scholarly journals A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination

2018 ◽  
Vol 37 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Mustafa Kaplan ◽  
Ihsan Ates ◽  
Erkin Oztas ◽  
Mahmut Yuksel ◽  
Muhammed Yener Akpinar ◽  
...  

SummaryBackground: We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality. Methods: This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels. Results: The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems. Conclusion: In our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.

2017 ◽  
Vol 27 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Anand Veeravagu ◽  
Amy Li ◽  
Christian Swinney ◽  
Lu Tian ◽  
Adrienne Moraff ◽  
...  

OBJECTIVEThe ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort.METHODSThe spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery.RESULTSThe authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60–0.74] in RAT, 0.669 [95% CI 0.60–0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48–0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018).CONCLUSIONSWhile the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.


2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 153-157 ◽  
Author(s):  
Narayan Prasad ◽  
Amit Gupta ◽  
Archana Sinha ◽  
Anurag Singh ◽  
Raj Kumar Sharma ◽  
...  

Background Case-mix comorbidities and malnutrition influence outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we analyzed the influence of stratified comorbidities on nutrition indices and survival in CAPD patients. Patients and Methods We categorized 373 CAPD patients (197 with and 176 without diabetes) into three risk groups: low—age under 70 years and no comorbid illness; medium—age 70 – 80 years, or any age with 1 comorbid illness, or age under 70 years with diabetes; high—age over 80 years, or any age with 2 comorbid illnesses. We then compared nutrition indices and malnutrition by subjective global assessment (SGA) between the three groups. Survival was compared using Kaplan–Meier survival analysis. Results Mean daily calorie and protein intakes in the low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79 ± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ± 0.26 g/kg) groups ( p = 0.001 and p = 0.04 respectively). Relative risk (RR) of malnutrition was less in the low-risk group (103/147, 70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64, 84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of patients in the low-, medium-, and high-risk groups were 51 patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3 patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7 patient–months (95% CI: 23 to 36.4 patient–months) respectively (log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-, and 5-year patient survivals in the low-, medium-, and high-risk groups were 96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%, 30%, and 30% respectively. Conclusions Intake of calories and protein was significantly lower in the medium-risk and high-risk groups than in the low-risk group. Survival was significantly better in low-risk patients than in medium- and high-risk patients.


2003 ◽  
Vol 15 (4) ◽  
pp. 351-366 ◽  
Author(s):  
Laurel A. Strain ◽  
Audrey A. Blandford ◽  
Lori A. Mitchell ◽  
Pamela G. Hawranik

Background: This study focused on the identification of risk profiles for institutionalization among older adults diagnosed with cognitive impairment-not dementia or dementia in 1991/92 and subsequent institutionalization in the following 5-year period. Methods: Data were from a sample of 123 individuals aged 65+ and their unpaid caregivers in Manitoba, Canada. Cluster analysis was conducted using baseline characteristics of age, cognition, disruptive behaviors, ADLs/IADLs, use of formal in-home services, and level of caregiver burden. Results: Three distinct groups emerged (high-risk [n = 12], medium risk [n = 40], and low risk [n = 71]). The high-risk group had the poorest cognitive scores, were the most likely to exhibit disruptive behaviors, were the most likely to need assistance with ADLs and IADLs, and had the highest level of burden among their caregivers. Follow-up of the groups validated the risk profiles; 75% of the high-risk group were institutionalized within the next 5 years, compared to 45% of the medium-risk group and 21% of the low-risk group. Discussion: The risk profiles highlight the diversity among individuals with cognitive impairment and the opportunity for differential targeting of services for the distinct needs of each group.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yong Zhu He ◽  
Kun He ◽  
Rui Qin Huang ◽  
Li Wen Liu ◽  
Shao Wei Ye ◽  
...  

AbstractPreoperative prediction of tumor recurrence after radiofrequency ablation (RFA) in patients with early hepatocellular carcinoma (HCC) is helpful for clinical decision-making before treatment. A total of 162 patients with HCC of 3 cm or less who were completely ablated by percutaneous RFA were divided into a derivation cohort (n = 108) and a validation cohort (n = 54). Based on X-Tiles software, Kaplan–Meier curve analysis and COX multivariate analysis to obtain valuable predictive indicators, a clinical scoring system for predicting tumor recurrence was established. In the verall cohort, derivation cohort and validation cohort, we found circulating tumor cells (CTC) > 2/3.2 mL, alpha-fetoprotein (AFP) > 20 ng/mL, and des-γ-carboxyprothrombin (DCP) > 40 mAU/mL, maximum tumor diameter > 20 mm, and the number of multiple tumors (≥ 2) are independent risk factors affecting tumor recurrence. Each independent risk factor was assigned a score of 1 to construct a predictive clinical scoring system, and X-Tiles software was used to divide the clinical score into a low-risk group (0 score–1 score), a medium-risk group (2 scores–3 scores), and a high-risk group (4 scores–5 scores). The cumulative tumor recurrence rates of patients in the low-risk group, middle-risk group, and high-risk group in 1 year, 2 years, and 3 years were 19.4%/27.5%/30.9%, 37.0%/63.2%/79.9% and 68.2%/100%/100%, respectively (Low-risk group vs medium-risk group: P < 0.001; medium-risk group vs high-risk group: P < 0.001). This clinical scoring system can predict the prognosis of patients with HCC of 3 cm or smaller undergoing percutaneous RFA, which has certain application value for making preoperative clinical decisions.


