THE RISK PREDICTIVE VALUES OF ACG CLASSIFICATION IN A COHORT OF ISCHEMIC COLITIS – REFINING THE DEFINITION OF MILD DISEASE

Background: Hematoma expansion (HE) is an important therapeutic target in intracerebral hemorrhage. Recently proposed HE definitions have not been validated, and no previous definition has accounted for withdrawal of care (WOC). Objective: To compare conventional and revised definitions of hematoma expansion (HE), while accounting for WOC. Methods: We analyzed data from the ATACH-2 trial, comparing revised definitions of HE incorporating intraventricular hemorrhage (IVH) expansion to the conventional definition of “≥6 mL or ≥33%”. The primary outcome was modified Rankin Scale of 4-6 at 90-days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c- statistic for all definitions of HE. Definitions were compared using non-parametric methods. Secondary analyses were performed after removing patients who experienced WOC. Results: Primary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any IVH”, with increased c -statistic from 60.2% to 65.9% (p < 0.001). Secondary analysis excluded 46 participants who experienced WOC. The revised definitions outperformed the conventional definition in this population as well, with the greatest improvement in c -statistic using “≥6 mL or ≥33% or any IVH” (58.1% vs 64.1%, p < 0.001). Conclusions: HE definitions incorporating intraventricular expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.

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Early PSA progression in abiraterone/enzalutamide-treated patients with metastatic castration-resistant prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16530 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16530-e16530

Author(s):

Fernando López-Campos ◽

Alfonso Gomez-Iturriaga ◽

Casilda Llacer Perez ◽

Ivan Henriquez ◽

Paula Peleteiro ◽

...

Keyword(s):

Prostate Cancer ◽

Radiographic Progression ◽

Cox Regression ◽

Castration Resistant Prostate Cancer ◽

Cox Models ◽

Predictive Values ◽

Castration Resistant ◽

Psa Progression ◽

Definition Of

e16530 Background: Changes in PSA are widely used as a biomarker for the monitoring of treatment outcome in Metastatic Castration-Resistant Prostate Cancer (mCRPC) in the clinical real-world setting. Early PSA changes (before 12 weeks) are not considered in the definition of PSA Progression (PSAProg) due to the potential for spurious “flare” reactions. We aimed to evaluate the significance of an early PSA increase in Abiraterone/Enzalutamide (Abi/Enz)-treated mCRPC patients (pts). Methods: We retrospectively evaluated Abi/Enz-treated mCRPC pts from 11 hospitals between 2011-2018. Early PSAProg was defined as a 25% increase in PSA from baseline at 4 (PSAProg4) or 8 (PSAProg8) weeks after treatment initiation. PSA progression at 12 weeks (PSAProg12) was confirmed by a second reading. Uni- and multivariable (MV) Cox regression models were conducted to explore the association of PSAProg and overall (OS) and radiographic progression-free (rPFS) survival. Sensitivity (Se), specificity (Sp) and predictive values (PPV, NPV) for the association of early PSAProg with PSAProg12 were calculated. Results: We analyzed 581 mCRPC pts; median follow-up: 19.1 months. 96 (17.1%); 105 (21.6%) and 85 (16.9%) pts had PSAprog at 4, 8 and 12 wks. PSAProg4 and PSAProg8 were significantly associated with confirmed PSAProg12. 55.3% of pts with PSAProg4 and 66.7% of pts with PSAProg8 had a confirmed PSAProg12. Only 9% of pts with no PSA prog at 4 wks and 4.1% of pts with no PSAProg8 had a confirmed PSAProg12. PSAProg4 had Se: 56.6%, Sp: 90.5%, PPV: 55.2%, NPV: 91% for the detection of PSAProg12. PSAProg8 had Se: 81.9%, Sp: 91.2%, PPV: 66.7%, NPV: 95.9% for the detection of PSAProg12. PSAprog at 4, 8 and 12 wks was significantly associated with OS and rPFS in uni- and MV Cox models (Table). Conclusions: Early PSAProg after Abi/Enz is significantly associated with both confirmed PSA Prog at 12 wks and outcome, and may help identify pts not benefitting from Abi/Enz before clinical or radiographic progression. Prospective validation studies are needed. [Table: see text]

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Concordance between the Clinical Definition of Polypathological Patient versus Automated Detection by Means of Combined Identification through ICD-9-CM Codes

Journal of Clinical Medicine ◽

10.3390/jcm8050613 ◽

2019 ◽

Vol 8 (5) ◽

pp. 613 ◽

Cited By ~ 1

Author(s):

Juan Gómez-Salgado ◽

Máximo Bernabeu-Wittel ◽

Carmen Aguilera-González ◽

Juan Antonio Goicoechea-Salazar ◽

Daniel Larrocha ◽

...

