scholarly journals Sarcopenia in Elderly Major Trauma; A Single Centre Retrospective Analysis of Psoas and Masseter Muscle Groups

2020 ◽  
Author(s):  
Surabhi Varma ◽  
Michael SJ Wilson ◽  
Mitesh Naik ◽  
Amandeep Sandhu ◽  
Helen Chidera Uchenna Ota ◽  
...  
Keyword(s):  
Major Trauma ◽  
Cox Regression ◽  
Psoas Muscle ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Traumatic Injuries ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Pelvic Imaging ◽  
Muscle Groups

Abstract Background: There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods: Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results: There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r=0.35, p<0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47-9.73, p=0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11-3.25, p=0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p=0.001).Conclusion: Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.

scholarly journals Sarcopenia in elderly major trauma; A single centre retrospective analysis of psoas and masseter muscle groups

2020 ◽  
Author(s):  
Surabhi Varma ◽  
Michael SJ Wilson ◽  
Mitesh Naik ◽  
Amandeep Sandhu ◽  
Helen Chidera Uchenna Ota ◽  
...  
Keyword(s):  
Major Trauma ◽  
Cox Regression ◽  
Psoas Muscle ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Traumatic Injuries ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Pelvic Imaging ◽  
Muscle Groups

Abstract Background There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r = 0.35, p < 0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47–9.73, p = 0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11–3.25, p = 0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p = 0.001). Conclusion Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.

scholarly journals Sarcopenia in Elderly Major Trauma; A Single Centre Retrospective Analysis of Psoas and Masseter Muscle Groups

2020 ◽  
Author(s):  
Surabhi Varma ◽  
Michael SJ Wilson ◽  
Mitesh Naik ◽  
Amandeep Sandhu ◽  
Helen Chidera Uchenna Ota ◽  
...  
Keyword(s):  
Major Trauma ◽  
Cox Regression ◽  
Psoas Muscle ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Traumatic Injuries ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Pelvic Imaging ◽  
Muscle Groups

Abstract Background: There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods: Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results: There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r=0.35, p<0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47-9.73, p=0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11-3.25, p=0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p=0.001).Conclusion: Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.

scholarly journals The Associations of Psoas and Masseter Muscles With Sarcopenia and Related Adverse Outcomes in Older Trauma Patients- A Retrospective Study

2020 ◽  
Author(s):  
Surabhi Varma ◽  
Michael SJ Wilson ◽  
Mitesh Naik ◽  
Amandeep Sandhu ◽  
Helen Chidera Uchenna Ota ◽  
...  
Keyword(s):  
Cox Regression ◽  
Psoas Muscle ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Cross Sectional ◽  
Traumatic Injuries ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Pelvic Imaging ◽  
Masseter Muscles

Abstract Background: There is an emerging role for the radiological evaluation of the psoas muscle as a marker of sarcopenia, and as a prognostic discriminant in elderly patients with traumatic injuries. Older trauma patients are more likely to undergo cranial than abdomino-pelvic imaging. Identifying sarcopenia using masseter cross sectional area (M-CSA) has shown correlation with mortality. We sought to determine the correlation between psoas: lumbar vertebral index (PLVI) and the M-CSA, and their association with health outcomes. Methods: Patients aged 65 or above, who presented as a trauma call over a 1 year period were included if they underwent cranial or abdominal CT imaging. Images were retrospectively analyzed to obtain PLVI and mean M-CSA measurements. Electronic records were abstracted for demographics and outcomes. Logistic regression methods, log scale analyses, Cox regression model and Kaplan-Meier plots were used to determine association of sarcopenia with outcomes. Results: There were 155 eligible patients in the M-CSA group and 204 patients in the PLVI group. Sarcopenia was defined as the lowest quartile in each group. Both PLVI and M-CSA measurements were available in 142 patients. Pearson’s correlation indicated a weakly positive linear relationship (r=0.35, p<0.001) between these. There was no statistical association between M-CSA sarcopenia status and any measured outcomes. Those with PLVI sarcopenia were more likely to die in hospital (adjusted OR 3.38, 95% CI 1.47-9.73, p=0.006) and at 2-years (adjusted HR 1.90, 95% CI 1.11-3.25, p=0.02). Only 29% patients with PLVI sarcopenia were discharged home, compared with 58% without sarcopenia (p=0.001).Conclusion: Sarcopenia, defined by PLVI, is predictive of increased in-patient and 2- year mortality. Our study did not support prognostic relevance of M-CSA. Further research should be directed at improving the validity of masseter measurements or identifying alternative radiological determinants of sarcopenia on cranial imaging.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

