The Metastatic Early Prognostic (MEP) score

2020 ◽  
Vol 102-B (1) ◽  
pp. 72-81 ◽  
Author(s):  
Samantha Downie ◽  
Florence Y. Lai ◽  
Judith Joss ◽  
Douglas Adamson ◽  
Arpit C. Jariwala
Keyword(s):  
Hip Fractures ◽  
Early Death ◽  
Trauma Centre ◽  
Mortality Prediction ◽  
Early Mortality ◽  
Control Group ◽  
Risk Of Death ◽  
Bony Metastases ◽  
One Year ◽  
Femoral Metastasis

Aims The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. Methods This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. Results There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. Conclusion This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72–81

scholarly journals Effect of Under Triage on Early Mortality After Major Pediatric Trauma: A Registry-based Propensity Score Matching Analysis

2020 ◽  
Author(s):  
François-Xavier Ageron ◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
Jules Greze ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Backgroundlittle is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24 hour-mortality after major pediatric trauma in a regional trauma systemMethodsThis cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24 hour-mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. ResultsA total of 1 143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 hours. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference: 6.0 [95% CI 1.3-10.7]) and Ps matching analyses (risk difference: 3.1 [95% CI 0.8-5.4]).ConclusionsIn a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

scholarly journals Association of age-related macular degeneration on fracture risks among osteoporosis population: a nationwide population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037028
Author(s):  
Chi Chin Sun ◽  
Ting-Shuo Huang ◽  
Tsai-Sheng Fu ◽  
Chia-Yi Lee ◽  
Bing-Yu Chen ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Macular Degeneration ◽  
Hip Fractures ◽  
Multivariable Analysis ◽  
Age Related Macular Degeneration ◽  
Control Group ◽  
Research Database ◽  
Risk Of Death ◽  
Age Related ◽  
Ulnar Fracture

ObjectivesVisual impairment is an important risk factor for fracture in the elderly population. Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment in elderly people. This study was conducted to explore the relationship between AMD and incident fractures in patients with osteoporosis (OS).DesignRetrospective analysis of Taiwan’s National Health Insurance Research Database (NHIRD).SettingA multicenter study conducted in Taiwan.Participants and controlsThe current study used the NHIRD in Taiwan between 1996 and 2011. A total of 13 584 and 54 336 patients with OS were enrolled in the AMD group and the non-AMD group, respectively.InterventionPatients with OS were included from the Taiwan’s NHIRD after exclusion, and each patient with AMD was matched for age, sex and comorbidities to four patients with non-AMD OS, who served as the control group. A Cox proportional hazard model was used for the multivariable analysis.Primary outcome measuresTransitions for OS to spine fracture, OS to hip fracture, OS to humero-radio-ulnar fracture and OS to death.ResultsThe risks of spine and hip fractures were significantly higher in the AMD group (HR=1.09, 95% CI=1.04 to 1.15, p<0.001; HR=1.18; 95% CI=1.08 to 1.30, p=0.001, respectively) than in the non-AMD group. The incidence of humero-radio-ulnar fracture between AMD and non-AMD individuals was similar (HR=0.98; 95% CI=0.90 to 1.06; p=0.599). However, the risk of death was higher in patients with OS with older age, male sex and all types of comorbidity (p<0.05), except for hyperthyroidism (p=0.200).ConclusionPatients with OS with AMD had a greater risk of spine and hip fractures than did patients without AMD.

Treatment-associated mortality in head and neck cancer: Analysis of phase III trials.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6064-6064
Author(s):  
Marina Shcherba ◽  
Shankar Viswanathan ◽  
Dukagjin Blakaj ◽  
Madhur Garg ◽  
Missak Haigentz
Keyword(s):  
Relative Risk ◽  
Head And Neck ◽  
Early Death ◽  
Early Mortality ◽  
Phase Iii ◽  
Eligibility Criteria ◽  
Curative Intent ◽  
Mortality Statistics ◽  
Risk Of Death ◽  
Phase Iii Trials

