Development of a nomogram for predicting the presence of combined pulmonary fibrosis and emphysema

Abstract Background In the clinical management of patients with combined pulmonary fibrosis and emphysema (CPFE), early recognition and appropriate treatment is essential. This study was designed to develop an accurate prognostic nomogram model to predict the presence of CPFE. Methods We retrospectively enrolled 85 patients with CPFE and 128 patients with idiopathic pulmonary fibrosis (IPF) between January 2015 and January 2020. Clinical characteristics were compared between groups. A multivariable logistic regression analysis was performed to identify risk factors for CPFE. Then, and a nomogram to predict the presence of CPFE was constructed for clinical use. Concordance index (C-index), area under the receiver operating characteristic curve (AUC), and calibration plot was used to evaluate the efficiency of the nomogram. Results Compared to the IPF group, the proportion of patients with male, smoking and allergies were significantly higher in the CPFE group. In terms of pulmonary function tests, patients with CPFE had lower FEV1/FVC%, DLCO/VA% pred, and higher RV, RV%pred, VC, VC%pred, TLC%pred, VA, TLC, TLC%pred, FVC, FVC%pred and FEV1 with significant difference than the other group. Positive correlation was found between DLCO and VA%, RV%, TLC% in patients with IPF but not in patients with CPFE. By multivariate analysis, male, smoking, allergies, FEV1/FVC% and DLCO/VA%pred were identified as independent predictors of the presence of CPFE. The nomogram was then developed using these five variables. After 1000 internal validations of bootstrap resampling, the C-index of the nomogram was 0.863 (95% CI 0.795–0.931) and the AUC was 0.839 (95% CI 0.764–0.913). Moreover, the calibration plot showed good concordance of incidence of CPFE between nomogram prediction and actual observation (Hosmer–Lemeshow test: P = 0.307). Conclusions Patients of CPFE have a characteristic lung function profile including relatively preserved lung volumes and ventilating function, contrasting with a disproportionate reduction of carbon monoxide transfer. By incorporating clinical risk factors, we created a nomogram to predict the presence of CPFE, which may serve as a potential tool to guide personalized treatment.

Download Full-text

Risk factors of prolonged ventilation after thymectomy in thymoma myasthenia gravis patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01668-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Anqi Du ◽

Xiao Li ◽

Youzhong An ◽

Zhancheng Gao

Keyword(s):

Risk Factors ◽

Myasthenia Gravis ◽

Characteristic Curve ◽

Operation Time ◽

Calibration Plot ◽

Multivariable Logistic Regression Analysis ◽

Predictive Tool ◽

Prolonged Ventilation ◽

Peking University ◽

Lemeshow Test

Abstract Background To explore the risk factors for prolonged ventilation after thymectomy in patients with thymoma associated with myasthenia gravis (TAMG). Methods We reviewed the records of 112 patients with TAMG after thymectomy between January 2010 and December 2019 in Peking University People’s Hospital. Demographic, pathological, preoperative data and the Anesthesia, surgery details were assessed with multivariable logistic regression analysis to predict the risk of prolonged ventilation after thymectomy. A nomogram to predict the probability of post-thymectomy ventilation was constructed with R software. Discrimination and calibration were employed to evaluate the performance of the nomogram. Results By multivariate analysis, male, low vital capacity (VC), Osserman classification (IIb, III, IV), total intravenous anesthesia, and long operation time were identified as the risk factors and entered into the nomogram. The nomogram showed a robust discrimination, with an area under the receiver operating characteristic curve (AUC) of 0. 835 (95% confidence interval [CI], 0.757–0.913). The calibration plot indicated that the nomogram-predicted probabilities compared very well with the actual probabilities (Hosmer–Lemeshow test: P = 0.921). Conclusion The nomogram is a valuable predictive tool for prolonged ventilation after thymectomy in patients with TAMG.

Download Full-text

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

BMC Cancer ◽

10.1186/s12885-021-08201-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jian Shen ◽

Feng Guo ◽

Yan Sun ◽

Jingyuan Zhao ◽

Jin Hu ◽

...

