A Predictive Risk Score for Cancer-Associated Thrombosis: Role of Screening In A Prospective Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3173-3173 ◽  
Author(s):  
Alok A. Khorana ◽  
Kimberly Herman ◽  
Deborah Rubens ◽  
Charles W. Francis
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Risk Score ◽  
Prospective Cohort ◽  
Risk Model ◽  
Conflicts Of Interest ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Predictive Risk

Abstract Abstract 3173 Background: We evaluated the utility of screening for VTE using a previously developed clinical risk score (Khorana et al, Blood 2008) in a prospective cohort of cancer patients initiating outpatient chemotherapy but not receiving thromboprophylaxis. Methods: Cancer patients initiating a new chemotherapy regimen and deemed high-risk based on a predictive risk model (score ≥3) were enrolled on an ongoing prospective cohort study with informed consent. Patients were evaluated with baseline and Q4 (± 1) week serial ultrasonography for upto 16 weeks; additionally, computed tomography scans for restaging were also evaluated for VTE. Results: Of 30 patients enrolled on study, 8 (27%) developed a VTE. This included 5 patients with DVT alone (17%), 1 patient with PE alone (3%) and 2 (7%) with both. Twenty-seven patients underwent a baseline ultrasound. Of these, 3 asymptomatic DVTs were identified (11%). Subsequent ultrasounds were performed in 18 patients at week 4 (0 DVT), 17 patients at week 8 (0 DVT) and 15 patients at week 12 (1 DVT, 7%). An additional two patients developed symptomatic DVT between weeks 1 and 4. Restaging CT scans identified an asymptomatic PE in 1 patient at week 6 and asymptomatic PE in 1 patient at week 9 with subsequent symptomatic DVT at week 10. Conclusions: In a prospective observational study, 27% of cancer outpatients deemed high-risk using a clinical risk score developed VTE, a rate much higher than observed even in hospitalized acutely ill patients. Thus, this study confirms the validity of a previously described risk score. The role of thromboprophylaxis in this population is currently being tested. The value of screening ultrasonography should be considered in high-risk patients based on this risk score. Disclosures: No relevant conflicts of interest to declare.

Abstract 14206: Assessing a Clinical Risk Score and the Impact of Race in Breast Cancer Patients at Risk of Cardiotoxicity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zachary Brumberger ◽  
Mary Branch ◽  
Joseph Rigdon ◽  
Suji Vasu
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Risk Score ◽  
Significant Risk ◽  
Statistical Characteristics ◽  
Risk Scores ◽  
Clinical Risk Score ◽  
Breast Cancer Patients ◽  
Clinical Risk ◽  
The Impact

Introduction: Cardiotoxicity is a well-known risk in breast cancer patients treated with anthracyclines and trastuzumab. Ezaz et al. developed a clinical risk score (CRS) to risk stratify these patients. Despite evidence that African American (AA) race is a significant risk factor for cardiotoxicity, no study has assessed the impact of AA race on this CRS. Here we assess the discrimination ability of the Ezaz et al. CRS with the addition of AA race. Methods: This is a retrospective cohort utilizing a registry of 118 patients with stage I-IV breast cancer treated with anthracyclines and/or trastuzumab. Patients without baseline echocardiography data or with baseline LVEF < 50% were excluded. The CRS from Ezaz et al. consisting of age, adjuvant chemotherapy, coronary artery disease, atrial fibrillation or flutter, diabetes mellitus, hypertension, and renal failure was calculated with the addition of AA race. Cardiotoxicity was defined by an LVEF decline of ≥ 10% to LVEF < 53% from baseline. Results: In our 118 patient cohort, the mean age was 59 years, 23 (20%) AA patients, 65 (55%) patients considered low risk (scores of 0-3) and 53 (45%) considered moderate to high risk (scores ≥4). After a follow up of 3 months to 5 years, 14 (12%) patients developed cardiotoxicity. Table 1 lists the CRS changes in statistical characteristics and predictability with the addition of AA race. In comparing the models, the AUC c-statistic increased from 0.609 to 0.642 (95% CI 0.47-0.75, 95% CI 0.49-0.79 respectively; P value = 0.56) with the addition of AA race ( Figure 1 ). Conclusions: In this study, the Ezaz et al. CRS demonstrated improved discrimination and sensitivity with the addition of AA race. This study suggests AA race improves the predictive ability of the Ezaz et al. CRS. Given the limited size of our study, we promote that this should be hypothesis-driving and encourage further investigation on the path to develop an important risk stratification tool.

