scholarly journals Tracheostomy in Infants after Cardiac Surgery: Indications, Timing and Outcomes

2021 ◽  
Vol 4 (10) ◽  
pp. 01-16
Author(s):  
Ujjwal Chowdhury
Keyword(s):  
Cardiac Surgery ◽  
Cox Regression ◽  
Pediatric Population ◽  
Characteristic Curve ◽  
Extubation Failure ◽  
Optimal Timing ◽  
Actuarial Survival ◽  
Early Tracheostomy ◽  
Cox Regression Analysis ◽  
Youden’S Index

Objective: There is little consensus on the indications and optimal timing of tracheostomy in the pediatric population. Our primary aim was to determine if early tracheostomy improves patient outcomes (between 10th and 15th postoperative day). Methods: A retrospective review of 84 neonates and infants requiring tracheostomy after cardiac surgery between January 1997 and December 2019 was performed. Indications and timings for tracheostomy, and risk factors for mortality were analyzed using Cox regression analysis. The receiver operating characteristic curve analysis, Youden’s index, sensitivity and specificity plot were performed to determine the optimal cut-off point of the timing of tracheostomy. Results: Twenty-five (29.76%) neonates and 59 (70.23%) infants with a median weight 7.6 kg (IQR: 3.1-9.25 kg) were studied. Extubation failure and unsuccessful weaning from ventilator occurred in 45 (53.6%) and 39 (46.4%) patients respectively. The timing of tracheostomy of 15 days as the optimal cut-off point was associated with a sensitivity of 73% and a specificity of 84% and a Youden’s index of 0.60. Early tracheostomy was associated with decreased mortality (p<0.001), morbidity (p<0.001), decreased duration of ventilation (p<0.001), ICU length of stay (p<0.001) and decreased time of decannulation (p<0.001). The hazard of death was 5.26 times (95% CI: 1.47-20.36) higher in patients undergoing late tracheostomy. At a median follow-up of 166 (IQR: 82.5-216) months, the actuarial survival was 86.61%±0.04%. Conclusions: Early tracheostomy within 15th postoperative day was associated with lower perioperative and late mortality, morbidity and ICU stay compared with tracheostomy between 15-30 days, and confers significant long-term advantages.

scholarly journals Identification and Validation of a Prognostic 5-Protein Signature for Biochemical Recurrence Following Radical Prostatectomy for Prostate Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Daojun Lv ◽  
Zanfeng Cao ◽  
Wenjie Li ◽  
Haige Zheng ◽  
Xiangkun Wu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Survival Analysis ◽  
Biochemical Recurrence ◽  
Cox Regression ◽  
Characteristic Curve ◽  
The Cancer Genome Atlas ◽  
Medical Decision ◽  
Regression Analyses ◽  
Cox Regression Analysis ◽  
Protein Signature

Background: Biochemical recurrence (BCR) is an indicator of prostate cancer (PCa)-specific recurrence and mortality. However, there is a lack of an effective prediction model that can be used to predict prognosis and to determine the optimal method of treatment for patients with BCR. Hence, the aim of this study was to construct a protein-based nomogram that could predict BCR in PCa.Methods: Protein expression data of PCa patients was obtained from The Cancer Proteome Atlas (TCPA) database. Clinical data on the patients was downloaded from The Cancer Genome Atlas (TCGA) database. Lasso and Cox regression analyses were conducted to select the most significant prognostic proteins and formulate a protein signature that could predict BCR. Subsequently, Kaplan–Meier survival analysis and Cox regression analyses were conducted to evaluate the performance of the prognostic protein-based signature. Additionally, a nomogram was constructed using multivariate Cox regression analysis.Results: We constructed a 5-protein-based prognostic prediction signature that could be used to identify high-risk and low-risk groups of PCa patients. The survival analysis demonstrated that patients with a higher BCR showed significantly worse survival than those with a lower BCR (p &lt; 0.0001). The time-dependent receiver operating characteristic curve showed that the signature had an excellent prognostic efficiency for 1, 3, and 5-year BCR (area under curve in training set: 0.691, 0.797, 0.808 and 0.74, 0.739, 0.82 in the test set). Univariate and multivariate analyses indicated that this 5-protein signature could be used as independent prognosis marker for PCa patients. Moreover, the concordance index (C-index) confirmed the predictive value of this 5-protein signature in 3, 5, and 10-year BCR overall survival (C-index: 0.764, 95% confidence interval: 0.701–0.827). Finally, we constructed a nomogram to predict BCR of PCa.Conclusions: Our study identified a 5-protein-based signature and constructed a nomogram that could reliably predict BCR. The findings might be of paramount importance for the prediction of PCa prognosis and medical decision-making.Subjects: Bioinformatics, oncology, urology.