Keyword(s):

Pancreatic Fistula ◽

Validation Cohort ◽

Characteristic Curve ◽

Postoperative Pancreatic Fistula ◽

Individual Risk ◽

Calibration Plot ◽

Multivariable Logistic Regression Analysis ◽

Lasso Regression ◽

Training Cohort ◽

Significant Difference

Abstract Background Postoperative pancreatic fistula (POPF) represents the most common complication following pancreaticoduodenectomy (PD). Predictive models are needed to select patients with a high risk of POPF. This study was aimed to establish an effective predictive nomogram for POPF following PD. Methods Consecutive patients who had undergone PD between January 2016 and May 2020 at a single institution were analysed retrospectively. A predictive nomogram was established based on a training cohort, and Lasso regression and multivariable logistic regression analysis were used to evaluate predictors. The predictive abilities of the predicting model were assessed for internal validation by the area under the receiver operating characteristic curve (AUC) and calibration plot using bootstrap resampling. The performance of the nomogram was compared with that of the currently used a-FRS model. Results A total of 459 patients were divided into a training cohort (n = 302) and a validation cohort (n = 157). No significant difference was observed between the two groups with respect to clinicopathological characteristics. The POPF rate was 16.56%. The risk factors of POPF POPF were albumin difference, drain amylase value on postoperative day 1, pancreas texture, and BMI, which were all selected into a nomogram. Nomogram application revealed good discrimination (AUC = 0.87, 95% CI: 0.81–0.94, P < 0.001) as well as calibration abilities in the validation cohort. The predictive value of the nomogram was better than that of the a-FRS model (AUC: 0.87 vs 0.62, P < 0.001). Conclusions This predictive nomogram could be used to evaluate the individual risk of POPF in patients following PD, and albumin difference is a new, accessible predictor of POPF after PD. Trial registration This study was registered in the Chinese Clinical Trial Register (ChiCTR2000034435).

Download Full-text

Development and Validation of a Nomogram for Predicting Bladder Calculi Risk in Patients With Benign Prostatic Hyperplasia

10.21203/rs.3.rs-934816/v1 ◽

2021 ◽

Author(s):

Euxu Xie ◽

Xuelian Gu ◽

Chen Ma ◽

Li Guo ◽

Man Li ◽

...

Keyword(s):

Risk Factors ◽

Benign Prostatic Hyperplasia ◽

Characteristic Curve ◽

Prostatic Hyperplasia ◽

Calibration Plot ◽

Lasso Regression ◽

Net Benefit ◽

Bladder Calculi ◽

Validation Set ◽

Selection Operator

Abstract Objective To develop and validate a nomogram for predicting bladder calculi risk in patients with benign prostatic hyperplasia (BPH).Methods A total of 368 patients who underwent transurethral resection of the prostate (TURP) and had histologically proven BPH from January 2018 to January 2021 were retrospectively collected. Eligible patients were randomly assigned to the training and validation datasets. Least absolute shrinkage and selection operator (LASSO) regression was used to select the optimal risk factors. A prediction model was established based on the selected characteristics. The performance of the nomogram was assessed by calibration plots and the area under the receiver operating characteristic curve (AUROC). Furthermore, decision curve analysis (DCA) was used to determine the net benefit rate of of the nomogram. Results Among 368 patients who met the inclusion criteria, older age, a history of diabetes and hyperuricemia, longer intravesical prostatic protrusion (IPP)and larger prostatic urethral angulation (PUA) were independent risk factors for bladder calculi in patients with BPH. These factors were used to develop a nomogram, which had a good identification ability in predicting the risk of bladder calculi in patients, with AUROCs of 0.911 (95% CI: 0.876–0.945) in the training set and 0.884 (95% CI: 0.820–0.948) in the validation set. The calibration plot showed that the model had good calibration. Moreover, DCA indicated that the model had a goodclinical benefit. Conclusion We developed and internally validated the first nomogram to date to help physicians assess the risk of bladder calculi in patients with BPH, which may help physicians improve individual interventions and make better clinical decisions.