Keyword(s):

Medical History ◽

Intraclass Correlation ◽

Screening Method ◽

Automated Detection ◽

Automatic Identification ◽

Cross Sectional ◽

Data Set ◽

Predictive Values ◽

Definition Of ◽

Polypathological Patient

It is unknown whether the digital application of automated ICD-9-CM codes recorded in the medical history are useful for a first screening in the detection of polypathological patients. In this study, the objective was to identify the degree of intra- and inter-observer concordance in the identification of in-patient polypathological patients between the standard clinical identification method and a new automatic method, using the basic minimum data set of ICD-9-CM codes in the digital medical history. For this, a cross-sectional multicenter study with 1518 administratively discharged patients from Andalusian hospitals during the period of 2013–2014 has been carried out. For the concordance between the clinical definition of a polypathological patient and the polypathological patient classification according to ICD-9-CM coding, a 0.661 kappa was obtained (95% confidence interval (CI); 0.622–0.701) with p < 0.0001. The intraclass correlation coefficient between both methods for the number of polypathological patient categories was 0.745 (95% CI; 0.721–0.768; p < 0.0001). The values of sensitivity, specificity, positive-, and negative predictive values of the automated detection using ICD-9-CM coding were 78%, 88%, 78%, and 88%, respectively. As conclusion, the automatic identification of polypathological patients by detecting ICD-9-CM codes is useful as a screening method for in-hospital patients.

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Remission in Rheumatoid Arthritis: A Comparison of the 2 Newly Proposed ACR/EULAR Remission Criteria with the Rheumatoid Arthritis Disease Activity Index-5, a Patient Self-report Disease Activity Index

The Journal of Rheumatology ◽

10.3899/jrheum.120952 ◽

2013 ◽

Vol 40 (4) ◽

pp. 394-400 ◽

Cited By ~ 8

Author(s):

Bernhard Rintelen ◽

Judith Sautner ◽

Pia Haindl ◽

Harsono Mai ◽

Hans-Peter Brezinschek ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

Self Report ◽

Kappa Statistics ◽

Predictive Values ◽

Rheumatoid Arthritis Disease Activity ◽

Rheumatoid Arthritis Disease ◽

Definition Of

Objective.We analyzed whether a patient self-report remission criterion, such as that according to the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5), meets the criteria of the 2011 proposed American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) definition of remission.Methods.The 2 approaches of the ACR/EULAR proposal [Boolean- and Simplified Disease Activity Index (SDAI)-based] as well as the RADAI-5 were used to assess whether patients with RA are in remission. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), and kappa analyses were performed to illustrate the relationship among the different approaches defining remission at a group level.Results.In total, 705 patients' assessments were included. Eighty-nine patients were classified as being in remission according to the Boolean-based and 169 according to the SDAI-based definition of the ACR/EULAR proposals, and 154 according to the RADAI-5. Sixty-eight assessments were classified as being in remission according to all 3 definitions. In the case of RADAI-5 remission, sensitivity was 78%, specificity 86%, PPV 45%, and NPV 96%, indicating remission according to the Boolean-based definition; and 60%, 92%, 66%, and 90%, respectively, indicating remission according to the SDAI-based definition. In the case of remission according to the SDAI-based ACR/EULAR definition, sensitivity was 52%, specificity 100%, PPV 98%, and NPV 87%, also indicating remission according to the Boolean definition; while according to the Boolean definition the values were 98%, 87%, 52%, and 100%, respectively. Kappa statistics showed fair to good agreement for all 3 definitions.Conclusion.Nearly twice as many assessments were classified as being in remission using the SDAI-based or the RADAI-5 definitions when compared to the Boolean-based definition. Remission according to the RADAI-5 also was highly specific for both ACR/EULAR criteria. Sensitivity for the RADAI-5 criterion was even better for the Boolean-based definition than that for the SDAI-based definition.

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Abstract TP325: Lack of Early Improvement Predicts Poor Clinical Outcome Following Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.tp325 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Vignan Yogendrakumar ◽

Eric E Smith ◽

Andrew M Demchuk ◽

RIchard I Aviv ◽

David Rodriguez-Luna ◽

...

