scholarly journals Design and validation of a scoring system for rapid identification of severe acute pancreatitis in patients with acute pancreatitis

2020 ◽  
Author(s):  
Ling Wang ◽  
Shaohong Wang ◽  
Jingguo Zhang

Abstract Purpose: Early identification of SAP and take necessary treatment can reduce the mortality rate of patients with AP. This study aimed to design a scoring system for rapid identification of SAP (RISAP) and evaluate its performance in predicting SAP in patients with AP. Methods: In the first phase, 1024 patients with AP who were admitted to the people's hospital of Qiandongnan Miao and Dong Autonomous Prefecture ,The Second Affiliated Hospital of Guizhou Medical University,the First People's Hospital of Kaili from January 2015 to June 2017 were included. Easily obtained indicators including patients’ gender, age, previous history of pancreatitis, acute diffuse peritonitis (ADP), pleural effusion (PE), heart rate (HR), respiratory rate (RR), and systolic blood pressure (SBP) measured under adequate analgesia, quietness conditions at admission were selected. Logistic regression analysis was performed to identify the risk factors for SAP. After determination of the cutoff values of the identified risk factors using ROC curve analysis, RISAP scoring system was designed. In the second phase, a total of 740 patients with AP who were admitted to our hospital from July 2017 to October 2019 were included and divided into SAP and non-SAP groups. RISAP, RANSON and BISAP scores were measured and compared between groups. The ROC curve was draw to analyze the ability of RISAP score in predicting SAP. Results: The number of patients who had history of pancreatitis,ADP, PE, HR, BR were significantly higher in the SAP group than in the non-SAP group (P <0.05). Logistic regression analysis showed that PE, HR, and RR were independent risk factors for SAP. Then RISAP score was designed based on the cutoff values of the three risk factors (0.5, 95.5, 22.5, respectively). The RISA, RANSON, and BISAP scores were significantly higher in the SAP group than that in the non-SAP group (U = -9.501,-3.701, -8.520 P <0.05). Compared with the RANSON, and BISAP scores, RISAP had the highest AUC values, sensitivity and specificity. Conclusion: The designed RISAP score is simple, convenient, economical, non-invasive, and highly repeatable, which is superior in rapid identification of SAP in patients with AP.

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Qiang Li ◽  
Chaoqun Hou ◽  
Yunpeng Peng ◽  
Xiaole Zhu ◽  
Chenyuan Shi ◽  
...  

Background. The incidence of hypertriglyceridemia-induced acute pancreatitis (HIAP) is increasing worldwide, and now it is the third leading cause of acute pancreatitis in the United States. But, there are only 5% of patients with severe hypertriglyceridemia (>1000 mg/dl) which might generate acute pancreatitis. In order to explore which part of the patients is easy to develop into pancreatitis, a case-control study was performed by us to consider which patient population tend to develop acute pancreatitis in patients with severe hypertriglyceridemia. To perform a retrospective case-control study, we identified severe hypertriglyceridemia patients without AP (HNAP) and with HIAP with a fasting triglyceride level of >1000 mg/dl from The First Affiliated Hospital of Nanjing Medical University during January 1, 2014, to December 31, 2016. Baseline patient characteristics, comorbidities, and risk factors were recorded and evaluated by the univariate and multivariate logistic regression analysis for HIAP and HNAP patients. A total of 124 patients with severe hypertriglyceridemia were included in this study; of which, 62 patients were in the HIAP group and 62 were in the HNAP group. Univariate logistic regression analysis showed that there was no gender difference in both groups; however, there were more younger patients in the HIAP group than in the HNAP group (P value < 0.001), and the HIAP group had low level of high-density lipoprotein compared to the HNAP group (P<0.05). Meanwhile, the presence of pancreatitis was associated with higher level of glycemia and a history of diabetes (P<0.05). Multivariate logistic regression analysis indicated that a history of diabetes and younger age were independent risk factors for acute pancreatitis in patients with severe hypertriglyceridemia. Uncontrolled diabetes and younger age are potential risk factors in patients with severe hypertriglyceridemia to develop acute pancreatitis.


Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2487-2487 ◽  
Author(s):  
Francoise Bernaudin ◽  
Suzanne Verlhac ◽  
Annie Kamdem ◽  
Cécile Arnaud ◽  
Lena Coïc ◽  
...  

Abstract Background Silent infarcts are associated with impaired cognitive functioning and have been shown to be predictors of stroke (Miller ST J Pediatr 2001). Until now, reported risk factors for silent infarcts were low pain event rate, history of seizures, high leukocyte count and Sen bS haplotype (Kinney TR Pediatrics 1999). Here, we seek to define the prevalence and risk factors of silent infarcts in the Créteil SCA pediatric cohort comprising patients assessed at least yearly by transcranial doppler (TCD) since 1992, and by MRI/MRA. Methods This study retrospectively analyzed data from the Créteil cohort stroke-free SS/Sb0 children (280; 134 F, 146 M), according to institutional review board. Time-averaged mean of maximum velocities higher than 200 cm/sec were considered as abnormal, resulting in initiation of a transfusion program (TP). A switch to hydroxyurea was proposed to patients with normalized velocities (&lt; 170 cm/sec) and normal MRA on TP, although TP was re-initiated in case of abnormal velocities recurrence. Patients with “conditional” velocities (170–199 cm/sec) were assessed by TCD 4 times yearly. Alpha genes and beta-globin haplotypes were determined. Baseline biological parameters (G6PD activity; WBC, PMN, Reticulocytes, Platelets counts; Hemoglobin, Hematocrit, HbF, LDH levels; MCV; SpO2) were obtained a minimum of 3 months away from a transfusion, one month from a painful episode, after 12 months of age, before the first TCD, and always before therapy intensification. Results. Patients were followed for a total of 2139 patient-years. Alpha-Thal was present in 114/254 patients (45%) and 27/241 (11.2%) had G6PD deficiency. Beta genotype, available in 240 patients, was BaBa in 102 (42.5%), BeBe in 54 (22.5%), SeSe in 19 (7.9%) and “other” in 65 (27.1%); TCD was abnormal in 52 of 280 patients (18.6%). MRA showed stenoses in 30 of 226 evaluated patients (13.3%) while MRI demonstrated presence of silent infarcts in 81/280 patients (28.9%). Abnormal TCD (p&lt;0.001), G6PD deficiency (p=0.008), high LDH (p=0.03), and low Hb (p=0.026) were significant risk factors for stenoses by univariate analysis while multivariate analysis retained only abnormal TCD as a significant risk factor for stenoses ([OR= 10.6, 95% CI (4.6–24.4)]; p&lt;0.001). Univariate logistic regression analysis showed that the risk of silent infarcts was not related to alpha-Thal, beta genotype, abnormal TCD, WBC, PMN, platelets, reticulocyte counts, MCV, LDH level, HbF %, pain or ACS rates but was significantly associated with stenoses detected by MRA (p&lt;0.001), gender (male; p=0.04), G6PD deficiency (p=0.05), low Hb (p=0.016) and Hct (p=0.012). Multivariate logistic regression analysis showed that gender ([OR= 2.1, 95% CI (1.03–4.27)]; p=0.042), low Hb ([OR= 1.4, 95% CI (1.0–1.1)]; p=0.05) and stenoses ([OR= 4.8, 95% CI (1.88–12.28)]; p=0.001) were all significant independent risk factors for silent infarcts. The presence of stenoses was the only significant risk factor for silent infarcts in patients with a history of abnormal TCD ([OR= 5.9, 95% CI (1.6–21.7)]; p=0.008). Conclusion We recently showed that G6PD deficiency, absence of alpha-Thal, and hemolysis are independent significant risk factors for abnormal TCD in stroke-free SCA patients (Bernaudin et al, Blood, 2008, in press). Here, we report that an abnormal TCD is the most significant risk factor for stenoses and, expanding previous studies, we demonstrate that stenoses, low Hb and gender are significant independent risk factors for silent infarcts.


