scholarly journals Disseminated intravascular coagulation in acute promyelocytic leukaemia and its impact on the induction failure: a single centre study

2014 ◽  
Vol 39 (2) ◽  
pp. 57-60 ◽  
Author(s):  
F Rahman ◽  
AL Kabir ◽  
MR Khan ◽  
A Aziz ◽  
MN Baqui ◽  
...  
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Disseminated Intravascular Coagulation ◽  
Risk Group ◽  
Remission Rate ◽  
Early Death ◽  
High Risk Group ◽  
P Value ◽  
Intravascular Coagulation ◽  
The Status

Life-threatening coagulopathy associated with acute promyelocytic leukemia (APL) has been the defining clinical characteristic and is an important risk factor for fatal haemorrhage and early death. Pathogenesis of coagulopathy in APL is complex and mainly includes disseminated intravascular coagulation (DIC). The study was done to see the status of DIC and its impact on the outcome of APL in our setting. Among the total 60 patients, induction mortality rate was 30% and remission rate was 70%. The main cause of induction mortality was bleeding that accounts for 66.7% of mortality. DIC was present among 32 out of 60 patients (53.33%). Induction mortality has significant relationship to DIC as the induction mortality rate is 47% in patients with DIC and 11% in patient without DIC (P value 0.0009 ). Induction motality rate in low, intermediate and high risk group is 6.7%, 24% and 58% respectively (p value <0.0001). Finally, risk group subclassification revealed presence of DIC in high risk group has the highest early mortality rate DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19642 Bangladesh Med Res Counc Bull 2013; 39: 57-60

scholarly journals Comparison of Thrombolysis in Myocardial Infarction Score and Heart Score in risk stratification of acute myocardial infarction patients, prognostic accuracy and arrhythmia incidence

2019 ◽  
Vol 7 (9) ◽  
pp. 3300
Author(s):  
Keerthana Batyala ◽  
M. V. Nagabhushana ◽  
Malli Dorasanamma
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
High Risk Group ◽  
P Value ◽  
Heart Score ◽  
Prognostic Accuracy ◽  
Timi Score

Background: To compare TIMI & HEART SCORE for their risk stratification in Acute Myocardial Infarction Patients,  prognostic accuracy and Arrhythmia incidence.Methods: This observational study is conducted in a Tertiary care hospital over a period of 2 years from August 2017 to July 2019. A total of 100 patients presented to ER with Chest Pain are selected for study. Patients were monitored for a period of one month in ICCU.Results: In present study out of 61 cases with TIMI score ≥5, mortality of 11.5%(7 cases, p value 0.028). Heart score more than 6  constitutes high risk group, out of which mortality was observed in 7.45% cases (p=0.48). Most of the arrhythmias (70.49%) in present study observed in patients with TIMI score ≥5 (High risk group) which is statistically significant with p value 0.002. Most of the arrhythmias in present study observed in patients with HS ≥8 which is not statistically significant with p value 0.135.Conclusions: In present study, overall mortality rate was 7% and these patients who died constitutes to high risk group with TIMI. HEART SCORE identified more patients as low risk compared to TIMI SCORE. TIMI SCORE is a good predictor of arrhythmia incidence.

ELYPSE 2: A prospective randomized trial comparing filgrastim (G-CSF) in primary and secondary prophylaxis in patients (pts) at high risk for febrile neutropenia (FN)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8614-8614 ◽  
Author(s):  
P. Biron ◽  
I. Ray-Coquard ◽  
A. Le Cesne ◽  
S. Dussart ◽  
C. Goilliot ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Model ◽  
Risk Group ◽  
Early Death ◽  
Median Number ◽  
Secondary Prophylaxis ◽  
High Risk Group ◽  
Duration Of Hospitalization ◽  
Life Threatening ◽  
Cost Efficient