Download Full-text

A Novel Nomogram for Predicting the Risk of Premature Delivery Based on the Thyroid Function in Pregnant Women

Frontiers in Endocrinology ◽

10.3389/fendo.2021.793650 ◽

2022 ◽

Vol 12 ◽

Author(s):

Yu Meng ◽

Jing Lin ◽

Jianxia Fan

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Preterm Delivery ◽

Thyroid Function ◽

Premature Delivery ◽

Multivariable Logistic Regression Analysis ◽

Decision Curve Analysis ◽

Cutoff Values ◽

Lemeshow Test ◽

Maternal Thyroid

BackgroundMaternal thyroid dysfunction and autoantibodies were associated with preterm delivery. However, recommendations for cutoff values of thyroperoxidase antibody (TPOAb) positivity and thyroid-stimulating homone (TSH) associated with premature delivery are lacking.ObjectiveTo identify the pregnancy-specific cutoff values for TPOAb positivity and TSH associated with preterm delivery. To develop a nomogram for the risk prediction of premature delivery based on maternal thyroid function in singleton pregnant women without pre-pregnancy complications.MethodsThis study included data from the International Peace Maternity and Child Care Health Hospital (IPMCH) in Shanghai, China, between January 2013 and December 2016. Added data between September 2019 and November 2019 as the test cohort. Youden’s index calculated the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration. Univariate and multivariable logistic regression analysis were used to screen the risk factors of premature delivery. The nomogram was developed according to the regression coefficient of relevant variables. Discrimination and calibration of the model were assessed using the C-index, Hosmer-Lemeshow test, calibration curve and decision curve analysis.Results45,467 pregnant women were divided into the training and validation cohorts according to the ratio of 7: 3. The testing cohort included 727 participants. The pregnancy-specific cutoff values associated with the risk of premature delivery during the first trimester were 5.14 IU/mL for TPOAb positivity and 1.33 mU/L for TSH concentration. Multivariable logistic regression analysis showed that maternal age, history of premature delivery, elevated TSH concentration and TPOAb positivity in the early pregnancy, preeclampsia and gestational diabetes mellitus were risk factors of premature delivery. The C-index was 0.62 of the nomogram. Hosmer-Lemeshow test showed that the Chi-square value was 2.64 (P = 0.955 > 0.05). Decision curve analysis showed a positive net benefit. The calibration curves of three cohorts were shown to be in good agreement.ConclusionsWe identified the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration associated with preterm delivery in singleton pregnant women without pre-pregnancy complications. We developed a nomogram to predict the occurrence of premature delivery based on thyroid function and other risk factors as a clinical decision-making tool.

Download Full-text

PREVALENCE OF BOVINE FACIOLOSIS IN HALABA MUNICIPAL ABATTOR SOUTHERN ETHIOPIA

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v4.i11.2016.2423 ◽

2016 ◽

Vol 4 (11) ◽

pp. 82-91

Author(s):

Muna Abdella ◽

WubitTafese Mhatebu

Keyword(s):

Risk Factors ◽

Body Condition ◽

Cross Sectional Study ◽

Control Measures ◽

Southern Ethiopia ◽

Multivariable Logistic Regression Analysis ◽

Cross Sectional ◽

Significant Difference ◽

Prevention And Control Measures ◽

Associated Risk Factors

A cross-sectional study was carried out from November 2015 to march 2016 on bovine fasciolosis, to assess the abattoir based prevalence, predominant species of bovine fasciolosis and associated risk factors of the disease in cattle slaughtered in Halaba municipal abattoir. A total of 384 cattle were examined using post mortem examination. Infection rates were (3.64%), 2.34%, 2.08%, and 1.82 % F. gigantic, F. hepatica, mixed and immature respectively with the overall prevalence of 9.88 % (38). F. gigantic was found to be the most prevalent species in cattle of the study area. Multivariable logistic regression analysis showed that the risk of fasciola infection was significantly higher in poor body condition animals than in medium and good body condition animals (p < 0.05). However, in terms of age, sex and breed, no statistically significant difference was found between infected animals (p > 0.05).The present study showed that bovine fasciolosis is one of the important pathogens in cattle in the study area and warrants appropriate disease prevention and control measures and further epidemiological investigations to determine the different agro ecological risk factors on the occurrence of the disease.

