Abstract WP434: The SAH score: An Outcome prediction model

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Neeraj S Naval ◽  
Robert Kowalski ◽  
Tiffany Chang ◽  
Filissa Caserta ◽  
Juan R Carhuapoma ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Prediction Model ◽  
Outcome Prediction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Risk Of Mortality ◽  
Relationship Of ◽  
Admission Variables

Objective: To create a reliable model for predicting mortality following aneurysmal subarachnoid hemorrhage (aSAH) based on admission variables. Background: Hunt & Hess grade is commonly used as a grading scale to predict mortality following aSAH. The scale relies only on clinical presentation and does not incorporate other admission factors making it suboptimal for outcome prediction. Methods: Prospectively collected data of aSAH patients admitted to our institution between 1991-2009 were reviewed. We analyzed factors that impacted in-hospital SAH mortality following multiple logistic regression analysis. Scores were ‘weighted’ based on relative risk of mortality following stratification of each of these variables. Hunt & Hess grade was subdivided into grades I/II, III, IV and V; age was split into 4 subgroups: 18-49, 50-69, 70-79 and >80. Medical co-morbidities were subdivided into none, 1 or >/=2 based on co-morbidities derived either from Charlson index or other factors (hypertension, cocaine) historically known to impact SAH outcomes, only if they were associated with increased mortality on univariate analysis. Results: 1134 patients were included; all-cause SAH hospital mortality was 18.3%. Hunt & Hess Grade, age and medical co-morbidities significantly impacted mortality following multivariate analysis (P< 0.05). Association with mortality based on Hunt & Hess Grade was 7%(I/II; score 0), 16%(III; score 1), 31%(IV; score 2) and 65%(V; score 4). Mortality based on age was 13%(18-49; score 0), 18%(50-69; score 1), 34% (70-79; score 2) and 46% (>80; score 3). Relationship of co-morbidities and mortality was 9%(none; score 0), 17%(one; score 1) and 32%(two/more; score 2). Summated Scores ranged from 0-9 with progressively increasing mortality at higher scores (0=1%/ 1=4%/ 2=9%/ 3=13%/ 4=22%/ 5=52%/ 6=77%/ 7=88%/ 8=100%/ 9=100%). PPV for scores in the range 7-9 was 90%; 6-9 was 83%. NPV for range 0-3 was 93% and 0-4 was 91%. The area under the curve (AUC) was 0.825 (good accuracy), which was superior to Hunt & Hess Grade (AUC 0.775, fair accuracy). Conclusions: The SAH score is a more accurate prediction model than the Hunt & Hess grade in estimating likelihood of hospital mortality following SAH.

scholarly journals Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

2018 ◽  
Vol 128 (4) ◽  
pp. 1032-1036 ◽  
Author(s):  
Ha Son Nguyen ◽  
Luyuan Li ◽  
Mohit Patel ◽  
Shekar Kurpad ◽  
Wade Mueller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Ventricular System ◽  
Fisher Grade ◽  
Gcs Score

OBJECTIVEThe presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores.METHODSThe authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1–3 and 4–5 subgroups for analysis.RESULTSOn univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895–0.979), GCS score (OR 3.422, 95% CI 1.9–6.164), and ventricular density (OR 0.937, 95% CI 0.878–0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1–3 and 4–5.CONCLUSIONSThis study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

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

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.

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

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.

scholarly journals Effect of Preoperative Atrial Fibrillation on Postoperative Outcome following Cardiac Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Nael Al-Sarraf ◽  
Lukman Thalib ◽  
Anne Hughes ◽  
Michael Tolan ◽  
Vincent Young ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Sinus Rhythm ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Postoperative Outcome ◽  
Maze Procedure ◽  
Gastrointestinal Complications ◽  
Major Complications ◽  
Risk Of Mortality

Atrial fibrillation remains the commonest arrhythmia encountered in cardiac surgery. Data on the effect of preoperative atrial fibrillation on postoperative outcome remain limited. We sought to assess the effects preoperative atrial fibrillation on patients' outcome following cardiac surgery. This is a retrospective review of prospectively collected departmental data of all patients who underwent cardiac surgery over 8-year period. Our cohort consisted of 3777 consecutive patients divided into atrial fibrillation (n=413, 11%) and sinus rhythm (n=3364, 89%). Postoperative complications and in-hospital mortality were analysed. Univariate analysis showed significantly increased mortality and major complications in atrial fibrillation compared to sinus rhythm patients. Using multiple logistic regression analysis and after accounting for Euro SCORE as a confounding variable, we found that preoperative atrial fibrillation significantly increases the risk of mortality (OR 1.7), low cardiac output state (OR 1.3), prolonged ventilation (OR 1.4), infective complication (OR 1.5), gastrointestinal complications (OR 2.0), and intensive care unit readmission (OR 1.6). Preoperative atrial fibrillation in cardiac surgery patients increases their risk of mortality and major complications following cardiac surgery. Surgical strategies such as Cox-Maze procedure may be beneficial in these patients.

