Real-world observational study of assessment of CHA2DS2-VASc, C2HEST and HAVOC scores for atrial fibrillation among patients with rheumatological disorders: a nationwide analysis

2021 ◽  
pp. postgradmedj-2021-140754
Author(s):  
Wei Syun Hu ◽  
Cheng Li Lin
Keyword(s):  
Atrial Fibrillation ◽  
Retrospective Study ◽  
Predictive Models ◽  
Operating Characteristic ◽  
Predictive Accuracy ◽  
Scoring Systems ◽  
Gray Model ◽  
Discriminative Ability ◽  
Discriminatory Ability ◽  
Rheumatological Disease

PurposeThis is a nationwide-based retrospective study aiming to compare the three different scoring systems (CHA2DS2-VASc, C2HEST and HAVOC scores) in the prediction of atrial fibrillation (AF) in patients with rheumatological disease.MethodsWe used the Fine and Gray model to estimate the risk of AF (subhazard ratio and 95% CI). The predictive accuracy and discriminatory ability of the predictive model were evaluated by receiver operating characteristic (ROC) curve.ResultsAmong the three predictive models, the model using CHA2DS2-VASc score had the better discriminative ability with an ROC of 0.79. The model with C2HEST score had an ROC of 0.78. The discriminative ability of the HAVOC score was 0.77, estimated by ROC.ConclusionWe concluded the CHA2DS2-VASc score has better performance in predicting AF compared with C2HEST score or HAVOC score.

Abstract 15298: A New Scoring System for the Prediction of Paroxysmal Atrial Fibrillation Progression and Relationship with Clinical Outcomes

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hyung Wook Park ◽  
Ki Hong Lee ◽  
Nam Sik Yoon ◽  
Jeong Gwan Cho ◽  
Sung Soo Kim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Paroxysmal Atrial Fibrillation ◽  
Scoring System ◽  
Predictive Accuracy ◽  
Chronic Renal Disease ◽  
Previous History ◽  
Scoring Systems ◽  
New Scoring

Background: The progression of paroxysmal atrial fibrillation (AF) to persistent, long lasting persistent AF is often associated with poor clinical outcomes. Although some factors were known to be useful, their accuracy and clinical relationship are not good enough to predict the progression. Hypothesis: We aimed to construct a new predictive scoring system for the progression of paroxysmal AF. Also, we aimed to evaluate the relationship of a new predicting system with clinical outcomes. Methods: We analyzed 2,047 patients (61.2±13.2 years old, 1158 males) who were newly diagnosed as AF from January 2006 to January 2013. Progression of AF and clinical outcomes were analyzed after at least one-year follow-up. Clinical outcomes were defined as the composite of death, hospitalization due to heart failure, and new onset stroke. Independent predictors of AF progression were analyzed and incorporated into a new predictive scoring system. Its predictive accuracy was compared with CHADS 2 , CHA 2 DS 2 -VASc, and HATCH scoring system. Results: Paroxysmal AF was diagnosed in 449 (21.6%) patients. Among them, 78 (17.4%) patients progressed to persistent AF. Multivariate analysis showed congestive heart failure (LVEF <45%), hypertension, older age (≥65 years old), chronic renal disease, previous history of stroke, COPD, left atrial enlargement (≥43mm), high NT-pro BNP serum levels (≥1,000 pg/mL) were independently associated with the progression. A new scoring system was calculated with the sum of 1 point at each independent risk factor. It showed better predictive accuracy for AF progression (area under curve (AUC): 0.754, 95% confidence interval [CI] 0.69-0.83, p<0.001) than CHADS 2 (AUC 0.643; 95% CI 0.58-0.71), CHA 2 DS 2 -VASc (AUC 0.647; 95% CI 0.58-0.71), and HATCH score (AUC 0.675; 95% CI 0.61-0.74). Also, it showed better predictive accuracy for the composite of clinical outcomes (AUC 0.764, 95% CI 0.68-0.83, p<0.001) with linear correlation (linear p<0.001) than the other scoring systems. More than 60% of patients with paroxysmal AF progressed into sustained AF if the score by a new system was more than 3. Conclusions: A new scoring system may help to the prediction of AF progression and prognosis for clinical outcomes in patients with paroxysmal AF.

scholarly journals Assessing elderly’s functional balance and mobility via analyzing data from waist-mounted tri-axial wearable accelerometers in timed up and go tests

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisha Yu ◽  
Yang Zhao ◽  
Hailiang Wang ◽  
Tien-Lung Sun ◽  
Terrence E. Murphy ◽  
...  
Keyword(s):  
Predictive Models ◽  
Cross Validation ◽  
Motor Coordination ◽  
Predictive Accuracy ◽  
Short Form ◽  
Community Dwelling ◽  
Regularized Regression ◽  
Balance Assessment ◽  
Timed Up And Go ◽  
Functional Balance

