Venous tortuosity as a novel biomarker of rupture risk in arteriovenous malformations: ARI score

BackgroundRisk of rupture in arteriovenous malformations (AVMs) varies considerably among series. Hemodynamic factors, especially within the venous side of the circuit, seem to be responsible but are not yet well defined. We analyzed tortuosity in the draining vein as a potential new marker of rupture in AVMs, and propose a simple index to predict AVM bleeding.MethodsA retrospective analysis of the venous angioarchitecture of brain AVMs was carried out at our center from 2013 to 2021, with special attention to venous tortuosity. After univariate analysis, the features of interest were combined to construct several predictive models using multivariate logistic regression. The best model proposed was the new AVM rupture index (ARI), which was then validated in an independent cohort.Results68 AVMs were included in the first step and 32 in the validation cohort. Venous tortuosity, expressed as at least one curve >180°, was a significant predictor of rupture (p=0.023). The proposed bleeding index consisted of: venous tortuosity (any curve of >180°), single draining vein, and paraventricular/infratentorial location. It seems to be a robust evaluation tool, with an area under the receiver operating characteristic (AUROC) curve of 0.806 (95% CI 0.714 to 0.899), consistently replicated in the independent sample (AUROC 0.759 (95% CI 0.607 to 0.911)), and with an inter-rater kappa coefficient of 0.81 .ConclusionsVenous tortuosity may serve as a predictor of bleeding in AVMs that warrants further investigation. This likely new marker was one of the three elements of the proposed ARI. ARI outperformed the predictive accuracy of previous scores, and remained consistent in an independent cohort.

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Return of the lesion: a meta-analysis of 1134 angiographically cured pediatric arteriovenous malformations

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.6.peds21227 ◽

2021 ◽

pp. 1-8

Author(s):

David C. Lauzier ◽

Ananth K. Vellimana ◽

Arindam R. Chatterjee ◽

Joshua W. Osbun ◽

Christopher J. Moran ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Pediatric Patients ◽

Web Of Science ◽

Meta Analysis ◽

Study Cohort ◽

Fisher Exact Test ◽

Exact Test ◽

Risk Of Rupture ◽

Brain Avms ◽

Prospective Database

OBJECTIVE Brain arteriovenous malformations (AVMs) carry a risk of rupture and subsequent morbidity or mortality unless fully treated. AVMs in pediatric patients are known to occasionally recur after obliteration. The objective of this study was to characterize the risk of AVM recurrence following angiographically confirmed obliteration in children. METHODS Consecutive pediatric AVMs treated at a single center were identified from a prospective database. Patients with angiographically confirmed AVM obliteration following treatment were included in this study. Associations between AVM recurrence and patient or procedural factors were characterized using the two-tailed Fisher exact test or Mann-Whitney U-test. A literature search was conducted using PubMed, Scopus, Embase, and the Clarivate Web of Science with defined search criteria, and eligible studies were included alongside this study cohort in a meta-analysis. Rates of AVM recurrence following obliteration were pooled across studies with a random-effects model and reported with 95% confidence intervals (CIs). RESULTS Recurrence after angiographic confirmation of AVM obliteration was observed in 10.4% (7/67) of pediatric AVMs treated at the authors’ center. Patients with recurrent AVMs were significantly younger than those without recurrence (p = 0.002). In the meta-analysis, which included 1134 patients across 24 studies, the rate of recurrence was 4.8% (95% CI 3.0%–6.7%). The rate of AVM recurrence following radiosurgery was 0.7% (95% CI 0%–1.6%), which was significantly lower than the 8.5% rate (95% CI 5.0%–12.0%) following microsurgery. CONCLUSIONS Recurrence of obliterated brain AVMs is common in children. Recurrence is more common in young children and following microsurgery.

