scholarly journals Preoperative nutritional score predicts underlying liver status and surgical risk of hepatocellular carcinoma

2021 ◽  
pp. 145749692110619
Author(s):  
Ryosuke Umino ◽  
Yuta Kobayashi ◽  
Miho Akabane ◽  
Kazutaka Kojima ◽  
Satoshi Okubo ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Confidence Interval ◽  
Nutritional Status ◽  
Surgical Outcomes ◽  
Odds Ratio ◽  
Characteristic Curve ◽  
Major Morbidity ◽  
Surgical Risk ◽  
Status Score ◽  
Nutritional Score

Background: Given the scarce evidence regarding the impact of preoperative nutritional status on surgical outcomes of patients with hepatocellular carcinoma, predictive powers of nutritional/inflammatory scores for short-term surgical outcomes in patients with hepatocellular carcinoma were investigated. Methods: Outcomes of 1272 patients with hepatocellular carcinoma were reviewed, and predictive powers of nine nutritional/inflammatory scores for short-term surgical outcomes were compared using the receiver-operating characteristic curve analysis. Clinical relevance of the best nutritional score was then studied in detail to clarify its utility as an alternative predictive measure for surgical risk of patients with hepatocellular carcinoma. Results: Receiver-operating characteristic curve analysis showed the controlling nutritional status score has the best performance in prediction of morbidity after hepatectomy for hepatocellular carcinoma (area under the curve, 0.593; 95% confidence interval: 0.552–0.635; p < 0.001), and multivariate analysis confirmed its correlation with the risk of any morbidity (odds ratio per +1 point, 1.17; 95% confidence interval: 1.08–1.27; p < 0.001) and major morbidity (odds ratio per +1 point, 1.14; 95% confidence interval: 0.99–1.27; p = 0.052). The undernutrition grade based on the controlling nutritional status score showed strong correlation with the degree of fibrosis in the liver ( p < 0.001), platelet count ( p < 0.001), and indocyanine green retention rate at 15 min ( p < 0.001). In addition, the controlling nutritional status undernutrition grade well stratified the risk of postoperative morbidity especially in cirrhotic subpopulation (odds ratio, 1.17 per +1 point; 95% confidence interval: 1.05–1.29 for any morbidity and odds ratio, 1.20 per +1 point; 95% confidence interval: 1.03–1.40 for major morbidity). Conclusion: The controlling nutritional status score could be an alternative measure for underlying liver injury and the surgical risk of hepatocellular carcinoma.

scholarly journals Controlling Nutritional Status score: A novel prognostic marker for patients with community-acquired pneumonia

2020 ◽  
pp. 102490792092391
Author(s):  
Birdal Yıldırım ◽  
Funda Sungur Biteker ◽  
Ethem Acar ◽  
Ahmet Demir
Keyword(s):  
Confidence Interval ◽  
Nutritional Status ◽  
Odds Ratio ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Study Endpoint ◽  
Primary Study ◽  
Cholesterol Levels ◽  
Status Score

Objective: We aimed to investigate the prevalence and prognostic value of malnutrition assessed by Controlling Nutritional Status score in community-acquired pneumonia patients. Methods: All adult patients admitted to our emergency department and hospitalized for community-acquired pneumonia were prospectively followed-up until hospital discharge or death. Nutritional status was assessed with the Controlling Nutritional Status score, which is based on serum albumin levels, total cholesterol levels, and lymphocyte counts. The primary study endpoint was complicated hospital course defined as need for mechanical ventilation, mortality, or intensive care unit admission. Results: Three hundred and five patients (mean age 68.6 ± 11.2 years and 51.8% female) were enrolled, and 40 patients (13.1%) had complicated hospitalizations. Older patients, patients with more comorbidities, and patients with higher Controlling Nutritional Status scores on admission were tended to have a higher rate of complications during their hospitalization. Multivariate analysis showed that older age (odds ratio 2.55, 95% confidence interval 1.41–4.64, p < 0.001), presence of diabetes (odds ratio 1.54; 95% confidence interval 1.09–3.65; p = 0.004), pneumonia severity index ⩾ 3 (odds ratio 1.27, 95% confidence interval 0.524–3.725, p = 0.035), and Controlling Nutritional Status score > 4 (odds ratio 2.23, 95% confidence interval 1.129–3.657, p = 0.001) were independent predictors of complicated hospitalizations. Conclusion: Malnutrition determined by Controlling Nutritional Status score predicts complications in hospitalized patients with community-acquired pneumonia.

scholarly journals Predictive value of fibrinogen in identifying inflammatory bowel disease in active stage

