Impact of mental disorders on COVID-19 outcomes

Objective: to analyze clinical and follow-up indicators in patients with mental disorders and COVID-19 and to identify on their basis predictors of poor outcomes associated with mental state.Patients and methods. We conducted a prospective study in a multidisciplinary hospital. The severity of coronavirus infection was determined according to the temporary guidelines. Data collection was carried out using a patient chart consisting of 109 variables. Predictors of poor outcomes were determined using predictive models (logit regression, Cox model). The study included 97 patients: 41 men (42.3%) and 56 (57.7%) women, mean age – 62.3±15.3 years. 26 patients died; 71 patients recovered.Results and discussion. The death occurred on 11.5 day. The mental state of these patients was severe, with a predominance of delirium cases. With increasing age, the probability of non-lethal outcome decreases [hazard ratio (HR) 1.03; 95% confidence interval (CI) 1.00–1.06; p=0.037]. The risk of death increased by 1.03 (p=0.037) for each year of life. An improvement in the mental state of patients during psychotropic therapy is associated with an 11.11-fold decrease in the risk of poor outcome of coronavirus infection (HR 0.09; 95% CI 0.01–0.76; p=0.027). Delirium is a predictor of low patient survival, especially in prolonged hospitalizations (HR 4.55; 95% CI 1.66–12.48; p=0.003). The severity of coronavirus infection makes the greatest contribution to the poor outcome: the risk of death increases by 33.17 times (CR 33.17; 95% CI 4.01–274.65; p<0.001). The severity of the mental disorder had a greater impact on the risk of death compared with age, increasing it by 4.55 times (p=0.003).Conclusion. We found significant differences between the groups of deceased and surviving patients with COVID-19 concerning the variables related to certain mental disorders, their severity and dynamics, and the severity of coronavirus infection. In addition, the age of the patients had a significant impact on the prognosis of COVID-19. The results reflect the special prognostic significance of delirium in the structure of mental disorders developing in patients with coronavirus infection.

Download Full-text

Stromal Cell-Derived Factor 1α (SDF-1α) in Invasive Breast Cancer: Associations with Vasculo-Angiogenic Factors and Prognostic Significance

Cancers ◽

10.3390/cancers13081952 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1952

Author(s):

Elżbieta Zarychta ◽

Barbara Ruszkowska-Ciastek ◽

Kornel Bielawski ◽

Piotr Rhone

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Stromal Cell ◽

Prognostic Significance ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Roc Curve Analysis ◽

Stromal Cell Derived Factor ◽

A Prospective Study

(1) Background: Tumour angiogenesis is critical for the progression of neoplasms. A prospective study was designed to examine the utility of stromal cell-derived factor 1α (SDF-1α) and selected vasculo-angiogenic parameters for estimating the probability of disease relapse in 84 primary, operable invasive breast cancer (IBrC) patients (40 (48%) with stage IA and 44 (52%) with stage IIA and IIB). (2) Methods: We explored the prognostic value of the plasma levels of SDF-1α, vascular endothelial growth factor A (VEGF-A), the soluble forms of VEGF receptors type 1 and 2, and the number of circulating endothelial progenitor cells (circulating EPCs) in breast cancer patients. The median follow-up duration was 58 months, with complete follow-up for the first event. (3) Results: According to ROC curve analysis, the optimal cut-off point for SDF-1α (for discriminating between patients at high and low risk of relapse) was 42 pg/mL, providing 57% sensitivity and 75% specificity. Kaplan–Meier curves for disease-free survival (DFS) showed that concentrations of SDF-1α lower than 42 pg/dL together with a VEGFR1 lower than 29.86 pg/mL were significantly associated with shorter DFS in IBrC patients (p = 0.0381). Patients with both SDF-1α lower than 42 pg/dL and a number of circulating EPCs lower than 9.68 cells/µL had significantly shorter DFS (p = 0.0138). (4) Conclusions: Our results imply the clinical usefulness of SDF-1α, sVEGFR1 and the number of circulating EPCs as prognostic markers for breast cancer in clinical settings.

Download Full-text

Anaemia: A risk factor for death and adverse outcomes following surgery for acute lower limb ischaemia

Vascular ◽

10.1177/17085381211026167 ◽

2021 ◽

pp. 170853812110261

Author(s):

Daniel Perren ◽

Lauren Shelmerdine ◽

Luke Boylan ◽

Craig Nesbitt ◽

James Prentis ◽

...

