Members of the glutathione (GSH) and ABC-transporter families are associated with clinical outcomes in patients with diffuse large B-cell lymphoma (DLCL)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10035-10035
Author(s):  
C. Andreadis ◽  
P. A. Gimotty ◽  
P. Wahl ◽  
R. Hammond ◽  
J. Houldsworth ◽  
...  
Keyword(s):  
Drug Resistance ◽  
High Risk ◽  
Abc Transporter ◽  
Failure Time ◽  
Risk Group ◽  
Risk Groups ◽  
Time To Failure ◽  
Key Genes ◽  
Probe Set ◽  
Disease Free

10035 Background: Chemotherapy only cures 60–70% of DLCL patients (pts). While genes in both the GSH and ABC-transporter families have been implicated in drug resistance in other malignancies, their role in DLCL remains controversial. Methods: This study includes 94 DLCL pts with tissue expression data obtained prior to anthracycline-based chemotherapy from 2 oligonucleotide microarray datasets (Affymetrix) with annotated clinical information. Patient-level expression was derived for 10 key genes utilizing probe set matching and levels were adjusted for a common probe set signal. Freedom-from-progression (FFP) was analyzed using an accelerated failure-time regression model, stratified by the international prognostic index (IPI). CART software was used to develop a classification tree for the 2-year disease-free rate. Results: Based on IPI, 48% of pts were low risk, 23% were low-intermediate (int) risk, 24% high-int risk, and 12% were high risk. After therapy, 30 pts (32%) had disease relapse or progression within 2 yrs and 58 pts (62%) were disease-free; 6 (6%) had shorter follow-up. Expression of multi-drug resistance 1 (MDR1; ABCB1) was favorably associated with FFP (β=1.89, p=0.004), with a 100-point change in the expression signal resulting in a near-doubling of the time to failure (time ratio (TR) = 2.2, 95%CI: 1.3–3.6). Expression of GSH S-transferase μ, classes 1/2/4 (GSTM124) was also favorably associated with FFP (β=0.14, p=0.001); a 1000-point signal change resulted in a near-doubling of the time to failure (TR=1.8, 1.3–2.4). Based on our tree, 2 risk groups were identified using IPI and 3 genes: ABCB1, GSTM124, and GSH cysteine ligase modifier (GCLM). Thus, 89% (78%-96%) pts in the low-risk group (N=56) were disease-free at 2 yrs vs. 25% (11%-43%) pts in the high-risk group (p<0.001). Conclusions: We observed a significant favorable association between expression of genes in the GSH and ABC-transporter families, and FFP in pts treated for DLCL. Moreover, we generated 2 risk groups based on the IPI and the expression of 3 key genes, which we plan to validate in an independent dataset. Our findings suggest an additional role for these genes that are classically associated with drug resistance. No significant financial relationships to disclose.

scholarly journals The Combination of MRD and Copy Number Alterations (CNAs) Defines an Ultra-High Risk Group of Children with Primary T-Lymphoblastic Leukemia (T-ALL)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2911-2911
Author(s):  
Joachim B. Kunz ◽  
Julia Seemann ◽  
Martin Zimmermann ◽  
Paulina Richter-Pechanska ◽  
Obul Reddy Bandapalli ◽  
...  
Keyword(s):  
High Risk ◽  
Candidate Genes ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Copy Number Alterations ◽  
Ultra High Risk ◽  
Cdkn2a Deletion ◽  
Probe Set ◽  
Risk Of Relapse