8614 Background: FN is a frequent life-threatening consequence of cytotoxic chemotherapy (CT). G-CSF reduces the risk of FN, but primary (1ry) prophylaxis using G-CSF may be cost efficient only if FN incidence is ≥20%. The identification of pts at high risk for FN with simple criterias would be useful in clinical practice. Here we report a randomized phase II trial comparing G-CSF in 1ry vs 2ry prophylaxis in a high risk group of pts (based on our risk model JCO 1996;14:737, Br J Cancer 2003;88:181). Methods: Pts ≥18 years with solid tumors or NHL at high risk for FN after CT were incluable: these were pts with day 1 or day 5 lymphocytes (Ly) count ≤700/μL AND “high risk CT” (HRCT) In pts with d1 and d5 Ly ≤700/μL, the observed incidence of FN was 40% and 66% respectively G-CSF (300 to 480μg/d from d6–12) was randomized either as in 1ry prophylaxis (Arm 1), or as 2ry prophylaxis after FN (Arm 2). Primary endpoint was the rate of grade 4 FN. Hypothesis was a reduction of 40% of the risk of FN with 1ry prophylaxis. Results: Between 03/97 and 12/04, 137 pts were included in 7 centers. The median age was 53 years (range 18–80) with 54% males. Most frequent tumors were sarcomas (36%), breast carcinomas (18%), lymphomas (15%), head and neck carcinomas (10%), and lung carcinomas (6%). 23% patients had PS>1 at the first line of chemotherapy. No difference was observed in terms of duration of hospitalization or antibiotherapy. Median number of days of G-CSF administration was 14 days (0–24) vs 0 (0–17) days (p<0.0000). After the 1st course, grade 4 FN was 38% in Arm 2 (2ry prophylaxis) and 25% in Arm 1 (1ry prophylaxis), showing a 34% reduction of FN in arm 1 (p=0.14): 1ry prophylaxis was associated with a significant reduction of FN using logistic regression (p=0.04). Incidence of FN after the 2 course in pts receiving 2ry prophylaxis was 22%. Among the subgroup of pts with PS>2 and Ly ≤700/μL, (a group with a reported 20% risk for early death, Br J Cancer 2001;85:816), 2 of 8 patients (25%) died after the 1st course, vs 0/13 in the G-CSF group (p=0.05). This difference was not significant in the whole group. Conclusions: This study confirms that lymphopenic pts receiving HRCT are a high risk group of pts for FN for whom 1ry prophylaxis with G-CSF reduces the incidence of FN. [Table: see text]

Treatment Outcome of Discontinued L-Asparaginase in Children with Standard-Risk Acute Lymphoblastic Leukemia: Tokyo Children’s Cancer Study Group (TCCSG) Study L99-15.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 878-878 ◽  
Author(s):  
Chitose Ogawa ◽  
Akira Ohara ◽  
Atsushi Manabe ◽  
Ryoji Hanada ◽  
Hiroyuki Takahashi ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Risk Group ◽  
Lymphoblastic Leukemia ◽  
Risk Groups ◽  
High Risk Group ◽  
P Value ◽  
Group A ◽  
Group B ◽  
Standard Risk

Abstract BACKGROUND: L-asparaginase (L-asp) is one of the key drugs in the treatment of acute lymphoblastic leukemia (ALL) in children. However, L-asp often produces severe adverse effects including anaphylaxis resulting in its discontinuation. OBJECTIVE: To evaluate retrospectively the outcome of discontinuation of L-asp in patients with ALL. PATIENTS AND METHODS: Children newly diagnosed as ALL between 1999 and 2003 were consecutively enrolled on the TCCSG L99-15 study. Risk stratification was based on the age, initial white blood cell count, immunophenotype, cytogenetics and the response to prednisolone monotherapy. Totally, 267 (35%) out of 770 children were categorized into a standard-risk group (SR), 317 (41%) into a high-risk group (HR) and 186 (24%) into a very high-risk group (HEX). Allogeneic stem cell transplantation was indicated approximately in 50% of the HEX patients. L-asp was used 9 times in the induction phase in all the risk groups. The total number of L-asp administration all through the treatment was 19 in SR, 20 in HR and at least 10 in HEX. Patients were divided into two groups in the analysis: group A patients who received at least 50% of scheduled doses of L-asp and group B patients who received less than 50%. RESULTS: Remission was obtained in 259 (97%) patients in SR, 311 (98%) in HR and 171(92%) in HEX. In the patients who achieved remission and were analyzed, 195 (83.7%) in SR, 223 (78.8%) in HR and 123 (83.7%) in HEX received all the scheduled doses of L-asp. Event-free survival (EFS) (SE) and overall survival (OS) (SE) at 5 years for all the risk groups are shown in the table. Notably, EFS in group A (92.9%) and in group B (74.1%) in SR was significantly different (p=0.025). CONCLUSION: The outcome in patients who received less than 50% of scheduled dose of L-asp was inferior to that in the patients who received more than 50% of the scheduled dose. This suggests that modification or intensification of the treatment should be considered for the patients who discontinued L-asp in SR. EFS and OS in each group Risk group EFS ± SE(%) OS ± SE(%) (No. in A /B) group A group B p value group A group B p value SR (223 /10) 92.9±2.4 74.1±16.1 0.025 97.8±1.1 88.9±10.5 0.066 HR (269 /14) 78.5±3.2 66.7±19.2 0.969 88.9±2.6 50.0±25.0 0.158 HEX (142 /5) 58.2±5.5 75.5±21.7 0.514 75.6±4.3 80.0±17.9 0.873