scholarly journals Development of a clinical risk score for incident diabetes: A 10‐year prospective cohort study

2020 ◽  
Author(s):  
Tae Jung Oh ◽  
Jae Hoon Moon ◽  
Sung Hee Choi ◽  
Young Min Cho ◽  
Kyong Soo Park ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Risk Score ◽  
Prospective Cohort ◽  
Incident Diabetes ◽  
Clinical Risk Score ◽  
Clinical Risk

The metabolic clinical risk score (mCRS) as a new prognostic model for surgical decision in patients with colorectal liver metastases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15094-e15094
Author(s):  
Ivan Duran Derijckere ◽  
Hugo Levillain ◽  
Ali Bohlok ◽  
Celine Mathey ◽  
Jonathan Nezri ◽  
...  
Keyword(s):  
High Risk ◽  
Liver Metastases ◽  
Risk Score ◽  
Fdg Pet ◽  
Colorectal Liver Metastases ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Pet Ct ◽  
Selection For ◽  
Fdg Pet Ct

e15094 Background: Selection for surgery in patients with colorectal liver metastases (CRLM) remains poorly accurate. We evaluated if baseline metabolic characteristics of CRLM, as assessed by [18]-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18FDG-PET/CT), may predict the postoperative outcome in patients operated for CRLM. Methods: In a series of 450 patients operated for CRLM, we retrospectively identified 2 groups: The long-term survival (LTS), as defined by postoperative recurrence-free survival (RFS)≥5 years, and the early relapse groups (ER), as defined by RFS < 1 year. Clinicopathologic characteristics, Clinical Risk Score (CRS) and baseline 18FDG-PET/CT metabolic parameters were analyzed. Baseline 18FDG-PET/CT was performed at the time of diagnosis of CRLM, before any preoperative treatment. Low and high-risk CRS were defined by scores of 0 to 2 and 3 to 5, respectively. Metabolic CRS (mCRS) was implemented, using 1 additional point to the standard CRS when the highest tumor standardized uptake value (SUVmax) and normal liver mean SUV (SUVmean(liver)) ratio was > 4.3. Low and high-risk mCRS were defined by scores of 0 to 2 and 3 to 6, respectively. Results: We analyzed 53 patients. No difference was observed between LTS (n = 23) and ER (n = 30) groups for clinicopathologic parameters related to the primary tumor and CRLM, CRS and rates of low/high risk CRS. All metabolic parameters analyzed, including SUVmax and SUVpeak, at the exception of metabolic tumor volume, were significantly increased in ER group. Median SUVmax/SUVmean(liver) ratio was significantly increased in the ER vs LTS, respectively of 4.2 and 2.8 (p = 0.008). mCRS was significantly higher in ER as compared to LTS patients (p = 0.024), while 61% of the LTS patients had a low-risk mCRS and 73% of the ER patients had a high-risk mCRS (p = 0.023). Conclusions: Baseline 18FDG-PET/CT characteristics demonstrate an increased tumor glucose uptake in patients who rapidly recur after curative-intent surgery for CRLM. The introduction of these data into clinical risk model may represent a new tool to improve selection for surgery in patients with CRLM.

scholarly journals Clinical Risk Score for the Prediction of Incident Atrial Fibrillation: Derivation in 7 220 654 Taiwan Patients With 438 930 Incident Atrial Fibrillations During a 16‐Year Follow‐Up

