-off of 4. The hypersensitivity risk score clearly differentiated the low (0-1), intermediate (2-3) and intermediate-high (4-5) and high (6-8) risk patients. Conclusions: The hypersensitivity risk score is a simple scoring system with high predictive value and differentiates low versus high risk patients. This score should be used for screen high risk of hypersensitivity reactions in patients receiving carboplatin.

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Role of Blood Stasis Syndrome of Kampo Medicine in the Early Pathogenic Stage of Atherosclerosis: A Retrospective Cross-Sectional Study

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/5557392 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Akira Morita ◽

Takao Namiki ◽

Toshiya Nakaguchi ◽

Kazunari Murai ◽

Yuki Watanabe ◽

...

Keyword(s):

Glucose Tolerance ◽

Characteristic Curve ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Laboratory Data ◽

Blood Stasis ◽

Area Under The Curve ◽

Kampo Medicine ◽

Blood Stasis Syndrome ◽

History Of

In Kampo medicine, blood stasis (BS) syndrome is strongly associated with microangiopathy and can lead to atherosclerosis. Vascular endothelial dysfunction (VED), evaluated through flow-mediated dilation (FMD), plays an important role in the early stages of atherosclerosis. However, the association of BS syndrome with VED, as determined using FMD, has not been reported. This study investigated the association between BS syndrome and VED using FMD. Forty-one patients with normal glucose tolerance or impaired glucose tolerance (IGT) and without macrovascular complications were evaluated using FMD from May 2017 to August 2017. Based on the BS score, the patients were divided into the non-BS (n = 19) and BS syndrome (n = 22) groups. Physical and background characteristics, physiological function test results, and laboratory data were compared. Univariate analysis revealed that FMD and a history of dyslipidemia/IGT were significantly different between the two groups ( p < 0.05 ). Multiple logistic regression analysis showed that BS syndrome was significantly associated with FMD (odds ratio: 6.26; p = 0.03 ) after adjusting for the history of dyslipidemia/IGT. The receiver operating characteristic curve showed that the area under the curve for BS syndrome (0.74; p < 0.001 ) and history of IGT ( p < 0.007 ) provided good diagnostic accuracy for FMD. The area under the curve for “BS syndrome + IGT” showed very good accuracy (0.80; p < 0.0001 ) and was higher than that for BS syndrome or IGT alone. In conclusion, the results of this study suggest that the BS score in Kampo medicine could be a useful tool for detecting the early pathogenic stages of atherosclerosis.

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Derivation and validation of a novel clinical decision aid to distinguish between uncomplicated and complicated appendicitis in children.

10.21203/rs.3.rs-23218/v1 ◽

2020 ◽

Author(s):

Stavros P. Loukogeorgakis ◽

Christina Major ◽

Ceri E Jones ◽

Harriet J. Corbett ◽

Semiu Eniola Folaranmi ◽

...

Keyword(s):

Prediction Model ◽

Operative Treatment ◽

Scoring System ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Laboratory Data ◽

Complicated Appendicitis ◽

Histopathological Analysis ◽

Characteristic Analysis ◽

Independent Cohort

Abstract Aim of Study:Non-operative treatment of acute uncomplicated appendicitis (UA) in children might be equally effective to surgery but requires accurate discrimination from those with complicated appendicitis (CA) to ensure safety and maximise efficacy. We aimed to identify specific clinical and laboratory parameters that would aid distinction between UA and CA in children.Methods:Retrospective review of consecutive children with a clinical +/- radiological diagnosis of acute appendicitis that underwent appendicectomy in three specialist paediatric surgical centres between March 2017 and February 2018. Demographic, clinical and laboratory data were retrieved and analysed in relation to intra-operative and histopathological findings. CA was defined as gangrene and/or perforation seen intra-operatively and/or in histopathological analysis. Multiple logistic regression analysis was used to derive a novel prediction model that could accurately distinguish UA and CA. A priori we set analytical parameters so as to ensure the score had a positive predictive value (PPV) for UA of >95%. The resulting scoring system was validated in an independent cohort of children.Main Results: The prediction model was derived from 130 children (UA: 71; CA: 59) with median age (range) 10 (2-15) years. Initial univariate analysis identified six factors significantly associated (p<0.01) with CA (duration of abdominal pain, presence of rebound tenderness, temperature, , white cell count, , neutrophil count and C-reactive protein [CRP]). These variables were entered in the regression model, and points awarded based on the adjusted odds ratios. Receiver operating characteristic analysis demonstrated a threshold of ≥4 points for prediction of CA. The scoring system was validated in an independent cohort of 112 children (UA: 51; CA: 61); it was found to have a sensitivity of 98% and specificity 78%. A score of <4 points had a PPV for UA of 98%.Conclusions: Our novel scoring system can discriminate between UA and CA in children with high accuracy. Children with a score <4 could be eligible for non-operative treatment.