scholarly journals MO584TRABECULAR BONE SCORE AND BONE MICROARCHITECTURE IN HEMODIALYSIS PATIENTS. ITS POTENTIAL RELATIONSHIP WITH PTH-RESISTANCE : A PILOT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Luciano De paola ◽  
Chiara Ciaccio ◽  
Laura Saturno ◽  
Maria antonietta Mascaro ◽  
Giovanni Ruotolo ◽  
...  
Keyword(s):  
Curve Fitting ◽  
Mineral Metabolism ◽  
Bone Microarchitecture ◽  
Univariate Analysis ◽  
Hemodialysis Patients ◽  
Predictive Variables ◽  
Risk Of Mortality ◽  
Significant Difference ◽  
Relationship Of ◽  
Pth Resistance

Abstract Background and Aims To explore:i)differences in predictive variables between TrabecularBoneScore(TBS)-derived and LumbarT-score derived bone types.ii)the relationship difference of TBS and LumbarT-score with various ranges of PTH levels in order to identify the levels of PTH that overcome PTH resistance iii) to conform normal upper limit of PTHi levels in hemodialysis patients recommended by K-DIGO guidelines. Method In twenty-five hemodialysis patients,following variables were recorded:biochemical variables,DXA derived variables(including TBS),FRAX-tool derived HRs.The relationship of variables with TBS-derived and LumbarTscore-derived bone types was tested by univariate analysis. The association of TBS,LumbarTscore and fracture HRs with PTHi was tested by univariate analysis and regression curve fitting(maximizing R²). Results Using univariate analysis,the predictive variables of lumbarT-score derived and TBS-derived bone types are different.By curve fitting regression TBS vs PTHi had a sinusoidal pattern with higher values,correlating to PTHi values in the 4th quartile(462 pg/ml (341 -696)corresponding to the normal levels recommended by K-DIGO guidelines.In the same range of values,LumbarT-score vs PTHi for BMD-derived bone type has a progressively increasing trend for osteopenia and osteoporosis,with a statistically significant difference(P0.008). Conclusion The predictive variables of TBs-derived and LumbarT-score derived bone types are different.Bone microarchitecture(MA),measured by TBS,correlates oppositely than LumbarT-score with higher PTHi values in the normal range of PTHi levels recommended by the K-DIGO-CKD-MBD2009-2017 guidelines.Within this range,PTHi values overcome PTH-resistance and improve the bone mineral metabolism. Results must not be extended to higher or lower levels of PTHi compared to those considered in the study for which there is a clear evidence of increase in the relative risk of mortality.

scholarly journals SARS-CoV-2 PCR cycle threshold at hospital admission associated with patient mortality

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244777
Author(s):  
Jui Choudhuri ◽  
Jamal Carter ◽  
Randin Nelson ◽  
Karin Skalina ◽  
Marika Osterbur-Badhey ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Survival Data ◽  
Area Under The Curve ◽  
Patient Discharge ◽  
Continuous Variable ◽  
Discriminative Ability ◽  
Cycle Threshold ◽  
Survival Difference ◽  
Ct Data ◽  
Relationship Of

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cycle threshold (Ct) has been suggested as an approximate measure of initial viral burden. The utility of cycle threshold, at admission, as a predictor of disease severity has not been thoroughly investigated. Methods and findings We conducted a retrospective study of SARS-CoV-2 positive, hospitalized patients from 3/26/2020 to 8/5/2020 who had SARS-CoV-2 Ct data within 48 hours of admission (n = 1044). Only patients with complete survival data, discharged (n = 774) or died in hospital (n = 270), were included in our analysis. Laboratory, demographic, and clinical data were extracted from electronic medical records. Multivariable logistic regression was applied to examine the relationship of patient mortality with Ct values while adjusting for established risk factors. Ct was analyzed as continuous variable and subdivided into quartiles to better illustrate its relationship with outcome. Cumulative incidence curves were created to assess whether there was a survival difference in the setting of the competing risks of death versus patient discharge. Mean Ct at admission was higher for survivors (28.6, SD = 5.8) compared to non-survivors (24.8, SD = 6.0, P<0.001). In-hospital mortality significantly differed (p<0.05) by Ct quartile. After adjusting for age, gender, BMI, hypertension and diabetes, increased cycle threshold was associated with decreased odds of in-hospital mortality (0.91, CI 0.89–0.94, p<0.001). Compared to the 4th Quartile, patients with Ct values in the 1st Quartile (Ct <22.9) and 2nd Quartile (Ct 23.0–27.3) had an adjusted odds ratio of in-hospital mortality of 3.8 and 2.6 respectively (p<0.001). The discriminative ability of Ct to predict inpatient mortality was found to be limited, possessing an area under the curve (AUC) of 0.68 (CI 0.63–0.71). Conclusion SARS-CoV-2 Ct was found to be an independent predictor of patient mortality. However, further study is needed on how to best clinically utilize such information given the result variation due to specimen quality, phase of disease, and the limited discriminative ability of the test.

