A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results

Background:Various scales have been devised to predict development of pressure ulcers on the basis of clinical and laboratory data, such as the Braden Scale (Braden score), which is used to monitor activity and skin conditions of bedridden patients. However, none of these scales facilitates clinically reliable prediction.Aims:To develop a clinical laboratory data-based predictive equation for the development of pressure ulcers.Methods:Subjects were 149 hospitalised patients with respiratory disorders who were monitored for the development of pressure ulcers over a 3-month period. The proportional hazards model (Cox regression) was used to analyse the results of 12 basic laboratory tests on the day of hospitalisation in comparison with Braden score.Results:Pressure ulcers developed in 38 patients within the study period. A Cox regression model consisting solely of Braden scale items showed that none of these items contributed to significantly predicting pressure ulcers. Rather, a combination of haemoglobin (Hb), C-reactive protein (CRP), albumin (Alb), age, and gender produced the best model for prediction. Using the set of explanatory variables, we created a new indicator based on a multiple logistic regression equation. The new indicator showed high sensitivity (0.73) and specificity (0.70), and its diagnostic power was higher than that of Alb, Hb, CRP, or the Braden score alone.Conclusions:The new indicator may become a more useful clinical tool for predicting presser ulcers than Braden score. The new indicator warrants verification studies to facilitate its clinical implementation in the future.

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Immunotherapy Monitoring with Immune Checkpoint Inhibitors Based on [18F]FDG PET/CT in Metastatic Melanomas and Lung Cancer

Journal of Clinical Medicine ◽

10.3390/jcm10215160 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5160

Author(s):

Egesta Lopci

Keyword(s):

Large Scale ◽

Clinical Laboratory ◽

Scale Validation ◽

Checkpoint Inhibitors ◽

Laboratory Data ◽

Major Change ◽

New Drugs ◽

Response Criteria ◽

Clinical Implementation ◽

Pet Ct

Immunotherapy with checkpoint inhibitors has prompted a major change not only in cancer treatment but also in medical imaging. In parallel with the implementation of new drugs modulating the immune system, new response criteria have been developed, aiming to overcome clinical drawbacks related to the new, unusual, patterns of response characterizing both solid tumors and lymphoma during the course of immunotherapy. The acknowledgement of pseudo-progression, hyper-progression, immune-dissociated response and so forth, has become mandatory for all imagers dealing with this clinical scenario. A long list of acronyms, i.e., irRC, iRECIST, irRECIST, imRECIST, PECRIT, PERCIMT, imPERCIST, iPERCIST, depicts the enormous effort made by radiology and nuclear medicine physicians in the last decade to optimize imaging parameters for better prediction of clinical benefit in immunotherapy regimens. Quite frequently, a combination of clinical-laboratory data with imaging findings has been tested, proving the ability to stratify patients into various risk groups. The next steps necessarily require a large scale validation of the most robust criteria, as well as the clinical implementation of immune-targeting tracers for immuno-PET or the exploitation of radiomics and artificial intelligence as complementary tools during the course of immunotherapy administration. For the present review article, a summary of PET/CT role for immunotherapy monitoring will be provided. By scrolling into various cancer types and applied response criteria, the reader will obtain necessary information for better understanding the potentials and limitations of the modality in the clinical setting.

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Implications of Laboratory Tests in Disease Grading and Death Risk Stratification of COVID-19: A Retrospective Study in Wuhan, China

Frontiers in Medicine ◽

10.3389/fmed.2021.629296 ◽

2021 ◽

Vol 8 ◽

Author(s):

Yang Bai ◽

Enxin Wang ◽

Shoujie Zhao ◽

Jing Li ◽

Yejing Zhu ◽

...

Keyword(s):