Abstract As relapses in precursor T-ALL are frequently refractory to treatment, patients at high risk of relapse need to be identified and treated with intensified or novel regimens. Because minimal residual disease (MRD) assessment identifies patients at high risk only after induction treatment has been completed, there is an urgent need for genetic markers that allow for early risk stratification. We aimed at identifying such markers by analyzing a cohort of patients treated by ALL BFM 2000 and AIEOP-BFM ALL 2009 protocols for CNAs in both established leukemia driver genes and in a set of nine novel candidate genes that had been found to be frequently affected by gene panel sequencing. We analyzed bone marrow DNA of a large cohort of children with T-ALL for copy number alterations (CNA) by multiplex ligation dependent probe amplification (MLPA) using the commercially available probe set P383 (MRC Holland) and a custom made probe set targeting additional 9 genes (STAT5B, CNOT3, CNOT6, CTCF, ABCA5, PDGFRB, MYC, PTK2B, AKT1). We correlated the occurrence of these CNAs with risk of relapse and found that none of the CNAs listed in tables 1 and 2 as a single alteration predicted the risk of relapse in any risk group. By contrast, the combination of CNAs can define risk signatures. Specifically, we found the frequently linked deletions of CDKN2A and MLLT3 on chromosome 9p21.3 to have distinct effects: While biallelic CDKN2A-deletions increase the risk of relapse (Hazard ratio 2.1, p(χ)=0.049), this effect is counteracted by deletions of MLLT3, which reduce the risk of relapse (hazard ratio 0.35, p(χ)=0.031). Consequently, a combination of CDKN2A and MLLT3 deletions, together with activating mutations of NOTCH1, defines three risk groups in the German cohort of 209 patients treated in the intermediate and high risk groups of the ALL BFM 2000 protocol: Patients that carry both a NOTCH1 mutation and an MLLT3 deletion, but not a biallelic CDKN2A deletion, have a 5 year cumulative incidence of relapse (CIR) of 3% (1/29), whereas patients with biallelic CDKN2A deletion without MLLT3 deletion have a 5 year CIR of 26% (20/78; p=0.0057). All remaining patients have a 5 year CIR of 10 % (10/102). Notably, this risk signature might be highly dependent on the treatment context, because it predicted risk neither in 119 AIEOP-BFM 2009 patients treated in Czech Republic and Germany nor in 80 ALL BFM 2000 patients treated in Austria. We next considered the MRD-defined high-risk (HR) group of the BFM 2000 and AIEOP-BFM 2009 protocols consisting of 37 patients. At least one of the 9 CNAs listed in table 2 was detected in 64 of 376 patients of whom a complete set of clinical data were available and in 11 of 37 HR-patients (p=0.04). The presence of any of these 9 CNAs splits the HR group in a smaller "ultra-high risk group" with a 5 year CIR of 82% (8/11) and a larger group of patients with a 5 year CIR of only 24% (6/26) (p(Gray)=0.005). Neither was there an effect in MRD-MR patients nor in patients who were HR defined by prednisone-poor-response only. It must be noted that the deletions and amplifications shown in table 2 are part of large CNAs. Therefore, the indicated genes do not necessarily define risk per se but may represent markers for other changes with functional relevance or may indicate a more general genomic instability. We conclude that complementing MRD risk parameters with an analysis of common CNAs refines the current risk stratification and may identify an ultra-high risk group of children with T-ALL, who are candidates for experimental treatment even in primary disease. Table 1 Frequency of known and functional CNAs detected by P383 in BFM 2000 and BFM 2009 T-ALL patients Table 1. Frequency of known and functional CNAs detected by P383 in BFM 2000 and BFM 2009 T-ALL patients Table 2 Frequency of CNA defined by novel candidate genes in BFM 2000 and 2009 patients Table 2. Frequency of CNA defined by novel candidate genes in BFM 2000 and 2009 patients Disclosures No relevant conflicts of interest to declare.

Short-term risk stratification using CADILLAC risk score in patients with ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Satou ◽  
H Kitahara ◽  
K Ishikawa ◽  
T Nakayama ◽  
Y Fujimoto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Adverse Events ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Short Term ◽  
Recurrent Myocardial Infarction ◽  
St Elevation

Abstract Background The recent reperfusion therapy for ST-elevation myocardial infarction (STEMI) has made the length of hospital stay shorter without adverse events. CADILLAC risk score is reportedly one of the risk scores predicting the long-term prognosis in STEMI patients. Purpose To invenstigate the usefulness of CADILLAC risk score for predicting short-term outcomes in STEMI patients. Methods Consecutive patients admitted to our university hospital and our medical center with STEMI (excluding shock, arrest case) who underwent primary PCI between January 2012 and April 2018 (n=387) were enrolled in this study. The patients were classified into 3 groups according to the CADILLAC risk score: low risk (n=176), intermediate risk (n=87), and high risk (n=124). Data on adverse events within 30 days after hospitalization, including in-hospital death, sustained ventricular arrhythmia, recurrent myocardial infarction, heart failure requiring intravenous treatment, stroke, or clinical hemorrhage, were collected. Results In the low risk group, adverse events within 30 days were significantly less observed, compared to the intermediate and high risk groups (n=13, 7.4% vs. n=13, 14.9% vs. n=58, 46.8%, p&lt;0.001). In particular, all adverse events occurred within 3 days in the low risk group, although adverse events, such as heart failure (n=4), recurrent myocardial infarction (n=1), stroke (n=1), and gastrointestinal bleeding (n=1), were substantially observed after day 4 of hospitalization in the intermediate and high risk groups. Conclusions In STEMI patients with low CADILLAC risk score, better short-term prognosis was observed compared to the intermediate and high risk groups, and all adverse events occurred within 3 days of hospitalization, suggesting that discharge at day 4 might be safe in this study population. CADILLAC risk score may help stratify patient risk for short-term prognosis and adjust management of STEMI patients. Initial event occurrence timing Funding Acknowledgement Type of funding source: None

scholarly journals Immune‐related Long Noncoding RNA Signature for Patients with Cervical Cancer

