Development of risk factor-based scoring system for detection of hypervirulent Klebsiella pneumoniae bloodstream infections.

Abstract Background Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. The hallmark of HVKp infections are liver abscess formation and metastatic infections. Due to the severe sequelae of these complications, method to identify patients at-risk of HVKp infections should be developed. Results A retrospective cohort study of 222 patients with K. pneumoniae bloodstream infections (BSIs) was performed. Patient demographics, clinical manifestations, and bacterial characteristics were investigated. Ten cases of liver abscesses were identified. Characteristics such as community-onset BSIs, hypermucoviscosity phenotype, and capsular serotype K1 were identified as risk factors for HVKp infections. A scoring system was developed based on the risk factors. The area under the receiver operating characteristic curve for the scoring system was 0.90. A score of ≥ 2 points provided sensitivity and specificity of 0.70 and 0.94, respectively. Conclusions Simple scoring system was developed for the diagnosis of HVKp infections. The system allows early identification of patients with K. pneumoniae BSIs in whom hypervirulent infections should be evaluated. Prospective evaluation is expected.

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Development of risk factor-based scoring system for detection of hypervirulent Klebsiella pneumoniae bloodstream infections.

10.21203/rs.3.rs-28511/v2 ◽

2020 ◽

Author(s):

Atsushi Togawa ◽

Michinobu Yoshimura ◽

Chiemi Tokushige ◽

Akira Matsunaga ◽

Tohru Takata ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Scoring System ◽

Operating Characteristic ◽

Characteristic Curve ◽

Clinical Manifestations ◽

Bloodstream Infections ◽

Patient Demographics ◽

Patients At Risk ◽

Community Onset

Abstract Background Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. The hallmark of HVKp infections are liver abscess formation and metastatic infections. Due to the severe sequelae of these complications, method to identify patients at-risk of HVKp infections should be developed. Results A retrospective cohort study of 222 patients with K. pneumoniae bloodstream infections (BSIs) was performed. Patient demographics, clinical manifestations, and bacterial characteristics were investigated. Ten cases of liver abscesses were identified. Characteristics such as community-onset BSIs, hypermucoviscosity phenotype, and capsular serotype K1 were identified as risk factors for HVKp infections. A scoring system was developed based on the risk factors. The area under the receiver operating characteristic curve for the scoring system was 0.90. A score of >2 points provided sensitivity and specificity of 0.70 and 0.94, respectively. Conclusions Simple scoring system was developed for the diagnosis of HVKp infections. The system allows early identification of patients with K. pneumoniae BSIs in whom hypervirulent infections should be evaluated. Prospective evaluation is expected.

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Urosepsis After Percutaneous Nephrolithotomy (PCNL) - a New Prediction Rule and Scoring System

10.21203/rs.3.rs-963655/v1 ◽

2021 ◽

Author(s):

Heng Yang ◽

Zhang Qin Wang ◽

Zhi Li Liu ◽

Qiang Zhi Hao ◽

Shen Jing Wang ◽

...

Keyword(s):

Risk Factors ◽

Receiver Operating Characteristic Curve ◽

Percutaneous Nephrolithotomy ◽

Blood Cells ◽

Scoring System ◽

Operating Characteristic ◽

Characteristic Curve ◽

White Blood Cells ◽

Operating Characteristic Curve ◽

Degree Of Association

Abstract Objective:Development and validation of a scoring system to predict the risk of urosepsis after percutaneous nephrolithotomy.Methods:The risk factors associated with urosepsis following PCNL(Percutaneous Nephrolithotomy) were identified by meta-analysis. Based on the degree of association, different scores were assigned to these risk factors. Finally Risk assessment scoring system for urosepsis after percutaneous nephrolithotomy (PCNL) was established and validated using ROC (Receiver Operating Characteristic) curve. Results:Based on the degree of association, Women, age (≥60yrs), diabetes mellitus, blood routine (White blood cells≥10×109/L), Urinalysis (White blood cells≥+), Urine culture (Positive), stone size(≥2cm), staghorn stone, hydronephrosis (moderate-severe) were assigned 3, 2, 3, 2, 2, 2, 2, 3, 2 points respectively with a total score of 21 points. The area under the ROC(Receiver Operating Characteristic) curve was 0.913, at the cut-off point of 8.5, the sensitivity and specificity were 90% and 89.4% respectively. Conclusions:The PuRass scoring system could be a useful tool in predicting the risk of urosepsis after PCNL(Percutaneous Nephrolithotomy). Clinician should pay attention to patients with a score above 8.5 during the perioperative period.

