Use of total illness burden index for prostate cancer (TIBI-CaP) to predict nonprostate cancer morbidity.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 215-215
Author(s):  
Michael Andre Liss ◽  
Kathryn Osann ◽  
Ross Moskowitz ◽  
Adam Kaplan ◽  
John Billimek ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hospital Admission ◽  
Prostate Biopsy ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
External Beam Radiation ◽  
Medical Decision ◽  
Illness Burden ◽  
Comorbidity Index

215 Background: Comorbidities significantly influence how physicians approach the treatment of prostate cancer and should be evaluated prior to the prostate biopsy. The Total Illness Burden Index for Prostate Cancer (TIBI-CaP) patient questionnaire and Charlson Comorbidity Index (CCI) usually calculated by the physician, may provide information on competing risks but have not been compared prospectively. Methods: A prospective observational cohort study was performed of 133 participants prior to obtaining a transrectal ultrasound guided prostate biopsy. Eleven patients had incomplete data or missing follow-up; therefore, a total of 122 (92%) patients were retained for a mean of 21 months (range 4 – 31 months). The TIBI-CaP and CCI scores were compared between subgroups defined by non-elective hospital admission, elective surgery, non-prostate malignancy and survival status using t-tests. Results: Patients averaged 64.5 years at enrollment. One patient died in the study from a metastatic sarcoma. The overall hospital admission rate was 17% (21/122), most commonly from cardiovascular or pulmonary complications. Forty-six men (38%) were diagnosed with cancer on the prostate biopsy. The most common treatments were prostatectomy (39%), active surveillance (26%), or external beam radiation therapy (20%). Twenty-three percent (28/122) had elective surgery and 5% (6/122) were diagnosed with a non-prostate malignancy. Mean TIBI-CaP scores were higher in men who were admitted to the hospital (5.1 vs. 3.5, p=0.03), had elective surgery (4.8 vs. 3.4, p=0.05) or non-prostate cancer (5.5 vs 3.7, p=0.17). No significant differences were observed in CCI scores In stepwise logistic regression, a TIBI-CaP score > 5.0 was associated with 3.5 times higher risk for hospital admission (95% CI: 1.3–10.0, p=0.02). Conclusions: The patient-reported measure of comorbidity (TIBI-CaP) identified patients at high risk for non-elective hospital admission over at 20 month average follow up period and may aid medical decision making specifically in the prostate biopsy population better than that of the Charlson Comorbidity Index.

The impact of Charlson Comorbidity Index on survival outcomes in men with prostate cancer who underwent definitive prostate radiotherapy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 114-114
Author(s):  
Ahmed I. Ghanem ◽  
Remonda M Khalil ◽  
Gehan Abd Elatti Khedr ◽  
Amy Tang ◽  
Amr A. Elsaid ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Charlson Comorbidity Index ◽  
Treatment Options ◽  
Patient Counselling ◽  
Prostate Radiotherapy ◽  
Survival Endpoints ◽  
Comorbidity Index ◽  
The Impact