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Nomogram Based on Cytokines for Cardiovascular Diseases in Xinjiang Kazakhs

Mediators of Inflammation ◽

10.1155/2019/4756295 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Lei Mao ◽

Xianghui Zhang ◽

Yunhua Hu ◽

Xinping Wang ◽

Yanpeng Song ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Operating Characteristic ◽

Validation Cohort ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Baseline Survey ◽

Cvd Risk ◽

Cytokine Levels ◽

Study Population ◽

The Town

Background. This study involved the development of a predictive 5-year morbidity nomogram for cardiovascular diseases (CVD) in Xinjiang Kazakhs based on cytokine levels. Methods. The nomogram was based on a baseline survey of the town of Nalati in the Kazakh Autonomous Prefecture of Xinjiang from 2009 to 2013. By 2016, we had monitored 1508 people for a median time of 5.17 years and identified CVD events in the study population by collecting case information from local hospitals. The study population was divided into the training (n=1005) and validation cohorts (n=503) in a 2 : 1 ratio. The area under the receiver operating characteristic curve (AUC) was used to verify the predictive accuracy of the nomogram. The result was assessed in a validation cohort. Results. At the end of the study, the incidence of CVD in Xinjiang Kazakhs was found to be 11.28%. We developed a new nomogram to predict the 5-year incidence of CVD based on age, interleukin-6 (IL-6), and adiponectin (APN) levels, diastolic blood pressure, and dyslipidemia. The AUC for the predictive accuracy of the nomogram was 0.836 (95% confidence interval: 0.802–0.869), which was higher than that for IL-6 and APN. These results were supported by validation studies. Conclusions. The nomogram model can more directly assess the risk of CVD in Kazakhs and can be used for CVD risk assessment.

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Validation of Androgen Receptor loss as a risk factor for the development of brain metastases from ovarian cancers

10.21203/rs.3.rs-15482/v1 ◽

2020 ◽

Author(s):

Gloria Mittica ◽

Margherita Goia ◽

Angela Gambino ◽

Giulia Scotto ◽

Mattia Fonte ◽

...

Keyword(s):

Androgen Receptor ◽

Brain Metastases ◽

Validation Cohort ◽

Univariate Analysis ◽

Early Assessment ◽

Kaplan Meier ◽

Small Series ◽

Significant Difference ◽

Predictive Role ◽

Independent Cohort

Abstract Background Central nervous system (CNS) spreading from epithelial ovarian carcinoma (EOC) is an uncommon but increasing phenomenon. We previously reported in a small series of 11 patients a correlation between Androgen Receptor (AR) loss and localization to CNS. Aims of this study were: to confirm predictive role of AR loss in an independent validation cohort; to evaluate if AR status impacts on EOC survival. Results We collected other 29 cases and 19 controls as validation cohort. In this independent cohort at univariate analysis, cases exhibited lower expression of AR, considered both as continuous ( p <0.001) and as discrete variable (10% cut-off: p <0.003; Immunoreactive score: p <0.001). AR negative EOC showed an odds ratio (OR) = 8.33 for CNS dissemination compared with AR positive EOC. Kaplan-Meier curves of the whole dataset showed that AR<10% significantly correlates with worse outcomes (p=0.005 for PFS and p=0.002 for brain PFS (bPFS) respectively). Comparison of AR expression between primary tissue and paired brain metastases in the whole dataset did not show any statistically significant difference. Conclusions AR’s deficiency confirms its predictive role for CNS involvement from EOC in an independent cohort of cases and controls. Early assessment of AR status could improve clinical management and patients’ prognosis.

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Cerebellar Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0b013e318271c081 ◽

2012 ◽

Vol 71 (6) ◽

pp. 1111-1124 ◽

Cited By ~ 52

Author(s):

◽

Ana Rodríguez-Hernández ◽

Helen Kim ◽

Tony Pourmohamad ◽

William L. Young ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Operating Characteristic ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Venous Drainage ◽

Martin Grade ◽

Operating Characteristic Curve ◽

Cerebral Avms ◽

Cerebellar Anatomy ◽

Better Than

ABSTRACT BACKGROUND: Anatomic diversity among cerebellar arteriovenous malformations (AVMs) calls for a classification that is intuitive and surgically informative. Selection tools like the Spetzler-Martin grading system are designed to work best with cerebral AVMs but have shortcomings with cerebellar AVMs. OBJECTIVE: To define subtypes of cerebellar AVMs that clarify anatomy and surgical management, to determine results according to subtypes, and to compare predictive accuracies of the Spetzler-Martin and supplementary systems. METHODS: From a consecutive surgical series of 500 patients, 60 had cerebellar AVMs, 39 had brainstem AVMs and were excluded, and 401 had cerebral AVMs. RESULTS: Cerebellar AVM subtypes were as follows: 18 vermian, 13 suboccipital, 12 tentorial, 12 petrosal, and 5 tonsillar. Patients with tonsillar and tentorial AVMs fared best. Cerebellar AVMs presented with hemorrhage more than cerebral AVMs (P < .001). Cerebellar AVMs were more likely to drain deep (P = .04) and less likely to be eloquent (P < .001). The predictive accuracy of the supplementary grade was better than that of the Spetzler-Martin grade with cerebellar AVMs (areas under the receiver-operating characteristic curve, 0.74 and 0.59, respectively). The predictive accuracy of the supplementary system was consistent for cerebral and cerebellar AVMs, whereas that of the Spetzler-Martin system was greater with cerebral AVMs. CONCLUSION: Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an aggressive treatment posture. The supplementary system is better than the Spetzler-Martin system at predicting outcomes after cerebellar AVM resection. Key components of the Spetzler-Martin system such as venous drainage and eloquence are distorted by cerebellar anatomy in ways that components of the supplementary system are not.