2020 ◽  
Author(s):  
Jianfeng Zheng ◽  
Jinyi Tong ◽  
Benben Cao ◽  
Xia Zhang ◽  
Zheng Niu
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Risk Score ◽  
Immune Cell ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Gene Set Enrichment Analysis ◽  
Training Set ◽  
Score Model

Abstract Background: Cervical cancer (CC) is a common gynecological malignancy for which prognostic and therapeutic biomarkers are urgently needed. The signature based on immune‐related lncRNAs(IRLs) of CC has never been reported. This study aimed to establish an IRL signature for patients with CC.Methods: The RNA-seq dataset was obtained from the TCGA, GEO, and GTEx database. The immune scores（IS）based on single-sample gene set enrichment analysis (ssGSEA) were calculated to identify the IRLs, which were then analyzed using univariate Cox regression analysis to identify significant prognostic IRLs. A risk score model was established to divide patients into low-risk and high-risk groups based on the median risk score of these IRLs. This was then validated by splitting TCGA dataset(n=304) into a training-set(n=152) and a valid-set(n=152). The fraction of 22 immune cell subpopulations was evaluated in each sample to identify the differences between low-risk and high-risk groups. Additionally, a ceRNA network associated with the IRLs was constructed.Results: A cohort of 326 CC and 21 normal tissue samples with corresponding clinical information was included in this study. Twenty-eight IRLs were collected according to the Pearson’s correlation analysis between immune score and lncRNA expression (P < 0.01). Four IRLs (BZRAP1-AS1, EMX2OS, ZNF667-AS1, and CTC-429P9.1) with the most significant prognostic values (P < 0.05) were identified which demonstrated an ability to stratify patients into low-risk and high-risk groups by developing a risk score model. It was observed that patients in the low‐risk group showed longer overall survival (OS) than those in the high‐risk group in the training-set, valid-set, and total-set. The area under the curve (AUC) of the receiver operating characteristic curve (ROC curve) for the four IRLs signature in predicting the one-, two-, and three-year survival rates were larger than 0.65. In addition, the low-risk and high-risk groups displayed different immune statuses in GSEA. These IRLs were also significantly correlated with immune cell infiltration. Conclusions: Our results showed that the IRL signature had a prognostic value for CC. Meanwhile, the specific mechanisms of the four-IRLs in the development of CC were ascertained preliminarily.

scholarly journals Establishment of an immune-related gene pairs model to predict colon adenocarcinoma prognosis

2020 ◽  
Author(s):  
Jihang Luo ◽  
Puyu Liu ◽  
Leibo Wang ◽  
Yi Huang ◽  
Yuanyan Wang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
High Risk ◽  
Risk Group ◽  
Colon Adenocarcinoma ◽  
Risk Groups ◽  
High Risk Group ◽  
Related Gene ◽  
Immune Genes ◽  
Gene Pairs ◽  
Immune Related Gene

Abstract Background Colon cancer is the most common type of gastrointestinal cancer and has high morbidity and mortality. Colon adenocarcinoma(COAD) is the main pathological type of colon cancer. There is a lot of evidence describing the correlation between the prognosis of COAD and the immune system. The objective of the current study was the development of a robust prognostic immune-related gene pairs (IRGPs) model for estimating overall survival of COAD. Methods The gene expression profiles and clinical information of patients with colon adenocarcinoma come from TCGA and GEO databases and are divided into training and validation cohorts. Immune genes were selected which show significantly association with prognosis. Results Among 1647 immune genes, a 17 IRGPs model was built which was significantly associated with OS in the training cohort. In the training and validation data set, the IRGPs model divided patients into high-risk groups and low-risk groups, and the prognosis of the high-risk group was significantly worse( P <0.001). Univariate and multivariate Cox proportional hazard analysis confirmed the feasibility of this model. Functional analysis confirmed that multiple tumor progression and stem cell growth-related pathways in high-risk groups were up-regulated. T cells regulatory and Macrophage M0 were significantly highly expressed in the high-risk group. Conclusion We successfully constructed an IRGPs model that can predict the prognosis of COAD, which provides new insights into the treatment strategy of COAD.

