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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Anqi Du ◽  
Xiao Li ◽  
Youzhong An ◽  
Zhancheng Gao

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.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xueting Yuan ◽  
Jin Jin ◽  
Xiaomao Xu

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.


2021 ◽  
Author(s):  
Euxu Xie ◽  
Xuelian Gu ◽  
Chen Ma ◽  
Li Guo ◽  
Man Li ◽  
...  

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.


2022 ◽  
Vol 12 ◽  
Author(s):  
Yu Meng ◽  
Jing Lin ◽  
Jianxia Fan

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.


2022 ◽  
Vol 12 ◽  
Author(s):  
Zhiqiang Zhang ◽  
Yunlin Ye ◽  
Jiajie Yu ◽  
Shufen Liao ◽  
Weibin Pan ◽  
...  

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.


2021 ◽  
Author(s):  
Shuguang Yang ◽  
Zhidong Gao ◽  
Huiying Zhao ◽  
Youzhong An ◽  
Jianghui Yang ◽  
...  

Abstract Objective: Postoperative bowel obstruction was one of the most severe complications in patients received colorectal surgeries. The aim of this study was to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods: The records of 1437 patients who underwent selective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 was retrospectively collect. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results: COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed a robust discrimination, with area under the receiver operating characteristic curve was 0.894 and was well calibrated. Conclusion: A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Shen ◽  
Feng Guo ◽  
Yan Sun ◽  
Jingyuan Zhao ◽  
Jin Hu ◽  
...  

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).


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuguang Yang ◽  
Huiying Zhao ◽  
Jianhui Yang ◽  
Youzhong An ◽  
Hua Zhang ◽  
...  

Abstract Objective Postoperative bowel obstruction was one of the most severe complications in patients who received colorectal surgeries. This study aimed to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods The records of 1437 patients who underwent elective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 were retrospectively collected. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed robust discrimination, with the area under the receiver operating characteristic curve was 0.894 and was well-calibrated. Conclusion A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.


2021 ◽  
pp. jim-2021-001855
Author(s):  
Yin Zhang ◽  
Qingxia Shi ◽  
Guochao Zhong ◽  
Xun Lei ◽  
Jilei Lin ◽  
...  

This study aims to establish a new scoring system based on biomarkers for predicting in-hospital mortality of children admitted to the pediatric intensive care unit (PICU). The biomarkers were chosen using the least absolute shrinkage and selection operator (LASSO)-logistic regression in this observational case-control study. The performance of the new predictive model was evaluated by the area under the receiver operating characteristic curve (AUC). Calibration plot was established to validate the new score accompanied by the Hosmer-Lemeshow test. There were 8818 patients included in this study. Finally, six predictors were included in the LASSO-regression model. Albumin <40 g/L, lactate dehydrogenase >452 U/L, lactate >3.2 mmol/L, urea >5.6 mmol/L, arterial PH <7.3 and glucose >6.9 mmol/L were treated as risk factors for higher mortality. The new score ranged from 1 to 6 among all the included patients. In the training set, the AUC of the probability of in-hospital mortality for the new predictive model was 0.81 (95% CI 0.79 to 0.84), which is larger than for the Pediatric Critical Illness Score (PCIS) (0.69, 95% CI 0.66 to 0.72). Similarly, in the validating set, the AUC of the probability of in-hospital mortality was larger for the new score (0.80, 95% CI 0.77 to 0.84) than for PCIS (0.67, 95% CI 0.63 to 0.72). The calibration plot and Hosmer-Lemeshow test showed excellent calibration. The calculated ORs showed a trend that higher scores indicated higher risk of death (p value for trend <0.001). In summary, this study develops and validates a totally biomarker-based new score to predict in-hospital mortality for pediatric patients admitted to PICU. More attention and more positive care and treatment should be given to children with a higher score.


2020 ◽  
Author(s):  
Shiwei Li ◽  
Hongcai Wang ◽  
Feng Li ◽  
Maosong Chen ◽  
Pandi Chen

Abstract Background: Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event, however, little is known about the risk factors and underlying mechanisms. This study aimed to investigate the association between NLRR (a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio) and DICH secondary to VP shunt.Methods: We performed a retrospective review of patients who underwent VP shunt between January 2016 and June 2020. Multivariable logistic regression analysis was used to assess the association of DICH and NLRR. Then patients were divided into two groups according to the optimal cut-off point of NLRR, propensity score matching (PSM) method was performed to reconfirm the result.Results: A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR (odds ratio [OR], 2.774; 95% confidence interval [CI], 1.372-5.609; P<0.001) and history of craniotomy (OR, 3.505; 95%CI, 1.040-11.813; p=0.043) were independent risk factors for DICH secondary to VP shunt. Receiver operating characteristic curve analysis of NLRR showed that area under the curve was 0.832. The optimal cut off point of NLRR was 2.05, and the sensitivity was 89.7%, the specificity was 63.4%. Patients with NLRR>2.05 had much higher incidence of DICH (OR, 11.25; 95%CI, 1.35-93.50; p=0.025; PSM cohort, n=82). Conclusions: Our finding suggested that DICH following VP shunt was not a rare complication and elevated NLRR could independently predict DICH. Inflammatory responses might play an important role in the development of DICH following VP shunt.


2021 ◽  
pp. 174749302110062
Author(s):  
Marie Louise E Bernsen ◽  
Frans Kauw ◽  
Jasper M Martens ◽  
Aad van der Lugt ◽  
Lonneke SF Yo ◽  
...  

Background Early prediction of malignant infarction may guide treatment decisions. For patients who received endovascular treatment, the risk of malignant infarction is unknown and risk factors are unrevealed. Aims The objective of this study is to estimate the incidence of malignant infarction after endovascular treatment in patients with an occlusion of the anterior circulation, to identify independent risk factors, and to establish a model for prediction. Methods We analyzed patients who received endovascular treatment for a large vessel occlusion in the anterior circulation within 6.5 h after symptom onset, included in the Dutch MR CLEAN Registry between March 2014 and June 2016. We compared patients with and without malignant infarction. Candidate predictors were incorporated in a multivariable binary logistic regression model. The final prediction model was established using backward elimination. Discrimination and calibration were evaluated with the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test. Results Of 1445 patients, 82 (6%) developed malignant infarction. Independent predictors were lower age, higher National Institutes of Health Stroke Scale (NIHSS), lower alberta stroke program early CT score (ASPECTS), internal carotid artery occlusion, lower collateral score, longer times from onset to groin puncture, and unsuccessful reperfusion. The AUROC of a prediction model combining these features was 0.83 (95% confidence interval (CI): 0.79–0.88) and the Hosmer-Lemeshow test indicated appropriate calibration (P = 0.937). Conclusion The risk of malignant infarction after endovascular treatment started within 6.5 h of stroke onset is approximately 6%. Successful reperfusion decreases the risk. A prediction model combining easily retrievable measures of age, ASPECTS, collateral status, and reperfusion shows good discrimination between patients who will develop malignant infarction and those who will not.


Sign in / Sign up

Export Citation Format

Share Document