Keyword(s):

Clinical Outcome ◽

Area Under The Curve ◽

Roc Curves ◽

Predictive Values ◽

Early Improvement ◽

Poor Outcome ◽

Using Data ◽

Definition Of ◽

Sensitivity Specificity ◽

The Cost

Background: Early Neurological Worsening (ENW) is common after ICH, and predicts poor outcome. However, there is limited data as to what degree of ENW best relates to outcome. We used two ICH cohorts to refine and validate a definition of ENW that best predicted 90-day outcomes. Methods: We generated receiver operating characteristic (ROC) curves for the association between 24-hour NIHSS change and ICH outcomes using data from the VISTA collaboration. Primary outcome was poor outcome at 90 days (mRS 4-6); secondary outcomes were other mRS cutpoints (mRS 2-6, 3-6, 5-6, 6). We tested the commonly used NIHSS≥4 definition and in addition employed Youden’s J Index to select optimal cutpoints and calculated sensitivity, specificity, and predictive values. Independent predictors of poor outcome were determined via multivariable logistic regression. Definitions were validated in the prospectively collected PREDICT-ICH cohort. Results: Using 552 patients from the VISTA cohort, ROC curves of 24hr NIHSS change had an area under the curve of 0.75. NIHSS change of ≥0 at 24hrs was seen in 46.4%. Youden’s method showed an optimum cutoff at -0.5. Based on this, ENW defined as >0 (Sens 43%, Spec 91%, PPV 83%, aOR 7.13 [CI:4.05-12.55]), ≥0 (Sens 65%, Spec 73%, PPV 70%, aOR 5.05 [CI:3.25-7.85]), or ≥-1 (Sens 78%, Spec 59%, PPV 65%, aOR 6.04 [CI:3.75-9.71]) all accurately predicted poor outcome. PPV increased with higher NIHSS cutoffs, but at the cost of lower sensitivities. Regression confirmed that all definitions independently predicted outcome at all mRS cutpoints. ENW definitions reproduced well in the validation cohort of 275 patients. Conclusion: All NIHSS cut-offs for ENW predict clinical outcome, regardless of outcome definition. In particular, lack of clinical improvement at 24 hours (i.e. NIHSS is the same or higher) robustly predicted poor outcome, but may not be sufficiently reliable to determine clinical management.

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Performance of rubella suspect case definition: implications for surveillance

Revista de Saúde Pública ◽

10.1590/s0034-89102006000300013 ◽

2006 ◽

Vol 40 (3) ◽

pp. 450-456 ◽

Cited By ~ 5

Author(s):

Solange Artimos de Oliveira ◽

Luiz Antonio Bastos Camacho ◽

Antonio Carlos de Medeiros Pereira ◽

Marília Mattos Bulhões ◽

Angélica Fortes Aguas ◽

...

Keyword(s):

Rubella Virus ◽

Signs And Symptoms ◽

Laboratory Diagnosis ◽

Case Definition ◽

Serum Samples ◽

Predictive Values ◽

Congenital Rubella ◽

Reference Serum ◽

Definition Of ◽

Suspect Case

OBJECTIVE: To assess the performance of the rubella suspect case definition among patients with rash diseases seen at primary care units. METHODS: From January 1994 to December 2002, patients with acute rash, with or without fever, were seen at two large primary health care units and at a public general hospital in the municipality of Niterói, metropolitan area of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate the positive predictive values of the definition of rubella suspect case from the Brazilian Ministry of Health and other combination of signs/symptoms taking serologic status as the reference. Serum samples were tested for anti-rubella virus IgM using commercially available enzyme immunoassays. Positive predictive values and respective 95% confidence intervals were calculated. RESULTS: A total of 1,186 patients with an illness characterized by variable combinations of rash with fever, arthropathy and lymphadenopathy were studied. Patients with rash, regardless of other signs and symptoms, had 8.8% likelihood of being IgM-positive for rubella. The Brazilian suspect case definition (fever and lymphadenopathy in addition to rash) had low predictive value (13.5%). This case definition would correctly identify 42.3% of the IgM-positive cases, and misclassify 26.1% of the IgM-negative cases. CONCLUSIONS: These results support the recommendation to investigate and collect clinical specimens for laboratory diagnosis of all cases of rash, for surveillance purposes. Although this strategy may increase costs, the benefits of interrupting the circulation of rubella virus and preventing the occurrence of congenital rubella syndrome should pay off.