Keyword(s):

Risk Factor ◽

Cox Model ◽

Univariate Analysis ◽

Adverse Outcomes ◽

Limb Ischaemia ◽

Risk Of Death ◽

Kaplan Meier ◽

Acute Limb Ischaemia ◽

Impact On Survival ◽

Poor Outcomes

Introduction Acute limb ischaemia (ALI) forms a significant part of the vascular surgery workload and carries with it high rates of morbidity and mortality. Anaemia is also common amongst vascular surgical patients and has been linked with poor outcomes in some subgroups. We aimed to assess the frequency of anaemia in patients with ALI and its impact on survival and complications following revascularisation to help direct future efforts to optimise outcomes in this patient group. Methods A retrospective analysis of prospectively collected departmental data on patients undergoing surgical intervention for ALI between 2014 and 2018 was performed. Anaemia was defined as a pre-operative haemoglobin (Hb) of <120 g/L for women and <130 g/L for men. The primary outcome was overall survival, assessed with the Kaplan–Meier estimator, with application of Cox proportional hazard modelling to adjust for confounding covariates. Results There were 158 patients who underwent treatment for ALI: 89 (56.3%) of these were non-anaemic with a mean Hb of 146 (SD = 18.4), and 69 (43.7%) were anaemic with a mean Hb of 106 (SD = 13.4). Anaemic patients had a significantly higher risk of death than their non-anaemic counterparts on univariate analysis (HR = 2.11, 95% CIs, 1.28–3.5, p = 0.0036). There was ongoing divergence in survival up to around 6 months between anaemic and non-anaemic groups. Under the Cox model, anaemia was similarly significant as a predictor of death (HR = 2.15, 95% CIs, 1.17–3.95, p = 0.013), accounting for recorded comorbidities, medication use and blood transfusion. Conclusions Anaemia is a significant and independent risk factor for death following revascularisation for ALI and can be potentially be modified. Vascular surgical centres should ensure they have robust pathways in place to identify and consider treating anaemia. There is scope for further work to assess how to best optimise a patient’s levels of circulating haemoglobin.

Download Full-text

Abstract P098: Slower Gait Speed is Associated with Increased Mortality Risk in Chronic Kidney Disease.

Circulation ◽

10.1161/circ.125.suppl_10.ap098 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Baback Roshanravan ◽

Cassiane Robinson-Cohen ◽

Kushang V Patel ◽

Greg Levin ◽

Ian H de Boer ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Gait Speed ◽

Proportional Hazards ◽

Prognostic Significance ◽

Continuous Variable ◽

Hazard Ratio ◽

Risk Of Death ◽

Social Security Death Index

Objective: Skeletal muscle dysfunction (sarcopenia) is an under-recognized complication of chronic kidney disease (CKD) that may have important clinical consequences. Gait speed is associated with sarcopenia and comorbid disease burden among older adults; however, little is known about the prognostic significance of gait speed in CKD. We determined the association of gait speed with all-cause mortality in a prospective cohort of non-dialysis CKD patients. Methods: We measured usual gait speed over 4-meters in 309 participants from a prospective study of non-dialysis CKD. Included subjects had an estimated glomerular filtration rate (eGFR ckdepi ) <90mL/min/1.73m 2 , were stroke-free and did not require a wheelchair for ambulation. Study coordinators assessed mortality during follow-up by phone contacts, medical record review, and the social security death index. We evaluated gait speed continuously, and using a cut point of 0.8 m/s, consistent with previous studies. We used Cox's proportional hazards to estimate the association of gait speed with mortality after adjustment for age, sex, race, smoking, diabetes, pre-existing CAD, BMI, eGFR and hemoglobin. Results: Median follow-up time was 2.7 years; range 27 days to 4.8 years. The mean age was 58.9 ± 13 years and mean eGFR by cystatin C (eGFR cysc ) was 48.5 ± 23mL/min/1.73m 2 . There were a total of 31 deaths (10.4%) during follow-up. Unadjusted mortality rates were 23 and 80 deaths per 1,000 person-years among participants who had a gait speed of >0.8m/s versus ≤0.8m/s, respectively. After full adjustment, gait speed ≤0.8m/s was associated with a 2.8-fold greater risk of death compared to a gait speed >0.8 m/s. Gait speed was also strongly associated with mortality when analyzed as a continuous variable ( Table ) and a stronger predictor of death than age, history of CAD, or diabetes. No. Deaths (%) Model 1 + Model 2 # Hazard Ratio 95% CI Hazard Ratio 95% CI Gait speed * 32(10) 0.74 (0.64-0.86) 0.75 (0.64-0.87) >0.8m/s 13 (6) Reference Reference ≤0.8m/s 19(19) 3.49 (1.54-7.95) 2.84 (1.25-6.48) * Gait speed analyzed continuously per 10cm/s increase in speed. +Model 1: Adjusted for age, sex, race, study site #Model 2: adds smoking, BMI, eGFR cysc , diabetes, prevalent coronary disease. Conclusion: Gait speed is strongly associated with death in a cohort of middle-aged CKD patients.

