scholarly journals A novel complex model of hemodialysis adequacy: Predictive value and relationship with malnutrition inflammation score

2017 ◽  
Vol 69 (1) ◽  
pp. 129-137
Author(s):  
Vlastimir Vlatkovic ◽  
Jasna Trbojevic-Stankovic ◽  
Dejan Nesic ◽  
Biljana Stojimirovic
Keyword(s):  
Prognostic Value ◽  
Serum Levels ◽  
Albumin Level ◽  
Complex Model ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Kaplan Meier ◽  
Major Factors ◽  
Karnofsky Index ◽  
Inflammation Score

Target dialysis dose to ensure the best patient outcome is still a matter of debate. Traditional models have a number of limitations and do not comprehensively reflect all factors involved. In this study we present a new complex model of dialysis adequacy, the hemodialysis adequacy score (HAS), and evaluate its prognostic value, as well as its relationship with the malnutrition-inflammation score (MIS). The components of HAS included paradigms of the 6 major factors known to influence the outcome of hemodialysis (HD) patients: the modified Karnofsky index (KI), the Charlson comorbidity index (CCI), Kt/V and URR measures of dialysis dose, body mass index (BMI) and serum albumin level, serum levels of hemoglobin and ferritin, intact parathyroid hormone (iPTH) and calciumphosphorus solubility product. The score was evaluated in a 24-month prospective study on 147 HD patients. Odds ratio analysis showed that hospitalized patients had twice the chance to have HAS >13 compared to those who were not hospitalized during the study period (OR=2.152, CI 95% (1.0024- 4.619). Mortality rate was significantly higher in patients with a HAS >13 at the 12-month follow-up (?2=16.416, p <0.0001). Patients with a HAS?13 had significantly higher survival rate (Kaplan- Meier), while those with a HAS>13 had significantly higher probability of death (log-rank Cox- Mantel=17.920, df=1, p <0.00023). The HAS directly and significantly correlated with the MIS at all measurements (p <0.0001). Results confirmed that the HAS is a useful tool to assess dialysis adequacy with a good prognostic value. The cutoff level for the HAS at 13 points was associated with an unfavorable outcome.

scholarly journals Hemodialysis (HD) dose and ultrafiltration rate are associated with survival in pediatric and adolescent patients on chronic HD—a large observational study with follow-up to young adult age

2021 ◽  
Author(s):  
Verena Gotta ◽  
Olivera Marsenic ◽  
Andrew Atkinson ◽  
Marc Pfister
Keyword(s):  
Rank Test ◽  
Primary Analysis ◽  
Ultrafiltration Rate ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Weibull Regression ◽  
Adult Age ◽  
Kaplan Meier ◽  
Continuous Scale ◽  
Weibull Regression Model

Abstract Background Hemodialysis (HD) dose targets and ultrafiltration rate (UFR) limits for pediatric patients on chronic HD are not known and are derived from adults (spKt/V>1.4 and <13 ml/kg/h). We aimed to characterize how delivered HD dose and UFR are associated with survival in a large cohort of patients who started HD in childhood. Methods Retrospective analysis on a cohort of patients <30 years, on chronic HD since childhood (<19 years), having received thrice-weekly HD 2004–2016 in outpatient DaVita centers. Outcome: Survival while remaining on HD. Predictors: (I) primary analysis: mean delivered dialysis dose stratified as spKt/V ≤1.4/1.4–1.6/>1.6 (Kaplan–Meier analysis), (II) secondary analyses: UFR and alternative dialysis adequacy measures [eKt/V, body-surface normalized Kt/BSA] on continuous scale (Weibull regression model). Results A total of 1780 patients were included (age at the start of HD: 0–12y: n=321, >12–18y: n=1459; median spKt/V=1.55, eKt/V=1.31, Kt/BSA=31.2 L/m2, UFR=10.6 mL/kg/h). (I) spKt/V<1.4 was associated with lower survival compared to spKt/V>1.4–1.6 (P<0.001, log-rank test), and spKt/V>1.6 (P<0.001), with 10-year survival of 69.3% (59.4–80.9%) versus 83.0% (76.8–89.8%) and 84.0% (79.6–88.5%), respectively. (II) Kt/BSA was a better predictor of survival than spKt/V or eKt/V. UFR was additionally associated with survival (P<0.001), with increased mortality <10/>18 mL/kg/h. Associations did not alter significantly following adjustment for demographic characteristics (age, etiology of kidney disease, and ethnicity). Conclusions Our results suggest usefulness of targeting Kt/BSA>30 L/m2 for best long-term outcomes, corresponding to spKt/V>1.4 (>12 years) and >1.6 (<12 years). In contrast to adults, higher UFR of 10–18 ml/kg/h was not associated with greater mortality in this population.

