Abstract TP192: Ability of the Khorana Score to Predict Recurrent Thromboembolism in Cancer Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Dylan Bobrow ◽  
Mary Cushman ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Mitchell S Elkind ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Cancer Patients ◽  
Recurrent Events ◽  
Tertiary Care ◽  
Cancer Center ◽  
Future Research ◽  
High Risk Population ◽  
Discriminatory Ability ◽  
C Statistic

Introduction: Cancer patients who develop acute ischemic stroke (AIS) are at high risk for recurrent thromboembolism. No risk stratification model exists to predict recurrent events in this population. The Khorana score is a validated risk score for predicting venous thromboembolism in newly diagnosed cancer patients. Hypothesis: The Khorana score can effectively classify the risk of recurrent thromboembolism (RTE) in cancer patients with AIS. Methods: We retrospectively identified all adults with active systemic cancer diagnosed with AIS by MRI at a tertiary-care cancer center from 2005 through 2009. Two neurologists independently reviewed all available medical records through July 31, 2012. The Khorana score at the time of index stroke was calculated for each patient. Points were assigned for specific cancer sites (2 points for very high-risk sites: stomach or pancreas; 1 point for high-risk sites: lung, lymphoma, gynecologic, bladder, testicular, or renal), platelet count ≥350,000/mcL, hemoglobin <10 g/dl, leukocyte count ≥11,000/mcL, and BMI ≥35 kg/m2. The primary outcome was a composite of RTE, defined as recurrent AIS, TIA, MI, systemic embolism, DVT, or PE. Logistic regression was used to evaluate the association between individual components of the Khorana score and RTE. The c-statistic was used to calculate the discriminatory ability of the Khorana score in predicting RTE. Results: Among 263 study patients, 90 (34%) were diagnosed with RTE, including 36 (14%) with recurrent AIS. The median Khorana score was 2 (IQR 1-2, range 0-5). None of the individual components of the score were independently associated with RTE, although there was a nonsignificant trend for high-risk cancer sites (OR 1.56, 95% CI 0.88-2.77). The rate of RTE was 28% among patients with a score of 0, 36% among patients with a score of 1-2, and 32% among patients with a score of 3-6. The c-statistic was 0.52 (95% CI 0.45-0.58) for predicting RTE and 0.49 (95% CI 0.38-0.59) for predicting recurrent AIS. Discussion: The Khorana score has poor discriminatory ability for predicting RTE in cancer patients with AIS, probably because these patients represent an especially high-risk group. Future research is needed to identify better methods for predicting RTE in this high-risk population.

Protecting high-risk oncology patients during the pandemic of COVID-19 by creating an outpatient cancer clinic for febrile neutropenia (California clinic).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 191-191
Author(s):  
Manidhar Reddy Lekkala ◽  
Mohammad Abedi ◽  
Tammy Clarke ◽  
Bahar Moftakhar ◽  
Arpan Patel
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Case Fatality ◽  
Cancer Center ◽  
High Risk Population ◽  
Oncology Patients ◽  
Number Of Patients ◽  
The Social ◽  
Rule Out

191 Background: Delivering care for vulnerable cancer patients during a pandemic is challenging given the competing risks of death from cancer versus the high case fatality rates from SARS-COV-2 (CV-19). Data currently available suggests a total fatality rate close to 30%-50% with CV-19 in active malignancy patients. In addition to adapting guidelines from national organizations to reduce the social footprint of patients in order to minimize risk of exposure of CV-19, our cancer center implemented an isolated clinic with personal protective equipment (PPE) and direct access to a CV-19 rule out floor (if admission warranted) in order to manage those with febrile neutropenia (FN) who otherwise would have been triaged to the emergency room (ED). Methods: We implemented an outpatient isolated extended hour clinic with access to PPE, blood work, intravenous antibiotics and fluids for FN patients as a pilot project from mid-April with expected duration during the pandemic with the aim to decrease the ED admissions for FN by 50%. We used the Multinational Association of Support Care in Cancer (MASCC) validated tool to assist with outpatient versus inpatient management of these patients. All patients were screened via polymerase chain reaction nasal swab for CV-19 to identify CV-19 in a high-risk population. Our PDSA (Plan Do Study Act) cycles have been in 2-week sessions with constant re-education to multiple providers. Results: Prior to CV-19, our databases show an approximate 15 to 20 FN hematology and oncology patients per month who are triaged to ED during the business hours. Since the implementation of our clinic in the last 45 days, we have screened 8 patients, of which 2 were discharged home with oral antibiotics on isolation until CV-19 testing returned, 6 were directly admitted to CV-19 rule out floor avoiding ED. Our overall patient numbers were low during the peak of the pandemic and we expect to see increasing number of patients utilizing the clinic over the next few months. Conclusions: Implementing the California clinic has thus far successfully decreased the social footprint of our highest-risk cancer patients, those with FN, in hopes of decreasing their possible exposure to CV-19 as well as the unnecessary exposure of the clinical personnel. [Table: see text]

scholarly journals Identification of high-risk patients for early death or unplanned readmission using the LACE index in an older Portuguese population