Download Full-text

Long-term outcomes of pediatric arteriovenous malformations: the 30-year Pittsburgh experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.3.peds19614 ◽

2020 ◽

Vol 26 (3) ◽

pp. 275-282

Author(s):

Michael M. McDowell ◽

Nitin Agarwal ◽

Gordon Mao ◽

Stephen Johnson ◽

Hideyuki Kano ◽

...

Keyword(s):

Multivariate Analysis ◽

Arteriovenous Malformations ◽

Multimodality Treatment ◽

Treatment Choice ◽

University Of Pittsburgh ◽

Poor Outcome ◽

Poor Outcomes ◽

The University

OBJECTIVEThe study of pediatric arteriovenous malformations (pAVMs) is complicated by the rarity of the entity. Treatment choice has often been affected by the availability of different modalities and the experience of the providers present. The University of Pittsburgh experience of multimodality treatment of pAVMs is presented.METHODSThe authors conducted a retrospective cohort study examining 212 patients with pAVM presenting to the University of Pittsburgh between 1988 and 2018, during which patients had access to surgical, endovascular, and radiosurgical options. Univariate analysis was performed comparing good and poor outcomes. A poor outcome was defined as a modified Rankin Scale (mRS) score of ≥ 3. Multivariate analysis via logistic regression was performed on appropriate variables with a p value of ≤ 0.2. Seventy-five percent of the cohort had at least 3 years of follow-up.RESULTSFive patients (2.4%) did not receive any intervention, 131 (61.8%) had GKRS alone, 14 (6.6%) had craniotomies alone, and 2 (0.9%) had embolization alone. Twenty-two (10.4%) had embolization and Gamma Knife radiosurgery (GKRS); 20 (9.4%) had craniotomies and GKRS; 8 (3.8%) had embolization and craniotomies; and 10 (4.7%) had embolization, craniotomies, and GKRS. Thirty-one patients (14.6%) were found to have poor outcome on follow-up. The multivariate analysis performed in patients with poor outcomes was notable for associations with no treatment (OR 18.9, p = 0.02), hemorrhage requiring craniotomy for decompression alone (OR 6, p = 0.03), preoperative mRS score (OR 2.1, p = 0.004), and Spetzler-Martin score (OR 1.8, p = 0.0005). The mean follow-up was 79.7 ± 62.1 months. The confirmed radiographic obliteration rate was 79.4% and there were 5 recurrences found on average 9.5 years after treatment.CONCLUSIONSHigh rates of long-term functional independence (mRS score of ≤ 2) can be achieved with comprehensive multimodality treatment of pAVMs. At this center there was no difference in outcome based on treatment choice when accounting for factors such as Spetzler-Martin grade and presenting morbidity. Recurrences are rare but frequently occur years after treatment, emphasizing the need for long-term screening after obliteration.

Download Full-text

Abstract 3752: Performance Of Color ADC Maps As A Prognostic Tool In Comatose Post-cardiac Arrest Patients

Stroke ◽

10.1161/str.43.suppl_1.a3752 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael Mlynash ◽

Jonathan T Kleinman ◽

Anna Finley Caulfield ◽

Chitra Ventkatasubramanian ◽

Marion Buckwalter ◽

...