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiao-Fu Chen ◽  
Yuan Zhao ◽  
Yu Guo ◽  
Zhi-Ming Huang ◽  
Xie-Lin Huang
Keyword(s):  
Inflammatory Bowel Disease ◽  
Confidence Interval ◽  
Disease Activity ◽  
Bowel Disease ◽  
Odds Ratio ◽  
Activity Index ◽  
Characteristic Curve ◽  
Disease Activity Index ◽  
Mayo Score ◽  
Inflammatory Bowel

Abstract Background We aimed to externally validate for the first time the diagnostic ability of fibrinogen to identify active inflammatory bowel disease (IBD). Methods The research totally involved 788 patients with IBD, consisted of 245 ulcerative colitis (UC) and 543 Crohn’ s disease (CD). The Mayo score and Crohn disease activity index (CDAI) assessed disease activity of UC and CD respectively. The independent association between fibrinogen and disease activity of patients with UC or CD was investigated by multivariate logistic regression analyses. Area under the receiver operating characteristic curve (AUROC) assessed the performance of various biomarkers in discriminating disease states. Results The fibrinogen levels in active patients with IBD significantly increased compared with those in remission stage (P < 0.001). Fibrinogen was an independent predictor to distinguish disease activity of UC (odds ratio: 2.247, 95% confidence interval: 1.428–3.537, P < 0.001) and CD (odds ratio: 2.124, 95% confidence interval: 1.433–3.148, P < 0.001). Fibrinogen was positively correlated with the Mayo score (r = 0.529, P < 0.001) and CDAI (r = 0.625, P < 0.001). Fibrinogen had a high discriminative capacity for both active UC (AUROC: 0.806, 95% confidence interval: 0.751–0.861) and CD (AUROC: 0.869, 95% confidence interval: 0.839–0.899). The optimum cut-off values of fibrinogen 3.22 was 70% sensitive and 77% specific for active UC, and 3.87 was 77% sensitive and 81% specific for active CD respectively. Conclusions Fibrinogen is a convenient and practical biomarker to identify active IBD.

scholarly journals Association between TP53 and MDM2 Gene Polymorphisms and Risk of Hepatocellular Carcinoma in Hepatitis C Virus among Egyptian Populations

2020 ◽  
pp. 148-156
Author(s):  
Ahmed Mohamed Zaky ◽  
Shaden Muawia Hanafy ◽  
Magdy Mamdouh El- Bordiny ◽  
Reham Abdel Haleem Abu El- Wafa
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Tumor Suppressor ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Tumor Suppressor Protein ◽  
Mdm2 Snp309 ◽  
Mdm2 Gene ◽  
Egyptian Patients

Background: The Murine double minute 2 (MDM2) gene is overexpressed in several human tumors. The oncogenic potential of MDM2 is partially explained by inhibition of the activity of the tumor suppressor protein P53 (negative regulator of the P53 tumor suppressor protein). A single nucleotide polymorphism (SNP) in the promoter region of MDM2 gene (T to G exchange at nucleotide 309) and TP53 gene (codon 72 exon 4, rs1042522 encoding either C or G) have been independently associated with increased risk of several cancer types. Few studies have analyzed the role of these polymorphisms in the development of hepatocellular carcinoma among Egyptian patients with chronic hepatitis C virus infection. Methods: The study consisted in the comparison of the genotype distribution of TP53 and MDM2 SNP309 in 100 viral hepatitis C-related hepatocellular carcinomas (HCC) cases and 100 controls without HCC matched for age, gender and ethnicity. PCR-RFLP (restriction fragment length polymorphism) and real time PCR methods were used to determine the genotype at the MDM2 SNP309T>G locus and TP53 rs1042522. Results: Overall, our results indicate that frequencies of TP53 alleles (C and G) were not significant different between HCC cases and healthy controls (p=0.093) (Odds Ratio, OR=1.361,95% Confidence Interval, 95% CI=0.949 – 1.951). A significant increase of MDM2 SNP309 G/G and T/G genotypes were observed among HCC cases (Odds Ratio, OR=4.868, 95% Confidence Interval, 95% CI= 2.873 – 8.251). Conclusions: Our finding suggest that people who have G allele increase the risk by 4.868 folds for developing HCC among Egyptian patients, consequently the MDM2 309T>G polymorphism is an important modulator of hepatocellular carcinoma development in Egyptian patients.