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Validation of Androgen Receptor loss as a risk factor for the development of brain metastases from ovarian cancers

10.21203/rs.3.rs-15482/v2 ◽

2020 ◽

Author(s):

Gloria Mittica ◽

Margherita Goia ◽

Angela Gambino ◽

Giulia Scotto ◽

Mattia Fonte ◽

...

Keyword(s):

Androgen Receptor ◽

Brain Metastases ◽

Validation Cohort ◽

Univariate Analysis ◽

Early Assessment ◽

Small Series ◽

Combining Data ◽

Significant Difference ◽

Predictive Role ◽

Independent Cohort

Abstract Background Central nervous system (CNS) spreading from epithelial ovarian carcinoma (EOC) is an uncommon but increasing phenomenon. We previously reported in a small series of 11 patients a correlation between Androgen Receptor (AR) loss and localization to CNS. Aims of this study were: to confirm a predictive role of AR loss in an independent validation cohort; to evaluate if AR status impacts on EOC survival. Results We collected an additional 29 cases and 19 controls as validation cohort. In this independent cohort at univariate analysis, cases exhibited lower expression of AR, considered both as continuous (p<0.001) and as discrete variable (10% cut-off: p<0.003; Immunoreactive score: p<0.001). AR negative EOC showed an odds ratio (OR) = 8.33 for CNS dissemination compared with AR positive EOC. Kaplan-Meier curves of the combined dataset, combining data of new validation cohort with the previously published cohort, showed that AR<10% significantly correlates with worse outcomes (p=0.005 for Progression Free Survival (PFS) and p=0.002 for brain PFS (bPFS) respectively). Comparison of AR expression between primary tissue and paired brain metastases in the combined dataset did not show any statistically significant difference. Conclusions We confirmed AR loss as predictive role for CNS involvement from EOC in an independent cohort of cases and controls. Early assessment of AR status could improve clinical management and patients’ prognosis.

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A Supplementary Grading Scale for Selecting Patients With Brain Arteriovenous Malformations for Surgery

Neurosurgery ◽

10.1227/01.neu.0000367555.16733.e1 ◽

2010 ◽

Vol 66 (4) ◽

pp. 702-713 ◽

Cited By ~ 213

Author(s):

Michael T. Lawton ◽

Helen Kim ◽

Charles E. McCulloch ◽

Bahar Mikhak ◽

William L. Young

Keyword(s):

Receiver Operating Characteristic Curve ◽

Patient Selection ◽

Arteriovenous Malformations ◽

Operating Characteristic ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Grading System ◽

Modified Rankin Scale ◽

Grading Scale ◽

Operating Characteristic Curve

Abstract BACKGROUND Patient age, hemorrhagic presentation, nidal diffuseness, and deep perforating artery supply are important factors when selecting patients with brain arteriovenous malformations (AVMs) for surgery. OBJECTIVE We hypothesized that these factors outside of the Spetzler-Martin grading system could be combined into a simple, supplementary grading system that would accurately predict neurologic outcome and refine patient selection. METHODS A consecutive, single-surgeon series of 300 patients with AVMs treated microsurgically was analyzed in terms of change between preoperative and final postoperative modified Rankin Scale scores. Three different multivariable logistic models (full, Spetzler-Martin, and supplementary models) were constructed to test the association of combined predictor variables with the change in modified Rankin Scale score. A simplified supplementary grading system was developed from the data with points assigned according to each variable and added together for a supplementary AVM grade. RESULTS Predictive accuracy was highest for the full multivariable model (receiver operating characteristic curve area, 0.78), followed by the supplementary model (0.73), and least for the Spetzler-Martin model (0.66). Predictive accuracy of the simplified supplementary grade was significantly better than that of the Spetzler-Martin grade (P = .042), with receiver operating characteristic curve areas of 0.73 and 0.65, respectively. CONCLUSION This new AVM grading system supplements rather than replaces the well-established Spetzler-Martin grading system and is a better predictor of neurologic outcomes after AVM surgery. The supplementary grading scale has high predictive accuracy on its own and stratifies surgical risk more evenly. The supplementary grading system is easily applicable at the bedside, where it is intended to improve preoperative risk prediction and patient selection for surgery.