scholarly journals Retrospective Comparative Analysis of POPF Using Fistula Risk Score According to Pancreaticoenterostomy Method

2021 ◽  
Vol 105 (1-3) ◽  
pp. 559-563
Author(s):  
Seungmin Lee ◽  
Kwang Yeol Paik
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Risk Score ◽  
Reconstructive Methods ◽  
Fistula Risk Score

Background The aim of this study is to examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. A total of 159 patients were stratified into 4 groups according to the Clinical Risk Score-Pancreatic Fistula. POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 17.1% (n = 14) in the PG group and 12.9% (n = 10) in the PJ group (P = 0.51). POPF rates were not different in intermediate, low, and negligible risks between 2 reconstructive methods. In the high-risk group (n = 47), there were 4 POPFs (22.2%) in PJ group and 9 (31.0%) in the PG group, respectively (P = 0.74). Conclusion In PD, there was no superior method of reconstruction with regard to POPF, even in high-risk glands.

Abstract 18787: Hypertension Treatment and Control Rates in United States Adults by Risk Group

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kunal N Karmali ◽  
Hongyan Ning ◽  
Donald M Lloyd-Jones
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Kidney Disease ◽  
Risk Group ◽  
Intensive Therapy ◽  
Risk Groups ◽  
Middle Aged ◽  
Ascvd Risk ◽  
Middle Aged Adults ◽  
And Control

Introduction: Ten-year cardiovascular disease (CVD) risk and absolute benefit from antihypertensive therapy vary at any given BP based on associated risk factor levels. Thus, implications of treatment and control rates at a particular BP vary substantially in different risk groups. Objectives: We examined the prevalence, treatment, and control of hypertension (HTN) by risk group in US adults without prevalent CVD. Methods: We used data from the National Health and Nutrition Examination Survey 2005 to 2010 for adults age 40-79 years without prevalent CVD (n=4,066). We estimated 10-year risk for an atherosclerotic CVD (ASCVD) event using the ACC/AHA 2013 Pooled Cohort risk equations. We examined HTN treatment and control rates according to current guidelines in middle-aged (40-59 years) and older (60-79 years) adults with: 10-year ASCVD risk <7.5% (no diabetes/kidney disease); 10-year ASCVD risk ≥7.5% (no diabetes/kidney disease); and either diabetes or kidney disease. Results: The proportion of adults with treatment-eligible HTN was 39.3% for those with 10-year ASCVD risk <7.5%, 32.2% for those with 10-year ASCVD risk ≥7.5%, and 28.4% for those with either diabetes or kidney disease (see Table 1). Treatment rates across the risk groups varied from 51.5% to 79.0% for middle-aged adults and 81.8% to 90.2% for older adults. HTN control rates were highest (87.7%) in older adults with 10-year ASCVD risk <7.5% but were lowest (29.3%) in middle-aged individuals with 10-year ASCVD risk ≥7.5%. Conclusions: US HTN guidelines, based solely on BP thresholds, identify a higher proportion of low-risk adults and a lower proportion of high-risk adults as being eligible for treatment. Control rates remain suboptimal in high-risk individuals, particularly middle-aged adults. Future guidelines should consider pre-treatment risk stratification to identify those at increased pretreatment ASCVD risk who would benefit most from more intensive therapy.

A Novel Risk Classification Model Predicts Overall Survival and Locoregional Surgery Benefit in Colorectal Patients with Distant Metastasis at the Initial Diagnosis

2020 ◽  
Author(s):  
Mo Chen ◽  
Tian-en Li ◽  
Pei-zhun Du ◽  
Junjie Pan ◽  
Zheng Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Risk Group ◽  
Risk Groups ◽  
Risk Classification ◽  
Low Risk ◽  
Classification Model ◽  
Intermediate Risk