scholarly journals Epidemiological,clinical and radiological findings in medical staff with COVID-19 in Wuhan, China: a single-centered, retrospective cohort study

2020 ◽  
Author(s):  
Jie Liu ◽  
Liu Ouyang ◽  
Pi Guo ◽  
Haisheng Wu ◽  
Peng Fu ◽  
...  
Keyword(s):  
Small Proportion ◽  
Medical Staff ◽  
Cox Regression ◽  
Early Stage ◽  
Wholesale Market ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Union Hospital ◽  
Potential Risk Factors ◽  
Novel Coronavirus

Abstract Backgrounds In December 2019, a pneumonia associated with the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) emerged in Wuhan city, China. As of 20 Feb 2020, a total of 2,055 medical staff infected with SARS-Cov-2 in China had been reported. The predominant cause of the infection and the failure of protection among medical staff remains unclear. We sought to explore the epidemiological, clinical characteristics and prognosis of novel coronavirus-infected medical staff.Methods Medical staff who infected with SARS-Cov-2 and admitted to Union Hospital, Wuhan between 16 Jan, 2020 to 25 Feb, 2020 were included retrospectively. Epidemiological, clinical and radiological data were compared by occupation and analyzed with the Kaplan-Meier and Cox regression methods.Results A total of 101 medical staff (32 males and 69 females; median age: 33 years old) were included in this study and 74% were nurses. None had an exposure to Huanan seafood wholesale market or wildlife. A small proportion of the cohort had contact with specimens (3%) as well as patients infected with SARS-Cov-2 in fever clinics (15%) and isolation wards (3%). 80% of medical staff showed abnormal IL-6 levels and 33% had lymphocytopenia. Chest CT mainly manifested as bilateral (62%), septal/subpleural (77%) and ground­glass opacities (48%). The major differences between doctors and nurses manifested in laboratory indicators. As of the last observed date, no patient was transferred to intensive care unit or died, and 98 (97%) had been discharged. Fever (HR=0.57; 95% CI 0.36-0.90) and IL-6 levels greater than >2.9 pg/ml (HR=0.50; 95% CI 0.30-0.86) on admission were unfavorable factors for discharge.Conclusions Our findings suggested that the infection of medical staff mainly occurred at the early stages of SARS-CoV-2 epidemic in Wuhan, and only a small proportion of infection had an exact mode. Meanwhile, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course than other ordinary patients, which may be partly due to their medical expertise, younger age and less underlying diseases. The potential risk factors of presence of fever and IL-6 levels greater than >2.9 pg/ml could help to identify medical staff with poor prognosis at an early stage.

The clinical impact and outcomes of immunohistochemistry-only metastases in breast cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 613-613
Author(s):  
M. S. Pugliese ◽  
M. M. Stempel ◽  
S. M. Patil ◽  
M. Hsu ◽  
H. S. Cody ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Rare Event ◽  
Axillary Recurrence ◽  
Unilateral Breast Cancer ◽  
Prognostic Features ◽  
Regression Methods ◽  
Kaplan Meier ◽  
History Of