6064 Background: Chemoradiotherapy is an accepted standard for patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN). Although acute and long-term toxicities of this approach are known, little is known about early mortality associated with curative-intent treatment. Methods: We reviewed 45 phase III trials of curative-intent radiotherapy in SCCHN published from 2000-2012 for adequate reporting of early mortality defined as deaths during and within 3 months of therapy, regardless of attribution. We estimated pooled proportions of deaths during prescribed therapy using a random effects model of radiotherapy alone (RT), concurrent chemoradiotherapy (CCRT) and induction chemotherapy (IC) regimens. The relative risk of death during CCRT vs. RT and CCRT/IC vs. RT were estimated. Results: Although all trials reported early mortality statistics, definitions had wide variability, and only 34 trials (75%) met adequate reporting characteristics. Ten trials excluded enrolled patients who died prior to initiating therapy. Of studies reporting early mortality statistics, crude frequency of death during prescribed therapy was 2.7% (308/11362). The pooled estimated rates of death observed during RT alone was 1.7% (SE: 0.3, I2=89.2%) from 29 studies, while 2.8% (SE: 0.4, I2=64.9%, 19 studies) and 3.1% (SE: 0.5, I2=53.5%, 9 studies) for CCRT and IC regimens, respectively. The pooled relative risk for death in CCRT compared to RT treatment was 1.08 (95%CI: 0.78, 1.48, p=0.63, I2=0, 15 studies). The relative risk for death in CCRT or IC therapy compared to RT was 1.06 (95%CI: 0.77, 1.45, p=0.72, I2=0, 15 studies). When reported, most early deaths were attributed to infectious complications or cardiovascular events. Conclusions: Early death remains an uncommon but important complication of curative-intent radiotherapy in SCCHN that necessitates consistent reporting. Despite strict eligibility criteria and protocol-defined care, treatment-associated death occurs with all regimens, though no clear increase was observed with CCRT/IC regimens over RT alone. Early mortality should be considered during treatment planning, particularly for patients with considerable comorbidities.

scholarly journals Prognostic and Predictive Factors in Newly Diagnosed Multiple Myeloma Patients with Early Mortality with Prediction Matrix and Three and Five-Year Overall Survival

2021 ◽  
Author(s):  
Howard R. Terebelo ◽  
Leo Reap
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Residual Disease ◽  
Survival Rates ◽  
Early Death ◽  
Mortality Prediction ◽  
Early Mortality ◽  
Standards Of Care ◽  
Newly Diagnosed ◽  
Disease Biology

Survival rates for newly diagnosed multiple myeloma have increased to a remarkable 8–12 years. Novel agents, autologous stem cell transplantation, monoclonal antibodies, improvements in supportive care and attention to minimal residual disease negative all have aided this remarkable journey. With these treatments we are identifying tools to achieve complete remissions. Prognostic factors have an important role in selecting proper patient approaches for trial designs. Prognostic and predictive clinical biomarkers have shaped staging and treatment selections for newly diagnosed multiple myeloma. Here we review the Early Mortality Prediction Matrix to identify those at risk of an early death (<6 months) incorporating both disease biology with patient fitness. We also review current standards of care for multiple myeloma and provide a three and five-year overall survival prediction matrix. We review benefits for MRD negativity and Next-Gen Sequencing. These tools will help clinicians improve upon reducing early mortality in newly diagnosed multiple myeloma patients and provide further framework for improving survival by assessing clinical, biologic and individual multiple myeloma patients.

scholarly journals One-year mortality among elderly people after hospitalization due to fall-related fractures: comparison with a control group of matched elderly

2012 ◽  
Vol 28 (4) ◽  
pp. 801-805 ◽  
Author(s):  
Evandro Silva Freire Coutinho ◽  
Katia Vergetti Bloch ◽  
Claudia Medina Coeli
Keyword(s):  
Local Community ◽  
Public Health Problem ◽  
The Elderly ◽  
Control Group ◽  
Important Public Health Problem ◽  
Elderly Individuals ◽  
Risk Of Death ◽  
Increased Risk ◽  
One Year ◽  
The One

Fall-related fractures among the elderly represent an important public health problem. Severe fractures have been related to increased risk of death. In order to investigate the mortality profile of elderly individuals with severe fractures, 250 patients aged 60 years and over, hospitalized due to fall-related fractures and 250 elderly without fractures living in the local community were followed-up for one year. They were matched according to sex, age, time of hospitalization and neighborhood. Deaths were identified using probabilistic linkage of the research dataset and the local mortality registry. The one-year cumulative mortality was 25.2% in the case of individuals with severe fractures and 4% for those individuals without. The mortality distribution was not homogeneous across the follow-up period. Two-thirds of deaths among the elderly individuals hospitalized due to fracture occurred within the first 3 months, whereas mortality among those individuals without fractures took place later. Heart disease, pneumonia, GI bleeding, sepsis, and pulmonary embolism, diabetes and stroke were important causes of one-year mortality.