114 Background: Life expectancy is very essential in deciding treatment options in men with prostate cancer (PCa); however, the impact of comorbidities on outcomes is not well-established. We investigated the influence of Charlson Comorbidity Index (CCI) on survival endpoints in men with localized PCa who were treated with prostate radiotherapy (RT). Methods: Men with intermediate and high risk PCa who were treated with definitive RT between 1/2007 and 12/2012 were included. Groups were created according to their baseline CCI score at diagnosis into no, mild and severe comorbidity (CCI 0, 1 or 2+). The groups were then compared based on patients’ characteristics and prognostic factors. Kaplan-Meier curves and Uni/multivariate analyses (MVA) were used to examine the impact of CCI groups on overall (OS), disease specific (DSS), and biochemical relapse free (BRFS) survival. Results: 257 patients were identified after excluding low risk, metastatic cases and those with inadequate follow up. Median follow-up was 92 months (range: 2-135) and median age was 73 years (range: 48-85). 53% of the cases were black and 67% were of intermediate risk. Median RT dose was 76 Gy and 47% received androgen deprivation therapy. CCI groups 0, 1 and 2+ encompassed 76 (30%), 54 (21%) and 127 (49%) patients, respectively. Groups were generally well-balanced. 10 and 15 years OS was significantly different across CCI groups (76% & 53%, 46% & 31% and 55% & 14%, for CCI-0, 1 and 2+ respectively; p < 0.001). CCI-0 had better DSS than CCI-2+ ( p = 0.03) with no difference for CCI-0 vs 1 ( p = 0.1). BRFS was non-different among CCI groups ( p = 0.99). On MVA, increased CCI was deterministic for OS ( p < 0.001) after adjusting for age, Gleason’s score and T-stage. For DSS, only age and T3 vs T1/2 were independently prognostic ( p < 0.001); whereas CCI-1 vs 0 was only marginal ( p = 0.05). Conclusions: Higher CCI was a significant predictor of shorter OS in intermediate and high-risk PCa. Baseline comorbidities should be taken into consideration during patient counselling for treatment options and in designing prospective trials for men with localized prostate cancer.

scholarly journals Early Administration of Bamlanivimab in Combination with Etesevimab Increases the Benefits of COVID-19 Treatment: Real-world Experience from the Liguria Region

2021 ◽  
Vol 10 (20) ◽  
pp. 4682
Author(s):  
Antonio Vena ◽  
Giovanni Cenderello ◽  
Elisa Balletto ◽  
Laura Mezzogori ◽  
Alessandro Santagostino Santagostino Barbone ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Charlson Comorbidity Index ◽  
Composite Endpoint ◽  
Supplemental Oxygen ◽  
Early Administration ◽  
Secondary Endpoints ◽  
Comorbidity Index ◽  
The Impact ◽  
To Receive

Monoclonal antibodies, such as bamlanivimab and etesevimab combination (BEC), have been proposed for patients with mild or moderate coronavirus disease 2019 (COVID-19). However, few studies have assessed the factors associated with the early administration of BEC or the impact of early BEC treatment on the clinical evolution of the patients. We conducted a retrospective cohort study of all adults with COVID-19 who received BEC at three institutions in the Liguria region. The primary endpoint was to investigate the clinical variables associated with early BEC infusion. Secondary endpoints were 30-day overall mortality and the composite endpoint of requirement of hospital admission or need for supplemental oxygen during the 30-day follow-up period. A total of 127 patients (median age 70 years; 56.7% males) received BEC. Of those, 93 (73.2%) received BEC within 5 days from symptoms onset (early BEC). Patients with a higher Charlson comorbidity index were more likely to receive early treatment (odds ratio (OR) 1.60, 95% confidence interval (CI) 1.04–2.45; p = 0.03) in contrast to those reporting fever at presentation (OR 0.26, 0.08–0.82; p = 0.02). Early BEC was associated with lower likelihood of hospital admission or need for supplemental oxygen (OR 0.19, 0.06–0.65; p = 0.008). Five patients who received early BEC died during the follow-up period, but only one of them due to COVID-19-related causes. Early bamlanivimab and etesevimab combination was more frequently administered to patients with a high Charlson comorbidity index. Despite this, early BEC was associated with a lower rate of hospital admission or need for any supplementary oxygen compared to late administration. These results suggest that efforts should focus on encouraging early BEC use in patients with mild–moderate COVID-19 at risk for complications.

scholarly journals Charlson Comorbidity Index Predicts 5-Year Survivorship of Surgically Treated Hip Fracture Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880644 ◽  
Author(s):  
Lei Jiang ◽  
Andrew Chia Chen Chou ◽  
Nivedita Nadkarni ◽  
Caris En Qi Ng ◽  
Yun San Chong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Charlson Comorbidity Index ◽  
Demographic Data ◽  
Survival Rates ◽  
Predictive Ability ◽  
Fracture Pattern ◽  
Mortality Data ◽  
Comorbidity Index