Albumin as a prognostic factor for overall survival in newly diagnosed patients with acute myeloid leukemia (AML).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6586-6586
Author(s):  
Awais M. Khan ◽  
Jeffrey E. Lancet ◽  
Mohamed A. Kharfan-Dabaja ◽  
Najla Al Ali ◽  
Alan F. List ◽  
...  
Keyword(s):  
Overall Survival ◽  
Serum Albumin ◽  
Induction Chemotherapy ◽  
Prognostic Value ◽  
Serum Albumin Level ◽  
Albumin Level ◽  
Normal Serum ◽  
Newly Diagnosed ◽  
Kaplan Meier ◽  
History Of

6586 Background: Hypoalbuminemia (HA) is an adverse prognostic factor in multiple neoplastic diseases. Severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009; 15). We examined the prognostic value of serum albumin level prior to induction chemotherapy in patients with newly diagnosed AML. Methods: Data were collected retrospectively in newly diagnosed AML patients receiving induction chemotherapy (3+ 7 regimen). Primary objective was to examine the relationship between serum albumin at baseline and probability of achieving complete remission (CR) or incomplete remission (CRi) and overall survival (OS). The Kaplan–Meier method used to estimate median overall survival; chi-square test used for comparison of categorical variables and t-test for continuous variables. Log rank test used to compare Kaplan–Meier survival estimates between two groups. Results: Between November 2004 to July 2007, 135 patients who received 3+7 induction chemotherapy were included. Patient baseline characteristics were similar between patients with serum albumin < 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to age, sex, FAB subtype, history of antecedent MDS, karyotype, and chemotherapy . In patients with HA, mean age was 60 years compared to 56.5 years in non HA group. The median OS for patients with HA was 221 days (95%CI 149.5-292.5) compared to 421 days (95%CI 236.7-605) with normal serum albumin (p<0.005). (Figure-1) The CR/CRi rate was 64%% for HA and 77.6% for those with normal albumin (p=0.09). In a multivariable Cox regression analysis including age ≥ 60 years, history of MDS, karyotype, and serum albumin level at baseline; only age, karyotype and serum albumin were independent predictors of OS [Hazard ratio 0.47 (95%CI 0.31-0.71) (p<0.005) for normal serum albumin group]. Conclusions: In newly diagnosed AML, we demonstrate that hypoalbuminemia < 3.5 g/dl is an independent covariate for overall survival with conventional chemotherapy management. The prognostic value of low serum albumin should be validated in a prospective study.

scholarly journals Elevated Serum Endothelin-1 Levels in Patients with Colorectal Cancer; Relevance for Prognosis

2000 ◽  
Vol 15 (4) ◽  
pp. 288-293 ◽  
Author(s):  
C.F. Peeters ◽  
C.M. Thomas ◽  
F.C. Sweep ◽  
P.N. Span ◽  
T. Wobbes ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Prognostic Value ◽  
Elevated Serum ◽  
Serum Levels ◽  
Endothelin 1 ◽  
Kaplan Meier ◽  
Preoperative Serum ◽  
Potent Vasoconstrictor ◽  
Group B