613 Background: Modern surgical and pathologic techniques can detect small volume axillary metastases in breast cancer. The clinical significance of these metastases was evaluated in comparison to patients with negative sentinel lymph nodes (Neg-SN). Methods: Retrospective database review from 1997 through 2003 for eligible patients with unilateral breast cancer and no history of significant non-breast malignancy identified 232 patients with sentinel lymph node (SLN) metastases identified only by immunohistochemical stains (IHC-SN). They were compared to 252 Neg-SN controls selected at random from the same database population. Statistical analysis was performed with 2-sample tests, Kaplan-Meier, and Cox regression methods. Results: IHC-SN patients had worse prognostic features and received more systemic therapy than controls (Table). Age and ER status were similar. In 123 IHC-SN patients treated with axillary dissection (ALND), 16% had macrometastases in the non-SLNs. Only one axillary recurrence occurred in the group of IHC-SN patients without ANLD (n=109). With median follow up of 5 years (range 0.01–12.0), 28 recurrences and 25 deaths occurred. There were no differences between cases and controls for recurrence-free survival (RFS) or overall survival (OS) both by univariate and multivariate models that included variables such as age, tumor size, chemotherapy and hormone therapy [HR 0.99 (95%CI 0.43–2.28, p=0.99) for RFS, HR 2.06 (95%CI 0.79–5.35) p=0.14 for OS]. In IHC-SN patients treated with ALND, patients with positive non-SLNs (n=20) tended to have worse RFS than those with negative non-SLNs (n=103) [RFS 89% vs. 97% at 5 yrs (p=0.06)]. Conclusions: A significant number of IHC-SN patients had a macrometastasis identified at ALND. In patients not undergoing dissection, axillary recurrence was a rare event. However, failure to identify additional metastases by omitting ALND may result in understaging and inadequate systemic treatment in some patients. [Table: see text] No significant financial relationships to disclose.

scholarly journals The Neutrophil-to-lymphocyte Ratio at the Time of Admission: A New Prognostic Indicator for Hospital Mortality of Trauma Patients

2021 ◽  
Author(s):  
Hamed Fouladseresht ◽  
Shahram Bolandparvaz ◽  
Hamid Reza Abbasi ◽  
Hossein Abdolrahimzadeh Fard ◽  
Shahram Paydar
Keyword(s):  
Survival Analysis ◽  
Hospital Mortality ◽  
Regression Models ◽  
Cox Regression ◽  
Prognostic Indicator ◽  
Neutrophil To Lymphocyte Ratio ◽  
Trauma Patients ◽  
Lymphocyte Ratio ◽  
Kaplan Meier ◽  
Time Of Admission

The elevated neutrophil-to-lymphocyte ratio (NLR) is associated with poor clinical outcomes, especially in pro-inflammatory states such as surgical injuries and severe hemorrhages. Therefore, it was hypothesized whether NLR value at the time of admission could be a prognostic indicator of hospital mortality in trauma patients. This retrospective cohort study was conducted on 865 trauma patients referred to Rajaee Hospital between April 2016 and July 2019. The NLR value was calculated at the time of admission, and receiver operating characteristics (ROC) curve analysis was used to determine the cut-off point value of admission NLR related to hospital mortality of trauma patients. Furthermore, Kaplan-Meier survival analysis and Cox regression models have been applied to determine the effectiveness and prognostic potential of the admission NLR in the hospital mortality of trauma patients. The median age of the trauma patients was 32 years with an interquartile range (IQR) of 23 to 48 years, and most of them were male (83.9%). Also, trauma patients had a median injury severity score (ISS) of 9 (IQR=4-16) and a median Glasgow coma scale (GCS) of 14 (IQR=9-15). The cut-off value for admission NLR was 5.27 (area under the curve: 0.642, 95%CI: 0.559-0.726, p=0.001). In Kaplan-Meier survival analysis, the admission NLR>5.27 was an indicator of hospital mortality in trauma patients (p=0.001). Multivariate Cox regression models demonstrated that trauma patients with an admission NLR>5.27 had a 2.33-fold risk of hospital mortality (hazard ratio=2.33, 95%CI: 1.02-5.38, p=0.041). Furthermore, the admission NLR>5.27 was associated with a higher risk of hospital mortality in trauma patients with age≥65 years, systolic blood pressure≤90 mmHg, blood potassium>4.5 mmol/L, blood sodium>144 mEq/L, blood potential hydrogen (pH)≤7.28, GCS≤8, ISS>24 and blood base excess≤-6.1 mEq/L. The NLR value greater than 5.27 at the time of admission was associated with poorer outcomes, and it can be considered an independent prognostic indicator of hospital mortality in trauma patients.

