Impact of the preoperative prognostic nutritional index as a predictor for postoperative complications after resection of locally recurrent rectal cancer

Abstract Background Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. Methods This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Results Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. Conclusions We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.

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Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

Global Spine Journal ◽

10.1177/2192568217700115 ◽

2017 ◽

Vol 7 (6) ◽

pp. 560-566 ◽

Cited By ~ 24

Author(s):

Kazuyoshi Kobayashi ◽

Shiro Imagama ◽

Kei Ando ◽

Naoki Ishiguro ◽

Masaomi Yamashita ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Blood Loss ◽

Elderly Patients ◽

Spine Surgery ◽

Multicenter Study ◽

Odds Ratio ◽

Postoperative Delirium ◽

Cervical Lesion ◽

Estimated Blood Loss

Study Design: Retrospective database analysis. Objective: Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions. Methods: A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined. Results: Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium. Conclusions: Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.

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Development and Validation of a Nomogram for Renal Involvement in Primary Sjögren Syndrome Patients: A Retrospective Analysis

Modern Rheumatology ◽

10.1093/mr/roab123 ◽

2021 ◽

Author(s):

Xinshi Huang ◽

Xiaobing Wang ◽

Dinglai Yu

Keyword(s):

Risk Factors ◽

Prediction Model ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Renal Involvement ◽

Calibration Plot ◽

Receiver Operating Characteristic Curves ◽

Logistic Analysis ◽

Validation Set ◽

Multivariate Logistic Analysis

Abstract Objective To establish and validate a nomogram for individualized prediction of renal involvement in pSS patients. Methods A total of 1293 patients with pSS from the First Affiliated Hospital of Wenzhou Medical University between January 2008 to January 2020 were recruited and further analyzed retrospectively. The patients were randomly divided into a development set (70%, n = 910) and a validation set (30%, n = 383). The univariable and multivariate logistic regression were performed to analyze the risk factors of renal involvement in pSS. Based on the regression β coefficients derived from multivariate logistic analysis, an individualized nomogram prediction model was developed. The prediction model of discrimination and calibration was evaluated with the area under the receiver operating characteristic curves and Calibration plot. Results Multivariate logistic analysis showed that hypertension, anemia, albumin, uric acid, anti-Ro52, hematuria and Chisholm-Mason grade were independent risk factors of renal involvement in pSS. The area under the receiver operating characteristic curves were 0.797 and 0.750 respectively in development set and validation set, indicating the nomogram had a good discrimination capacity. The Calibration plot showed nomogram had a strong concordance performance between the prediction probability and the actual probability. Conclusion The individualized nomogram for pSS patients those who had renal involvement could be used by clinicians to predict the risk of pSS patients developing into renal involvement and improve early screening and intervention.

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Retrospective Analysis of Risk Factors for Postoperative Perineal Hernia After Endoscopic Abdominoperineal Excision for Rectal Cancer

10.21203/rs.3.rs-962418/v1 ◽

2021 ◽

Author(s):

Tatsuya Manabe ◽

Yusuke Mizuuchi ◽

Yasuhiro Tsuru ◽

Hiroshi Kitagawa ◽

Takaaki Fujimoto ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Regression Analysis ◽

Odds Ratio ◽

Open Surgery ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

Lower Rectal Cancer ◽

Peritoneal Closure ◽

Initial Surgery

Abstract Background: In contrast to open-surgery abdominoperineal excision (APE) for rectal cancer, postoperative perineal hernia (PPH) is reported to increase after extralevator APE and endoscopic surgery. In this study, therefore, we aimed to determine the risk factors for PPH after endoscopic APE.Methods: A total 73 patients who underwent endoscopic APE for lower rectal cancer were collected from January 2009 to March 2020, and the risk factors for PPH were analyzed retrospectively.Results: Nineteen patients (26%) developed PPH after endoscopic APE, and the diagnosis of PPH was made at 9–393 days (median: 183 days) after initial surgery. Logistic regression analysis showed that absence of pelvic peritoneal closure alone increased the incidence of PPH significantly (odds ratio; 13.76, 95% confidence interval; 1.48–1884.84, p = 0.004).Conclusions: Pelvic peritoneal closure should be performed when possible after endoscopic APE to prevent PPH.