2019 ◽  

Osteoporosis (OP) is a progressive metabolic bone disease caused by disturbed balance between bone formation and bone resorption. Osteoporotic fractures lead to a deterioration in the quality of patients’ life due to high morbidity and mortality, and the economic burden of osteoporotic fractures is expected to increase. Various tools have been developed to assess the risk of osteoporosis in the clinical practice. The Osteoporosis Self-Assessment Tool (OST) is used to predict osteoporosis and is suitable for self-assessment. The purpose of this study is to assess the ability of the OST score to predict the risk of OP. 180 postmenopausal women with a mean age of 61 ± 13 years (38-86 years) were included in the study. The OST score was evaluated using the formula: (body weight  age) × 0.2. Patients were divided into three groups according to the risk of OP: low risk (> -1), moderate risk (-1 to -4) and high risk (<-4). Based on the total lumbar spine T-score, measured by dual-energy X-ray absorptiometry (DEXA), the actual number of the women with OP was established. According to the OST score, 22 women were in the high risk group, 41 women in the moderate risk group, and 117 women in the low risk group. There was a correlation between the risk of OP calculated with OST and the number of patients with OP, established by DEXA measurement - with increased risk of OP, the number of the women with OP also increased (p = 0.000). The percentage of the women with osteoporosis is highest in the high risk group and lowest in the low risk group. In the high risk group, 95.5% of the women had a diagnosis of osteoporosis. These results demonstrate the good ability of OST score to predict the risk of OP in the Bulgarian population.


2021 ◽  
Author(s):  
Lizhao Yan ◽  
Yinghao Cao ◽  
Shenghe Deng ◽  
Junnan Gu ◽  
Fuwei Mao ◽  
...  

Abstract Background: To investigate the predictive value of the neutrophil-lymphocyte ratio (NLR), white blood cell-lymphocyte ratio (WLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) in grading the malignant potential of the gastrointestinal stromal tumour (GIST).Methods: We retrospectively reviewed 843 GIST patients who underwent surgery during hospitalisation from June 2016 to July 2020 and 374 unrelated healthy controls. Demographic data were collected for each participant, including age, gender, body mass index, laboratory test results, and pathological results. We compared the NLR, WLR, MLR, and PLR between GIST and healthy individuals, as well as among patients with different risk grades of GIST.Results: NLR, WLR, MLR, and PLR values of patients with GIST were significantly increased compared with those of the control group (P<0.05). These values also showed statistically significant differences among the four risk degree groups. The NLR, WLR, MLR, and PLR values of the high-risk group were significantly higher than those of the very low-risk group, low-risk group, and intermediate-risk group (p<0.001). The NLR, WLR, MLR, and PLR showed a high predictive value in the high-risk group, with an area under the receiver operating characteristic curve of 0.802, 0.824, 0.866, and 0.814, and a cut-off value of 2.059, 3.347, 0.221, and 141.4, respectively.Conclusion: Preoperative NLR, WLR, MLR, and PLR have a high predictive value for grading the malignant potential of GIST, especially in the high-risk group. These values provide a convenient and inexpensive way to determine preoperative chemotherapy and surgical strategies.


2020 ◽  
Author(s):  
Xiaotong Wang ◽  
Zhongyu Wang ◽  
Bing Li ◽  
Ping Yang

Abstract Background:Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. Syntax and Syntax II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method:396 patients with ACS undergoing percutaneous coronary intervention(PCI)and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during the next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results:①Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium/high risk group(p=0.011). Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group(p=0.032).② Compared with SYNTAX II low-risk group,cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group(p=0.001,p<0.001 respectively). ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group(p=0.019, p=0.023 respectively). ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group(p=0.023,p=0.044 respectively). ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years(p=0.038,p=0.016 respectively),SYNTAX score was an independent predictor of MACCE events in 1 year(medium-risk group:p=0.02;high-risk group:p=0.015)SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs(p=0.003). Conclusions:①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjamin Bondue ◽  
Pascal Schlossmacher ◽  
Nathalie Allou ◽  
Virgile Gazaille ◽  
Olivier Taton ◽  
...  

Abstract Background The surgical lung biopsy (SLB) is the recommended sampling technique when the pathological analysis of the lung is required in the work-up of an interstitial lung disease (ILD) but trans-bronchial lung cryobiopsy (TBLC) is increasingly recognized as an alternative approach. As TBLCs have lower mortality and morbidity risks than SLB, this study aimed to investigate the safety of TBLCs in patients at higher risk of complications and for whom SLB was not considered as an alternative. Method This prospective study was conducted in two hospitals in which TBLCs were performed in patients with body mass index (BMI) > 35, and/or older than 75 years, and/or with severely impaired lung function (FVC < 50% or DLCO < 30%), and/or systolic pulmonary artery pressure > 45 mmHg, and/or a clinically significant cardiac disease. Patients with any of these risk factors constituted the high-risk group. Clinical outcomes were compared with those obtained in patients without these risk factors (low-risk group). Results Ninety-six patients were included between April 2015 and April 2020, respectively 38 and 58 in the high-risk or the low-risk group. No statistically significant difference was observed between both groups in terms of severity and rate of bleeding, pneumothorax, or duration of hospital stay (p value ranging from 0.419 to 0.914). Conclusion This preliminary study on a limited number of patients suggests that TBLC appears safe in those in whom lung biopsy is at high-risk of complications according to their age, BMI, lung impairment, and cardiac comorbidities.