Abstract 50: Impact of Acute Cocaine use on Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Neeraj S Naval ◽  
Tiffany Chang ◽  
Robert Kowalski ◽  
Filissa Caserta ◽  
Juan R Carhuapoma ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Univariate Analysis ◽  
Cocaine Exposure ◽  
Cocaine Use ◽  
History Of ◽  
Cocaine Users ◽  
The Impact ◽  
Patient Presentation

Objective: To analyze the impact of acute cocaine use on presentation and outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Background: Acute cocaine use has been temporally associated with aSAH but there are varying reports describing how it affects patient presentation, complications and outcomes. Design/Methods: Data of aSAH patients admitted to our institution between 1991-2009 were reviewed to determine which patients had used cocaine within 72 hours of aSAH based on positive urine toxicology or a history of cocaine use within 72 hours (C). These patients were then compared with aSAH patients without recent cocaine exposure (NC) in relation to their clinical and radiological presentations, complications such as DIND (delayed ischemic neurological deficit defined by vasospasm mediated cerebral infarcts) and outcomes defined by hospital mortality. Results: Data of 1134 patients were reviewed; aSAH in142 patients (12.5%) was associated with cocaine use. Cocaine users were more likely to be younger (mean age: C:49, NC:53, p0.05), admission GCS 0.05), associated IVH (C:56%, NC:51%, p>0.05) or hydrocephalus on admission CT (C:49%; NC:52%, p> 0.05). Cocaine users were more likely to have vasospasm related infarcts when compared to non-cocaine users (C:22%; NC:16%, p<0.05) but after correcting for other factors impacting vasospasm, cocaine use was not independently associated with DIND. Cocaine users had higher rates of aneurysm re-rupture (C:7.7%, NC:2.7%, p0.004). Cocaine users were less likely to survive hospitalization compared to non-users following univariate analysis (Mortality: C:26%, NC:17%, p< 0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users following multivariate analysis (p<0.001). Conclusions: Acute cocaine use was associated with a higher risk of aneurysm re-rupture and hospital mortality following aSAH. The various mechanisms for the nearly threefold increased odds of death associated with cocaine use warrants further investigation.

scholarly journals Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

2022 ◽  
Vol 12 ◽  
Author(s):  
Yibin Zhang ◽  
Shufa Zheng ◽  
Haojie Wang ◽  
Guogong Chen ◽  
Chunwang Li ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Serum Phosphate ◽  
Lower Serum ◽  
Acute Hydrocephalus ◽  
Phosphate Ion ◽  
Baseline Characteristics ◽  
The Relationship

Introduction: The relationship between serum phosphate ion (sPi) and the occurrence of acute hydrocephalus (aHCP) in aneurysmal subarachnoid hemorrhage (aSAH) remains largely unknown and controversial. The primary aim of this study was to investigate the association between sPi on admission and aHCP following aSAH.Methods: The study included 635 patients over the age of 19 years diagnosed with aSAH in our institution from September 2012 to June 2018. Data on clinical characteristics, laboratory parameters, treatments, and outcomes were collected and analyzed. The association between lower sPi levels and aHCP was assessed in univariate and multivariate analyses. Propensity-score matching (PSM) analysis was performed to reduce significant differences in baseline characteristics between the aHCP group and non-HCP group.Results: The overall incidence of aHCP following aSAH was 19.37% (123/512). Lower sPi levels were detected in patients with aHCP compared with those without [0.86 (0.67–1.06) vs. 1.04 (0.84–1.21) mmol/L] in the univariate analysis. In the multivariate analysis, lower sPi level, high modified Fisher (mFisher) grade, and high Hunt-Hess grade were associated with aHCP [odds ratios (OR) 1.729, 95% confidence interval (CI) 1.139–2.623, p = 0.01; mFisher OR 0.097,95% CI 0.055–0.172, p &lt; 0.001; Hunt-Hess, OR 0.555, 95% CI 0.320–0.961, P = 0.036]. After PSM, the matched aHCP group had a significantly lower sPi level than the matched non-aHCP group [0.86 (0.67–1.06) vs. 0.94 (0.76–1.12) mmol/L, p = 0.044]. The area under the curve (AUC) of the sPi level and the logistic regression model based on these predictors (sPi, Hunt-Hess grade, and mFisher grade) was 0.667 and 0.840 (sensitivity of 88.6% and specificity of 68.4%) for predicting aHCP, respectively.Conclusions: Lower sPi levels predict the occurrence of aHCP, and the model constructed by sPi levels, Hunt-Hess grade, and mFisher grade markedly enhances the prediction of aHCP after aSAH.