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 1798 ◽  
Author(s):  
João Fonseca ◽  
Flávio Costa ◽  
José Mateus ◽  
Diana Ferreira ◽  
Hugo Clemente ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Readmissions ◽  
Tertiary Care ◽  
Early Death ◽  
Unplanned Readmission ◽  
High Risk Population ◽  
Care Hospital ◽  
Portuguese Population ◽  
C Statistic ◽  
Risk Patients

Background: Unplanned readmissions are frequent, associated with high costs and potentially preventable. Pre-discharge risk screening is a crucial step to prevent hospital readmissions. This study evaluates the LACE index as a tool capable of identifying patients with high risk of early readmission or death in an older Portuguese population. Methods: We performed a retrospective study in a tertiary care hospital in Portugal. All acute patients, aged ≥ 65 years, discharged from the Internal Medicine Service between 1 January and 30 June 2014 were included. Data was collected from hospital records. The LACE index was calculated for each patient. A comparative analysis was performed based on a cutoff of 10 (≥10 indicates a high-risk population) for the LACE score. Results: 1407 patients were evaluated, with a mean age of 81.7±7.6 years; 41.2% were male, 52.2% were dependent for ≥1 activities of daily living, the average Charlson comorbidity index was 3.54±2.8. There were 236 (16.8%) readmissions, 132 (9.4%) deaths and 307 (21.8%) patients were dead and/or readmitted within 30 days of discharge. At 90 days, 523 (37.2%) patients were dead and/or readmitted. The LACE score was higher in patients who died or were readmitted within 30 days compared with those who were not (13.2±2.7 versus 11.5±3.0, p <0.0001). Patients with LACE score ≥10 had significantly higher mortality and readmission rates compared to those with LACE score <10: at 30 days, 25.5% versus 9.3% (OR 3.34, 95% CI 2.24-4.98, p <0.0001); at 90 days, 43.4% versus 16.2% (OR 3.98, 95% CI 2.89-5.49, p <0.0001). However, the discriminative capacity of LACE index assessed by C-statistic was relatively poor: 0.663 (95% CI 0.630-0.696) and 0.676 (95% CI 0.648-0.704), respectively. Conclusions: This study shows that the LACE index should be used with reservations for predicting 30 and 90-day readmission or death in complex elderly patients.

scholarly journals Iodine status and its determinants in subpopulation of pregnant women in rural Central India

2018 ◽  
Vol 7 (2) ◽  
pp. 665
Author(s):  
Surekha A. Tayade ◽  
Shakuntala Chhabra
Keyword(s):  
Family History ◽  
High Risk ◽  
Pregnant Women ◽  
Iodine Deficiency ◽  
Tertiary Care ◽  
Central India ◽  
Iodized Salt ◽  
High Risk Population ◽  
Iodine Status ◽  
Rich Food

Background: There is an increased demand for iodine and thyroid hormones, in pregnancy starting from the early weeks of pregnancy suggesting that there may be a need for additional supplements of iodine in high risk population to prevent iodine deficiency and its associated disorders. Hence this study was undertaken to determine the iodine status and its determinants in a subpopulation of pregnant women from a rural area of Central India.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, use of iodized salt, iodine rich food and goitrogens as part of diet and other determinants. Spot urine samples were obtained, and assessment of urine iodine concentration was done by using Sandell-Kolthoff reaction.Results: Among 250 pregnant women of first trimester, iodine deficiency (ID) was present in 11.8 %, of which 59.25% had mild deficiency, 33.33% moderate deficiency and 7.4% severe deficiency. More women with iodine deficiency were of higher age, had less formal education and belonged to lower middle and lower economic class. Higher number of women with iodine deficiency had family history of thyroid disorders compared to iodine sufficient (18.51% versus 5.58%), more iodine deficient commonly had goitrogens (cabbage, cauliflower, radish, sweet potato, soya etc) as part of their meals (77.77% versus 68.60%), lesser women with ID ate iodine rich food (fish, milk yoghurt, bread) (18.51% versus 68.60%) and fewer of them used iodized salt during food preparation (25.92% versus 69.95%) compared to iodine sufficient, with a significant difference.Conclusions: Iodine deficiency is prevalent in pregnant women in this geographic region of central India. Age, low socioeconomic status, lack of education, family history, low intake of iodized salt and iodine rich food and more consumption of goitrogenic food as part of diet are risk factors. Appropriate health education, promoting use of iodized salt, quality assurance of universal salt iodization by household survey and screening in high risk group is suggested.