Background It has been demonstrated that the Doppler Perfusion Index (DPI) is increased in patients who are at risk of developing liver metastases from colorectal cancer. It has been postulated that a circulating hormonal factor is involved in the relative vasoconstriction throughout the splanchnic bed. Endothelin-1 (ET-1), a potent vasoconstrictor which has been associated with tumor growth and is produced by colorectal tumors, may play an important role in this phenomenon. In this paper the prognostic value of serum ET-1 in colorectal cancer is discussed. Methods Preoperative serum levels of ET-1 were assessed in three groups of patients: group A underwent resection of the colorectal tumor and remained free of recurrence (n=20); group B developed metachronous liver metastases at least six months after colorectal resection (n=14); and group C presented with colorectal cancer and synchronous liver metastases (n=22). Results The mean (SD) serum ET-1 levels in groups A, B and C were 1.59 (0.41) pmol/L, 1.70 (0.32) pmol/L and 1.85 (0.47) pmol/L, respectively. These values were significantly different from those of healthy controls (1.22 (0.31), p<0.05). Kaplan-Meier analyses revealed no prognostic value of preoperative serum ET-1 levels. Conclusions These preliminary results demonstrate that serum ET-1 levels are raised in patients with colorectal cancer. Serum ET-1 levels do not seem to be of prognostic value for survival.

Albumin Is a Prognostic Factor for Response and Overall Survival in Relapsed or Refractory Acute Myeloid Leukemia (AML).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4685-4685
Author(s):  
Rami S. Komrokji ◽  
Mohamed A Kharfan-Dabaja ◽  
Samantha L Price ◽  
Gene A Wetzstein ◽  
Alan F List ◽  
...  
Keyword(s):  
Overall Survival ◽  
Serum Albumin ◽  
Prognostic Value ◽  
Serum Albumin Level ◽  
Cox Regression ◽  
Salvage Chemotherapy ◽  
Albumin Level ◽  
Baseline Serum ◽  
Kaplan Meier ◽  
History Of

Abstract Abstract 4685 Background Hypoalbuminemia (HA) is a strong predictor of poor clinical outcomes in many medical conditions. Low serum albumin levels has been shown to be an adverse prognostic factor in patients with neoplastic diseases such as multiple myeloma, melanoma, and colon cancer. Severe hypoalbuminemia (<3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was recently reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009;15). In this retrospective analysis we examined the prognostic value of serum albumin level at baseline, day 14 and day 30 of treatment with salvage chemotherapy regimens for relapsed or refractory AML (RR-AML). Methods Data were collected retrospectively in a cohort of patients with RR-AML patients who received CLAG (cladribine, cytarabine, and filgrastim) or MEC (mitoxantrone, etoposide, and cytarabine) regimens as salvage chemotherapy. The primary objective was to examine the relationship between serum albumin at baseline, day 14 and day 30 of salvage chemotherapy and probability for achieving complete remission (CR) and overall survival (OS). Patients were divided into two groups; the first group with serum albumin < 3.5 g/dl and the second group patients with serum albumin ≥3.5 g/dl. International Working Group criteria were used to define CR. Primary refractory AML (PR-AML) in this study was defined as failure to achieve CR1 and less than 50% reduction in myeloblasts after first line of induction. All analyses were conducted using SPSS version 15.0. (SPSS Inc, Chicago, IL). The Kaplan–Meier method was used to estimate median overall survival; chi-square test was used for comparison of categorical variables and t-test for continuous variables. Log rank test was used to compare Kaplan–Meier survival estimates between two groups and Cox regression for multivariable analysis. Results Between January 2005 and June 2008, 162 patients were treated with CLAG or MEC for RR-AML. Patient baseline characteristics were similar between patients with baseline serum albumin < 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to sex, FAB subtype, salvage chemotherapy, prior therapy and cytogenetics. Patients with HA were older, mean age 57 years compared to 52 years in non HA group (p=0.039). More patients with HA had prior history of MDS (35.6% versus 19.2%) (p=0.021). Based on baseline serum albumin obtained prior to start of salvage chemotherapy for RR-AML; overall CR rates were HA, 23.8% (19/80) vs. no HA, 41.2% (28/68) (p= 0.033). Median OS was 4.3 months for HA group vs. 8.07 months for no HA, p=0.028. Serum albumin at day 14 of salvage chemotherapy also correlated with OS. The CR was 38.5% for no HA and 27.1% for HA (p=0.12), median OS was 10.0 mo for no HA group versus 4.8 month (p=0.046). Serum albumin at day 30 of salvage chemotherapy was significantly correlated with survival as well with a median OS for HA group was 6.7 month compared to 13.44 month for no HA group (p=0.008).(figure-1) CR was 58% in no HA and 38% in HA group (p=0.072). In a multivariable Cox regression analysis including age, history of MDS, CR rates and serum albumin level at day 30; only CR rates and serum albumin were independent predictors of OS. (Table-1) Conclusion In this retrospective analysis of a cohort of patients with RR-AML; we demonstrated that serum albumin < 3.5 g/dl prior to start of salvage chemotherapy, at day 14 and at day 30 correlated with lower CR rates and worse OS. Serum albumin is a surrogate marker of general health, co- morbidities, and performance status. The prognostic value of low serum albumin need to be examined in newly diagnosed AML patients in context of known other prognostic factors; and validated in a prospective fashion. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic value of TP53 expression and MGMT methylation in glioblastoma patients treated with temozolomide combined with other chemotherapies