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Combination of GI-RADS and 3D-CEUS for differential diagnosis of ovarian masses

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.7.959 ◽

2019 ◽

Vol 65 (7) ◽

pp. 959-964

Author(s):

Xiali Wang ◽

ShupingYang ◽

Guorong Lv ◽

Jianmei Liao ◽

Shufen Wu ◽

...

Keyword(s):

Scoring System ◽

Multiple Logistic Regression Analysis ◽

Three Dimensional ◽

Area Under The Curve ◽

Chi Square ◽

Kappa Value ◽

Long Term Follow Up ◽

Chi Square Test ◽

Contrast Enhanced Ultrasonography ◽

Ovarian Masses

SUMMARY OBJECTIVE The purpose of this study is to evaluate the efficacy of the combination of gynecologic imaging reporting and data system (GI-RADS) ultrasonographic stratification and three-dimensional contrast-enhanced ultrasonography (3D-CEUS) in order to distinguish malignant from benign ovarian masses. METHODS In this study, 102 patients with ovarian masses were examined by both two-dimensional ultrasound(2D-US) and 3D-CEUS. Sonographic features of ovarian masses obtained from 3D-CEUS were analyzed and compared with 2D-US. All patients with ovarian masses were confirmed by operational pathology or long-term follow-up results. RESULTS (1)The Chi-square test and multiple Logistic regression analysis confirmed that there were only eight independent predictors of malignant masses, including thick septa (≥3mm), thick papillary projections(≥7mm), solid areas, presence of ascites, central vascularization, contrast enhancement, distribution of contrast agent, and vascular characteristics of the solid part and their odds ratios which were 5.52, 5.39, 4.94, 4.34, 5.92, 7.44, 6.09, and 7.67, respectively (P<0.05). (2)These eight signs were used to combine the GI-RADS with 3D-CEUS scoring system in which the corresponding value of the area under the curve (AUC) was 0.969, which was superior to using GI-RADS lonely (Z-value=1.64, P<0.025). Using 4 points as the cut-off, the scoring system showed the performance was clearly better than using GI-RADS alone (P<0.05). (3) The Kappa value was 0.872 for two different clinicians with equal experience. CONCLUSIONS The combination of GI-RADS and 3D-CEUS scoring system would be a more effective method to distinguish malignant from benign ovarian masses.

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ABCD2 risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis

Stroke and Vascular Neurology ◽

10.1136/svn-2017-000073 ◽

2017 ◽

Vol 2 (2) ◽

pp. 41-46 ◽

Cited By ~ 2

Author(s):

Mahmud Saedon ◽

Charles E Hutchinson ◽

Christopher H E Imray ◽

Donald R J Singer

Keyword(s):