Abstract Background and aims: In this research, we aimed to construct a risk classification model to predict overall survival (OS) and locoregional surgery benefit in colorectal cancer (CRC) patients with distant metastasis.Methods: We selected a cohort consisting of 12741 CRC patients diagnosed with distant metastasis between 2010 and 2014, from the Surveillance, Epidemiology and End Results (SEER) database. Patients were randomly assigned into training group and validation group at the ratio of 2:1. Univariable and multivariable Cox regression models were applied to screen independent prognostic factors. A nomogram was constructed and assessed by the Harrell’s concordance index (C-index) and calibration plots. A novel risk classification model was further established based on the nomogram.Results: Ultimately 12 independent risk factors including race, age, marriage, tumor site, tumor size, grade, T stage, N stage, bone metastasis, brain metastasis, lung metastasis and liver metastasis were identified and adopted in the nomogram. The C-indexes of training and validation groups were 0.77 (95% confidence interval [CI] 0.73-0.81) and 0.75 (95% CI 0.72-0.78), respectively. The risk classification model stratified patients into three risk groups (low-, intermediate- and high-risk) with divergent median OS (low-risk: 36.0 months, 95% CI 34.1-37.9; intermediate-risk: 18.0 months, 95% CI 17.4-18.6; high-risk: 6.0 months, 95% CI 5.3-6.7). Locoregional therapies including surgery and radiotherapy could prognostically benefit patients in the low-risk group (surgery: hazard ratio [HR] 0.59, 95% CI 0.50-0.71; radiotherapy: HR 0.84, 95% CI 0.72-0.98) and intermediate risk group (surgery: HR 0.61, 95% CI 0.54-0.68; radiotherapy: HR 0.86, 95% CI 0.77-0.95), but not in the high-risk group (surgery: HR 1.03, 95% CI 0.82-1.29; radiotherapy: HR 1.03, 95% CI 0.81-1.31). And all risk groups could benefit from systemic therapy (low-risk: HR 0.68, 95% CI 0.58-0.80; intermediate-risk: HR 0.50, 95% CI 0.47-0.54; high-risk: HR 0.46, 95% CI 0.40-0.53).Conclusion: A novel risk classification model predicting prognosis and locoregional surgery benefit of CRC patients with distant metastasis was established and validated. This predictive model could be further utilized by physicians and be of great significance for medical practice.

scholarly journals MO048MULTICENTRE PROSPECTIVE VALIDATION OF THE URINARY PEPTIDOME-BASED CLASSIFIER CKD273 AS A PREDICTOR OF RENAL FUNCTION DECLINE IN SUBJECTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Morten Lindhardt ◽  
Nete Tofte ◽  
Gemma Currie ◽  
Marie Frimodt-Moeller ◽  
Heiko Von der Leyen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Renal Function ◽  
High Risk ◽  
Risk Group ◽  
Cox Model ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Renal Function Decline

Abstract Background and Aims In the PRIORITY study, it was recently demonstrated that the urinary peptidome-based classifier CKD273 was associated with increased risk for progression to microalbuminuria. As a prespecified secondary outcome, we aim to evaluate the classifier CKD273 as a determinant of relative reductions in eGFR (CKD-EPI) of 30% and 40% from baseline, at one timepoint without requirements of confirmation. Method The ‘Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria trial’ (PRIORITY) is the first prospective observational study to evaluate the early detection of diabetic kidney disease in subjects with type 2 diabetes (T2D) and normoalbuminuria using the CKD273 classifier. Setting 1775 subjects from 15 European sites with a mean follow-up time of 2.6 years (minimum of 7 days and a maximum of 4.3 years). Patients Subjects with T2D, normoalbuminuria and estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73m2. Participants were stratified into high- or low-risk groups based on their CKD273 score in a urine sample at screening (high-risk defined as score &gt; 0.154). Results In total, 12 % (n = 216) of the subjects had a high-risk proteomic pattern. Mean (SD) baseline eGFR was 88 (15) ml/min/1.73m2 in the low-risk group and 81 (17) ml/min/1.73m2 in the high-risk group (p &lt; 0.01). Baseline median (interquartile range) urinary albumin to creatinine ratio (UACR) was 5 (3-8) mg/g and 7 (4-12) mg/g in the low-risk and high-risk groups, respectively (p &lt; 0.01). A 30 % reduction in eGFR from baseline was seen in 42 (19.4 %) subjects in the high-risk group as compared to 62 (3.9 %) in the low-risk group (p &lt; 0.0001). In an unadjusted Cox-model the hazard ratio (HR) for the high-risk group was 5.7, 95 % confidence interval (CI) (3.9 to 8.5; p&lt;0.0001). After adjustment for baseline eGFR and UACR, the HR was 5.2, 95 % CI (3.4 to 7.8; p&lt;0.0001). A 40 % reduction in eGFR was seen in 15 (6.9 %) subjects in the high-risk group whereas 22 (1.4 %) in the low-risk group developed this endpoint (p&lt;0.0001). In an unadjusted Cox-model the HR for the high-risk group was 5.0, 95 % CI (2.6 to 9.6; p&lt;0.0001). After adjustment for baseline eGFR and UACR, the HR was 4.8, 95 % CI (2.4 to 9.7; p&lt;0.0001). Conclusion In normoalbuminuric subjects with T2D, the urinary proteomic classifier CKD273 predicts renal function decline of 30 % and 40 %, independent of baseline eGFR and albuminuria.