Validation of the failure to maturation equation and proposal for a novel scoring system for arteriovenous fistula maturation in multiethnic Asian haemodialysis patients

2019 ◽  
Vol 21 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Alvin Ren Kwang Tng ◽  
Kian Guan Lee ◽  
Ru Yu Tan ◽  
Suh Chien Pang ◽  
Marjorie Wai Yin Foo ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Arteriovenous Fistula ◽  
Odds Ratio ◽  
Scoring System ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Success Predictors ◽  
Fistula Maturation ◽  
Arteriovenous Fistula Maturation

Introduction: A successful arteriovenous fistula is essential for effective haemodialysis. We aim to validate the existing failure to maturation equation and to propose a new clinical scoring system by evaluating arteriovenous fistula success predictors. Methods: Data of end-stage renal disease patients initiated on haemodialysis from January 2010 to December 2012 were retrospectively obtained from medical records with follow-up until 1 January 2014. Application of the failure to maturation equation was evaluated. A nomogram was developed using arteriovenous fistula success predictors and was calibrated with a bootstrapping technique. Results: A total of 694 patients were included with mean duration of follow-up of 2.3 years. Arteriovenous fistula maturation was achieved by 542 patients (78%). Comparing our cohort with the failure to maturation cohort, there were statistically significant differences in mean age, ethnicity and presence of diabetes mellitus. The failure to maturation equation failed to predict arteriovenous fistula outcomes with area under the curve performance of 0.519 on a receiver operating characteristic curve. Multivariate logistic regression showed that Malay patients (odds ratio = 0.628; 95% confidence interval = 0.403–0.978; p < 0.05) and patients requiring preoperative vein mapping (odds ratio = 0.601; 95% confidence interval = 0.410–0.883; p < 0.01) had a lower chance of arteriovenous fistula success, whereas male gender (odds ratio = 1.526; 95% confidence interval = 1.040–2.241; p < 0.05) and presence of postoperative good thrill (odds ratio = 3.137; 95% confidence interval = 2.127–4.625; p < 0.0001) had a higher chance of arteriovenous fistula success. The derived nomogram predicted arteriovenous fistula success (odds ratio = 1.030; 95% confidence interval = 1.022–1.038; p < 0.0001) with the area under the curve of 0.695 on a receiver operating characteristic curve and an adequacy index of 99.86% ( p < 0.0001). Conclusion: The failure to maturation equation was not validated in our cohort. The clinical utility of our proposed arteriovenous fistula scoring system requires external validation in larger studies.

Misinterpretation of online surgical outcomes: The British Association of Urological Surgeons Surgical Outcomes Audit

2018 ◽  
Vol 12 (3) ◽  
pp. 205-210
Author(s):  
Niranjan J Sathianathen ◽  
Jacob Albersheim-Carter ◽  
Lucas Labine ◽  
Brett Watson ◽  
Badrinath R Konety ◽  
...  
Keyword(s):  
General Population ◽  
Confidence Interval ◽  
Complication Rate ◽  
Surgical Outcomes ◽  
Odds Ratio ◽  
British Association ◽  
Healthcare Decision ◽  
Level Of Evidence ◽  
Electronic Survey ◽  
Primary Output

Objective: The purpose of this study was to evaluate whether the information presented in the British Association of Urological Surgeons Surgical Outcomes Audit is comprehended by the general population. Methods: An in-person electronic survey was administered at the local state fair in 2016. Participants were presented with an representative output from the British Association of Urological Surgeons Surgical Outcomes Audit and were asked to estimate the complication rate and make a hypothetical healthcare decision. The primary output depicted a complication rate of 6.7% which was above the 99th percentile. The degree of misinterpretation and the risk of making an inappropriate healthcare decision was evaluated. Results: Of the 350 completed responses, only 142 (40.6%) correctly estimated the surgeons’ complication rate. Individuals who were not college educated (odds ratio 3.02, 95% confidence interval 1.88–4.95) were more likely to misinterpret the information. Only 7.6% recognized that the surgeon’s complication rate was above the 99th percentile. Despite the high complication rate, 16.6% decided to continue with the surgery as planned and not ask the surgeon about their rates, seek a second opinion or change surgeons. Misinterpreters had a higher risk of making an inappropriate hypothetical decision (odds ratio 2.75, 95% confidence interval 1.42–5.62). Conclusion: The general population have difficulty in interpreting the data presented by The British Association of Urological Surgeons Surgical Outcomes Audit and are thus vulnerable to making poor healthcare decisions or decisions which are inconsistent with their goals of care. Level of evidence: IIb

scholarly journals Redefining Tumor Burden in Patients with Intermediate-Stage Hepatocellular Carcinoma: The Seven-Eleven Criteria

Liver Cancer ◽  
2021 ◽  
pp. 1-12
Author(s):  
Ya-Wen Hung ◽  
I-Cheng Lee ◽  
Chen-Ta Chi ◽  
Rheun-Chuan Lee ◽  
Chien-An Liu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Odds Ratio ◽  
Characteristic Curve ◽  
Intermediate Stage ◽  
Complete Response ◽  
Tumor Burden ◽  
Hazard Ratio ◽  
Information Criteria ◽  
High Burden ◽  
High Tumor Burden