Carotid Artery ◽

Risk Score ◽

Carotid Artery Stenosis ◽

Area Under The Curve ◽

Roc Curves ◽

Artery Stenosis ◽

Minor Stroke ◽

Early Assessment ◽

Symptomatic Carotid ◽

Significant Difference

IntroductionABCD2 risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD2 risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.Participants and methodsWe studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%). 86 patients (age 70±1 (SEM: years), 58 men, 83 Caucasian) had evidence of microemboli; 72 (84%) of these underwent carotid endarterectomy (CEA). 120 patients (age 72±1 years, 91 men, 113 Caucasian) did not have microemboli detected; 102 (85%) of these underwent CEA. Data were analysed using X2 and Mann–Whitney U tests and receiver operating characteristic (ROC) curves.Results140/206 (68%: 95% CI 61.63 to 74.37) patients with hyper-acute symptomatic critical carotid stenosis had an ABCD2 risk score ≥4. There was no significant difference in the NICE red flag criterion for early assessment (ABCD2 risk score ≥4) for patients with cerebral microemboli versus those without microemboli (59/86 vs 81/120 patients: OR 1.05 ABCD2 risk score ≥4 (95% CI 0.58 to 1.90, p=0.867)). The ABCD2 risk score was <4 in 27 of 86 (31%: 95% CI 21 to 41) embolising patients and in 39 of 120 (31%: 95% CI 23 to 39) without cerebral microemboli. After adjusting for pre-neurological event antiplatelet treatment (APT), area under the curve (AUC) of ROC for ABCD2 risk score showed no prediction of cerebral microemboli (no pre-event APT, n=57: AUC 0.45 (95% CI 0.29 to 0.60, p=0.531); pre-event APT, n=147: AUC 0.51 (95% CI 0.42 to 0.60, p=0.804)).ConclusionsThe ABCD2 score did not predict the presence of cerebral microemboli or carotid disease in over one-quarter of patients with symptomatic critical carotid artery stenosis. On the basis of NICE guidelines (refer early if ABCD2 ≥4), assessment of high stroke risk based on ABCD2 scoring may lead to inappropriate delay in urgent treatment in many patients.

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Hsa_circ_0005729 enhances the accuracy in diagnosing parathyroid carcinoma

Endocrine Connections ◽

10.1530/ec-21-0605 ◽

2022 ◽

Author(s):

Qian Wang ◽

Jiacheng Wang ◽

Yunhui Xin ◽

Ziyang He ◽

Xiang Zhou ◽

...

Keyword(s):

Serum Calcium ◽

Parathyroid Carcinoma ◽

Laboratory Data ◽

Area Under The Curve ◽

Circular Rna ◽

Circular Rnas ◽

Diagnostic Efficiency ◽

En Bloc ◽

Initial Surgery ◽

Parathyroid Lesions

Background: Parathyroid carcinoma (PC), often misdiagnosed as parathyroid adenoma (PA), is prone to local relapse due to the initial surgery being restricted to parathyroid lesions instead of en bloc resection of parathyroid lesions with negative incision margins. However, it is very challenging to distinguish PC from PA preoperatively; hence, this study investigated an effective biomarker for increasing accuracy in PC diagnosis. Method: First, differentially expressed the circular RNAs between three PC tissues and three PA tissues were screened by high-throughput circular RNA sequencing, and the expression of hsa_circ_0005729 was verified by qRT-PCR in 14 patients with PC and 40 patients with PA. Second, the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to analyze the diagnostic efficiency of hsa_circ_0005729 in PC by combining with laboratory data. Third, RNF138 mRNA, the corresponding linear transcript of hsa_circ_0005729 was measured, and the relationship between hsa_circ_0005729 and RNF138 mRNA was analyzed in patients with PA and patients with PC. Results: Hsa_circ_0005729 expression was significantly higher in patients with PC than in patients with PA. Serum calcium (p = 0.045), alkaline phosphatase (ALP) (p = 0.048), and creatinine levels (p = 0.036) were significantly higher in patients with PC than in patients with PA. The AUC increased to 0.86 when hsa_circ_0005729 combined with serum calcium, creatinine, and ALP. In addition, hsa_circ_0005729 was positively correlated with RNF138 mRNA in patients with PA but not in patients with PC. Conclusion: The novel circular RNA hsa_circ_0005729 was found to have a higher expression in patients with PC, and indicating its usefulness for distinguishing PC from PA.

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The Role of Laboratory Parameters in Assessment of Disease Severity and Outcome in COVID-19 patients – A Retrospective Study in a Tertiary Care Centre in Southern India

Annals of Pathology and Laboratory Medicine ◽

10.21276/apalm.3066 ◽

2021 ◽

Vol 8 (7) ◽

pp. A164-173

Author(s):

Rajeshwari B ◽

Salapathi Shanmugam ◽

Anila Mathan ◽

Dhananjayan R ◽

Isabella Princess B ◽

...