Introduction: This study aims to assess the correlation of the age-adjusted Charlson comorbidity index (ACCI) with 5-year mortality in a surgically treated hip fracture population. Materials and Methods: A retrospective analysis was performed on 1057 patients aged 60 years and above who underwent surgery for hip fracture with a minimum of 5-year follow-up (92.2% 5-year follow-up rate) in a tertiary hospital. Manual review of patients’ electronic hospital records was performed to record demographic data, comorbidities, and length of stay. Mortality data were extracted from the hospital’s electronic medical records and corroborated with the National Electronic Health Record. Results: Of the 1057 patients, 283 (26.8%) were male. The majority of patients were 80 years of age and above (42.5%), with the oldest patient operated on age 102 with a mean age of 77.8 (8.6) years. Four hundred eighteen (39.5%) patients sustained extracapsular intertrochanteric fractures. The mean follow-up duration was 8 years and 3 days with an overall survivorship of 37.2%. A multiple regression model constructed with ACCI, age, gender, and fracture pattern demonstrated satisfactory predictive ability with a concordance statistic of 0.68. Patients with a higher ACCI category (≥6) had an increased 5-year mortality rate (41.8%) with an odds ratio of 13.6 (6.7-31.8, P < .001) compared to those with an ACCI category of 3 and below (89.3%). Discussion: The study demonstrates that ACCI correlated with 5-year mortality after surgical treatment of hip fracture. This information is pertinent in the counseling of patients with regard to their midterm survival following hip fracture surgery and may inform policy makers of the varied midterm survival rates in patients with differing ACCI scores and educate the allocation of health-care resources. Conclusion: The ACCI correlates with 5-year mortality after surgical treatment of hip fracture.

scholarly journals Prognosis of COVID-19 Pneumonia Can Be Early Predicted Combining Age-Adjusted Charlson Comorbidity Index, CRB Score and Baseline Oxygen Saturation.

2021 ◽  
Author(s):  
Pilar Nuevo-Ortega ◽  
Carmen Reina-Artacho ◽  
Francisco Dominguez-Moreno ◽  
Victor Manuel Becerra-Muñoz ◽  
Luis Ruiz-Del-Fresno ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Charlson Comorbidity Index ◽  
Severe Disease ◽  
Hospital Environment ◽  
Severe Illness ◽  
Comorbidity Index ◽  
Clinical Tools ◽  
Discharge From Hospital ◽  
Statistical Criteria

Abstract Background: In potentially severe diseases in general and COVID-19 in particular, it is vital to early identify those patients who are going to develop complications. The last update of a recent living systematic review dedicated to predictive models in COVID-19,[1] critically appraises 145 models, 8 of them focused on prediction of severe disease and 23 on mortality. Unfortunately, in all 145 models, they found a risk of bias significant enough to finally "not recommend any for clinical use". Authors suggest concentrating on avoiding biases in sampling and prioritising the study of already identified predictive factors, rather than the identification of new ones that are often dependent on the database. Our objective is to develop a model to predict which patients with COVID-19 pneumonia are at high risk of developing severe illness or dying, using basic and validated clinical tools.Methods: prospective cohort of consecutive patients admitted in a teaching hospital during the “first wave” of the COVID-19 pandemic. Follow-up to discharge from hospital. Multiple logistic regression selecting variables according to clinical and statistical criteria. Results: 404 consecutive patients were evaluated, 392 (97%) completed follow-up. Mean age was 61 years; 59% were men. The median burden of comorbidity was 2 points in the Age-adjusted Charlson Comorbidity Index, CRB was abnormal in 18% of patients and basal oxygen saturation on admission lower than 90% in 18%. A model composed of Age-adjusted Charlson Comorbidity Index, CRB score and basal oxygen saturation can predict unfavorable evolution or death with an area under the ROC curve of 0.85 (95% CI: 0.80-0.89), and 0.90 (95% CI: 0.86 to 0.94), respectively.Conclusion: prognosis of COVID-19 pneumonia can be predicted in the out-of-hospital environment using two classic prognostic scales and a pocket pulse oximeter.