scholarly journals Immune-Related Four-lncRNA Signature for Patients with Cervical Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
Jianfeng Zheng ◽  
Benben Cao ◽  
Xia Zhang ◽  
Zheng Niu ◽  
Jinyi Tong
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Immune Cell ◽  
Risk Group ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Risk Groups ◽  
High Risk Group ◽  
Low Risk ◽  
Gynecological Malignancy

Cervical cancer (CC) is a common gynecological malignancy for which prognostic and therapeutic biomarkers are urgently needed. The signature based on immune-related lncRNAs (IRLs) of CC has never been reported. This study is aimed at establishing an IRL signature for patients with CC. A cohort of 326 CC and 21 normal tissue samples with corresponding clinical information was included in this study. Twenty-eight IRLs were collected according to the Pearson correlation analysis between the immune score and lncRNA expression ( p < 0.01 ). Four IRLs (BZRAP1-AS1, EMX2OS, ZNF667-AS1, and CTC-429P9.1) with the most significant prognostic values ( p < 0.05 ) were identified which demonstrated an ability to stratify patients into the low-risk and high-risk groups by developing a risk score model. It was observed that patients in the low-risk group showed longer overall survival (OS) than those in the high-risk group in the training set, valid set, and total set. The area under the curve (AUC) of the receiver operating characteristic curve (ROC curve) for the four-IRL signature in predicting the one-, two-, and three-year survival rates was larger than 0.65. In addition, the low-risk and high-risk groups displayed different immune statuses in GSEA. These IRLs were also significantly correlated with immune cell infiltration. Our results showed that the IRL signature had a prognostic value for CC. Meanwhile, the specific mechanisms of the four IRLs in the development of CC were ascertained preliminarily.

Validation of Postpartum Hemorrhage Admission Risk Factor Stratification in a Large Obstetrics Population

2020 ◽  
Author(s):  
Halley Ruppel ◽  
Vincent X. Liu ◽  
Neeru R. Gupta ◽  
Lauren Soltesz ◽  
Gabriel J. Escobar
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Risk Group ◽  
Risk Groups ◽  
Low Risk ◽  
Hemorrhage Risk ◽  
Present On Admission

Abstract Objective This study aimed to evaluate the performance of the California Maternal Quality Care Collaborative (CMQCC) admission risk criteria for stratifying postpartum hemorrhage risk in a large obstetrics population. Study Design Using detailed electronic health record data, we classified 261,964 delivery hospitalizations from Kaiser Permanente Northern California hospitals between 2010 and 2017 into high-, medium-, and low-risk groups based on CMQCC criteria. We used logistic regression to assess associations between CMQCC risk groups and postpartum hemorrhage using two different postpartum hemorrhage definitions, standard postpartum hemorrhage (blood loss ≥1,000 mL) and severe postpartum hemorrhage (based on transfusion, laboratory, and blood loss data). Among the low-risk group, we also evaluated associations between additional present-on-admission factors and severe postpartum hemorrhage. Results Using the standard definition, postpartum hemorrhage occurred in approximately 5% of hospitalizations (n = 13,479), with a rate of 3.2, 10.5, and 10.2% in the low-, medium-, and high-risk groups. Severe postpartum hemorrhage occurred in 824 hospitalizations (0.3%), with a rate of 0.2, 0.5, and 1.3% in the low-, medium-, and high-risk groups. For either definition, the odds of postpartum hemorrhage were significantly higher in medium- and high-risk groups compared with the low-risk group. Over 40% of postpartum hemorrhages occurred in hospitalizations that were classified as low risk. Among the low-risk group, risk factors including hypertension and diabetes were associated with higher odds of severe postpartum hemorrhage. Conclusion We found that the CMQCC admission risk assessment criteria stratified women by increasing rates of severe postpartum hemorrhage in our sample, which enables early preparation for many postpartum hemorrhages. However, the CMQCC risk factors missed a substantial proportion of postpartum hemorrhages. Efforts to improve postpartum hemorrhage risk assessment using present-on-admission risk factors should consider inclusion of other nonobstetrical factors.

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