Keyword(s):

Virus Disease ◽

Severe Disease ◽

Tertiary Care ◽

Laboratory Data ◽

Initial Assessment ◽

P Value ◽

Laboratory Parameters ◽

Severity Of The Disease ◽

Laboratory Biomarkers ◽

Time Of Admission

Background: Corona Virus Disease 2019 (COVID19) is a global pandemic, the outbreak of which started in China in December 2019. Apart from the clinical symptoms and pulmonary computed tomography (CT) findings, several laboratory biomarkers also play an important role in management of these patients so that immediate attention can be given to those with severe disease and critical illness. In this study we tried to find the association of various laboratory biomarkers in COVID-19 patients, analyzed around the time of admission, with the severity of the disease and outcome. Methods: In this study 1048 COVID19 positive cases admitted in our hospital during the study period from April 2020 to October 2020 were included. The cases were clinically assessed based on the severity of the disease at the time of presentation and during the course in hospital and categorized into 3 categories as Mild, Moderate and Severe according to our hospital protocol for management of COVID 19 patients. The clinical and laboratory data were retrieved from electronic medical records. The levels of various laboratory parameters at/around the time of admission were compared with clinical categories, severity and outcome of the disease. Result: We found a statistically significant association of severity and outcome of COVID-19 with various laboratory parameters. There were significantly higher levels of D-dimer, LDH, CK, CRP, Sr Ferritin, cTnI, NT pro BNP, PCT, IL-6 and lower ALC in non survivors compared to survivors and in severe disease compared to mild disease with a p value of <0.05. Conclusion: In this study we propose that along with the initial clinical assessment, age and concurrent co-morbidities of COVID-19 patients which determine the need for their admission to ICUs, the initial assessment of several laboratory parameters is helpful in triaging the patients who need intensive care so that proper allocation of resources can be done.

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A novel scoring system for assessing the severity of electrolyte and acid-base disorders and predicting outcomes in hospitalized patients

Journal of Investigative Medicine ◽

10.1136/jim-2018-000900 ◽

2018 ◽

Vol 67 (4) ◽

pp. 750-760

Author(s):

Yimei Wang ◽

Jiachang Hu ◽

Xuemei Geng ◽

Xiaoyan Zhang ◽

Xialian Xu ◽

...

Keyword(s):

Risk Score ◽

Scoring System ◽

Validation Cohort ◽

Characteristic Curve ◽

Multiple Logistic Regression Analysis ◽

Survival Rates ◽

Hospitalized Patients ◽

Hospital Death ◽

Acid Base ◽

Derivation Cohort

Electrolyte and acid-base disorders are commonly seen in critically ill and other hospitalized patients. A scoring system is needed to assess the severity of electrolyte and acid-base disorders and to predict outcome in hospital patients. Herein, we prospectively enrolled a total of 322,046 patients, including 84,700 patients in the derivation cohort and 237,346 in the validation cohort, in a large, tertiary hospital in East China from 2014 to 2017. A points-scoring system of general electrolyte and acid-base disorders with a sum of 20.8 points was generated by multiple logistic regression analysis of the derivation cohort. Receiver operating characteristic curve analysis showed that the optimal cut-off value of 2.0 was associated with 65.4% sensitivity and 88.4% specificity (area under the curve: 0.818 (95% CI 0.809 to 0.827)) to predict hospital mortality in the validation cohort. On Kaplan-Meier survival analysis, the five intervals of risk score (Q1: 0 to 2.0; Q2: 2.1 to 2.5; Q3: 2.6 to 3.3; Q4: 3.4 to 4.5; and Q5: >4.5 points) showed differences in hospital survival (p<0.001). Elevated (delta) risk score >2 during hospitalization increased the risk of hospital death, while those with a delta risk score <0 and <−2 points had higher survival rates. This novel scoring system could be used to evaluate and to dynamically monitor the severity of electrolyte and acid-base disorders in hospitalized patients.

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