Hospital Costs and Severity of Illness in Three Types of Elective Surgery

1997 ◽  
Vol 86 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Alex Macario ◽  
Terry S. Vitez ◽  
Brian Dunn ◽  
Tom McDonald ◽  
Byron Brown
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Operating Room ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Hospital Costs ◽  
Severity Of Illness ◽  
Total Hospital ◽  
Comorbidity Index

Background If patients who are more severely ill have greater hospital costs for surgery, then health-care reimbursements need to be adjusted appropriately so that providers caring for more seriously ill patients are not penalized for incurring higher costs. The authors' goal for this study was to determine if severity of illness, as measured by either the American Society of Anesthesiologists Physical Status (ASA PS) or the comorbidity index developed by Charlson, can predict anesthesia costs, operating room costs, total hospital costs, or length of stay for elective surgery. Methods The authors randomly selected 224 inpatients (60% sampling fraction) having either colectomy (n = 30), total knee replacement (n = 100), or laparoscopic cholecystectomy (n = 94) from September 1993 to September 1994. For each surgical procedure, backward-elimination multiple regression was used to build models to predict (1) total hospital costs, (2) operating room costs, (3) anesthesia costs, and (4) length of stay. Explanatory candidate variables included patient age (years), sex, ASA PS, Charlson comorbidity index (which weighs the number and seriousness of coexisting diseases), and type of insurance (Medicare/Medicaid, managed care, or indemnity). These analyses were repeated for the pooled data of all 224 patients. Costs (not patient charges) were obtained from the hospital cost accounting software. Results Mean total hospital costs were $3,778 (95% confidence interval +/- 299) for laparoscopic cholecystectomy, $13,614 (95% CI +/- 3,019) for colectomy, and $18,788 (95% CI +/- 573) for knee replacement. The correlation (r) between ASA PS and Charlson comorbidity scores equaled 0.34 (P &lt; .001). No consistent relation was found between hospital costs and either of the two severity-of-illness indices. The Charlson comorbidity index (but not the ASA PS) predicted hospital costs only for knee replacement (P = .003). The ASA PS, but not the Charlson index, predicted operating room and anesthesia costs only for colectomy (P &lt; .03). Conclusions Severity of illness, as categorized by ASA PS categories 1-3 or by the Charlson comorbidity index, was not a consistent predictor of hospital costs and lengths of stay for three types of elective surgery. Hospital resources for these lower-risk elective procedures may be expended primarily to manage the consequences of the surgical disease, rather than to manage the patient's coexisting diseases.

Disease-specific survival outcomes in lymph node–positive patients with prostate cancer treated with radiotherapy.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 182-182 ◽  
Author(s):  
G. Crehange ◽  
V. K. Weinberg ◽  
A. Izaguirre ◽  
C. C. Hsu ◽  
I. J. Hsu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disease Free Survival ◽  
External Beam Radiation ◽  
Survival Outcomes ◽  
Primary Therapy ◽  
Newly Diagnosed ◽  
Beam Radiation ◽  
Androgen Ablation ◽  
Disease Free