scholarly journals A Novel Uremic Score Reflecting Accumulation of Specific Uremic Toxins More Precisely Predicts One-Year Mortality after Hemodialysis Commencement: A Retrospective Cohort Study

Toxins ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 634
Author(s):  
Yohei Arai ◽  
Shingo Shioji ◽  
Hiroyuki Tanaka ◽  
Daisuke Katagiri ◽  
Fumihiko Hinoshita
Keyword(s):  
Cohort Study ◽  
Primary Outcome ◽  
Early Death ◽  
Early Mortality ◽  
Uremic Toxins ◽  
Point Increase ◽  
Cox Proportional Hazard Models ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Uremic toxins (UTs) generally accumulate in patients developing end-stage renal disease (ESRD). Although some kinds of UTs cause early death after starting hemodialysis (HD), it remains unknown whether the degree of excessive accumulation of various UTs is associated with worsening of prognosis. We retrospectively conducted this cohort study consisting of adult patients developing ESRD who initiated HD at the National Center for Global Health and Medicine from 2010 to 2019. We created a new uremic score, which was defined as the aggregate score of the following variables reflecting uremic state: elevated blood urea nitrogen, β2-microglobulin, and anion gap before starting HD. The primary outcome was early mortality within 1-year after HD commencement. The hazard ratio (HR) and 95% confidence interval (CI) for a one-point increase in uremic score was calculated with Cox proportional hazard models adjusted by baseline conditions. We included 230 participants, 16 of whom experienced the primary outcome of early mortality after HD commencement. Uremic score was significantly associated with the primary outcome (crude HR: 1.91, 95% CI 1.16–3.14; adjusted HR: 4.19, 95% CI 1.79–9.78). Our novel uremic score, reflecting accumulation of specific UTs, more precisely predicts early mortality after HD commencement.

scholarly journals A Study on the Short-Term Mortality and Related Risk Factors of Fragile Hip Fracture

2020 ◽  
Author(s):  
Pei-Wen Wang ◽  
Hua-Feng Zhuang ◽  
Yi-Zhong Li ◽  
Hao Xu ◽  
Jin-Kuang Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Hip Fractures ◽  
Total Mortality ◽  
Early Mortality ◽  
Factors Affecting ◽  
Related Risk ◽  
Independent Risk Factors ◽  
One Year

Abstract BackgroundThis study aimed to observe the mortality of patients with fragile hip fractures and assess the death-associated risk factors.MethodsSix hundred and ninety patients with osteoporotic hip fractures(aged 50-103-years-old) that were treated from January 2010 to December 2015 were enrolled in this study and followed-up and the clinical data were retrospectively examined. Three months, one year, and the total mortality during the follow-up time were measured. Mortality-related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications.ResultsThe 286 patients were followed up between 6 months and 42 months, with an average of 21.42±9.88 months. The three-month mortality was 7.69%, the number of patients who were followed up over one year was 231, the one-year mortality was 16.02%, and the total mortality of the follow-up time was 17.48%. The higher mortality was related to age over 75 years, associated cardio-respiratory diseases, male gender, non-operative treatment, surgery delayed over 5 days. Binary Logistic regression analysis showed that the independent risk factors affecting mortality included age (OR=5.385, P=0.003), surgery (OR=21.217, P=0.000), the number of complications (OR=9.038, P=0.000), and pre-injury cardiovascular disease (OR=3.201, P=0.041).ConclusionThe early mortality of fragile hip fractures was high and was also related to many risk factors. Age, surgery, the number of complications, and pre-injury cardiovascular disease were the independent risk factors affecting the mortality of patients with fragile hip fractures. Effective treatment without complications and early surgery can lower early mortality in patients with fragile hip fractures.

scholarly journals Effect of under triage on early mortality after major pediatric trauma: a registry-based propensity score matching analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
François-Xavier Ageron ◽  
◽  
Jordan Porteaud ◽  
Jean-Noël Evain ◽  
Anne Millet ◽  
...  
Keyword(s):  
Propensity Score ◽  
Trauma Care ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Early Death ◽  
Risk Difference ◽  
Early Mortality ◽  
Trauma Patients ◽  
Risk Of Death