2021 ◽  
Author(s):  
Tze‐Fan Chao ◽  
Chern‐En Chiang ◽  
Tzeng‐Ji Chen ◽  
Jo‐Nan Liao ◽  
Ta‐Chuan Tuan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Risk Score ◽  
Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Asian Patients

Background Although several risk schemes have been proposed to predict new‐onset atrial fibrillation (AF), clinical prediction models specific for Asian patients were limited. In the present study, we aimed to develop a clinical risk score (Taiwan AF score) for AF prediction using the whole Taiwan population database with a long‐term follow‐up. Methods and Results Among 7 220 654 individuals aged ≥40 years without a past history of cardiac arrhythmia identified from the Taiwan Health Insurance Research Database, 438 930 incident AFs occurred after a 16‐year follow‐up. Clinical risk factors of AF were identified using Cox regression analysis and then combined into a clinical risk score (Taiwan AF score). The Taiwan AF score included age, male sex, and important comorbidities (hypertension, heart failure, coronary artery disease, end‐stage renal disease, and alcoholism) and ranged from −2 to 15. The area under the receiver operating characteristic curve of the Taiwan AF scores in the predictions of AF are 0.857 for the 1‐year follow‐up, 0.825 for the 5‐year follow‐up, 0.797 for the 10‐year follow‐up, and 0.756 for the 16‐year follow‐up. The annual risks of incident AF were 0.21%/year, 1.31%/year, and 3.37%/year for the low‐risk (score −2 to 3), intermediate‐risk (score 4 to 9), and high‐risk (score ≥10) groups, respectively. Compared with low‐risk patients, the hazard ratios of incident AF were 5.78 (95% CI, 3.76–7.75) for the intermediate‐risk group and 8.94 (95% CI, 6.47–10.80) for the high‐risk group. Conclusions We developed a clinical AF prediction model, the Taiwan AF score, among a large‐scale Asian cohort. The new score could help physicians to identify Asian patients at high risk of AF in whom more aggressive and frequent detections and screenings may be considered.

410Heart failure risk stratification and efficacy of dapagliflozin in patients with type 2 diabetes mellitus

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Berg ◽  
S Wiviott ◽  
B Scirica ◽  
Y Gurmu ◽  
O Mosenzon ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Risk Score ◽  
Absolute Risk ◽  
Sglt2 Inhibitor ◽  
Risk Indicators ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Risk Patients

Abstract Background Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure (HF). Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors reduces the risk of hospitalization for HF (HHF) in patients with T2DM. Purpose To develop and validate a practical, multivariable clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with an SGLT2 inhibitor. Methods We developed a clinical risk score for centrally-adjudicated HHF using independent clinical risk indicators of HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53. Candidate variables were assessed using multivariable Cox regression and independent clinical risk indicators achieving statistical significance of p<0.001 were included in the risk score and given weights proportional to the regression coefficients. We externally validated the score in 8578 patients with T2DM in the placebo arm of DECLARE-TIMI 58. Discrimination was assessed using Harrell's c-index. The relative and absolute risk reductions in HHF with the SGLT2 inhibitor dapagliflozin were assessed by baseline HHF risk. Results The 5 independent clinical risk indicators were prior heart failure, atrial fibrillation, coronary artery disease, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR) (Figure, left). A simple integer-based scheme using these predictors identified a strong >16-fold gradient of HHF risk (p-trend <0.001) in both the derivation and validation cohorts, with c-indices of 0.81 and 0.78, respectively. Whereas relative risk reductions were similar across the risk score (25–34%), absolute risk reductions were greater in those at higher baseline risk (interaction p-value for absolute risk reduction <0.01), with high-risk (2 points) and very high-risk patients (≥3 points) having 1.5% and 2.7% absolute risk reductions in HHF at 4 years with dapagliflozin, translating into NNTs of only 65 and 36, respectively (Figure, right). Conclusion(s) Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater benefit from treatment with the SGLT2 inhibitor dapagliflozin. Acknowledgement/Funding SAVOR-TIMI 53 and DECLARE-TIMI 58 were sponsored by AstraZeneca.