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Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz123 ◽

2019 ◽

Vol 14 (2) ◽

pp. 169-175 ◽

Cited By ~ 5

Author(s):

Fernando Magro ◽

Joanne Lopes ◽

Paula Borralho ◽

Susana Lopes ◽

Rosa Coelho ◽

...

Keyword(s):

Healthy Population ◽

Strongly Correlated ◽

Histological Response ◽

Faecal Calprotectin ◽

Predictive Values ◽

Endoscopic Remission ◽

Prospective Cohorts ◽

Histological Activity ◽

Histological Remission ◽

Definition Of

Abstract Background and Aims The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes—the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]—regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. Methods This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. Results The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. Conclusion The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.

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Studies in Chronic Lymphocytic Leukemia: Further Studies of the Proliferative Abnormality of the Blood Lymphocyte

Blood ◽

10.1182/blood.v33.2.313.313 ◽

1969 ◽

Vol 33 (2) ◽

pp. 313-328 ◽

Cited By ~ 51

Author(s):

ARNOLD D. RUBIN ◽

KLAUS HAVEMANN ◽

WILLIAM DAMESHEK

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Lymphocytic Leukemia ◽

Lymphocyte Function ◽

In Vitro Test ◽

Mild Disease ◽

Abnormal Cells ◽

Vitro Test ◽

Definition Of ◽

Immunoglobulin Levels

Abstract Peripheral lymphocytes from patients with chronic lymphocytic leukemia were exposed to phytohemagglutinin in culture. Quantitative assessment of the proliferative response provided an in vitro test of lymphocyte function. The results were correlated with several clinical parameters, both hematologic and immune. Lymphocytes from patients with modestly elevated lymphocyte counts and mild disease manifested slightly delayed and depressed reactions to PHA. All immunoglobulin levels in these patients were also moderately reduced. Further delay and depression of the PHA response showed a rough correlation with progressive lymphocytosis and reduction in circulating immunoglobulins. Kinetic and autoradiographic analyses have suggested that late-reacting lymphocytes formed distinct populations of abnormal cells which did not seem to be appreciably contaminated with normal lymphocytes, even in instances of mild disease. Only in a patient with splenic lymphosarcoma were multiple circulating populations of normal and late reacting lymphocytes detected simultaneously. In that case, at least some of the late-reacting lymphocytes appeared to originate in parenchymal lymphoid masses. A definition of CLL could well include, not only the findings in the blood and bone marrow, but a statement of the reaction of the lymphocytes to phytohemagglutinin and of the immunoglobulin characteristics.

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Rare Clinical Association between Clostridioides difficile Infection and Ischemic Colitis: Case Report and Literature Review

Medicina ◽

10.3390/medicina57070705 ◽

2021 ◽

Vol 57 (7) ◽

pp. 705

Author(s):

Elena Mirela Ionescu ◽

Ana-Maria Curte ◽

Andrei Ovidiu Olteanu ◽

Carmen Monica Preda ◽

Ioana Tieranu ◽

...

Keyword(s):

Case Report ◽

Ischemic Colitis ◽

Specific Treatment ◽

Oral Vancomycin ◽

Mild Disease ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Fecal Tests ◽

Histologic Changes ◽

Severe Colitis

Background and Objectives: Gut microbiota plays an important role in the wellbeing of the host through different interactions between microflora constituents. In certain instances, Clostridioides difficile may pullulate, causing infection with associated colitis that may vary in terms of severity from mild disease to severe colitis, with increased associated mortality due to its complications. However, there are few literature data regarding the association between Clostridioides difficile and ischemic colitis. Case report: We report the case of a 30-year-old male patient, overweight, with impending dehydration, who presented with hematochezia and colicky abdominal pain, with positive fecal tests for the detection of Clostridioides difficile infection and endoscopic appearance suggesting ischemic colitis in the sigmoid and left colon, confirmed by computed tomography and histology. The patient was treated with oral Vancomycin, with resolution of symptoms, and was reevaluated through colonoscopy eight weeks after discharge, with endoscopic mucosal normalization and histological scarring process on biopsy samples. Conclusion: We report one of the few cases in the literature of ischemic colitis associated with Clostridioides difficile infection, with resolution of clinical, endoscopic, and histologic changes after specific treatment with oral Vancomycin suggesting a possible association between the two diseases. We also review the existing literature data regarding this comorbid association.

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