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Development and Verification of a Deep Learning Algorithm to Evaluate Small-Bowel Preparation Quality

Diagnostics ◽

10.3390/diagnostics11061127 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1127

Author(s):

Ji Hyung Nam ◽

Dong Jun Oh ◽

Sumin Lee ◽

Hyun Joo Song ◽

Yun Jeong Lim

Keyword(s):

Deep Learning ◽

Small Bowel ◽

Scoring System ◽

Operating Characteristic ◽

Clinical Evidence ◽

Learning Algorithm ◽

Characteristic Curve ◽

External Validation ◽

Test Results ◽

Deep Learning Algorithm

Capsule endoscopy (CE) quality control requires an objective scoring system to evaluate the preparation of the small bowel (SB). We propose a deep learning algorithm to calculate SB cleansing scores and verify the algorithm’s performance. A 5-point scoring system based on clarity of mucosal visualization was used to develop the deep learning algorithm (400,000 frames; 280,000 for training and 120,000 for testing). External validation was performed using additional CE cases (n = 50), and average cleansing scores (1.0 to 5.0) calculated using the algorithm were compared to clinical grades (A to C) assigned by clinicians. Test results obtained using 120,000 frames exhibited 93% accuracy. The separate CE case exhibited substantial agreement between the deep learning algorithm scores and clinicians’ assessments (Cohen’s kappa: 0.672). In the external validation, the cleansing score decreased with worsening clinical grade (scores of 3.9, 3.2, and 2.5 for grades A, B, and C, respectively, p < 0.001). Receiver operating characteristic curve analysis revealed that a cleansing score cut-off of 2.95 indicated clinically adequate preparation. This algorithm provides an objective and automated cleansing score for evaluating SB preparation for CE. The results of this study will serve as clinical evidence supporting the practical use of deep learning algorithms for evaluating SB preparation quality.

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Abnormal interhemispheric functional connectivity in patients with strabismic amblyopia: a resting-state fMRI study using voxel-mirrored homotopic connectivity

BMC Ophthalmology ◽

10.1186/s12886-021-02015-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuang Zhang ◽

Gui-Ping Gao ◽

Wen-Qing Shi ◽

Biao Li ◽

Qi Lin ◽

...

Keyword(s):

Functional Connectivity ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Brain Activity ◽

Characteristic Curve ◽

Clinical Manifestations ◽

Resting State Fmri ◽

Diagnostic Value ◽

Functional Connections ◽

Receiver Operating

Abstract Background Previous studies have demonstrated that strabismus amblyopia can result in markedly brain function alterations. However, the differences in spontaneous brain activities of strabismus amblyopia (SA) patients still remain unclear. Therefore, the current study intended to employthe voxel-mirrored homotopic connectivity (VMHC) method to investigate the intrinsic brain activity changes in SA patients. Purpose To investigate the changes in cerebral hemispheric functional connections in patients with SA and their relationship with clinical manifestations using the VMHC method. Material and methods In the present study, a total of 17 patients with SA (eight males and nine females) and 17 age- and weight-matched healthy control (HC) groups were enrolled. Based on the VMHC method, all subjects were examined by functional magnetic resonance imaging. The functional interaction between cerebral hemispheres was directly evaluated. The Pearson’s correlation test was used to analyze the clinical features of patients with SA. In addition, their mean VMHC signal values and the receiver operating characteristic curve were used to distinguish patients with SA and HC groups. Results Compared with HC group, patients with SA had higher VMHC values in bilateral cingulum ant, caudate, hippocampus, and cerebellum crus 1. Moreover, the VMHC values of some regions were positively correlated with some clinical manifestations. In addition, receiver operating characteristic curves presented higher diagnostic value in these areas. Conclusion SA subjects showed abnormal brain interhemispheric functional connectivity in visual pathways, which might give some instructive information for understanding the neurological mechanisms of SA patients.

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Prediction of anemia at delivery

Scientific Reports ◽

10.1038/s41598-021-85622-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Enav Yefet ◽

Avishag Yossef ◽

Zohar Nachum

Keyword(s):

Risk Factors ◽

Operating Characteristic ◽

Complete Blood Count ◽

Characteristic Curve ◽

Secondary Analysis ◽

Area Under The Curve ◽

Iron Supplement ◽

Independent Risk Factors ◽

Operating Characteristic Curve ◽

Study Database

AbstractWe aimed to assess risk factors for anemia at delivery by conducting a secondary analysis of a prospective cohort study database including 1527 women who delivered vaginally ≥ 36 gestational weeks. Anemia (Hemoglobin (Hb) < 10.5 g/dL) was assessed at delivery. A complete blood count results during pregnancy as well as maternal and obstetrical characteristics were collected. The primary endpoint was to determine the Hb cutoff between 24 and 30 gestational weeks that is predictive of anemia at delivery by using the area under the curve (AUC) of the receiver operating characteristic curve. Independent risk factors for anemia at delivery were assessed using stepwise multivariable logistic regression. Hb and infrequent iron supplement treatment were independent risk factors for anemia at delivery (OR 0.3 95%CI [0.2–0.4] and OR 2.4 95%CI [1.2–4.8], respectively; C statistics 83%). Hb 10.6 g/dL was an accurate cutoff to predict anemia at delivery (AUC 80% 95%CI 75–84%; sensitivity 75% and specificity 74%). Iron supplement was beneficial to prevent anemia regardless of Hb value. Altogether, Hb should be routinely tested between 24 and 30 gestational weeks to screen for anemia. A flow chart for anemia screening and treatment during pregnancy is proposed in the manuscript.Trial registration: ClinicalTrials.gov Identifier: NCT02434653.