Inflammatory markers in cerebrospinal fluid: independent prognostic biomarkers in amyotrophic lateral sclerosis?

2019 ◽  
pp. jnnp-2018-319586 ◽  
Author(s):  
Benjamin Gille ◽  
Maxim De Schaepdryver ◽  
Lieselot Dedeene ◽  
Janne Goossens ◽  
Kristl G Claeys ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Cerebrospinal Fluid ◽  
Disease Progression ◽  
Inflammatory Markers ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Progression Rate ◽  
Cox Regression Analysis ◽  
Lateral Sclerosis ◽  
Discriminatory Performance

ObjectiveInflammation is a key pathological hallmark in amyotrophic lateral sclerosis (ALS), which seems to be linked to the disease progression. It is not clear what the added diagnostic and prognostic value are of inflammatory markers in the cerebrospinal fluid (CSF) of patients with ALS.MethodsChitotriosidase-1 (CHIT1), chitinase-3-like protein 1 (YKL-40) and monocyte chemoattractant protein-1 (MCP-1) were measured in CSF and serum of patients with ALS (n=105), disease controls (n=102) and patients with a disease mimicking ALS (n=16). The discriminatory performance was evaluated by means of a receiver operating characteristic curve analysis. CSF and serum levels were correlated with several clinical parameters. A multivariate Cox regression analysis, including eight other established prognostic markers, was used to evaluate survival in ALS.ResultsIn CSF, CHIT1, YKL-40 and MCP-1 showed a weak discriminatory performance between ALS and ALS mimics (area under the curve: 0.79, p<0.0001; 0.72, p=0.001; 0.75, p=0.001, respectively). CHIT1 and YKL-40 correlated with the disease progression rate (ρ=0.28, p=0.009; ρ=0.34, p=0.002, respectively). CHIT1 levels were elevated in patients with a higher number of regions displaying motor neuron degeneration (one vs three regions: 4248 vs 13 518 pg/mL, p = 0.0075). In CSF, YKL-40 and MCP-1 were independently associated with survival (HR: 29.7, p=0.0003; 6.14, p=0.001, respectively).ConclusionsOur findings show that inflammation in patients with ALS reflects the disease progression as an independent predictor of survival. Our data encourage the use of inflammatory markers in patient stratification and as surrogate markers of therapy response in clinical trials.

scholarly journals Five lncRNAs Associated With Prostate Cancer Prognosis Identified by Coexpression Network Analysis

2020 ◽  
Vol 19 ◽  
pp. 153303382096357
Author(s):  
Xiaoyong Gong ◽  
Bobin Ning
Keyword(s):  
Prostate Cancer ◽  
Network Analysis ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Interaction Network ◽  
The Cancer Genome Atlas ◽  
Cancer Prognosis ◽  
Normal Prostate ◽  
Cox Regression Analysis ◽  
Incidence And Mortality

Prostate cancer (PCa) is a highly malignant tumor, with increasing incidence and mortality rates worldwide. The aim of this study was to identify the prognostic lncRNAs and construct an lncRNA signature for PCa diagnosis by the interaction network between lncRNAs and protein-coding genes (PCGs). The differentially expressed lncRNAs (DElncRNAs) and PCGs (DEPCGs) between PCa and normal prostate tissues were screened from The Cancer Genome Atlas (TCGA) database. The DEPCGs were functionally annotated in terms of the enriched pathways. Weighted gene co-expression network analysis (WGCNA) of 104 PCa samples identified 15 co-expression modules, of which the Turquoise module was negatively correlated with cancer and included 5 key lncRNAs and 47 PCGs. KEGG pathway analyses of the core 47 PCGs showed significant enrichment in classic PCa-related pathways, and overlapped with the enriched pathways of the DEPCGs. LINC00857, LINC00900, LINC00908, LINC00900, SNHG3 and FENDRR were significantly associated with the survival of PCa and have not been reported previously. Finally, Multivariable Cox regression analysis was used to establish a prognostic risk formula, and the patients were accordingly stratified into the low- and high-risk groups. The latter had significantly worse OS compared to the low-risk group (P < 0.01), and the area under the receiver operating characteristic curve (ROC) of 14-year OS was 0.829. The accuracy of our prediction model was determined by calculating the corresponding concordance index (C-index) and risk curves. In conclusion, we established a 5-lncRNA prognostic signature that provides insights into the biological and clinical relevance of lncRNAs in PCa.