<b><i>Background and Aims:</i></b> For patients with intermediate-stage hepatocellular carcinoma (HCC), the definition of high tumor burden remains controversial. This study aimed to compare the prognostic value of different criteria of tumor burden in patients with intermediate-stage HCC undergoing transarterial chemoembolization (TACE). <b><i>Methods:</i></b> From 2007 to 2019, 632 treatment-naive patients with intermediate-stage HCC undergoing TACE were retrospectively enrolled. We compared different criteria of tumor burden in discriminating radiologic response and survival, including up-to-7, up-to-11, 5–7, 7 lesions criteria, and newly proposed 7–11 criteria. <b><i>Results:</i></b> The proportions of patients classified as high tumor burden were varied by different criteria. Among the 5 criteria, 7–11 criteria have the best performance to discriminate complete response (CR) and overall survival (OS) after TACE. In patients with low, intermediate, and high tumor burden classified by 7–11 criteria, the CR rate was 21, 12, and 2.5%, respectively (<i>p</i> &#x3c; 0.001), and the median OS was 33.1, 22.3, and 11.9 months, respectively (<i>p</i> &#x3c; 0.001). By multivariate analysis, 7–11 criteria were significantly associated with CR (intermediate vs. high burden, odds ratio = 4.617, <i>p</i> = 0.002; low vs. high burden, odds ratio = 8.675, <i>p</i> &#x3c; 0.001) and OS (intermediate vs. high burden, hazard ratio = 0.650, <i>p</i> &#x3c; 0.001; low vs. high burden, hazard ratio = 0.520, <i>p</i> &#x3c; 0.001). Seven to 11 criteria also had the lowest corrected Akaike information criteria, highest homogeneity value, and highest area under the receiver operating characteristic curve in predicting 1-, 2-, and 3-year mortality among all criteria. <b><i>Conclusion:</i></b> Conventional definitions of tumor burden were not optimal for patients with intermediate HCC. The new 7–11 criteria had the best discriminative power in predicting radiologic response and survival in patients with intermediate-stage HCC undergoing TACE.

scholarly journals Soil-transmitted helminth infections and nutritional status of school children in government elementary schools in Jimma Town, Southwestern Ethiopia

2020 ◽  
Vol 8 ◽  
pp. 205031212095469
Author(s):  
Zeleke Mekonnen ◽  
Derartu Hassen ◽  
Serkadis Debalke ◽  
Abebaw Tiruneh ◽  
Yaregal Asres ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Nutritional Status ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Intestinal Parasites ◽  
School Age Children ◽  
School Age ◽  
Soil Transmitted Helminths ◽  
Helminth Infections ◽  
Jimma Town

Introduction: Soil-transmitted helminth infections and malnutrition are major health problems of school-age children in developing countries. Malnutrition and soil-transmitted helminth infections often co-exist with synergetic consequences. Objective: The aim of this study was to determine the prevalence and intensity of soil-transmitted helminths and its association with nutritional status of school-age children. Methods: School-based cross-sectional study was carried out from April to May 2014 among 404 elementary school-age children in Jimma Town, Southwest Ethiopia. Data on background characteristics were collected using structured interviewer administered questionnaire. Anthropometric measurements were taken according to World Health Organization standard. Fresh single stool sample was collected from each study participant and examined using direct wet mount and McMaster techniques. Anthropometric indices were generated using WHO AnthroPlus software. Multivariable logistic regression models were fitted to isolate independent predictors of intestinal parasitic infection and nutritional status using STATA-MP software. All tests were two-sided and P < 0.05 was used to declare statistical significance. Results: The overall prevalence of intestinal parasites and soil-transmitted helminths were 68.6% (n = 277) and 55.0% (n = 222), respectively. A total of eight species of intestinal parasites were identified in this study, Trichuris trichiura being the most common parasite identified followed by Ascaris lumbricoides. Study participants who had a habit of open defecation were two times more likely to be infected with soil-transmitted helminths (adjusted odds ratio = 1.9, 95% confidence interval: 1.0–3.4). The overall prevalence of stunting and thinness were 21.0% (n = 85) and 6.9% (n = 28), respectively. The odds of stunting was significantly high (adjusted odds ratio = 4.0, 95% confidence interval: 1.7–9.7) among children who had fathers working as daily labourers and children with personal dietary diversity score of ⩽3 (adjusted odds ratio = 3.5, 95% confidence interval: 1.5–8.0). T. trichiura infection (adjusted odds ratio = 9.4, 95% confidence interval: 2.0–44.8) was identified as an independent predictor of stunting among school-age children. Conclusion: Both the prevalence of soil-transmitted helminths and stunting are high among school-age children in Jimma Town. Although there was no statistically significant association between the STHs, in general, T. trichiura was reported as predictor of stunting. The results imply the need for strengthening strategies for reduction of parasitic infection to curb the pervasively high prevalence of stunting.

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