Abstract Background Little is known about the effect of under triage on early mortality in trauma in a pediatric population. Our objective is to describe the effect of under triage on 24-h mortality after major pediatric trauma in a regional trauma system. Methods This cohort study was conducted from January 2009 to December 2017. Data were obtained from the registry of the Northern French Alps Trauma System. The network guidelines triage pediatric trauma patients according to an algorithm shared with adult patients. Under triage was defined by the number of pediatric trauma patients that required specialized trauma care transported to a non-level I pediatric trauma center on the total number of injured patients with critical resource use. The effect of under triage on 24-h mortality was assessed with inverse probability treatment weighting (IPTW) and a propensity score (Ps) matching analysis. Results A total of 1143 pediatric patients were included (mean [SD], age 10 [5] years), mainly after a blunt trauma (1130 [99%]). Of the children, 402 (35%) had an ISS higher than 15 and 547 (48%) required specialized trauma care. Nineteen (1.7%) patients died within 24 h. Under triage rate was 33% based on the need of specialized trauma care. Under triage of children requiring specialized trauma care increased the risk of death in IPTW (risk difference 6.0 [95% CI 1.3–10.7]) and Ps matching analyses (risk difference 3.1 [95% CI 0.8–5.4]). Conclusions In a regional inclusive trauma system, under triage increased the risk of early death after pediatric major trauma.

Levels of Prothrombin Fragment F1+2 in Patients with Hyperhomocysteinemia and a History of Venous Thromboembolism

1997 ◽  
Vol 78 (05) ◽  
pp. 1327-1331 ◽  
Author(s):  
Paul A Kyrle ◽  
Andreas Stümpflen ◽  
Mirko Hirschl ◽  
Christine Bialonczyk ◽  
Kurt Herkner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Thrombin Generation ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Control Group ◽  
Prothrombin Fragment ◽  
Hemostatic System ◽  
Significant Difference ◽  
System Activation ◽  
One Year

SummaryIncreased thrombin generation occurs in many individuals with inherited defects in the antithrombin or protein C anticoagulant pathways and is also seen in patients with thrombosis without a defined clotting abnormality. Hyperhomocysteinemia (H-HC) is an important risk factor of venous thromboembolism (VTE). We prospectively followed 48 patients with H-HC (median age 62 years, range 26-83; 18 males) and 183 patients (median age 50 years, range 18-85; 83 males) without H-HC for a period of up to one year. Prothrombin fragment Fl+2 (Fl+2) was determined in the patient’s plasma as a measure of thrombin generation during and at several time points after discontinuation of secondary thromboprophylaxis with oral anticoagulants. While on anticoagulants, patients with H-HC had significantly higher Fl+2 levels than patients without H-HC (mean 0.52 ± 0.49 nmol/1, median 0.4, range 0.2-2.8, versus 0.36 ± 0.2 nmol/1, median 0.3, range 0.1-2.1; p = 0.02). Three weeks and 3,6,9 and 12 months after discontinuation of oral anticoagulants, up to 20% of the patients with H-HC and 5 to 6% without H-HC had higher Fl+2 levels than a corresponding age- and sex-matched control group. 16% of the patients with H-HC and 4% of the patients without H-HC had either Fl+2 levels above the upper limit of normal controls at least at 2 occasions or (an) elevated Fl+2 level(s) followed by recurrent VTE. No statistical significant difference in the Fl+2 levels was seen between patients with and without H-HC. We conclude that a permanent hemostatic system activation is detectable in a proportion of patients with H-HC after discontinuation of oral anticoagulant therapy following VTE. Furthermore, secondary thromboprophylaxis with conventional doses of oral anticoagulants may not be sufficient to suppress hemostatic system activation in patients with H-HC.

RELATED FACTORS TO RELAPSE IN DEPRESSED PATIENTS AFTER COGNITIVE BEHAVIOURAL THERAPY DURING ONE YEAR PROSPECTIVE FOLLOW-UP

2011 ◽  
pp. 13-19
Author(s):  
Nhu Minh Hang Tran ◽  
Huu Cat Nguyen ◽  
Dang Doanh Nguyen ◽  
Van Luong Ngo ◽  
Vu Hoang Nguyen ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Relapse Rate ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Related Factors ◽  
Depressed Patients ◽  
One Year

Objectives: To determine factors impact on the relapse in depressed patients treated with Cognitive Behavioral Therapy (CBT) during one year follow-up. Materials and Methods: 80 depressed patients divided into two groups, group 1: included 40 patients treated with CBT; group 2: 40 patients on amitriptyline. Non-randomized controlled clinical trial, opened, longiditual and prospective research. Results and Conclusions: relapse rate after CBT during 1 year follow-up is 10% (compared to 25% in control group), related factors to relapse rate in depression after CBT are age and education. Shared predictors between 2 groups are severity and recurrence of depression. Key words: Depression, relapse, Cognitive Behavioral Therapy (CBT)

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