2020 ◽  
Author(s):  
Xiaotong Wang ◽  
Zhongyu Wang ◽  
Bing Li(New Corresponding Author) ◽  
Ping Yang(Former Corresponding Author)

Abstract Background:Acute coronary syndrome (ACS) is a group of clinical syndromes associated with substantial morbidity and mortality rate. Syntax and Syntax II score used to be a reference for surgical selection of coronary revascularization and prognosis evaluation in patients with 3-vessel or left main artery disease. In addition, apoB/apoA1 is an important predictor of ACS risk. This study aims to assess the prognosis value of different kinds of SYNTAX score together with apoB/apoA1 in universal ACS patients (Regardless of ACS type, lesion location and vessel numbers). Method:396 patients with ACS undergoing percutaneous coronary intervention(PCI)and coronary stenting from 2013 to 2014 were chosen and recorded the major adverse cardiovascular and cerebrovascular events (MACCE) and quality of life during next 5 years. According to SYNTAX and SYNTAX II score, the patients were divided into low-risk, medium-risk and high-risk groups, and the clinical features, MACCE incidence and EQ-5D score at each time points were compared. And the predictive factors of MACCE incidence were analyzed. Results:①Compared with SYNTAX low-risk group, MACCE incidence in 1 year significantly increased in medium-high risk group(p=0.011). Compared with SYNTAX II low-risk group, MACCE incidence in 5 years significantly increased in medium and high-risk group(p=0.032).② Compared with SYNTAX II low-risk group,cardiovascular mortality in 3 and 5 years significantly elevated in high-risk group(p=0.001,p<0.001 respectively). ③ Compared with SYNTAX II low and medium-risk group, EQ-5D score in 5 years significantly decreased in high-risk group(p=0.001). ④ ApoB/ApoA1 was more likely to be classified as high risk in SYNTAX/SYNTAX II medium and high-risk group(p=0.023,p=0.044 respectively). ⑤Logistic regression analysis showed that apoB/apoA1 was an independent predictor of MACCE events in hospital and 5 years(p=0.038,p=0.016 respectively),SYNTAX score was an independent predictor of MACCE events in 1 year(medium-risk group:p=0.02;high-risk group:p=0.015)SYNTAX II score was an independent predictor of MACCE events in 5 yeasrs(p=0.003). Conclusions:①SYNTAX score has a high predictive value for short-term prognosis while SYNTAX II score is more predictive of long-term prognosis. ② SYNTAX II score is superior to SYNTAX score in predicting cardiovascular death. ③ The combination of apoB/apoA1 high-risk and SYNTAX II medium and high-risk group is the focus of clinical treatment and long-term follow-up observation.


2021 ◽  
Vol 11 (2) ◽  
pp. 642-647
Author(s):  
Wang Chen ◽  
Rong Guo ◽  
WeiGao Sun ◽  
DingYou Lu

Objective: The study aims to explore the role of computed tomography (CT) in clinical diagnosis, thus having a preliminary understanding of the relationship between CT signs and the risk of gastric stromal tumors (GSTs). Methods: In this study, 213 patients with GST with complete preoperative CT and postoperative pathological results in Yancheng No. 1 People's Hospital from January 2016 to August 2019 are selected as research objects. The patient's basic information is collected. CT machine (Toshiba 320 row CT and Siemens dualsource CT (Somatom Definition Flash)) is used to examine all patients. The obtained image data are evaluated. Patients are divided into low-risk group, medium risk group and high-risk group according to the risk classification standard of GST. The data collected are analyzed statistically. Results: After risk classification of all patients, 87 patients in low-risk group, 74 in medium-risk group and 52 in high-risk group are found. After further analysis of the risk classification, it is found that there is no significant difference in GST risk classification between the tumor sites (P > 0.05). In the GST risk classification, the smaller the tumor, the more the low-risk group, the larger the tumor, the more the high-risk group, the difference is statistically significant (P < 0.05). In the observation of the relationship between tumor growth pattern and risk classification, it is found that the number of intraluminal growth is the most, while mixed growth is the least (P < 0.05). Further analysis of tumor density, solid part enhancement, distant metastasis and risk grade show that there are significant differences (P < 0.05). Conclusion: As an auxiliary diagnostic method in clinic, CT signs can be used to analyze the relationship with risk grade from tumor location, tumor size, tumor growth mode, tumor density, solid part enhancement degree and tumor distant metastasis, so as to have a more accurate understanding of patients' situation, and provide experimental basis for the later application of CT signs in tumor and auxiliary diagnosis.


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