scholarly journals Systematic Construction of an Autophagic Risk Model in Bone Marrow for Prognostic Prediction in Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4713-4713
Author(s):  
Lingling Shu ◽  
Han-Ying Huang ◽  
Yang Liu ◽  
Yang Li ◽  
Weida Wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Regression Analysis ◽  
Risk Score ◽  
Risk Model ◽  
Cox Regression ◽  
Conflicts Of Interest ◽  
Critical Role ◽  
Cox Regression Analysis

Abstract Autophagy is an intracellular self-degradative process that balances cell energy source and regulates tissue homeostasis, which plays critical role in the pathogenesis of multiple myeloma (MM). However, the prognostic role of autophagy-related genes (ARGs) in MM remains undefined. In the present study, the ARGs were obtained from Gene Expression Omnibus datasets (accession GSE24080, GSE136337, GSE57317), which contains 1038 samples of patients with MM. Univariate Cox regression analysis identified 38 ARGs that were significantly associated with overall survival of MM. Furthermore, a risk score model with 11 prognosis-associated ARGs was developed using multivariate Cox regression analysis, including ARNT, ATG4D, BIRC5, BNIP3L, CDKN1A, EIF2S1, IRGM, ITGA3, NCKAP1, NRG1 and TM9SF1. The 3-year area under the curve (AUC) values for the receiver operating characteristic curves were 0.717(0.662, 0.758), 0.646(0.587, 0.703) and 0.906(0.694, 1.000) for GSE24080, GSE136337, GSE57317 prognosis predictions, respectively (Figure A-C). Using this prognostic signature, patients with MM could be separated into high- and low-risk groups with distinct clinical outcomes (Figure D-F). Moreover, autophagy risk score was an independent prognostic factor by multivariate analysis. KEGG revealed that most pathways were related to autophagy and metabolism. Furthermore, we validated the expression of 11 genes and ARNT in bone marrow of MM patients (Figure G-I) and showed the critical role of ARNT-mediated autophagy in the proliferation and drug resistance of bortezomib in myeloma cells (Figure J-M). In conclusion, we constructed ARGs-based prognostic model to predict the prognosis of MM, targeting specific autophagic gene such as ARNT might provide therapeutic clues for MM treatment. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Diagnostic and Prognostic Value of BEN-Domain (BEND) Family Genes in Gastric Cancer

2022 ◽  
Author(s):  
Jiaxin Fan ◽  
Min Yang ◽  
Chaojie Liang ◽  
Chaowei Liang ◽  
Jiansheng Guo
Keyword(s):  
Gastric Cancer ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Score ◽  
Prognostic Value ◽  
Risk Model ◽  
Malignant Tumors ◽  
Risk Groups ◽  
Risk Scores ◽  
Gastric Cancer Patients

Abstract BEND(BEN domain-containing protein)is a domain protein-coding gene, whose abnormal expression is related to the occurrence of malignant tumors. But studies on gastric cancer are rare. We attempted to investigate the role of BEND family genes in evaluating the prognosis of gastric cancer and guiding clinical treatment. We analyzed the BEND family genes expression, prognostic value, and drug sensitivity in pan-cancer, and the correlation between their expression and tumor microenvironment of gastric cancer, stemness index, immune subtypes, and clinicopathological characteristics were analyzed. We constructed a model using BEND3P1 and BEND6 to evaluate the prognosis of gastric cancer patients. Multivariate Cox proportional risk model analysis showed that risk score is an independent risk factor for gastric cancer patients. To assess the value of risk score for prognosis, patients were divided into high-risk and low-risk groups based on median risk scores, and survival analyses were performed. The results showed that the OS of patients with high-risk scores is significantly lower. We also constructed a nomogram to predict individual survival probability using the BEND risk score and clinical case characteristics. In conclusion, the BEND family genes can predict the prognosis and guide the treatment of gastric cancer patients.

Sign in / Sign up

Export Citation Format

Share Document