Radiation for bone metastases: Reconsidering the optimal timing.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10122-10122 ◽  
Author(s):  
Joanna C. Yang ◽  
Brittany Hsu ◽  
Abraham Jing-Ching Wu ◽  
Zachary Kohutek ◽  
T. Jonathan Yang
Keyword(s):  
Chronic Pain ◽  
Bone Metastases ◽  
Hospice Care ◽  
Cox Regression ◽  
Optimal Timing ◽  
Inpatient Setting ◽  
Cox Regression Analysis ◽  
Symptomatic Disease ◽  
Select Group ◽  
Painful Bone Metastases

10122 Background: Bone metastases impair function and decrease quality of life due to acute or chronic pain. The standard approach for patients with multiple bone metastases is systemic therapy and palliative radiation therapy (RT) when the metastases become symptomatic. This study aims to understand the characteristics and outcomes for inpatients admitted for painful bone metastases. Methods: An inpatient radiation oncology consult registry was created in 2015 to evaluate patterns of care for patients receiving RT in the inpatient setting. Of the 1151 consults requested between 7/2015 and 6/2016, 28% (n = 323) were for evaluation of symptomatic bone metastases in patients who were hospitalized for acute or chronic pain. Among this cohort, 64% (n = 208) went on to receive RT for 225 bone metastases. Sixty percent of RT courses were initiated while the patient was hospitalized. Clinical characteristics correlated with overall survival (OS) were evaluated through Cox regression analysis. Results: The median follow up for the 208 patients who received RT was 4 months (0.1-9 months). Patient median age was 61 (10-92 years), and the median KPS was 70 (20-90). The most common sites treated were spine (50%), joints such as hip and shoulder (11%), long bones including femur and humerus (11%), and pelvis (10%). Sixty-one percent (n = 138) of the treated metastases were diagnosed ≥4 months prior to RT. The median survival after receiving palliative RT was 4 months (0-19 months). Among the 141 patients who had died at the time of analysis, 92 (65%) died within 2 months, and 128 (91%) within 6 months. Eighteen patients (9%) discontinued RT to transition to hospice care. OS after RT is significantly correlated with KPS (p < 0.0001) at the time of consult but not with patient age or site of treated disease. Conclusions: In this select group of inpatients who were evaluated for palliation of symptomatic bone metastases, we found a short OS after RT. The majority of metastases were present for ≥4 months prior to RT. This study suggests that earlier RT for high-risk metastases should be considered to prevent development of symptomatic disease that requires hospitalization. Risk factors for development of painful bone metastases are being studied prospectively at our institution.

scholarly journals A Novel Prognostic Risk Score Based on Ferroptosis-related LncRNAs Predicting Ovarian Cancer Patient Survival

2021 ◽  
Author(s):  
Keyu Chen ◽  
Xiaohong Li ◽  
Caixia Qi
Keyword(s):  
Ovarian Cancer ◽  
Risk Score ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Therapeutic Targets ◽  
Cancer Prognosis ◽  
Cancer Tissue ◽  
Clinical Implementation ◽  
Tumour Immunity ◽  
Cox Regression Analysis

Abstract Background: Long non-coding RNAs (lncRNAs) are thought to be associated with several processes during cancer development and have been shown to be involved in the regulation of ferroptosis. Ovarian cancer is highly malignant tumour with a poor prognosis. The identification biomarkers with prognostic value in ovarian cancer may improve patient outcomes and can help to elucidate potential future therapeutic targets.Results: We report differential expression of 187 ferroptosis-related lncRNAs in normal and ovarian cancer tissue. Using univariate and multivariable Cox regression analysis, we identified four lncRNAs that were strongly associated with prognosis. We constructed a prognostic risk score based on these four lncRNAs which was effectively able to distinguish between low- and high-risk OC patients based on survival time. Univariate and multivariable Cox regression analyses and time-related receiver operating characteristic curve analyses revealed that this risk score represented an independent prognostic factor in patients with ovarian cancer. For clinical implementation, we developed a nomogram based on the prognostic feature and patient age. Gene Ontology(GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that the four ferroptosis-related lncRNAs were related to tumour immunity.Conclusions: we identify four novel ferroptosis-related lncRNAs as predictors of ovarian cancer prognosis and potential future therapeutic targets for ovarian cancer.

scholarly journals Risk Factors for Atrial Fibrillation following a Cardiac Surgery