2021 ◽  
Vol 152 (3) ◽  
pp. 541-549
Author(s):  
Maher Kurdi ◽  
Nadeem Shafique Butt ◽  
Saleh Baeesa ◽  
Badrah Alghamdi ◽  
Yazid Maghrabi ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Dna Methyltransferase ◽  
Chemotherapeutic Agents ◽  
Recurrence Interval ◽  
Mgmt Methylation ◽  
Conventional Radiotherapy ◽  
Methylguanine Dna Methyltransferase ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Temozolomide Chemotherapy

Abstract Objective To assess the recurrence interval and predictive significance of TP53 expression and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in glioblastomas treated with radiotherapy and combined chemotherapies, including temozolomide, lomustine, procarbazine and bevacizumab. Method We reviewed the clinical outcomes of 52 totally resected glioblastoma patients, who received conventional radiotherapy and temozolomide with other chemotherapeutic agents. Correlation of TP53 expression and MGMT promotor methylation with recurrence interval was analyzed using Kaplan Meier estimates. Results No significant association was found between MGMT promotor methylation and TP53 expression in glioblastomas (P-value = 0.158). Patients with non-methylated MGMT who received temozolomide chemotherapy with other chemotherapeutic agents showed significantly later recurrence (P-value = 0.007) compared with patients with non-methylated MGMT who received temozolomide alone. No significant difference was found in recurrence interval among glioblastoma patients with methylated MGMT who received temozolomide alone or with other chemotherapies (P-value = 0.667). Moreover, patients with non-TP53-expressing tumors who received temozolomide with other chemotherapies had significantly later recurrence (P-value = 0.04) compared with patients who received temozolomide alone. Conclusion Totally resected glioblastoma patients, with non-methylated MGMT or non-TP53-expressing tumors treated with radiotherapy and combined chemotherapies had a reduced chance of tumor recurrence and a more favorable outcome. Furthermore, both MGMT and TP53 are independent prognostic factors for glioblastoma.