Keyword(s):

Cardiac Arrest ◽

Therapeutic Hypothermia ◽

Predictive Performance ◽

Post Processing ◽

Poor Outcome ◽

Apparent Diffusion ◽

Predicting Outcome ◽

Poor Outcomes ◽

Predictive Rate ◽

A Prospective Study

Background: Predicting outcome for comatose post-cardiac arrest survivors is challenging and compounded by the use of therapeutic hypothermia and sedative agents in recent years. Previous studies suggest that brain abnormalities on MRI are predictive for poor outcome. MRI based predictive factors are attractive because they are not affected by drugs or metabolic derangements; however, most of the methods proposed require image post-processing with specialized software. We assessed the prognostic value of color apparent diffusion coefficient (ADC) maps in a prospective study. Methods: Consecutive patients who remained comatose after cardiac arrest were prospectively enrolled. Color ADC maps were created by assigning computed ADC values to 8 colors of spectrum ranging from red to blue ( Figure ). The color ADC maps were not available to the clinical teams caring for the patient. Two raters (a neurocritical care/stroke neurologist and a medical student) independently and blinded reviewed the color ADC maps and predicted 3 month outcome as poor (Glasgow Outcome Scale (GOS) 1 or 2), impaired (GOS=3) or good (GOS of 4 or 5). Both raters were “trained” by viewing 4 examples of patients with good, impaired and poor outcomes. A 3 month GOS of 3-5 was considered a favorable outcome. The agreement between raters and the predictive performance of the color ADC maps were assessed. Results: 112 color ADC maps of 94 patients (56% with poor, 12% with impaired, and 32% with good outcome) were reviewed: age 59±15 years, 36% females, 69% underwent therapeutic hypothermia, median (IQR) arrest duration 20min (14-30), and time between the arrest and MRI 82hours (60-141). Kappa with quadratic weighting for agreement on predicting all 3 levels of outcomes was 0.74, while kappa for favorable vs. unfavorable outcome was 0.76. For the two reviewers, the sensitivity for predicting poor outcome was 0.85 (95%CI 0.73-0.92) and 0.78 (0.66-0.87), the specificity 0.81(0.66-0.90) and 0.74(0.59-0.86), and the true positive predictive rate 86% (74-93%) and 81% (69-89%), respectively. After excluding early (≤24 hours) and late (>120 hours) scans (ADC changes are time dependent and most apparent after day 1 and before day 6), the specificity improved to 0.87 (0.68-0.96) and 0.77 (0.57-0.89), respectively. Conclusion: MRI color ADC maps hold promise as a useful and easy to interpret adjunct for predicting outcome of comatose post-cardiac arrest patients in the first few days after the arrest. Since these maps do not require post-processing and can be created in real-time, they can easily be implemented in the clinical setting.

Download Full-text

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial

Journal of Neurosurgery ◽

10.3171/2020.7.jns193431 ◽

2021 ◽

pp. 1-5

Author(s):

Joshua S. Catapano ◽

Mohamed A. Labib ◽

Fabio A. Frisoli ◽

Megan S. Cadigan ◽

Jacob F. Baranoski ◽

...

Keyword(s):

Univariate Analysis ◽

Ruptured Aneurysm ◽

Poor Outcome ◽

Increased Risk ◽

Grade Ii ◽

Grading Scale ◽

Poor Outcomes ◽

Grade Iii

OBJECTIVEThe SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.METHODSThe records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups.RESULTSA total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5–4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2–6.2; p < 0.001) follow-ups.CONCLUSIONSHigh SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.

Download Full-text

Requirement for Etoposide in the Treatment of Epstein-Barr Virus–Associated Hemophagocytic Lymphohistiocytosis

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.10.2665 ◽

2001 ◽

Vol 19 (10) ◽

pp. 2665-2673 ◽

Cited By ~ 159

Author(s):

Shinsaku Imashuku ◽

Kikuko Kuriyama ◽

Tomoko Teramura ◽

Eiichi Ishii ◽

Naoko Kinugawa ◽

...