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Prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907917742873 ◽

2018 ◽

Vol 25 (1) ◽

pp. 3-11 ◽

Cited By ~ 1

Author(s):

Xiaowei Liu ◽

Tao Ma ◽

Zhi Liu

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Prognostic Significance ◽

Urine Concentration ◽

Paraquat Poisoning ◽

Independent Risk Factors ◽

Receiver Operating

Objective: To assess the prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department. Methods: Patients with acute paraquat poisoning admitted to the emergency department were recruited. Survivors and non-survivors were compared with regard to urinary paraquat concentration. The urinary level predictive of mortality was assessed by receiver operating characteristic curve. Risk factors of mortality were evaluated by regression analysis. Results: The overall mortality rate was 70.9% over the 28-day follow-up period. There was a significant difference in the urine paraquat concentrations recorded on admission between non-surviving and surviving patients ( p = 0.022). Receiver operating characteristic curve analysis revealed that the area under the curve when applied to receiver operating characteristic of the admission urine paraquat concentrations for predicting mortality was 0.854 with a cut-off value of 34.5 µg/mL. The dose of paraquat ingested, arterial lactate, and urine concentration were independent risk factors predicting 28-day mortality. The time interval between ingestion and hemoperfusion, arterial lactate, and urine concentration of paraquat were independent risk factors predicting acute kidney injury, while the partial pressure of carbon dioxide (PaCO2) and urine concentration of paraquat were independent risk factors predicting acute lung injury. Conclusion: The urine concentrations of paraquat on admission at emergency department demonstrated predictive ability for the prognosis of patients with acute paraquat poisoning.

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Prediction of Core and Lower Extremity Strains and Sprains in Collegiate Football Players: A Preliminary Study

Journal of Athletic Training ◽

10.4085/1062-6050-47.3.17 ◽

2012 ◽

Vol 47 (3) ◽

pp. 264-272 ◽

Cited By ~ 47

Author(s):

Gary B. Wilkerson ◽

Jessica L. Giles ◽

Dustin K. Seibel

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Lower Extremity ◽

Receiver Operating Characteristic ◽

Injury Risk ◽

Operating Characteristic ◽

Football Players ◽

Low Back ◽

Collegiate Football ◽

Receiver Operating

Context: Poor core stability is believed to increase vulnerability to uncontrolled joint displacements throughout the kinetic chain between the foot and the lumbar spine. Objective: To assess the value of preparticipation measurements as predictors of core or lower extremity strains or sprains in collegiate football players. Design: Cohort study. Setting: National Collegiate Athletic Association Division I Football Championship Subdivision football program. Patients or Other Participants: All team members who were present for a mandatory physical examination on the day before preseason practice sessions began (n = 83). Main Outcome Measure(s): Preparticipation administration of surveys to assess low back, knee, and ankle function; documentation of knee and ankle injury history; determination of body mass index; 4 different assessments of core muscle endurance; and measurement of step-test recovery heart rate. All injuries were documented throughout the preseason practice period and 11-game season. Receiver operating characteristic analysis and logistic regression analysis were used to identify dichotomized predictive factors that best discriminated injured from uninjured status. The 75th and 50th percentiles were evaluated as alternative cutpoints for dichotomization of injury predictors. Results: Players with ≥2 of 3 potentially modifiable risk factors related to core function had 2 times greater risk for injury than those with <2 factors (95% confidence interval = 1.27, 4.22), and adding a high level of exposure to game conditions increased the injury risk to 3 times greater (95% confidence interval = 1.95, 4.98). Prediction models that used the 75th and 50th percentile cutpoints yielded results that were very similar to those for the model that used receiver operating characteristic-derived cutpoints. Conclusions: Low back dysfunction and suboptimal endurance of the core musculature appear to be important modifiable football injury risk factors that can be identified on preparticipation screening. These predictors need to be assessed in a prospective manner with a larger sample of collegiate football players.

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Risk factors for postoperative systemic complications in elderly patients with brain tumors

Journal of Neurosurgery ◽

10.3171/2008.10.17669 ◽

2009 ◽

Vol 111 (2) ◽

pp. 258-264 ◽

Cited By ~ 7

Author(s):

Kenichiro Asano ◽

Takahiro Nakano ◽

Tetsuji Takeda ◽

Hiroki Ohkuma

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Brain Tumors ◽

Blood Loss ◽

Elderly Patients ◽

Univariate Analysis ◽

Intraoperative Blood Loss ◽

Systemic Complications ◽

Level Difference ◽

Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

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Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000339 ◽

2015 ◽

Vol 25 (2) ◽

pp. 193-202 ◽

Cited By ~ 10

Author(s):

Mariam AlHilli ◽

Carrie Langstraat ◽

Christine Tran ◽

Janice Martin ◽

Amy Weaver ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Postoperative Complications ◽

Epithelial Ovarian Cancer ◽

Odds Ratio ◽

Residual Disease ◽

Factors Associated ◽

Primary Surgery ◽

American Society ◽

American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

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Systematic Review with Meta-Analysis: Fecal Calprotectin as a Surrogate Marker for Predicting Relapse in Adults with Ulcerative Colitis

