scholarly journals POS0320 POOR PROGNOSIS PREDICTION IN ANTI-MDA5 POSITIVE DERMATOMYOSITIS ASSOCIATED WITH INTERSTITIAL LUNG DISEASE: THE CROSS-CAR DECISION TREE MODEL

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 387.2-387
Author(s):  
L. Wang ◽  
C. Lv ◽  
F. Yuan ◽  
J. Li ◽  
M. Wu ◽  
...  
Keyword(s):  
High Risk ◽  
Interstitial Lung Disease ◽  
Decision Tree ◽  
Prediction Model ◽  
Decision Tree Model ◽  
C Reactive Protein ◽  
Tree Model ◽  
Reactive Protein ◽  
Risk Patients ◽  
The Cross

Background:The prognosis of anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM) – associated interstitial lung disease (ILD) is poor and heterogeneity.Objectives:The aim of this study was to evaluate prognostic factors and to develop a simple and generally applicable bedside decision tree model for predicting outcomes in patients with anti-MDA5+ DM and to guide treatment.Methods:We analyzed data for 246 anti-MDA5+ DM patients from Myositis Study Group-Jiangsu, a multicenter cohort across eighteen tertiary hospitals in Jiangsu province, from March 2019 to October 2020. The primary end point was all-cause death, and the secondary end point was occurring of rapidly progressive-ILD (rp-ILD). We used a multivariable Cox proportional hazards model to identify the independent prognostic risk factors of death and rp-ILD respectively. A decision-tree prediction model was developed by using data from 10 hospital of southern region (n=163), with validation by using contemporaneous data from northern region (n=83).Results:To assess the risk of rp-ILD, we developed a combined risk score, the CROSS score, that included the following values and scores: C-reactive protein (≤8mg/L, 0; >8mg/L, 3), anti-Ro52 antibody (negative, 0; positive, 4), Sex (Female, 0; Male, 2) and Short course of disease (More than 3 months, 0; Less than 3 months, 2). The mortality risk was identified by the CAR score, including C-reactive protein (≤8mg/L, 0; >8mg/L, 1), Alanine Transaminase (≤50units/L, 0; >50units/L, 1) and rp-ILD (non-rpILD, 0; rp-ILD, 3). We divided patients into three risk groups according to the CROSS score: low, 0 to 3; medium, 4 to 7; and high 8-11. And then Use of a simple decision tree prediction model permitted stratification into three different outcome prediction groups. High-risk patients had significantly higher mortality rates than low- and medium-risk patients in both discovery and validation cohorts (p < 0.0001).Conclusion:The CROSS-CAR decision tree model is easy to evaluate the poor prognostic risk in MDA5+ DM patients during any follow-up period. Unnecessary lung examination, such as chest CT scan and arterial blood gas analysis was avoided in low- and medium- rpILD risk patients. The special ambulance, with red cross sign tagged on car in China, may help to screen the high risk patients and to guide further treatment.Disclosure of Interests:None declared

scholarly journals Antiviral treatment for outpatient use during an influenza pandemic: a decision tree model of outcomes averted and cost-effectiveness

2018 ◽  
Vol 41 (2) ◽  
pp. 379-390
Author(s):  
Sudhir Venkatesan ◽  
Cristina Carias ◽  
Matthew Biggerstaff ◽  
Angela P Campbell ◽  
Jonathan S Nguyen-Van-Tam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Saving ◽  
Decision Tree ◽  
Antiviral Treatment ◽  
Decision Tree Model ◽  
High Risk Population ◽  
Tree Model ◽  
Community Based ◽  
Population Groups