2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Zhichuang Lian ◽  
Yafang Li ◽  
Wenyi Wang ◽  
Wei Ding ◽  
Zongxin Niu ◽  
...  

This study analyzed the risk factors for patients with COVID-19 developing severe illnesses and explored the value of applying the logistic model combined with ROC curve analysis to predict the risk of severe illnesses at COVID-19 patients’ admissions. The clinical data of 1046 COVID-19 patients admitted to a designated hospital in a certain city from July to September 2020 were retrospectively analyzed, the clinical characteristics of the patients were collected, and a multivariate unconditional logistic regression analysis was used to determine the risk factors for severe illnesses in COVID-19 patients during hospitalization. Based on the analysis results, a prediction model for severe conditions and the ROC curve were constructed, and the predictive value of the model was assessed. Logistic regression analysis showed that age (OR = 3.257, 95% CI 10.466–18.584), complications with chronic obstructive pulmonary disease (OR = 7.337, 95% CI 0.227–87.021), cough (OR = 5517, 95% CI 0.258–65.024), and venous thrombosis (OR = 7322, 95% CI 0.278–95.020) were risk factors for COVID-19 patients developing severe conditions during hospitalization. When complications were not taken into consideration, COVID-19 patients’ ages, number of diseases, and underlying diseases were risk factors influencing the development of severe illnesses. The ROC curve analysis results showed that the AUC that predicted the severity of COVID-19 patients at admission was 0.943, the optimal threshold was −3.24, and the specificity was 0.824, while the sensitivity was 0.827. The changes in the condition of severe COVID-19 patients are related to many factors such as age, clinical symptoms, and underlying diseases. This study has a certain value in predicting COVID-19 patients that develop from mild to severe conditions, and this prediction model is a useful tool in the quick prediction of the changes in patients’ conditions and providing early intervention for those with risk factors.


2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Kula Jilo ◽  
Dechassa Tegegne ◽  
Sadik Kasim ◽  
Golo Dabasa ◽  
Wubishet Zewdei

Toxoplasmosis is a zoonotic protozoan disease. Data on seroepidemiology of toxoplasmosis in Ethiopia is scarce, almost null in the pastoral area of the Borana zone. The study was carried out to determine the seroprevalence, to identify risk factors of toxoplasmosis in sheep and goats, and to assess the awareness level of pastoralists about toxoplasmosis in the Yabello district of Borana zone, Southern Ethiopia. A cross-sectional study was conducted from November 2016 to April 2017 in six peasant associations of the Yabello district of Borana zone, Southern Ethiopia. A total of 400 serum samples of randomly selected small ruminants owned by pastoralists were examined to detect antibodies specific to Toxoplasma gondii using Latex Agglutination Test (SPINREACT, Girona, Spain). A semistructured questionnaire survey was used to conduct a face-to-face interview with owners (n = 100) of sampled flocks. Logistic regression analysis was used to determine the association of hypothesized risk factors. The overall seroprevalence was 52.8% of which 57.8 and 47.8% were sheep and goats, respectively. Univariate logistic regression analysis revealed a higher seroprevalence ratio of T. gondii infection in sheep than goats (COR: 1.95, 95% CI: 1.226–3.112; P  = 0.005). Multivariate logistic regression analysis indicated significantly higher odds of acquiring T. gondii infection in adult animals (sheep: (AOR = 2.26, 95% CI: 1.323–3.874; P  = 0.003), goats: (AOR = 2.15; 95% CI: 1.009–4.579; P  = 0.047)), female sheep (AOR = 2.45; CI: 1.313–4.568; P  = 0.005), animals from lowland areas (sheep: (AOR = 2.28; CI: 1.190–4.356; P  = 0.013), goat: (AOR = 3.27; CI: 1.386–7.723; P  = 0.007)), animal drinking lake water (sheep: (AOR = 1.93; CI: 1.011–3.698; P  = 0.046), goat: (AOR = 2.96; CI: 1.297–6.771; P  = 0.010)), and goats with history of abortion (AOR = 2.42; CI: 1.242–4.711; P  = 0.009) than young animals, male (sheep), animals from midland areas, animals drinking wells water, and flock with no history of abortion (goat), respectively. Among respondents, 97.0% had no knowledge about toxoplasmosis and 75.0% drink raw milk and consume the meat of sheep and goats. 80.0% of respondents had no knowledge about the risk of cats to human and animal health while 70.0% of them had domestic cats and practice improper fetal body handling. Highly prevailing toxoplasmosis in small ruminants of the Yabello district might pose a serious economic loss and be a potential public health threat to the extremely vulnerable pastoralists. Therefore, awareness and further studies are warranted to tackle the economic and public health consequences of T. gondii infection.