2021 ◽  
Author(s):  
Ibrahim Marai ◽  
Wiaam Khatib ◽  
Liza Grosman-Rimon ◽  
Shemy Carasso ◽  
Ali Sakhnini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cox Regression ◽  
Medical Center ◽  
Clinical Impact ◽  
Cox Regression Analysis ◽  
History Of ◽  
Vascular Accidents ◽  
Preoperative Factors

Background: Atrial fibrillation (AF) following cardiac surgery is common and has clinical impact on morbidity. The preoperative and intraoperative risk factors are still not well defined. The objective of the study was to examine preoperative and intraoperative risk factors for AF following cardiac surgery. Methods: A retrospective analysis of a database of cardiac surgeries was performed during 2017-2019 at Poriya Medical Center. Preoperative factors and intraoperative were recorded. Results: 208 patients were included in this analysis. Overall AF following cardiac surgery was detected in 50 (24%) patients. Of 175 patients who did not have history of AF prior to surgery, 27 (15.5%) had post-operative AF. In the 33 patients with previous AF, AF following surgery was detected in 23 (70%). Patients with AF following surgery who were older (66.2±8.0 vs. 60.7± 11.4 years, p=0.002), were treated more with anti-arrhythmic drugs (18.9% vs 4.5, p<0.001), and had higher rates of pre-operative AF (46% vs 6.3%, p=0.0001), prior cerebral vascular accidents (14% vs 4.4%, p=0.019), and prior valve replacement (10% vs 1.9%, p=0.009) compared to patients without AF following surgery. In multivariate Cox regression analysis, age (HR 1.04, CI 1.01-1.07, P=0.006) and history of preoperative AF (HR 6.01, CI 3.42-10.57, P<0.001) were predictors of AF following cardiac surgery. The probability of being free of postsurgical AF was 80% among patients without history of AF compared to 30% in patients with previous AF history (p<0.001). Conclusion: Preoperative AF and age were predictors of AF following cardiac surgery

scholarly journals Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255744
Author(s):  
Yan Lu ◽  
Haoyang Guo ◽  
Xuya Chen ◽  
Qiaohong Zhang
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Medical Information ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Severe Heart Failure ◽  
Albumin Ratio ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
All Cause Mortality

Previous studies have shown that lactate/albumin ratio (LAR) can be used as a prognostic biomarker to independently predict the mortality of sepsis and severe heart failure. However, the role of LAR as an independent prognostic factor in all-cause mortality in patients with acute respiratory failure (ARF) remains to be clarified. Therefore, we retrospectively analyzed 2170 patients with ARF in Medical Information Mart for Intensive Care Database III from 2001 to 2012. By drawing the receiver operating characteristic curve, LAR shows a better predictive value in predicting the 30-day mortality of ARF patients (AUC: 0.646), which is higher than that of albumin (AUC: 0.631) or lactate (AUC: 0.616) alone, and even higher than SOFA score(AUC: 0.642). COX regression analysis and Kaplan-Meier curve objectively and intuitively show that high LAR is a risk factor for patients with ARF, which is positively correlated with all-cause mortality. As an easy-to-obtain and objective biomarker, LAR deserves further verification by multi-center prospective studies.

scholarly journals Controlling Nutritional Status (CONUT) score predicts worse outcomes in Chinese cardiac surgery patients

2020 ◽  
Author(s):  
Yan Yang ◽  
Pei Zhang ◽  
Hua Zhou ◽  
Min Yang
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Laboratory Data ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Conut Score

Abstract Background & Aims: Nutritional and immunological status was assessed by the Controlling Nutritional Status (CONUT) score calculated from serum albumin, total cholesterol and total peripheral lymphocyte count. The aim of this study was to determine the prognostic impact of the CONUT score on patients underwent cardiac surgery.Methods: This is a single-center retrospective observational study in cardiac surgery patients. Baseline characteristics, comorbidities, and laboratory data were collected. The primary outcome was all-cause mortality. The secondary outcomes were postoperative complications including acute kidney injury (AKI), transient ischemic attack or stroke, reoperation for bleeding. Univariate and multivariate Cox regression were performed to investigate the association between confounding factors and outcomes. The cut-off value of CONUT score was accessed by the receiving operating characteristic curve. We used the Kaplan-Meier curve to compare the outcomes according to the cut-off CONUT score. The area under the curve (AUC) was used to test discriminative power of CONUT score and relevant clinical parameters. Results: A total of 408 patients were enrolled in this study. During a median follow-up period of 72.12 months, 28 (6.9%) patients died and 43 (10.5%) patients occurred postoperative complications. The rate of all-cause mortality and postoperative complications was higher in the high CONUT score (>3) group than in the low CONUT score group (p=0.002, p=0.02). High CONUT score (hazard ratio [HR] =2.367, 95% confidence interval [CI]=1.072 to 5.266, P=0.033) was an independent predictor of all-cause mortality. The AUC of the joint probability of CONUT score, age, and hypertension in predicting all-cause mortality was 0.744 (95% CI: 0.687–0.775). The high CONUT score was still an independent risk factor of secondary outcomes (HR=2.316, 95%CI=1.122 to 4.780, P=0.023).Conclusion: The CONUT score was independently associated with all-cause mortality and postoperative complications in patients underwent cardiac surgery.