scholarly journals Pathways to care and diagnostic delay among cervical cancer patients attending a tertiary care hospital in Puducherry: a cross-sectional study

2020 ◽  
Vol 7 (6) ◽  
pp. 2298
Author(s):  
Roshina Sunny ◽  
Sitanshu Sekhar Kar ◽  
Dasari Papa ◽  
Sujiv Akkilagunta ◽  
Jeby Jose Olickal
Keyword(s):  
Cervical Cancer ◽  
Cancer Patients ◽  
Tertiary Care ◽  
Diagnostic Delay ◽  
Cross Sectional Study ◽  
Cancer Center ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Facilities

Background: The high mortality among cervical cancer patients in India can be attributed to presentation at advanced stages. The varied and lengthy pathway taken up to diagnosis could be a major reason for advanced stage at presentation. Hence, we aimed to describe the care pathways and diagnostic delay among cervical cancer patients.Methods: A hospital-based cross-sectional study was conducted among 101 cervical cancer patients attending a cancer clinic at a Regional Cancer Center. The histo-pathologically confirmed cases of cervical cancer, who registered in July to October 2018 were approached. Data were collected through personal interviews using a semi-structured questionnaire. Descriptive statistics were used to describe the number of providers visited and diagnostic delay.Results: The median (range) number of providers visited by the patients up to diagnosis was 2 (1-5). As the first point of care, 14% of participants approached sub-center or primary care facilities, 27% approached secondary care facilities, 49% participants approached tertiary care facilities and 11% came directly to a regional cancer center. Diagnosis was made only in 24% of participants at secondary and tertiary care levels. The median (IQR) number of days to get diagnosed was 66 (30-130) days and three fourth of the patients had a diagnostic delay.Conclusions: The diagnostic delay was higher among patients who consulted multiple providers. Implementing a protocol to be followed at all three levels of health care delivery system may enhance the early diagnosis. 

Development and validation of a new clinical prediction model of catheter-related thrombosis in cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14031-e14031
Author(s):  
Binliang Liu ◽  
Junying Xie ◽  
Xiaoying Sun ◽  
Yanfeng Wang ◽  
Zhong Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Prediction Model ◽  
Receiver Operating Characteristic ◽  
Cancer Patients ◽  
Retrospective Cohort ◽  
Operating Characteristic ◽  
Risk Group ◽  
Cancer Center ◽  
Catheter Related Thrombosis

e14031 Background: The central venous catheter brings convenience for drug delivery and improves comfort for cancer patients, it also causes serious complications. The most common one is catheter-related thrombosis (CRT). This study aimed to evaluate the incidence and risk factors of CRT in cancer patients, and to develop an effective prediction model for CRT in cancer patients. Methods: The development of our prediction model was based on the data of a retrospective cohort (n = 3131) from National Cancer Center. The validation of our prediction model was done in a prospective cohort from National Cancer Center (n = 685) and a retrospective cohort from Hunan Cancer Hospital (n = 61). The predictive accuracy and the discriminative ability were determined by the receiver operating characteristic curves and calibration plots. Results: Multivariate analysis demonstrated that sex, cancer type, catheter type, position of the catheter tip, chemotherapy status, and antiplatelet/anticoagulation status at baseline were independent risk factors for CRT. The area under receiver operating characteristic (ROC) curve of our prediction model was 0.741 (CI: 0.715-0.766) in the primary cohort; 0.754 (CI: 0.704-0.803) and 0.658 (CI: 0.470-0.845) in validation cohorts respectively. Good calibration and clinical impact were also shown in primary and validation cohorts. The high-risk group had a higher incidence of CRTs than the low-risk group in the primary cohort and two validation cohort (p < 0.001). Conclusions: Our model is a novel prediction tool for CRT risk which helps to assigning cancer patients into high-risk or low-risk group accurately. Our model will be valuable for clinicians in decision making of thromboprophylaxis.

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