scholarly journals Clinicopathological and Prognostic Characteristics of CD276 (B7-H3) Expression in Adrenocortical Carcinoma

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jiayu Liang ◽  
Zhihong Liu ◽  
Tianjiao Pei ◽  
Yingming Xiao ◽  
Liang Zhou ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Cox Regression ◽  
Therapeutic Option ◽  
Immunohistochemical Analysis ◽  
Endocrine Tumor ◽  
The Cancer Genome Atlas ◽  
Clinicopathological Parameters ◽  
Cox Regression Analysis ◽  
Regression Methods ◽  
Kaplan Meier

Background. Adrenocortical carcinoma (ACC) is a rare malignant endocrine tumor with a high tumor recurrence rate and poor postoperative survival. Recent studies suggest that CD276- (B7-H3) targeted therapy represents a promising therapeutic option for solid tumors. However, little is known about the expression status of CD276 or its association with progression and prognosis of ACC. Methods. Clinical data were retrospectively analyzed from patients who underwent resection of ACC at our institution (n=48). Archived, formalin-fixed, and paraffin-embedded samples were collected for immunohistochemical analysis, and the correlation between CD276 expression and clinicopathological parameters was evaluated. Kaplan–Meier and univariate/multivariate Cox regression methods were implemented to identify any prognostic effects. Data from The Cancer Genome Atlas (TCGA) ACC cohort (n=77) were retrieved for quantitative validation analysis. Results. Positive expression of CD276 was detected on the cell membrane and in the cytoplasm of cancer cells or tumor-associated vascular cells in 91.67% (44/48) of ACCs. Vascular expression of CD276 was associated with local aggression (higher T stage, P=0.029) and advanced ENSAT stage (P=0.02). Specifically, patients with a higher CD276-positive cancer cell density exhibited significantly worse overall survival and recurrence-free survival in our cohort (HR=2.8, P=0.01, and HR=7.52, P<0.001, respectively) and in the validation cohort (HR=2.4, P=0.033, and HR=3.7, P<0.001, respectively). The prognostic association remained significant in multivariate Cox regression analysis. Further analysis indicated that CD276 participates in regulating the immune response as well as in the malignant biological behaviors of ACC. Conclusion. These findings highlight the immune checkpoint factor CD276 as an independent prognostic factor and a potential therapeutic target in ACC.

scholarly journals Real-world effectiveness outcomes in patients diagnosed with metastatic triple-negative breast cancer

2020 ◽  
Author(s):  
Karen E Skinner ◽  
Amin Haiderali ◽  
Min Huang ◽  
Lee S Schwartzberg
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Cox Regression ◽  
Unmet Need ◽  
Progression Free Survival ◽  
Free Survival ◽  
Regression Methods ◽  
Kaplan Meier ◽  
Community Oncology

Aim: This study examined treatment patterns and effectiveness outcomes of patients with metastatic triple-negative breast cancer (mTNBC) from US community oncology centers. Materials & methods: Eligible patients were females, aged ≥18 years, diagnosed with mTNBC between 1 January 2010 and 31 January 2016. Kaplan–Meier and Cox regression methods were used. Results: Sample comprised 608 patients with average age of 57.5 years and 505/608 patients (83.1%) received systemic treatment. Overall survival (OS) from first-line treatment found that African–American patients had shorter OS than White (9.3 vs 13.7 months; hazard ratio: 1.35; p = 0.006). Conclusion: More than 15% of women with mTNBC were not treated, indicating a high unmet need. Overall prognosis remains poor, which highlights the opportunity for newer therapies to improve progression-free survival and OS.

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