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Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

10.21203/rs.3.rs-658252/v1 ◽

2021 ◽

Author(s):

Yuzhen Qiu ◽

Wen Xu ◽

Yunqi Dai ◽

Ruoming Tan ◽

Jialin Liu ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill Patients ◽

Bloodstream Infections ◽

Polymyxin B ◽

Mortality Rates ◽

Carbapenem Resistant ◽

All Cause Mortality ◽

Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

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Risk Factors of Catheter-Related Infection in Patients Undergoing Hemodialysis Using Double Lumen Catheter at Dr. M. Djamil Hospital Padang

BioScientia Medicina ◽

10.37275/bsm.v6i1.436 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1292-1299

Author(s):

Muhammad Iqbal ◽

Raflis Rustam ◽

Vendry Rivaldy

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Clinical Manifestations ◽

Bloodstream Infections ◽

Sampling Technique ◽

Exit Site ◽

Double Lumen ◽

Exit Site Infection ◽

Double Lumen Catheter ◽

Lumen Catheter

Background. Chronic kidney disease (CKD) is a terminal disease requiring hemodialysis. Hemodialysis requires vascular access using a double lumen catheter (DLC). However, the use of DLC may increase complications mainly infection, either infection of exit site or bloodstream. This study is aimed to seek risk factors contributing to the incidence of central catheter-related infections in CKD patients with DLC undergoing HD at Dr. M. Djamil Hospital, Padang. Methods. This study is a prospective study on patients undergoing HD at Dr. M. Djamil Hospital, Padang. This study using consecutive sampling technique. Data were analyzed using SPSS version 25.0. Results. This study involved 40 CKD patients undergoing HD. Majority of the samples had bloodstream infections (67.5%). Clinical manifestations of purulent secretion, duration of catheter used, and hypoalbuminemia had significant differences in the incidence of DLC infection based on bloodstream infection and exit site infection (p<0.05). The most common bacterial found was Pseudomonas aeruginosa (22.5%) which was sensitive to ceftazidime, cefepime, meropenem, amikacin, gentamicin, ciprofloxacin. Conclusion. Factors contributing to the incidence of DLC-related infections at Dr. M. Djamil Hospital are duration of catheter use and hypoalbuminemia. Pseudomonas aeruginosa is the most common cause of DLC-related infections.

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Bloodstream Infections Caused by Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae: Risk Factors, Molecular Epidemiology, and Clinical Outcome

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.50.2.498-504.2006 ◽

2006 ◽

Vol 50 (2) ◽

pp. 498-504 ◽

Cited By ~ 163

Author(s):

Mario Tumbarello ◽

Teresa Spanu ◽

Maurizio Sanguinetti ◽

Rita Citton ◽

Eva Montuori ◽

...

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Treatment Failure ◽

Bloodstream Infections ◽

Initial Response ◽

Infected Group ◽

Retrospective Case ◽

Extended Spectrum ◽

Epidemiological Characteristics ◽

Length Of Hospitalization

ABSTRACT Bloodstream infections caused by extended-spectrum-β-lactamase (ESBL)-producing Klebsiella pneumoniae isolates are a major concern for clinicians, since they markedly increase the rates of treatment failure and death. One hundred forty-seven patients with K. pneumoniae bloodstream infections were identified over a 5-year period (January 1999 to December 2003). The production of ESBLs in bloodstream isolates was evaluated by molecular methods. A retrospective case-case-control study was conducted to identify risk factors for the isolation of ESBL-producing K. pneumoniae or non-ESBL-producing K. pneumoniae isolates in blood cultures. Forty-eight cases infected with ESBL-producing K. pneumoniae isolates and 99 cases infected with non-ESBL-producing K. pneumoniae isolates were compared to controls. Risk factors for isolation of ESBL-producing K. pneumoniae isolates were exposure to antibiotic therapy (odds ratio [OR], 11.81; 95% confidence interval [CI], 2.72 to 51.08), age (OR, 1.14; 95% CI, 1.08 to 1.21), and length of hospitalization (OR, 1.10; 95% CI, 1.04 to 1.16). Independent determinants for isolation of non-ESBL-producing K. pneumoniae were previous urinary tract infection (OR, 8.50; 95% CI, 3.69 to 19.54) and length of hospitalization (OR, 1.07; 95% CI, 1.04 to 1.10). When the initial response was assessed at 72 h after antimicrobial therapy, the treatment failure rate for the ESBL-producing K. pneumoniae-infected group was almost twice as high as that of the non-ESBL-producing K. pneumoniae-infected group (31% versus 17%; OR, 2.19; 95% CI, 0.98 to 4.89). The 21-day mortality rate for all patients was 37% (54 of 147); it was 52% (25 of 48) for patients with ESBL-producing K. pneumoniae bloodstream infections and 29% (29 of 99) for patients with non-ESBL-producing K. pneumoniae bloodstream infections (OR, 2.62; 95% CI, 1.28 to 5.35). In summary, this investigation identifies epidemiological characteristics that distinguish ESBL-producing K. pneumoniae infections from non-ESBL-producing K. pneumoniae ESBL bloodstream infections.