Abstract Background Poor balance has been cited as one of the key causal factors of falls. Timely detection of balance impairment can help identify the elderly prone to falls and also trigger early interventions to prevent them. The goal of this study was to develop a surrogate approach for assessing elderly’s functional balance based on Short Form Berg Balance Scale (SFBBS) score. Methods Data were collected from a waist-mounted tri-axial accelerometer while participants performed a timed up and go test. Clinically relevant variables were extracted from the segmented accelerometer signals for fitting SFBBS predictive models. Regularized regression together with random-shuffle-split cross-validation was used to facilitate the development of the predictive models for automatic balance estimation. Results Eighty-five community-dwelling older adults (72.12 ± 6.99 year) participated in our study. Our results demonstrated that combined clinical and sensor-based variables, together with regularized regression and cross-validation, achieved moderate-high predictive accuracy of SFBBS scores (mean MAE = 2.01 and mean RMSE = 2.55). Step length, gender, gait speed and linear acceleration variables describe the motor coordination were identified as significantly contributed variables of balance estimation. The predictive model also showed moderate-high discriminations in classifying the risk levels in the performance of three balance assessment motions in terms of AUC values of 0.72, 0.79 and 0.76 respectively. Conclusions The study presented a feasible option for quantitatively accurate, objectively measured, and unobtrusively collected functional balance assessment at the point-of-care or home environment. It also provided clinicians and elderly with stable and sensitive biomarkers for long-term monitoring of functional balance.

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

Thorax ◽  
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.

scholarly journals Relationship between serum angiopoietin-like 4 levels and recurrence of atrial fibrillation

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098839
Author(s):  
Zhongping Ning ◽  
Xinming Li ◽  
Xi Zhu ◽  
Jun Luo ◽  
Yingbiao Wu
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
High Sensitivity ◽  
Peroxisome Proliferator ◽  
C Reactive Protein ◽  
Peroxisome Proliferator Activated Receptor ◽  
Reactive Protein ◽  
New Onset

Objective To investigate the association between serum angiopoietin-like 4 (ANGPTL4) levels and recurrence of atrial fibrillation (AF) after catheter ablation. Methods This retrospective study recruited patients with AF undergoing catheter ablation and they were divided into two groups (new-onset AF group and recurrent AF group). Demographic, clinical, and laboratory parameters were collected. Results A total of 192 patients with AF were included, including 69 patients with recurrence of AF. Serum ANGPTL4 levels were lower in patients with recurrent AF than in those with new-onset AF. Serum ANGPTL4 levels were positively correlated with superoxide dismutase and peroxisome proliferator-activated receptor γ, and negatively correlated with the CHA2DS2-VASC score, left atrial diameter, and levels of brain natriuretic peptide, malondialdehyde, high-sensitivity C-reactive protein, and interleukin-6. The receiver operating characteristic curve showed that the best cut-off for recurrent AF was serum ANGPTL4 levels  < 19.735 ng/mL, with a sensitivity and specificity of 63.9% and 74.5%, respectively. Serum ANGPTL4 levels were significantly associated with recurrence and new onset of AF (odds ratio, 2.241; 95% confidence interval, 1.081–4.648). Conclusions Serum ANGPTL4 levels are lower in patients with recurrent AF than in those with new-onset AF, and are associated with cardiac hypertrophy, oxidative stress, and inflammation.

scholarly journals Prognostic Value of Inflammatory Biomarkers in Patients with Severe COVID-19: A Single-Center Retrospective Study

2021 ◽  
Vol 16 ◽  
pp. 117727192110270
Author(s):  
Gönül Açıksarı ◽  
Mehmet Koçak ◽  
Yasemin Çağ ◽  
Lütfiye Nilsun Altunal ◽  
Adem Atıcı ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hospital Mortality ◽  
Prognostic Value ◽  
Current Knowledge ◽  
Area Under The Curve ◽  
Prognostic Nutritional Index ◽  
Inflammatory Biomarkers ◽  
Single Center ◽  
Discriminative Ability ◽  
Lymphocyte Ratio

Background: The current knowledge about novel coronavirus-2019 (COVID-19) indicates that the immune system and inflammatory response play a crucial role in the severity and prognosis of the disease. In this study, we aimed to investigate prognostic value of systemic inflammatory biomarkers including C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with severe COVID-19. Methods: This single-center, retrospective study included a total of 223 patients diagnosed with severe COVID-19. Primary outcome measure was mortality during hospitalization. Multivariate logistic regression analyses were performed to identify independent predictors associated with mortality in patients with severe COVID-19. Receiver operating characteristic (ROC) curve was used to determine cut-offs, and area under the curve (AUC) values were used to demonstrate discriminative ability of biomarkers. Results: Compared to survivors of severe COVID-19, non-survivors had higher CAR, NLR, and PLR, and lower LMR and lower PNI ( P < .05 for all). The optimal CAR, PNI, NLR, PLR, and LMR cut-off values for detecting prognosis were 3.4, 40.2, 6. 27, 312, and 1.54 respectively. The AUC values of CAR, PNI, NLR, PLR, and LMR for predicting hospital mortality in patients with severe COVID-19 were 0.81, 0.91, 0.85, 0.63, and 0.65, respectively. In ROC analysis, comparative discriminative ability of CAR, PNI, and NLR for hospital mortality were superior to PLR and LMR. Multivariate analysis revealed that CAR (⩾0.34, P = .004), NLR (⩾6.27, P = .012), and PNI (⩽40.2, P = .009) were independent predictors associated with mortality in severe COVID-19 patients. Conclusions: The CAR, PNI, and NLR are independent predictors of mortality in hospitalized severe COVID-19 patients and are more closely associated with prognosis than PLR or LMR.