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Epstein Barr Virus ◽

Cox Model ◽

Short Interval ◽

Prognostic Significance ◽

Rank Test ◽

Term Survival ◽

Barr Virus ◽

Risk Of Death ◽

Epstein Barr

PURPOSE: We sought to identify the clinical variables most critical to successful treatment of Epstein-Barr virus (EBV)–associated hemophagocytic lymphohistiocytosis (HLH). PATIENTS AND METHODS: Among the factors tested were age at diagnosis (< 2 years or ≥ 2 years), time from diagnosis to initiation of treatment with or without etoposide-containing regimens, timing of cyclosporin A (CSA) administration during induction therapy, and the presence or absence of etoposide. RESULTS: By Kaplan-Meier analysis, the overall survival rate for the entire cohort of 47 patients, most of whom had moderately severe to severe disease, was 78.3% ± 6.7% (SE) at 4 years. The probability of long-term survival was significantly higher when etoposide treatment was begun less than 4 weeks from diagnosis (90.2% ± 6.9% v 56.5% ± 12.6% for patients receiving this agent later or not at all; P < .01, log-rank test). Multivariate analysis with the Cox proportional hazards model demonstrated the independent prognostic significance of a short interval from EBV-HLH diagnosis to etoposide administration (relative risk of death for patients lacking this feature, 14.1; 95% confidence interval, 1.16 to 166.7; P = .04). None of the competing variables analyzed had significant predictive strength in the Cox model. However, concomitant use of CSA with etoposide in a subset of patients appears to have prevented serious complications from neutropenia during the first year of treatment. CONCLUSION: We conclude that early administration of etoposide, preferably with CSA, is the treatment of choice for patients with EBV-HLH.

Download Full-text

What is the behavior of Breslow’s thickness?

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9097 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9097-9097

Author(s):

Gelcio L. Q. Mendes ◽

Sergio Koifman

Keyword(s):

Cox Model ◽

Demographic Data ◽

Mitotic Rate ◽

Continuous Variable ◽

Stage I ◽

Linear Component ◽

Risk Of Death ◽

Kaplan Meier ◽

Advanced Stages

9097 Background: Localized cutaneous melanomas (CM) have their clinical course predicted by microscopic findings in the tumor specimen, mostly Breslow’s thickness (BTL), ulceration and mitoses. It is not certain whether BTL has a linear relationship with overall survival (OS) or relapse-free survival (RFS). The aim of this study was to evaluate BTL´s linear (LC) and its non-linear component (NLC) with relation to survival. Methods: All consecutive cases of CM treated from 1997 to 2006 at a single institution were identified, individuals with stage I or II tumors, minimum follow up of one month and known BTL were selected, socio-demographic data, clinical and pathological findings, treatment and outcomes were abstracted. Information about ulceration was missing in more that 30% of cases and it was not evaluated, there was no information about mitotic rate. Survival was estimated by the Kaplan-Meier method. Multivariate analyses were performed by the Cox model. BTL was evaluated as a continuous variable, and the LC and NLC by the technique of smoothing, using p-splines. Results: There were 1465 cases of CM, 51 with no follow up, 137 had no information about BTL and 202 had advanced stages. This analysis is based on 1075 cases. In the Cox model, the variables associated OS were age [hazard ratio (HR) 1.02, 95% CI 1.01 to 1.03], sex (HR 1.56, 95% CI 1.2 to 2.04) and BTL (HR=1.079, 95% CI 1.065 to 1.094). The variables associated with RFS were age (HR 1.017, 95% CI 1.009 to 1.024), sex (HR 1.372, 95% CI 1.104 to 1.704) and BTL (1.068, 95% CI 1.057 to 1.080). In the analysis of LC and NLC of BTL, it was found that both LC and NLC were statistically significant for OS and RFS. There was an increase in the HR as BTL increased in those lesions thinner than 4mm, then such increase was not as evident and lesions with more than 10mm had a similar OS and RFS (plateau). Conclusions: BTL is one of the most powerful prognostic criteria of patients with stage I and II CM. The risk of death increases linearly for thin lesions up to 4mm, lesions thicker than 10mm behave as a uniform group with no further decrease in OS or RFS as the lesion becomes larger. In conclusion, BTL may not behave as a linear function, it has a LC for thinner lesions, but for thicker lesions, above 10mm, further increase in BTL may add no more risk.

Download Full-text

Predictors of Diabetic Foot Reulceration beneath the Hallux

Journal of Diabetes Research ◽

10.1155/2019/9038171 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

R. J. Molines-Barroso ◽

J. L. Lázaro-Martínez ◽

J. V. Beneit-Montesinos ◽

F. J. Álvaro-Afonso ◽

E. García-Morales ◽

...

Keyword(s):

Diabetic Neuropathy ◽

Diabetic Foot ◽

Cox Model ◽

Sociodemographic Factors ◽

Hallux Limitus ◽

Therapeutic Footwear ◽

Custom Made ◽

History Of ◽

A Prospective Study

Aims. To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. Methods. A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study. Results. Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p=0.005, 95% CI (2.097–73.128), HR 12.384) and increased body mass index (p=0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model. Conclusions. Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.

Download Full-text