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A validated novel preoperative index to predict the extent of intraperitoneal contamination in patients with acute abdominal pathology: A cohort study

Journal of Perioperative Practice ◽

10.1177/1750458919875592 ◽

2019 ◽

Vol 30 (7-8) ◽

pp. 221-228

Author(s):

Shahab Hajibandeh ◽

Shahin Hajibandeh ◽

Nicholas Hobbs ◽

Jigar Shah ◽

Matthew Harris ◽

...

Keyword(s):

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Validation Cohort ◽

Characteristic Curve ◽

Curve Analysis ◽

Emergency Laparotomy ◽

Contamination Index ◽

Operating Characteristic Curve ◽

Receiver Operating

Aims To investigate whether an intraperitoneal contamination index (ICI) derived from combined preoperative levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin could predict the extent of intraperitoneal contamination in patients with acute abdominal pathology. Methods Patients aged over 18 who underwent emergency laparotomy for acute abdominal pathology between January 2014 and October 2018 were randomly divided into primary and validation cohorts. The proposed intraperitoneal contamination index was calculated for each patient in each cohort. Receiver operating characteristic curve analysis was performed to determine discrimination of the index and cut-off values of preoperative intraperitoneal contamination index that could predict the extent of intraperitoneal contamination. Results Overall, 468 patients were included in this study; 234 in the primary cohort and 234 in the validation cohort. The analyses identified intraperitoneal contamination index of 24.77 and 24.32 as cut-off values for purulent contamination in the primary cohort (area under the curve (AUC): 0.73, P < 0.0001; sensitivity: 84%, specificity: 60%) and validation cohort (AUC: 0.83, P < 0.0001; sensitivity: 91%, specificity: 69%), respectively. Receiver operating characteristic curve analysis also identified intraperitoneal contamination index of 33.70 and 33.41 as cut-off values for feculent contamination in the primary cohort (AUC: 0.78, P < 0.0001; sensitivity: 87%, specificity: 64%) and validation cohort (AUC: 0.79, P < 0.0001; sensitivity: 86%, specificity: 73%), respectively. Conclusions As a predictive measure which is derived purely from biomarkers, intraperitoneal contamination index may be accurate enough to predict the extent of intraperitoneal contamination in patients with acute abdominal pathology and to facilitate decision-making together with clinical and radiological findings.

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Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score

Thorax ◽

10.1136/thoraxjnl-2020-216425 ◽

2021 ◽

pp. thoraxjnl-2020-216425

Author(s):

Felix Chua ◽

Rama Vancheeswaran ◽

Adrian Draper ◽

Tejal Vaghela ◽

Matthew Knight ◽

...

Keyword(s):

Operating Characteristic ◽

Predictive Accuracy ◽

Fatal Outcome ◽

Individual Characteristics ◽

Adverse Outcomes ◽

Hospital Death ◽

Outpatient Monitoring ◽

Characteristic Values ◽

Large Random Sample ◽

Mortality Predictors

IntroductionRisk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking.MethodsMultivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290).Results983 patients (median age 70, IQR 53–83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0–1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%).ConclusionThe SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.

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Derivation and validation of a lipid-covered prognostic model for mature T-cell lymphomas

Cancer Cell International ◽

10.1186/s12935-021-02042-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tiange Lu ◽

Lei Shi ◽

Guanggang Shi ◽

Yiqing Cai ◽

Shunfeng Hu ◽

...