Risk Factors ◽

Risk Stratification ◽

Laboratory Tests ◽

Cox Regression ◽

Laboratory Data ◽

Clinical Severity ◽

Prognostic Models ◽

Time Activity ◽

Death Risk ◽

Severe Group

Background: Although laboratory tests have become an indispensable part in clinical practice, its application in severity classification and death risk stratification of COVID-19 remains unvalidated. This study aims to explore the significance of laboratory tests in the management of COVID-19.Methods: In 3,342 hospitalized patients with COVID-19, those of mild or moderate subtype were categorized into the non-severe group, while those of severe or critical subtype were categorized into the severe group. Initial laboratory data were analyzed and compared according to disease severity and outcome. Diagnostic models for the severe group were generated on risk factors identified by logistic regression and receiver operating characteristic (ROC) analyses. Cox regression and ROC analyses on risk factors were utilized to construct prognostic models.Results: In identification of patients in the severe group, while age, neutrophil-to-lymphocyte ratio, and α-hydroxybutyrate dehydrogenase were identified as independent predictors, the value of combination of them appears modest [area under the curve (AUC) = 0.694]. Further ROC analyses indicated that among patients in the severe group, laboratory indices had a favorable value in identifying patients of critical subtype rather than severe subtype. For death outcome, IL-6, co-existing cerebrovascular disease, prothrombin time activity, and urea nitrogen were independent risk factors. An IL-6 single-parameter model was finalized for distinguishing between fatal and recovered individuals (AUC = 0.953). Finally, a modified death risk stratification strategy based on clinical severity and IL-6 levels enables more identification of non-survivors in patients with non-critical disease.Conclusions: Laboratory screening provides a useful tool for COVID-19 management in identifying patients with critical condition and stratifying risk levels of death.

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Electronic tools in clinical laboratory diagnostics: key examples, limitations, and value in laboratory medicine

Journal of Laboratory Medicine ◽

10.1515/labmed-2021-0114 ◽

2021 ◽

Vol 45 (6) ◽

pp. 319-324

Author(s):

Mary Kathryn Bohn ◽

Giulia F. Fabiano ◽

Khosrow Adeli

Keyword(s):

Clinical Laboratory ◽

Laboratory Data ◽

Reference Intervals ◽

Medical Laboratory ◽

Laboratory Diagnostics ◽

Evidence Based ◽

Complex Data ◽

Clinical Implementation ◽

Patient Centered ◽

Diagnostic Management

Abstract Electronic tools in clinical laboratory diagnostics can assist laboratory professionals, clinicians, and patients in medical diagnostic management and laboratory test interpretation. With increasing implementation of electronic health records (EHRs) and laboratory information systems worldwide, there is increasing demand for well-designed and evidence-based electronic resources. Both complex data-driven and simple interpretative electronic healthcare tools are currently available to improve the integration of clinical and laboratory information towards a more patient-centered approach to medicine. Several studies have reported positive clinical impact of electronic healthcare tool implementation in clinical laboratory diagnostics, including in the management of neonatal bilirubinemia, cardiac disease, and nutritional status. As patients have increasing access to their medical laboratory data, it is essential that accessible electronic healthcare tools are evidence-based and user-friendly for individuals of varying digital and medical literacy. Indeed, studies suggest electronic healthcare tool development processes significantly lack the involvement of relevant healthcare professionals and often present misinformation, including erroneous calculation algorithms or inappropriate interpretative recommendations. The current review provides an overview of the utility of available electronic healthcare tools in clinical laboratory diagnostics and critically reviews potential limitations and benefits of their clinical implementation. The Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) online database is also detailed as an example of a pediatric diagnostic tool with widespread global impact.

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Impacto do Escore de Desnutrição-Inflamação na sobrevida de pacientes em hemodiálise

Abr-Jun - Braspen Journal ◽

10.37111/braspenj.2020353011 ◽

2020 ◽

Vol 35 (3) ◽

pp. 264-269

Author(s):

Melissa Nihi Sato ◽

Caroline Finger Sostisso ◽

Mayara Olikszechen ◽

Scheila Karam ◽

Miriam de Aguiar Souza Cruz Oliveira ◽

...

Keyword(s):

Vascular Access ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Regression ◽

Clinical Laboratory ◽

Protein Energy Malnutrition ◽

Nutritional Risk ◽

Chi Square ◽

Integrated Method ◽

Kaplan Meier

Introduction: The protein-energy malnutrition is found in a large proportion in dialysis patients. The malnutrition-inflammation score (MIS) seems to be the most appropriate integrated method for assessing the nutritional status or nutritional risk of these patients. The aim of the study is to evaluate the MIS, in the diagnostic accuracy for the assessment of malnutrition, and its correlation with the survival time of patients in hemodialysis (HD). Methods: Study carried out in HD units in the city of Curitiba, Brazil, from January 2013 to December 2015. Clinical, laboratory and anthropometric data were evaluated. The data comparison between patients was made according to the t-test and the chi-square. The Kaplan-Meier curve was constructed to assess the influence of MIS on patient survival and log rank tests were used to verify the equality of survival distributions in these groups. Results: 113 HD patients were evaluated, 74% male. From the multivariable proportional hazards model (Cox regression), the MIS> 5 was a predictor of mortality, as well as creatinine <7 mg/dl and vascular access via HD catheter. In Kaplan-Meier survival analysis, patients with MIS <5 had a significantly higher survival rate. It was also possible to confirm a significant association between creatinine <7 mg/dl and catheter vascular access, and mortality. Conclusion: MIS is an independent predictor of mortality in HD patients. The cutoff 5 was able to predict mortality

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The computer as a diagnostic consultant, with emphasis on use of laboratory data.