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Prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907917742873 ◽

2018 ◽

Vol 25 (1) ◽

pp. 3-11 ◽

Cited By ~ 1

Author(s):

Xiaowei Liu ◽

Tao Ma ◽

Zhi Liu

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Prognostic Significance ◽

Urine Concentration ◽

Paraquat Poisoning ◽

Independent Risk Factors ◽

Receiver Operating

Objective: To assess the prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department. Methods: Patients with acute paraquat poisoning admitted to the emergency department were recruited. Survivors and non-survivors were compared with regard to urinary paraquat concentration. The urinary level predictive of mortality was assessed by receiver operating characteristic curve. Risk factors of mortality were evaluated by regression analysis. Results: The overall mortality rate was 70.9% over the 28-day follow-up period. There was a significant difference in the urine paraquat concentrations recorded on admission between non-surviving and surviving patients ( p = 0.022). Receiver operating characteristic curve analysis revealed that the area under the curve when applied to receiver operating characteristic of the admission urine paraquat concentrations for predicting mortality was 0.854 with a cut-off value of 34.5 µg/mL. The dose of paraquat ingested, arterial lactate, and urine concentration were independent risk factors predicting 28-day mortality. The time interval between ingestion and hemoperfusion, arterial lactate, and urine concentration of paraquat were independent risk factors predicting acute kidney injury, while the partial pressure of carbon dioxide (PaCO2) and urine concentration of paraquat were independent risk factors predicting acute lung injury. Conclusion: The urine concentrations of paraquat on admission at emergency department demonstrated predictive ability for the prognosis of patients with acute paraquat poisoning.

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Derivation and Validation of the Cancer READMIT Score: A Readmission Risk Scoring System for Patients With Solid Tumor Malignancies

JCO Oncology Practice ◽

10.1200/op.20.01077 ◽

2021 ◽

pp. OP.20.01077

Author(s):

Joanna-Grace M. Manzano ◽

Heather Lin ◽

Hui Zhao ◽

Josiah Halm ◽

Maria E. Suarez-Almazor

Keyword(s):

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Solid Tumor ◽

Scoring System ◽

Operating Characteristic ◽

Characteristic Curve ◽

Risk Scoring ◽

Operating Characteristic Curve ◽

Risk Scoring System ◽

Readmission Risk

PURPOSE Readmissions for the medical treatment of cancer have traditionally been excluded from readmission measures under the Hospital Readmissions Reduction Program. Patients with cancer often have higher readmission rates and may need heightened support to ensure effective care transitions after hospitalization. Estimating readmission risk before discharge may assist in discharge planning efforts and help promote care coordination at time of discharge. PATIENTS AND METHODS We developed and validated a readmission risk scoring system among a cohort of adult cancer patients with solid tumor admitted at a comprehensive cancer center. Multivariate logistic regression analysis was used to develop the model. The model's discriminative capacity was evaluated through a receiver operating characteristic curve analysis. We further compared the performance of the developed score with existing risk scores for 30-day readmission. RESULTS The 30-day unplanned readmission rate in the total cohort was 16.0% (n = 1,078 of 6,720). After multivariate analysis, Cancer site, Recent emergency room visit within 30 days, non-English primary language, Anemia defined as hemoglobin < 10 g/dL, > 4 Days length of stay during the index admission, unmarried Marital status, Increased white blood cell count > 11 × 109/L, and distant Tumor spread were significantly associated with risk of unplanned 30-day readmission. The derived score, which we call the Cancer READMIT score, had modest discriminatory performance in predicting readmissions (area under the curve for the model receiver operating characteristic curve = 0.647). CONCLUSION The Cancer READMIT score was able to predict 30-day unplanned readmissions to our institution with fairly modest performance. External validation of our derived risk scoring system is recommended.

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