Keyword(s):

Lipid Metabolism ◽

T Cell ◽

Scoring System ◽

Serum Lipid ◽

Prognostic Model ◽

Validation Cohort ◽

Univariate Analysis ◽

Prognostic Significance ◽

Cox Regression Analysis ◽

T Cell Lymphomas

Abstract Background Mature T-cell lymphomas (MTCLs), a group of diseases with high aggressiveness and vulnerable prognosis, lack for the accurate prognostic stratification systems at present. Novel prognostic markers and models are urgently demanded. Aberrant lipid metabolism is closely related to the tumor progression but its prognostic significance in MTCLs remains unexplored. This study aims to investigate the relationship between dysregulated lipid metabolism and survival prognosis of MTCLs and establish a novel and well-performed prognostic scoring system for MTCL patients. Methods A total of 173 treatment-naive patients were enrolled in this study. Univariate and multivariate Cox regression analysis were performed to assess the prognostic significance of serum lipid profiles and screen out independent prognostic factors, which constituted a novel prognostic model for MTCLs. The performance of the novel model was assessed in the training and validation cohort, respectively, by examining its calibration, discrimination and clinical utility. Results Among the 173 included patients, 115 patients (01/2006–12/2016) constituted the training cohort and 58 patients (01/2017–06/2020) formed the validation cohort. Univariate analysis revealed declined total cholesterol (TC, P = 0.000), high-density lipoprotein cholesterol (HDL-C, P = 0.000) and increased triglycerides (TG, P = 0.000) correlated to inferior survival outcomes. Multivariate analysis revealed extranodal involved sites ≥ 2 (hazard ratio [HR]: 2.439; P = 0.036), β2-MG ≥ 3 mg/L (HR: 4.165; P = 0.003) and TC < 3.58 mmol/L (HR: 3.338; P = 0.000) were independent predictors. Subsequently, a novel prognostic model, EnBC score, was constructed with these three factors. Harrell’s C-index of the model in the training and validation cohort was 0.840 (95% CI 0.810–0.870) and 0.882 (95% CI 0.822–0.942), respectively, with well-fitted calibration curves. The model divided patients into four risk groups with distinct OS [median OS: not available (NA) vs. NA vs. 14.0 vs. 4.0 months, P < 0.0001] and PFS (median PFS: 84.0 vs. 19.0 vs. 8.0 vs. 1.5 months, P < 0.0001). Time-dependent receiver operating characteristic curve and decision curve analysis further revealed that EnBC score provided higher diagnostic capacity and clinical benefit, compared with International Prognostic Index (IPI). Conclusion Firstly, abnormal serum lipid metabolism was demonstrated significantly related to the survival of MTCL patients. Furthermore, a lipid-covered prognostic scoring system was established and performed well in stratifying patients with MTCLs.

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Prospective Validation of Pentraxin-3 as a Novel Serum Biomarker to Predict the Risk of Prostate Cancer in Patients Scheduled for Prostate Biopsy

Cancers ◽

10.3390/cancers13071611 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1611

Author(s):

Ugo Giovanni Falagario ◽

Gian Maria Busetto ◽

Giuseppe Stefano Netti ◽

Francesca Sanguedolce ◽

Oscar Selvaggio ◽

...

Keyword(s):

Prostate Biopsy ◽

Predictive Accuracy ◽

Characteristic Curve ◽

Univariate Analysis ◽

Digital Rectal Examination ◽

Multivariable Logistic Regression Analysis ◽

Gleason Grade ◽

Pentraxin 3 ◽

Net Benefit ◽

Multivariable Models

Purpose: To test and internally validate serum Pentraxin-3 (PTX3) levels as a potential PCa biomarker to predict prostate biopsy (PBx) results. Materials and Methods: Serum PSA and serum PTX3 were prospectively assessed in patients scheduled for PBx at our Institution due to increased serum PSA levels or abnormal digital rectal examination. Uni- and multivariable logistic regression analysis, area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA), were used to test the accuracy of serum PTX3 in predicting anyPCa and clinically significant PCa (csPCa) defined as Gleason Grade (GG) ≥ 2. Results: Among the 455 eligible patients, PCa was detected in 49% and csPCa in 25%. During univariate analysis, PTX3 outperformed other variables in predicting both anyPCa and csPCa. The addition of PTX3 to multivariable models based on standard clinical variables, significantly increased each model’s predictive accuracy for anyPCa (AUC from 0.73 to 0.82; p < 0.001) and csPCa (AUC from 0.79 to 0.83; p < 0.001). At DCA, PTX3, and PTX3, density showed higher net benefit than PSA and PSA density and increased the net benefit of multivariable models in deciding when to perform PBx. Conclusions: Serum PTX3 levels might be of clinical utility in predicting prostate biopsy results. Should our findings be confirmed, this novel reflex test could be used to reduce the number and burden of unnecessary prostate biopsies.

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