Clinical Chemistry ◽

10.1093/clinchem/32.9.1714 ◽

1986 ◽

Vol 32 (9) ◽

pp. 1714-1718 ◽

Cited By ~ 12

Author(s):

J D Myers

Keyword(s):

Laboratory Tests ◽

Clinical Laboratory ◽

Massachusetts General Hospital ◽

Correct Diagnosis ◽

Computer Systems ◽

Laboratory Data ◽

Diagnostic Errors ◽

Preliminary Evidence ◽

Preliminary Study ◽

Complex Cases

Abstract In this preliminary study concerning the applicability of expert computer systems, such as INTERNIST-I, to providing advice to clinical pathologists regarding patients' diagnoses and the pertinence of performing further laboratory tests, 32 complex cases, drawn from Case Records of the Massachusetts General Hospital, were analyzed diagnostically by computer, on the basis of clinical laboratory data only. Half (16 cases) were diagnosed correctly, but in 15 of the rest no diagnostic conclusion could be reached. However, no diagnostic errors were made. The study provides preliminary evidence that expert computer systems can be useful to clinical pathologists and clinical internists in guiding the laboratory workup of patients toward correct diagnosis.

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Encyclopedia of clinical laboratory tests. Ed. prof. N. W. Titsa. - M .: Labinform, 1997 (translation, edited by V.V. Menshikov)

Problems of Endocrinology ◽

10.14341/probl11709 ◽

2019 ◽

Vol 45 (1) ◽

pp. 55-55

Author(s):

G. A. Melnichenko

Keyword(s):

Laboratory Tests ◽

Clinical Laboratory ◽

Laboratory Data ◽

Significant Proportion ◽

Laboratory Studies ◽

Significant Enrichment ◽

New Hypothesis ◽

Intensive Development ◽

Active Interaction

The intensive development of biology and its branches, their active interaction with chemistry, physics, and also with the technical sciences in the second half of the 20th century led to a significant enrichment of the field of medicine called laboratory. Both in the diagnosis of most diseases and in monitoring their course, laboratory studies have firmly taken the place of a very extensive source of valuable information about the patient’s body condition. They play a role in preventive examinations and during follow-up, and in monitoring the condition in critical situations. The research results help the doctor to verify their diagnostic assumptions or turn to a new hypothesis. Despite the fact that not every case of the disease can be finally recognized on the basis of laboratory data, the vast majority of hospitalized patients and a significant proportion of outpatients undergo one or another laboratory study. For 1 patient in Russian hospitals in 1996, an average of 32.7 analyzes were made, and for 1 visit to the clinic - 0.88 analyzes.

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Factors associated with the incidence of pressure ulcer during hospital stay

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2016015803223 ◽

2017 ◽

Vol 51 (0) ◽

Cited By ~ 7

Author(s):

Fernanda Penido Matozinhos ◽

Gustavo Velasquez-Melendez ◽

Sabrina Daros Tiensoli ◽

Alexandra Dias Moreira ◽

Flávia Sampaio Latini Gomes

Keyword(s):

Pressure Ulcer ◽

Pressure Ulcers ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Hypothesis Test ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Factors Associated ◽

Hazards Model ◽

Braden Scale

Abstract OBJECTIVE Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. METHOD This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. RESULTS The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. CONCLUSION These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers.

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A STUDY OF HEPATITIS B VIRUS GENOTYPES IN CHRONIC HEPATITIS B PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.3.4 ◽

2011 ◽

pp. 25-29

Author(s):

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Clinical Laboratory ◽

Laboratory Data ◽

Hbv Dna ◽

Hbv Genotypes ◽

B Virus ◽

Virus Genotypes ◽

Genotype C

Aims: To measure the prevalence of HBV genotypes in chronic hepatitis B patients and their relation to HBeAg and HBV DNA level. Methods: 81 patients were enrolled in this study from January 2009 to December 2010. Clinical, laboratory data were collected during the patient’s hospitalization. Sera were quantitatively tested for HBeAg and HBV DNA. HBV genotyping was made by real-time PCR. Results: Among the 81 patients, 60.5% had genotype B, 26.7% had genotype C and 8.6% had mixed genotype B-C. Prevalence of symptoms (fatigue, anorexia, insomnia...) was higher in genotype C than in genotype B. Genotype C patients had positivity higher HBeAg than genotype B patients (56% vs. 38,8%, p <0.05). The rate of HBV DNA > 107 copies/mL was higher in genotype C group than in genotype B group (36% vs. 28,6%, p > 0.05). Conclusions: Most of the patients had genotypes B or C. Patients with genotype C had positive HBeAg and may be related to higher serological HBV DNA level than in genotype B.

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