Cognitive impairment predicts conversion to multiple sclerosis in clinically isolated syndromes

2009 ◽  
Vol 16 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Valentina Zipoli ◽  
Benedetta Goretti ◽  
Bahia Hakiki ◽  
Gianfranco Siracusa ◽  
Sandro Sorbi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Prognostic Value ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Clinically Isolated Syndromes ◽  
Kaplan Meier ◽  
Sizable Proportion ◽  
One Year ◽  
Therapeutic Decision Making

Significant cognitive impairment has been found in 20—30% of patients with clinically isolated syndromes suggestive of multiple sclerosis. In this study we aimed to assess the prognostic value of the presence of cognitive impairment for the conversion to multiple sclerosis in patients with clinically isolated syndromes. All patients with clinically isolated syndromes consecutively referred to our centre since 2002 and who had been followed-up for at least one year underwent cognitive assessment through the Rao’s Battery and the Stroop test. Possible predictors of conversion to clinically definite multiple sclerosis were evaluated through the Kaplan Meier curves and Cox regression analysis. A total of 56 patients (41 women; age 33.2 ± 8.5 years; expanded disability scale score 1.2 ± 0.7) were recruited. At baseline, 32 patients (57%) fulfilled McDonald’s criteria for dissemination in space. During the follow-up (3.5 ± 2.3 years), 26 patients (46%) converted to a diagnosis of multiple sclerosis. In particular, 64% of patients failing ≥ 2 tests and 88% of patients failing ≥ 3 tests converted to multiple sclerosis. In the Cox regression model, the failure of at least three tests (HR 3.3; 95% CI 1.4—8.1; p = 0.003) and the presence of McDonald’s dissemination in space at baseline (HR 3.8; 95% CI 1.5—9.7; p = 0.005), were found to be predictors for conversion to multiple sclerosis. We conclude that cognitive impairment is detectable in a sizable proportion of patients with clinically isolated syndromes. In these subjects cognitive impairment has a prognostic value in predicting conversion to multiple sclerosis and may therefore play a role in therapeutic decision making.

scholarly journals Prognostic Value ofTc99m-Pertechnetate Thyroid Scintigraphy in Radioiodine Therapy in a Cohort of Chinese Graves’ Disease Patients: A Pilot Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Haifeng Hou ◽  
Shu Hu ◽  
Rong Fan ◽  
Wen Sun ◽  
Xiaofei Zhang ◽  
...  
Keyword(s):  
Single Dose ◽  
Prognostic Value ◽  
Low Dose ◽  
Radioiodine Therapy ◽  
Treatment Success ◽  
Serum Levels ◽  
Graves Disease ◽  
Thyroid Scintigraphy ◽  
Thyroid Mass ◽  
Pilot Clinical Study

Objectives. This study is to assess the prognostic value ofTc99m-pertechnetate thyroid scintigraphy for predicting the outcomes of fixed low dose of radioiodine therapy (RIT) in a cohort of Chinese Graves’ disease (GD) patients.Materials and Methods. This is a retrospective study of GD patients who received RIT with a single dose of radioiodine (5 mCi). All the patients receivedTc99m-pertechnetate thyroid scintigraphy prior to RIT. Thyroid mass,Tc99m-pertechnetate uptake, gender, age at diagnosis, duration of the disease, ophthalmopathy, and serum levels of FT4, FT3, TT4, and TT3 prior to RIT were analyzed as potential interference factors for outcomes of RIT.Results. One hundred and eighteen GD patients who completed RIT were followed up for 12 months. The outcomes (euthyroidism, hypothyroidism, and hyperthyroidism) were found to be significantly associated with thyroid mass andTc99m-pertechnetate uptake. Patients with thyroid mass ≤ 40.1 g orTc99m-pertechnetate uptake ≤ 15.2% had higher treatment success.Conclusions. A fixed low dose of 5 mCi radioiodine seems to be practical and effective for the treatment of Chinese GD patients with thyroid mass ≤ 40.1 g andTc99m-pertechnetate uptake ≤ 15.2%. This study demonstratesTc99m-pertechnetate thyroid scintigraphy is an important prognostic factor for predicting the outcomes of RIT.