182 Background: Involvement of regional lymph nodes (LN+) at the time of prostate cancer (PCa) diagnosis is widely regarded as an adverse prognostic factor associated with poor outcome. No commonly utilized treatment, composed of any combination of androgen ablation, surgery and radiation, has proven to be superior for survival. This study will evaluate the clinical survival outcomes of patients (pts) with newly diagnosed LN+ PCa at the University of California San Francisco (UCSF). Methods: All newly diagnosed LN+ PCa pts treated with External Beam Radiation Therapy (EBRT) as primary therapy or after surgery, each with and without androgen ablation between 1987 and 2009 were included. All pts had confirmed pathologic or radiologic LN+ whereas none had evidence of metastases on the work up. Cause Specific Survival (CSS), Disease Free survival (DFS) and biochemical control were measured from the start of treatment. PSA failure was determined by the Phoenix definition after EBRT and by a confirmed PSA >1 ng/mL following RP+EBRT. Results: A retrospective analysis identified 91 pts with LN+ at the time of diagnosis (75.8% high risk pts) with disease follow-up. Thirty-four (37%) were managed with exclusive EBRT alone (eRT), 18 pts (20%) with a combination of radical prostatectomy (RP) and adjuvant EBRT (RP+aRT) and 39 pts (43%) were treated with a combination of RP + salvage RT (RP+sRT). Overall 78% of patients also received hormone therapy (HT): 74.0% with eRT, 89% with RP+aRT and 79% with RP+sRT. The 10 years CSS estimates was 89% for eRT, 0% after RP+aRT and 88% after RP+sRT. The 10 years DFS estimates was 33% for eRT, 0% after RP+aRT and 75% after RP+sRT. Among pts remaining disease free the median follow-up is 38 mos for eRT, 26 mos for RP+aRT and 64 mos for RP+sRT. The last PSA for these patients was <0.1 for 85% of all patients which included 47% following eRT, 100% after RP+aRT and 97% after RP+sRT. There were 7 deaths due to PCa occurring between 5 and 73 mos from the start of EBRT. Conclusions: The results of the current analysis indicate that some pts with LN+ from PCa have prolonged disease free outcomes; and for these men, aggressive treatment may be appropriate. No significant financial relationships to disclose.

Impact of dose-escalated radiation on overall survival in men with nonmetastatic prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 28-28
Author(s):  
Anusha Kalbasi ◽  
Jiaqi Li ◽  
Abigail T. Berman ◽  
Samuel Swisher-McClure ◽  
Marc C. Smaldone ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Standard Dose ◽  
Low Risk ◽  
External Beam Radiation ◽  
Risk Category ◽  
Beam Radiation ◽  
Treatment Groups

28 Background: Infive publishedRCTs, dose-escalated external beam radiation therapy (EBRT) for prostate cancer resulted in improved biochemical and local control. However, the question of whether dose escalation improves overall survival (OS) remains unanswered. We examined OS among men with non-metastatic prostate cancer undergoing EBRT in the modern era. Methods: Using the National Cancer Database (NCDB), we conducted non-randomized comparative effectiveness studies of dose-escalated versus standard-dose EBRT in men diagnosed from 2004-2006 in three analytic cohorts defined by NCCN risk category: low- (N=12,848), intermediate- (N=14,966) or high-risk (N=14,587) prostate cancer. We categorized patients in each risk cohort into 2 treatment groups: standard-dose (68.4 Gy to <75.6 Gy) or dose-escalated (≥75.6 Gy to 90 Gy) EBRT. The primary outcome was time to death from any cause, measured from diagnosis to NCDB date of death or end of follow-up (December 31, 2011). We compared OS between treatment groups in the three analytic cohorts using Cox proportional hazard models. Inverse probability weighted propensity score methods were used to balance differences between treatment groups in age, race, year of diagnosis, AJCC T- and N-stage, PSA, Gleason score, androgen deprivation therapy, IMRT use, comorbid disease, income, insurance, urban/rural location, facility type and facility volume. In secondary analyses, we evaluated dose response for survival by categorizing dose in approximately 2 Gy increments. Results: Median follow up for survivors was between 73 and 74 months in all three risk cohorts. Dose-escalated EBRT was associated with improved survival in the intermediate-risk (adjusted HR 0.81, 95% CI 0.77 and 0.85, p<0.0001) and high-risk groups (aHR 0.85, 95% CI 0.81 and 0.89, p<0.0001), but not the low-risk group (aHR 0.99, 95% CI 0.92-1.06, p=0.803). For every incremental ~2Gy increase in dose, there was a 9% (95% CI 6% – 11%, p<0.0001) and 7% (95% CI 3% - 10%, p=0.004) reduction in the hazard of death for intermediate- and high-risk patients, respectively. Conclusions: Dose-escalated EBRT is associated with improved survival in men with intermediate- and high-risk, but not low-risk, prostate cancer.

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