Download Full-text

FC04-02 - Traumatic experiences as a risk factor for suicide in adolescence

European Psychiatry ◽

10.1016/s0924-9338(11)73533-7 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1829-1829

Author(s):

M. Delalle ◽

K. Dodig-Ćurković ◽

P. Filaković

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Early Recognition ◽

Child And Adolescent Psychiatry ◽

University Hospital ◽

Traumatic Experience ◽

Traumatic Experiences ◽

Hospital Treatment ◽

Control Group ◽

Significant Difference

IntroductionToday, the general interpretation of the etiology of various psychopathological symptoms in adolescence does not talk about causes, but the risk factors.AimWe tried to determine whether traumatic experiences among adolescents represent a risk factor for suicide.MethodsThe study was conducted at the University Department for Child and Adolescent Psychiatry, University Hospital Osijek in 2006. and 2007. years.In the study period we included 100 patients, the experimental group consisted of 50 patients who were admitted to the department for attempted suicide in the order of admission to hospital treatment, the control group consisted of 50 patients admitted to the department for other psychiatric disorders, also in the order of admission to treatment / diagnosed according to DSM IV/.ResultsAge range of 13–18 years. There was no statistically significant difference between the two groups of subjects according to age (χ2 = 5289, df = 5, p = .382) and according to sex (χ2 = .694, df = 1, p = .405). In the suicidal group 38 patients (76%) reported traumatic experiences /most in family context/ while in nonsuicidal group 27 patients (54%) what is statistical difference (χ2 = 5319, df = 1, p = .021).ConclusionIn daily psychiatric work we must focus on adolescents who have experienced traumatic experiences and is therefore extremely important in anamnesis always ask for the lived traumatic experience. Family practitioners, specialists in educational institutions, parents and adolescents themselves have a role in early recognition of these risk factors.

Download Full-text

1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1345 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S540-S540

Author(s):

Bhavana Surapareddy ◽

Muralidhar Varma ◽

Shashidhar V

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Laboratory Data ◽

Kidney Injury ◽

Serum Lactate ◽

Significant Difference ◽

Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

Download Full-text

Clinical and follow-up study of bronchiolitis obliterans in pediatric patients in China

European Journal of Inflammation ◽

10.1177/1721727x17733392 ◽

2017 ◽

Vol 15 (3) ◽

pp. 152-159 ◽

Cited By ~ 1

Author(s):

Li Huang ◽

Yaping Xie ◽

Huifeng Fan ◽

Gen Lu ◽

Jialu Yu ◽

...

Keyword(s):

Risk Factors ◽

Bronchiolitis Obliterans ◽

Pediatric Patients ◽

Medical Center ◽

Pulmonary Function Tests ◽

Age At Onset ◽

Airflow Obstruction ◽

High Resolution Computed Tomography ◽

Significant Difference ◽

Post Infectious

Bronchiolitis obliterans (BO) is in general a rare and life-threatening form of non-reversible obstructive lung disease in which the bronchioles are compressed and narrowed by fibrosis and/or inflammation. The purpose of this study was to evaluate the clinical features of BO in pediatric patients and explore its risk factors. The medical records of 35 pediatric patients with BO at Guangzhou Women and Children’s Medical Center were evaluated. The age at onset of symptoms was 2–42 months (mean 13.3 ± 8.9 months), with age at diagnosis of 5 months–4 years (mean 17.8 ± 9.0 months). High-resolution computed tomography findings included mosaic pattern (100%), atelectasis (37.1%), air trapping (31.4%), and bronchiectasis (20.0%). Three patients received lung biopsies and mainly exhibited an inflammatory process surrounding the lumen of bronchioles. BO predominantly resulted from post-infectious causes (91.4%) which were primarily caused by adenovirus (50%), followed by Mycoplasma pneumoniae (46.7%) and influenza (20%). Pulmonary function tests (PFTs) showed severe and fixed airflow obstruction, decreased compliance, and increased resistance. No significant difference was found between before and after steroid treatment ( P > 0.05). Two patients died owing to severe pulmonary complications, one of whom had inherent immunodeficiency. Our study suggests that the occurrence of BO, especially post-infectious BO, in China is relatively high and might result from primary immunodeficiency diseases in severe cases. Recurrent aspiration pneumonia caused by congenital dysplasia of the larynx and vaccination not on schedule might be potential risk factors for persistent and recurrent BO.