2021 ◽  
Vol 11 (9) ◽  
pp. 836
Author(s):  
Jun-Young Park ◽  
Jihion Yu ◽  
Jun Hyuk Hong ◽  
Bumjin Lim ◽  
Youngdo Kim ◽  
...  

Acute kidney injury (AKI) is related to mortality and morbidity. The De Ritis ratio, calculated by dividing the aspartate aminotransferase by the alanine aminotransferase, is used as a prognostic indicator. We evaluated risk factors for AKI after radical retropubic prostatectomy (RRP). This retrospective study included patients who performed RRP. Multivariable logistic regression analysis and a receiver operating characteristic (ROC) curve analysis were conducted. Other postoperative outcomes were also evaluated. Among the 1415 patients, 77 (5.4%) had AKI postoperatively. The multivariable logistic regression analysis showed that estimated glomerular filtration rate, albumin level, and the De Ritis ratio at postoperative day 1 were risk factors for AKI. The area under the ROC curve of the De Ritis ratio at postoperative day 1 was 0.801 (cutoff = 1.2). Multivariable-adjusted analysis revealed that the De Ritis ratio at ≥1.2 was significantly related to AKI (odds ratio = 8.637, p < 0.001). Postoperative AKI was associated with longer hospitalization duration (11 ± 5 days vs. 10 ± 4 days, p = 0.002). These results collectively show that an elevated De Ritis ratio at postoperative day 1 is associated with AKI after RRP in patients with prostate cancer.


2021 ◽  
Author(s):  
Hongchuan Niu ◽  
Cunxin Tan ◽  
Kehan Jin ◽  
Ran Duan ◽  
Guangchao Shi ◽  
...  

Abstract Background To investigate the risk factors of early seizure after revascularization in patients with moyamoya disease (MMD). Methods A total of 298 patients with MMD diagnosed in our hospital from 2015 to 2018 were analyzed retrospectively. We summarized the characteristics of seizure after revascularization in patients with MMD and analyzed the predictors of early postoperative seizure. Results We identified 15 patients with MMD who developed seizures within 1 week after revascularization. According to logistic regression analysis, age (OR:1.04, 95% CI 0.998–1.086; P = 0.060), and infarct side (OR:1.92, 95% CI 0.856–4.290; P = 0.113) were not significantly associated with incident early seizure. Postoperative infarction (OR:12.89, 95% CI 4.198–39.525; P = 0.000) and preoperative cerebral infarction (OR:4.08, 95% CI 1.267–13.119; P = 0.018) were confirmed as risk factors for early seizure. Conclusions We believe that history of preoperative infarction and new infarction are independent risk factors of early seizure in patients with MMD after revascularization.


2012 ◽  
Vol 59 (4) ◽  
Author(s):  
Ashraf Direkvand-Moghadam ◽  
Afra Khosravi ◽  
Kourosh Sayehmiri

Several risk factors have been used to predict preeclampsia. The role of some risk factors as predictors associated with preeclampsia among Iranian women was analyzed in the present study using logistic regression. 610 women attending the obstetric ward of Mustafa hospital in Ilam were enrolled in this study. Demographic variables such as age, Body Mass Index (BMI), medical and obstetrics variables such as education, number of pregnancy, abortion and parity from May to September 2010 were analyzed. We used the unvaried and multiple logistic regression analyses to predict preeclampsia. The history of preeclampsia, hypertension, and infertility showed to be good independent predicator variables for preeclampsia using multivariate logistic regression analysis (OR was 5.46, 2.34 and 3.07 respectively). Area Under the Receiver Operation Character (AUROC) was estimated to be 0.67 (95% CI 0.59-0.67, p


2020 ◽  
Author(s):  
Xiaoyue Wang ◽  
Desheng Jiang ◽  
Huang Huang ◽  
Xiaofeng Chen ◽  
Chunlei Zhou ◽  
...  