Mediators of Inflammation ◽

10.1155/2019/2136501 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Jiajia Li ◽

Xiaojing Zhao ◽

Xueting Li ◽

Meijiao Lu ◽

Hongjie Zhang

Keyword(s):

Ulcerative Colitis ◽

Receiver Operating Characteristic ◽

Likelihood Ratio ◽

Odds Ratio ◽

Operating Characteristic ◽

Diagnostic Odds Ratio ◽

Fecal Calprotectin ◽

Clinical Relapse ◽

Sensitivity Specificity ◽

Receiver Operating

The clinical course of ulcerative colitis (UC) is featured by remission and relapse, which remains unpredictable. Recent studies revealed that fecal calprotectin (FC) could predict clinical relapse for UC patients in remission, which has not yet been well accepted. To detect the predictive value of FC for clinical relapse in adult UC patients based on updated literature, we carried out a comprehensive electronic search of PubMed, Web of Science, Embase, and the Cochrane Library to identify all eligible studies. Diagnostic accuracy including pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and pooled area under the receiver operating characteristic (AUROC) was calculated using a random effects model. Heterogeneity across studies was assessed by the I2 metric. Sources of heterogeneity were detected using subgroup analysis. Metaregression was used to test potential factors correlated to DOR. Publication bias was assessed using Deek’s funnel plots. In our study, 14 articles enrolling a total of 1110 participants were finally included, and all articles underwent a quality assessment. Pooled sensitivity, specificity, PLR, and NLR with 95% confidence intervals (CIs) were 0.75 (95% CI: 0.70–0.79), 0.77 (95% CI: 0.74–0.80), 3.45 (95% CI: 2.31–5.14), and 0.37 (95% CI: 0.28–0.49) respectively. The area under the summary receiver operating characteristic (sROC) curve was 0.82, and the diagnostic odds ratio was 10.54 (95% CI: 6.16–18.02). Our study suggested that FC is useful in predicting clinical relapse for adult UC patients in remission as a simple and noninvasive marker.

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14031 ◽

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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Performa Rapid Emergency Medicine Score dalam Memprediksi Outcome Pasien Trauma Kepala di Instalasi Gawat Darurat

Jurnal Kedokteran Brawijaya ◽

10.21776/ub.jkb.2019.030.04.13 ◽

2019 ◽

Vol 30 (4) ◽

pp. 302

Author(s):

Didik Mulyono ◽

Nurdiana Nurdiana ◽

Rinik Eko Kapti

Keyword(s):

Emergency Medicine ◽

Glasgow Coma Scale ◽

Receiver Operating Characteristic ◽

Odds Ratio ◽

Area Under Curve ◽

Operating Characteristic ◽

Severe Disability ◽

P Value ◽

Coma Scale ◽

Purposive Sampling

<p><br />Rapid Emergency Medicine Score (REMS) merupakan suatu sistem skor yang telah digunakan secara luas di berbagai negara untuk memprediksi mortalitas pasien non bedah maupun trauma di Instalasi Gawat Darurat (IGD), tetapi belum diuji pada populasi yang spesifik pada trauma kepala. Tujuan penelitian ini untuk menilai performa REMS dalam memprediksi outcome pasien trauma kepala di IGD. Penelitian ini menggunakan desain observasi analitik dengan pendekatan retrospektif. Sampel menggunakan data rekam medis pasien dengan trauma kepala sedang-berat disesuaikan dengan kriteria inklusi dan eksklusi dan digunakan teknik purposive sampling yaitu sebanyak 181 responden. Analisis bivariat yang dilakukan pada penelitian ini menggunakan uji Somers'd, sedangkan analisis multivariat menggunakan regresi logistik ordinal. Selanjutnya, kemampuan untuk memprediksi outcome dinilai menggunakan analisis the area under the receiver operating characteristic (AUROC). Hasil uji bivariat menunjukkan bahwa nilai somers'd REMS sebesar 0,310 dengan p value <0,001 dan arah hubungan positif dengan outcome pasien trauma kepala. Hasil regresi logistik ordinal menunjukkan parameter Glasgow Coma Scale (GCS) memperoleh Odds Ratio sebesar 0,7, artinya skor GCS yang rendah memiliki risiko memperoleh outcome death sebesar 0,7 kali lebih besar dibandingkan memperoleh outcome moderate disability, severe disability, persisten vegetatif state. Nilai Area Under Curve (AUC) REMS pada cut of point >5 dengan sensitivitas 61,4 dan spesifisitas 77,8 adalah 0,753 (95% CI; 0,683-0,814. REMS menunjukkan performa yang baik dalam memprediksi outcome pasien trauma kepala.</p>

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