Abstract Background Many countries have acquired antiviral stockpiles for pandemic influenza mitigation and a significant part of the stockpile may be focussed towards community-based treatment. Methods We developed a spreadsheet-based, decision tree model to assess outcomes averted and cost-effectiveness of antiviral treatment for outpatient use from the perspective of the healthcare payer in the UK. We defined five pandemic scenarios—one based on the 2009 A(H1N1) pandemic and four hypothetical scenarios varying in measures of transmissibility and severity. Results Community-based antiviral treatment was estimated to avert 14–23% of hospitalizations in an overall population of 62.28 million. Higher proportions of averted outcomes were seen in patients with high-risk conditions, when compared to non-high-risk patients. We found that antiviral treatment was cost-saving across pandemic scenarios for high-risk population groups, and cost-saving for the overall population in higher severity influenza pandemics. Antiviral effectiveness had the greatest influence on both the number of hospitalizations averted and on cost-effectiveness. Conclusions This analysis shows that across pandemic scenarios, antiviral treatment can be cost-saving for population groups at high risk of influenza-related complications.

scholarly journals Exploring the value of routinely measured hematology parameters for identification of elderly patients at high risk of death at the Emergency Department

2018 ◽  
Vol 17 (4) ◽  
pp. 188-202
Author(s):  
Renuka S Bindraban ◽  
◽  
Maarten J ten Berg ◽  
Saskia Haitjema ◽  
Imo E Hoefer ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Hematological Parameters ◽  
Added Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Laboratory Results ◽  
Risk Patients ◽  
Hematology Parameters

Of the warning scores in use for recognition of high-risk patients at the Emergency Department (ED), few incorporate laboratory results. Although hematological characteristics have shown prognostic value in small studies, large studies in elderly ED populations are lacking. We studied the association between blood cell and platelet counts and characteristics as well as C-reactive protein (CRP) at ED presentation with mortality in non-multitrauma patients ≥ 65 years. Comparison between survivors and non-survivors showed small, significant differences with AUROCs ranging between 56.6% and 65.2% for 30-day mortality. Combining parameters yielded an evident improvement (AUROC of 70.4%). Efforts should be pursued to study the added value of hematological parameters on top of clinical data when assessing patient risk.

The Role of Suppressing Inflammation in the Treatment of Atherosclerotic Cardiovascular Disease

2020 ◽  
Vol 54 (10) ◽  
pp. 1021-1029
Author(s):  
Yuani M. Roman ◽  
Adrian V. Hernandez ◽  
C. Michael White
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
English Language ◽  
Atherosclerotic Cardiovascular Disease ◽  
C Reactive Protein ◽  
High Risk Patients ◽  
Reactive Protein ◽  
Risk Patients ◽  
Hs Crp ◽  
The Impact

Objective: To review the 3 anti-inflammatory drugs, canakinumab, colchicine, and methotrexate, that have been investigated in major clinical trials for treating patients with atherosclerotic cardiovascular disease (ASCVD). Data Sources: An Ovid MEDLINE literature search (1946 to February 2, 2020) was performed using search strategy [( C-reactive protein OR ASCVD OR cardiac disease OR cardiovascular disease) AND (canakinumab OR methotrexate OR Colchicine)]. Additional references were identified from the citations. Study Selection and Data Extraction: English-language studies assessing the impact of these 3 drugs on inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) or the association with reducing ASCVD events were included. Data Synthesis: Canakinumab and colchicine significantly reduced ASCVD events in high-risk patients with median baseline hs-CRP levels of ~4.0 mg/L. Methotrexate was ineffective at reducing ASCVD events in high-risk patients, but their baseline hs-CRP concentrations were a median of <2 mg/L. In subgroup analyses of the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS), patients whose baseline hs-CRP was 2 to 4 mg/L had benefits from canakinumab therapy similar to those with baseline levels exceeding 4. Relevance to Patient Care and Clinical Practice: Even with the best current drug therapies, patients with underlying inflammation can benefit from the addition of both colchicine and canakinumab to further lower CV events. Given its cost, colchicine is a more attractive option. Conclusions: Patients at high risk of recurrent cardiovascular disease events with an hs-CRP of 2 mg/L or greater can reduce the occurrence of ASCVD events with canakinumab or colchicine therapy. Colchicine is the preferable option, in particular for those with myocardial infarction, given its more reasonable cost.

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