Download Full-text

A Nomogram for Predicting Intraoperative Hemodynamic Instability in Patients With Pheochromocytoma

Frontiers in Endocrinology ◽

10.3389/fendo.2021.787786 ◽

2022 ◽

Vol 12 ◽

Author(s):

Zhiqiang Zhang ◽

Yunlin Ye ◽

Jiajie Yu ◽

Shufen Liao ◽

Weibin Pan ◽

...

Keyword(s):

Characteristic Curve ◽

Clinical Effectiveness ◽

Hemodynamic Instability ◽

Calibration Plot ◽

Surgical Removal ◽

Lemeshow Test ◽

Life Threatening ◽

Selection Operator ◽

Risk Predictors ◽

Good Agreement

PurposeSurgical removal of pheochromocytoma (PCC), including open, laparoscopic, and robot-assisted adrenalectomy, is the cornerstone of therapy, which is associated with high risk of intraoperative and postoperative life-threatening complications due to intraoperative hemodynamic instability (IHD). This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery.MethodsThe data from 112 patients with pheochromocytoma were collected at a single center between January 1, 2010, and December 31, 2019. Clinical and radiological features were selected with the least absolute shrinkage and selection operator regression analysis to predict IHD then constitute a nomogram. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultsAge, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD. The nomogram was then developed using these seven variables. The model showed good discrimination with a C-index of 0.773 (95% CI, 0.683–0.862) and an area under the receiver operating characteristic curve (AUC) of 0.739 (95% CI, 0.642–0.837). The calibration plot suggested good agreement between predicted and actual probabilities. Besides, calibration was tested with the Hosmer–Lemeshow test (P = 0.961). The decision curve showed the clinical effectiveness of the nomogram.ConclusionsOur nomogram based on clinical and CT parameters could facilitate the treatment strategy according to assessment of the risk of IHD in patients with pheochromocytoma.

Download Full-text

Nomogram Prediction of Severe Risk in Patients With COVID-19 Pneumonia: A Retrospective Study

10.21203/rs.3.rs-42479/v1 ◽

2020 ◽

Author(s):

Fang Zheng ◽

Run Yao ◽

Jiyang Liu ◽

Ruochan Chen ◽

Ning Li

Keyword(s):

Risk Factors ◽

Severe Pneumonia ◽

Clinical Decision ◽

Calibration Plot ◽

Therapeutic Effects ◽

Net Benefit ◽

Effective Therapeutic Strategy ◽

Independent Risk Factors ◽

Logical Regression ◽

Good Concordance

Abstract Background COVID-19 elicits a range of different responses in patients and can manifest into mild to very severe cases in different individuals, depending on many factors. We aimed to establish a prediction model of severe risk in COVID-19 patients, to help clinicians achieve early prevention, intervention, and aid them in choosing effective therapeutic strategy. Methods We selected confirmed COVID-19 patients who admitted to First Hospital of Changsha city between January 29 and February 15, 2020 and collected their clinical data. Multivariate logical regression was used to identify the risk factors associated with severe risk. These factors were incorporated into the nomogram to establish the model. The ROC curve, calibration plot and decision curve were used to assess the performance of model. Results 239 patients were enrolled and 45 (18.83%) patients developed severe pneumonia. Univariate and multivariate analysis showed that age, COPD, shortness of breath, fatigue, creatine kinase, D-dimer, lymphocytes and h CRP were independent risk factors for severe risk in COVID-19 patients. Incorporating these factors, the nomogram achieved good concordance indexes of 0.873 (95% CI: 0.819–0.927), and well-fitted calibration plot curves. The model provided superior net benefit when clinical decision thresholds were between 10–70% predicted risk. Conclusions Using the model, clinicians can intervene early, improve therapeutic effects and reduce the severity of COVID-19, thus ensuring more targeted and efficient use of medical resources.

Download Full-text