Abstract Objective The aim of this study was to identify early warning signs for severe novel coronavirus-infected pneumonia (COVID-19).Methods We retrospectively analyzed the clinical data of 90 patients with COVID-19 at the Guanggu District of Hubei Women and Children Medical and Healthcare Center comprising 60 mild cases and 30 severe cases. The demographic data, underlying diseases, clinical manifestations and laboratory blood test results were compared between the two groups. Logistic regression analysis was performed to identify the independent risk factors that predicted severe COVID-19. The receiver-operating characteristic (ROC) curve of independent risk factors was calculated, and the area under the curve (AUC) was used to evaluate the efficiency of the prediction of severe COVID-19.Results The patients with mild and severe COVID-19 showed significant differences in terms of cancer incidence, age, pretreatment neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and the serum albumin (ALB) level (P<0.05). The severity of COVID-19 was correlated positively with the comorbidity of cancer, age, NLR, and CRP but was negatively correlated with the ALB level (P<0.05). Multivariate logistic regression analysis showed that the NLR and ALB level were independent risk factors for severe COVID-19 (OR=1.319, 95% CI: 1.043-1.669, P=0.021; OR=0.739, 95% CI: 0.616-0.886, P=0.001), with AUCs of 0.851 and 0.128, respectively. An NLR of 4.939 corresponded to the maximum joint sensitivity and specificity according to the ROC curve (0.700 and 0.917, respectively).Conclusion An increased NLR can serve as an early warning sign of severe COVID-19.


2020 ◽  
Vol 8 ◽  
Author(s):  
Chen Dong ◽  
Minhui Zhu ◽  
Luguang Huang ◽  
Wei Liu ◽  
Hengxin Liu ◽  
...  

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p &lt; 0.001), larger volume of expander (200–400 ml vs &lt;200 ml; OR, 1.74; p = 0.032; &gt;400 ml vs &lt;200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of &lt;1 year, expander volume of &gt;200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.


2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
David Gustafson ◽  
Osvaldo Padilla

Abstract Introduction Gallbladder adenocarcinoma (GBC) is a rare malignancy. Frequency of incidental adenocarcinoma of the gallbladder in the literature is approximately 0.2% to 3%. Typically, GBC is the most common type and is discovered late, not until significant symptoms develop. Common symptoms include right upper quadrant pain, nausea, anorexia, and jaundice. A number of risk factors in the literature are noted for GBC. These risk factors are also more prevalent in Hispanic populations. This study sought to compare patients with incidental gallbladder adenocarcinomas (IGBC) to those with high preoperative suspicion for GBC. Predictor variables included age, sex, ethnicity, radiologic wall thickening, gross pathology characteristics (wall thickness, stone size, stone number, and tumor size), histologic grade, and staging. Methods Cases of GBC were retrospectively analyzed from 2009 through 2017, yielding 21 cases. Data were collected via Cerner EMR of predictor variables noted above. Statistical analysis utilized conditional logistic regression analysis. Results The majority of patients were female (n = 20) and Hispanic (n = 19). There were 14 IGBCs and 7 nonincidental GBCs. In contrast with previous research, exact conditional logistic regression analysis revealed no statistically significant findings. For every one-unit increase in AJCC TNM staging, there was a nonsignificant 73% reduction in odds (OR = 0.27) of an incidental finding of gallbladder carcinoma. Conclusion This study is important in that it attempts to expand existing literature regarding a rare type of cancer in a unique population, one particularly affected by gallbladder disease. Further studies are needed to increase predictive knowledge of this cancer. Longer studies are needed to examine how predictive power affects patient outcomes. This study reinforces the need for routine pathologic examination of cholecystectomy specimens for cholelithiasis.


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