Abstract 10384: Validation of a Simple Score to Determine Risk of Hospital Mortality After the Norwood Procedure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shahryar M Chowdhury ◽  
Eric M Graham ◽  
Andrew M Atz ◽  
Scott M Bradley ◽  
Minoo M Kavarana ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Risk Score ◽  
Validation Cohort ◽  
Univariate Analysis ◽  
Risk Groups ◽  
Norwood Procedure ◽  
Analysis Model ◽  
Multivariable Logistic Regression Model ◽  
Risk Of Mortality ◽  
Weighted Regression Analysis

Background: The NIH/NHLBI Pediatric Heart Network Single Ventricle Reconstruction (SVR) trial identified risk factors for hospital mortality after the Norwood procedure. However, the ability to quantify pre-operative risk remains elusive. This study aimed to develop an accurate and clinically feasible score to assess the risk of hospital mortality in neonates undergoing the Norwood procedure. Methods: All patients (n = 549) in the publically available SVR database were included in the analysis. Patients were randomly divided into a derivation (75%) and validation (25%) cohort. Pre-operative patient, center, and surgeon-related covariates found to be associated with mortality upon univariate analysis (p < 0.2) were included in the initial multivariable logistic regression model. The final model was derived by including only variables independently associated with mortality (p < 0.05). A risk score was then developed using relative magnitudes of the covariates’ odds ratio. The score was then tested in the validation cohort. Results: A 20-point risk score using 6 variables (see Table) was developed. The derivation and validation cohorts did not differ in age, sex, mortality, and the score covariates. Mean score in derivation and validation cohort were 5.2 ± 3.2 and 5.6 ± 3.5, p = 0.35, respectively. In weighted regression analysis, model predicted risk of mortality correlated closely with actual rates of mortality in the derivation (R 2 = 0.87, p < 0.01) and validation cohorts (R 2 = 0.82, p 10). Patients were classified as low (score 0-5), medium (6-10), or high risk (>10). Mortality differed significantly between risk groups in the derivation (6% vs. 22% vs. 77%, p < 0.01) and validation (4% vs. 30% vs. 53%, p < 0.01) cohorts. Conclusion: This mortality score is accurate in determining risk of hospital mortality in neonates undergoing the Norwood operation. The score has the potential to be used in clinical practice to aid in risk assessment prior to surgery.

Predicting the Coexistence of an Endometrial Adenocarcinoma in the Presence of Atypical Complex Hyperplasia: Immunohistochemical Analysis of Endometrial Samples

2012 ◽  
Vol 22 (7) ◽  
pp. 1264-1272 ◽  
Author(s):  
Elisabeth J.M. Robbe ◽  
Sander M.J. van Kuijk ◽  
Ella M. de Boed ◽  
Luc J.M. Smits ◽  
Anneke A.M. van der Wurff ◽  
...  
Keyword(s):  
Prediction Model ◽  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Endometrial Adenocarcinoma ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Immunohistochemical Analysis ◽  
Pten Expression ◽  
Immunohistochemical Markers ◽  
Mib 1

ObjectiveThis study aimed to determine whether immunohistochemical markers in complex atypical endometrial hyperplasia could predict the presence of a concurrent endometrial carcinoma.MethodsEndometrial biopsies of 39 patients with complex atypical hyperplasia were selected retrospectively between 1999 and 2006. Only patients who underwent a hysterectomy were included. A coexisting endometrial carcinoma was present in 25 patients (64%). Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded sections of the endometrial biopsies, using antibodies for MIB-1, β-catenin, E-cadherin, p53, PTEN, CD44, HER2-neu, survivin, COX-2, tenascin, and bcl-2. To evaluate the potential utility of these markers, a prediction model was constructed.ResultsIn the univariate analysis, expressions of both PTEN and HER2-neu were significantly different between the groups with and without a coexisting endometrial carcinoma (P < 0.05). Loss of PTEN staining was found in 13 (54%) and 1 (7%) of the patients with and without a coexistent carcinoma, respectively (odds ratio, 16.55; 95% confidence interval [CI], 1.87–146.65). HER2-neu expression was found in only 2 (8.6%) and 6 (43%) patients with and without a coexistent carcinoma, respectively, and was excluded from further analysis because of its low expression. A prediction model containing PTEN expression only showed an area under the curve of 73.4% (95% CI, 57.3%–89.6%). After adding MIB-1 and p53, discriminative power improved to 87.2% (95% CI, 75.1%–99.3%).ConclusionsThis study showed that PTEN expression in complex endometrial hyperplasia is a promising factor for the prediction of the presence of a coexisting endometrial carcinoma, and prediction may even better when MIB-1 and p53 expressions are considered simultaneously.

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