scholarly journals A Novel Predictive Model Associated With Osteosarcoma Metastasis

2021 ◽  
Author(s):  
Han Zhang ◽  
Guanhong Chen ◽  
Xiajie Lyu ◽  
Tao Li ◽  
Rong Chun ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Cox Regression ◽  
High Reliability ◽  
Characteristic Curve ◽  
Predictive Ability ◽  
Lasso Regression ◽  
Cox Regression Analysis ◽  
Metastasis Model ◽  
Non Coding Rnas ◽  
Novel Model

Abstract Background: Long non-coding RNAs (lncRNAs) have diverse roles in modulating gene expression on both transcriptional and translational aspects, whereas its role in the metastasis of osteosarcoma (OS) is unclear.Method: Expression and clinical data were downloaded from TARGET datasets. The OS metastasis model was established by seven lncRNAs screened by univariate cox regression, lasso regression and multivariate cox regression analysis. The area under receiver operating characteristic curve (AUC) values were used to evaluate the models.Results: The predictive ability of this model is extraordinary (1 year: AUC = 0.92, 95% Cl = 0.83–1.01; 3 years: AUC = 0.87, 95% Cl = 0.79–0.96; 5 years: AUC = 0.86, 95% Cl = 0.76–0.96). Patients in high group had poor survival compared to low group (p < 0.0001). “NOTCH_SIGNALING”, and “WNT_BETA_CATENIN_SIGNALING” were enriched via the GSEA analysis and dendritic cells resting were associated with the AL512422.1, AL357507.1 and AC006033.2 (p < 0.05).Conclusion: We constructed a novel model with high reliability and accuracy to predict the metastasis of OS patients based on seven prognosis-related lncRNAs.

scholarly journals Association of Perioperative Risk Factors and Cumulative Duration of Low Bispectral Index with Intermediate-term Mortality after Cardiac Surgery in the B-Unaware Trial

2010 ◽  
Vol 112 (5) ◽  
pp. 1116-1127 ◽  
Author(s):  
Miklos D. Kertai ◽  
Nirvik Pal ◽  
Ben J. A. Palanca ◽  
Nan Lin ◽  
Sylvia A. Searleman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Bispectral Index ◽  
Cox Regression ◽  
Medical Center ◽  
Discriminative Ability ◽  
Cox Regression Analysis ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Cumulative Duration

Background Current data suggest that mortality after noncardiac surgery may be associated with persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS). This study assessed the relationships among cumulative duration of low BIS (BIS &lt; 45), intermediate-term mortality, and anesthetic dose after cardiac surgery. Methods The authors studied 460 patients (mean age, 63.0 +/- 13.1 yr; 287 men) who underwent cardiac surgery between September 2005 and October 2006 at Washington University Medical Center, St Louis, Missouri. By using multivariable Cox regression analysis, perioperative factors were evaluated for their potential association with intermediate-term all-cause mortality. Results A total of 82 patients (17.8%) died during a median follow-up of 3 yr (interquartile range, 2.7-3.3 yr). Comparing patients who died with those who survived, there was no statistically significant difference in the relationship between end-tidal anesthetic gas concentrations during the anesthetic maintenance phase and the BIS. Cumulative duration of low BIS was independently associated with intermediate-term mortality. The 1.29 adjusted hazard ratio (95% CI, 1.12-1.49) for intermediate-term mortality with cumulative duration of low BIS translated into a 29% increased risk of death for every cumulative hour spent with a BIS less than 45. The final multivariable Cox regression model showed a good discriminative ability (c-index of 0.78). Conclusions This study found an association between cumulative duration of low BIS and mortality in the setting of cardiac surgery. Notably, this association was independent of both volatile anesthetic concentration and duration of anesthesia, suggesting that intermediate-term mortality after cardiac surgery was not causally related to excessive anesthetic dose.

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