scholarly journals Predisposition, Insult/Infection, Response and Organ Dysfunction (PIRO): A Pilot Clinical Staging System for Hospital Mortality in Patients with Infection

PLoS ONE ◽  
2013 ◽  
Vol 8 (7) ◽  
pp. e70806 ◽  
Author(s):  
Teresa Cardoso ◽  
Armando Teixeira-Pinto ◽  
Pedro Pereira Rodrigues ◽  
Irene Aragão ◽  
Altamiro Costa-Pereira ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Organ Dysfunction ◽  
Staging System ◽  
Clinical Staging ◽  
Infection Response ◽  
Clinical Staging System

scholarly journals Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
T. Cardoso ◽  
P. P. Rodrigues ◽  
C. Nunes ◽  
M. Almeida ◽  
J. Cancela ◽  
...  
Keyword(s):  
Intensive Care ◽  
Organ Dysfunction ◽  
Stage Iv ◽  
Staging System ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Clinical Staging ◽  
Operating Characteristics ◽  
Infection Response

Abstract Background Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important. Methods Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included. Results There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10 ± 3 vs 8 ± 4, p < 0.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic. Conclusions To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage.

Revision of the clinical staging system for cancer of the larynx

Cancer ◽  
1973 ◽  
Vol 31 (1) ◽  
pp. 72-80 ◽  
Author(s):  
Robert R. Smith ◽  
Ralph Caulk ◽  
Edgar Frazell ◽  
Paul H. Holinger ◽  
William S. Maccomb ◽  
...  
Keyword(s):  
Staging System ◽  
Clinical Staging ◽  
Clinical Staging System

A proposed clinical staging system for obesity

2009 ◽  
Vol 33 (3) ◽  
pp. 289-295 ◽  
Author(s):  
A M Sharma ◽  
R F Kushner
Keyword(s):  
Staging System ◽  
Clinical Staging ◽  
Clinical Staging System

A TNM-Based Clinical Staging System of Ocular Adnexal Lymphomas

2009 ◽  
Vol 133 (8) ◽  
pp. 1262-1267 ◽  
Author(s):  
Sarah E. Coupland ◽  
Valerie A. White ◽  
Jack Rootman ◽  
Bertil Damato ◽  
Paul T. Finger
Keyword(s):  
Prognostic Significance ◽  
Staging System ◽  
Clinical Staging ◽  
Disease Extent ◽  
Non Hodgkin Lymphoma ◽  
Ann Arbor ◽  
Data Points ◽  
Specific Factors ◽  
Clinical Staging System ◽  
User Friendly

Abstract Context.—The ocular adnexal lymphomas (OAL) arise in the conjunctiva, orbit, lacrimal gland, and eyelids. To date, they have been clinically staged using the Ann Arbor staging system, first designed for Hodgkin and later for nodal, non–Hodgkin lymphoma. The Ann Arbor system has several shortcomings, particularly when staging extranodal non– Hodgkin lymphomas, such as OAL, which show different dissemination patterns from nodal lymphomas. Objective.—To describe the first TNM-based clinical staging system for OAL. Design.—Retrospective literature review. Results.—We have developed, to our knowledge, the first American Joint Committee on Cancer–International Union Against Cancer TNM-based staging system for OAL to overcome the limitations of the Ann Arbor system. Our staging system defines disease extent more precisely within the various anatomic compartments of the ocular adnexa and allows for analysis of site-specific factors not addressed previously. It aims to facilitate future studies by identifying clinical and histomorphologic features of prognostic significance. This system is for primary OAL only and is not intended for intraocular lymphomas. Conclusions.—Our TNM-based staging system for OAL is a user-friendly, anatomic documentation of disease extent, which creates a common language for multicenter and international collaboration. Data points will be collected with the aim of identifying biomarkers to be incorporated into the staging system.

A rational clinical staging system for childhood rhabdomyosarcoma.

1984 ◽  
Vol 2 (2) ◽  
pp. 135-139 ◽  
Author(s):  
S S Donaldson ◽  
J A Belli
Keyword(s):  
Natural History ◽  
Therapeutic Strategy ◽  
Tumor Volume ◽  
Staging System ◽  
Clinical Staging ◽  
Tumor Node Metastasis ◽  
Node Metastasis ◽  
History Of ◽  
Clinical Staging System ◽  
Childhood Rhabdomyosarcoma

There is a need for a rational and useful staging system for childhood rhabdomyosarcoma that predicts prognosis based on the biology and natural history of the disease. Important factors to consider are age, histology, tumor volume, extent of invasion, and lymphatic involvement. A clinical staging system based on a classical tumor/node/metastasis status, and which accounts for natural history as a function of site of primary, local invasion, and lymphatic or hematogenous metastases is presented. This staging system eliminates the requirement that stage is assigned following an initial therapeutic strategy and removing the implication that prognosis is determined by that strategy.

scholarly journals Clinical staging system for hairy-cell leukemia

Blood ◽  
1982 ◽  
Vol 60 (3) ◽  
pp. 571-577 ◽  
Author(s):  
J Jansen ◽  
J Hermans
Keyword(s):  
Hairy Cell Leukemia ◽  
Staging System ◽  
Hemoglobin Level ◽  
Clinical Staging ◽  
Costal Margin ◽  
Hairy Cell ◽  
Cell Leukemia ◽  
Staging Systems ◽  
Clinical Staging System ◽  
Choice Of Therapy

Abstract To find a clinical staging system for patients with hairy cell leukemia, 391 patients contributed by 22 centers were analyzed using the proportional hazard survival model. Attention was paid to nonsplenectomized patients to find a staging system to predict the survival length at the time of diagnosis. On the basis of hemoglobin level and spleen size at the time of diagnosis, 3 stages could be distinguished with significantly different prognoses (stages I-III). In addition, we addressed the question of splenectomy to identify those patients who benefit from the operation. Using arbitrary, but clinically relevant, criteria to call the operation beneficial, splenectomy appears to be indicated for patients with large spleens (greater than or equal to 4 cm under costal margin) or with smaller, but palpable, spleens when anemia (Hb less than 12 g/dl) is present. The third question concerned the splenectomized patients. To indicate the patients who have a poor postsplenectomy survival, a staging system was developed on the basis of hemoglobin level and number of neutrophils at 2–3 mo after the operation (stages A-C). The validity of the two staging systems was supported by the results of an analysis of an independent test series of patients. These staging systems may be helpful for the choice of therapy and in the planning of clinical trials in patients with hairy-cell leukemia.

scholarly journals Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?

Cancer ◽  
2002 ◽  
Vol 95 (6) ◽  
pp. 1334-1345 ◽  
Author(s):  
Andrea Baur ◽  
Axel Stäbler ◽  
Dorothea Nagel ◽  
Rolf Lamerz ◽  
Reiner Bartl ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Staging System ◽  
Clinical Staging ◽  
Resonance Imaging ◽  
Clinical Staging System
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