scholarly journals Evaluation of serum ATX and LPA as potential diagnostic biomarkers in patients with pancreatic cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiang Chen ◽  
Hongyu Li ◽  
Wenda Xu ◽  
Xiaozhong Guo
Keyword(s):  
Pancreatic Cancer ◽  
Poor Prognosis ◽  
Prognostic Value ◽  
Potential Role ◽  
Early Stage ◽  
Serum Levels ◽  
Diagnostic Efficacy ◽  
Diagnostic Biomarkers ◽  
The Poor

Abstract Background Pancreatic cancer (PC) is a devastating disease that has a poor prognosis and a total 5-year survival rate of around 5%. The poor prognosis of PC is due in part to a lack of suitable biomarkers that can allow early diagnosis. The lysophospholipase autotaxin (ATX) and its product lysophosphatidic acid (LPA) play an essential role in disease progression in PC patients and are associated with increased morbidity in several types of cancer. In this study, we evaluated both the potential role of serum LPA and ATX as diagnostic markers in PC and their prognostic value for PC either alone or in combination with CA19-9. Methods ATX, LPA and CA19-9 levels were evaluated using ELISA of serum obtained from PC patients (n = 114) healthy volunteers (HVs: n = 120) and patients with benign pancreatic diseases (BPDs: n = 94). Results Serum levels of ATX, LPA and CA19-9 in PC patients were substantially higher than that for BPD patients or HVs (p < 0.001). The sensitivity of LPA in early phase PC was 91.74% and the specificity of ATX was 80%. The levels of ATX, LPA and CA19-9 were all substantially higher for early stage PC patients compared to levels in serum from BPD patients and HVs. The diagnostic efficacy of CA19-9 for PC was significantly enhanced by the addition of ATX and LPA (p = 0.0012). Conclusion Measurement of LPA and ATX levels together with CA19-9 levels can be used for early detection of PC and diagnosis of PC in general.

scholarly journals The role of phosphoprotein phosphatases catalytic subunit genes in pancreatic cancer

2021 ◽  
Vol 41 (1) ◽  
Author(s):  
Junjie Hang ◽  
Steven Yuk-Fai Lau ◽  
Ruohan Yin ◽  
Lina Zhu ◽  
Siyuan Zhou ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Value ◽  
Chi Square ◽  
Catalytic Subunits ◽  
Beneficial Effects ◽  
Phosphoprotein Phosphatases ◽  
Kaplan Meier ◽  
Chi Square Test ◽  
Independent Cohort

Abstract Compelling evidence suggests that phosphoprotein phosphatases (PPPs) are involved in a large spectrum of physiological and pathological processes, but little is known about their roles in pancreatic cancer. We investigated the expression level, prognostic value, and potential function of PPPs with data from Oncomine, GEPIA, THPA, and TCGA databases and an independent cohort of patients with pancreatic cancer. Among all the PPP catalytic subunits (PPPcs), the transcription levels of PPP1CA, PPP1CB, PPP3CA, PPP3CB, and PPP4C were higher in pancreatic cancer than in normal pancreas (P&lt;0.01, fold change &gt; 2). Kaplan–Meier analysis showed that high transcription levels of PPP1CA, PPP1CB, PPP2CA, PPP2CB, PPP3CA, and PPP4C correlated with poorer survival. In contrast, patients with high levels of PPP3CB, PPP3CC, PPP5C, PPP6C, and PPEF2 had much better prognoses. Data from THPA and patients with pancreatic cancer enrolled in our hospital also confirmed the prognostic value of PPP1CA, PPP1CB, PPP2CA, PPP2CB, PPP3CA, PPP3CB, and PPP6C at the protein level. In addition, the Pearson Chi-square test showed that PPP3CB level was significantly correlated with T and N stages. GO and KEGG analyses showed that the genes and pathways related to the pathogenesis and progression of pancreatic cancer were greatly affected by alterations in PPPcs. Results of the present study suggest that PPP1CA, PPP1CB, PPP2CA, PPP2CB, and PPP3CA have deleterious effects but PPP3CB, PPP5C, and PPP6C have beneficial effects on pancreatic cancer.

Sign in / Sign up

Export Citation Format

Share Document