Abstract WP333: A Simplified Score to Predict Stroke Risk in Nonvalvular Atrial Fibrillation

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Clare T Garrard ◽  
Mahesh Amin ◽  
Abdul H Hakki
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Predictive Accuracy ◽  
Myocardial Infarct ◽  
Female Gender ◽  
Arterial Disease ◽  
Nonvalvular Atrial Fibrillation ◽  
Aortic Plaque ◽  
Cerebrovascular Events

The widely used CHADS2 score has been validated to predict the annual stroke risk (SR) in patients with non-valvular atrial fibrillation (AF). The CHA2DS2-VASc score incorporates 5 more risk factors including female gender, age 65 to 74 years, and peripheral arterial disease (PAD), prior myocardial infarct or aortic plaque. The two schemes have different SR and require separate tables to calculate SR (Table 1) . Table 1 An acronym (AFIB)2S4 + PaF2 (Table 2) is presented to predict SR that increases with higher scores, simplifies memorization of the score, incorporates all known risk factors and more accurately predicts SR without the use of tables. Table 2 The SR per 100 patient-years is calculated by adding (AFIB)2S4 + PaF2 scores. For example if all are positive including age 75 years then the SR is 15%, while if all are negative, including age <65 and male gender, then the SR is 0. To determine the predictive accuracy of the three scores, we reviewed the records of 100 consecutive patients admitted with acute cerebrovascular events and AF. The results showed 83% would have been classified as moderate to high risk (score>1) by CHADS2 , 95% by CHA2DS2-VASc , and 99% by (AFIB)2S4 + PaF2. (P <0.012). Conclusion: Compared to the CHADS2 , and CHA2DS2-VASc , (AFIB)2S4 + PaF2 more accurately predicts risk of acute cerebrovascular events in patients with AF. It is easy to remember and does not require the use of tables to assess SR in AF. Further studies are needed for validation. PEN ©

Development of prognostic nomograms using institutional data for patients with triple-negative breast cancer

2021 ◽  
Author(s):  
Jie-Yu Zhou ◽  
Kang-Kang Lu ◽  
Wei-Da Fu ◽  
Hao Shi ◽  
Jun-Wei Gu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Discriminative Ability ◽  
Free Survival ◽  
Disease Free

Background: Triple-negative breast cancer (TNBC) is an aggressive disease. Nomograms can predict prognosis of patients with TNBC. Methods: A total of 745 eligible TNBC patients were recruited and randomly divided into training and validation groups. Endpoints were disease-free survival and overall survival. Concordance index, area under the curve and calibration curves were used to analyze the predictive accuracy and discriminative ability of nomograms. Results: Based on the training cohort, neutrophil-to-lymphocyte ratio, positive lymph nodes, tumor size and tumor-infiltrating lymphocytes were used to construct a nomogram for disease-free survival. In addition, age was added to the overall survival nomogram. Conclusion: The current study developed and validated well-calibrated nomograms for predicting disease-free survival and overall survival in patients with TNBC.

CHEST X RAY SCORE AND CLINICAL SEVERITY IN COVID-19 PATIENTS

2021 ◽  
pp. 31-32
Author(s):  
Sheeba Rana ◽  
Vicky Bakshi ◽  
Yavini Rawat ◽  
Zaid Bin Afroz
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Scoring Systems ◽  
Clinical Severity ◽  
X Rays ◽  
Antigen Test ◽  
X Ray ◽  
Classi Cation ◽  
Chest X Ray ◽  
Male Subjects

INTRODUCTION: Various chest X-ray scoring systems have been discovered and are employed to correlate with clinical severity, outcome and progression of diseases. With, the coronavirus outbreak, few chest radiograph classication were formulated, like the BSTI classication and the Brixia chest X-ray score. Brixia CXR scoring is used for assessing the clinical severity and outcome of COVID-19. This study aims to compare the Brixia CXR score with clinical severity of COVID-19 patients. MATERIAL& METHODS:This was a retrospective study in which medical records of patients aged 18 years or above, who tested for RTPCR or st st Rapid Antigen Test (RAT) for COVID positive from 1 February 2021 to 31 July 2021 (6 months) were taken. These subjects were stratied into mild, moderate and severe patients according to the ICMR guidelines. Chest X Rays were obtained and lesions were classied according to Brixia scoring system. RESULTS: Out of these 375 patients, 123 (32.8%) were female and 252 (67.2%) were male subjects. The average brixia score was 11.12. Average Brixia CXR score for mild, moderate and severe diseased subjects were 5.23, 11.20, and 14.43 respectively. DISCUSSION:The extent of chest x-ray involvement is proportional to the clinical severity of the patient. Although, a perplexing nding was that the average Brixia score of the female subjects were slightly higher than their male counterparts in the same clinical groups. CONCLUSION: Brixia CXR score correlates well with the clinical severity of the COVID-19.

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