Identification of Differential Methylation Markers Among Cytogenetic Risk Groups of Acute Myeloid Leukemia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1464-1464
Author(s):  
Min Fang ◽  
Xiaoyu Qu ◽  
Jerry Davison ◽  
Liping Du ◽  
Frederick R. Appelbaum ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Differential Methylation ◽  
The Other ◽  
P Value ◽  
Single Region ◽  
The Right ◽  
Methylation Ratio

Abstract Abstract 1464 Aberrant DNA methylation has been shown as an important mechanism in the progression from myelodysplasia (MDS) to acute myeloid leukemia (AML), leading to use of the demethylating agents, 5-azacitidine and decitabine, for treatment of both disorders. While these drugs produce responses, the ability to distinguish potential responders from potential non-responders remains limited. The purpose of this work was to bring new technology to study this problem. Recent studies demonstrated that promoter DNA methylation is not randomly distributed in AML blasts but rather is highly organized and associated with biologically distinct AML subtypes. Because cytogenetics at presentation is the most important prognostic factors in predicting response to therapy, remission duration and overall survival in AML, we aimed to identify differentially methylated genomic regions (DMR) in cytogenetically defined risk groups of AML. Published literature suggested that the new comprehensive high-throughput array-based relative methylation analysis (CHARM) has the highest sensitivity and specificity among all the array-based genome profiling methods and should be the most accurate means to identify methylation markers. It is a customized NimbleGen HD2 array of tiled 50mer-probes typically separated by 30–40 bases covering approximately 4.6 million CpG sites across the genome. This assay is highly quantitative for approximately 100,000 independent CpG sites. We performed methylation profiling with CHARM on 15 age-matched patients divided into 3 groups (n=5 in each): (1) high-risk AML, defined as patients with a complex or monosomal karyotype, inv(3)/t(3;3), t(6;9), or FLT3-ITD; (2) intermediate-risk AML, defined as patients with normal karyotype, trisomy 8, t(9;11), or others; (3) low-risk AML, defined as patients with t(8;21) or inv(16). Five age-matched normal individuals served as control. Randomly fractionated DNA was divided into two equal portions with and without McrBC treatment, which cleaves methylated DNA, then size-fractionated, purified and subject to whole-genome amplification prior to hybridization with the CHARM array. Data analysis was performed with R and Bioconductor. AML patients showed a very strong hypermethylation signature as compared with the normal control blood. A unique set of DMRs was identified which distinguishes between any two risk groups. The number of DMRs and those with p -values < 0.01 are shown in Table 1. There were fewer methylation discriminators between low- and mid-risk groups than between high-risk and the other risk groups. Figure 1 shows the comparison between high-risk group and other risk groups highlighting the 12 top DMRs with lowest p -values. In silico validation of the DMRs identified by CHARM verified previously reported aberrant hypermethylation of tumor suppressor genes like p15CDKN2B, discriminating normal from AML patients, CDH1 promoter hypermethylation in high-risk AML compared with mid-risk AML, and HOXB3 hypomethylation in mid-risk AML compared with both low-risk and high-risk AML, etc. Technical validation using quantitative bisulfite pyrosequencing on 8 genes, including DCC, DUOX2, NEFL, and PITX1, demonstrated an 87.5% concordant rate with CHARM. Testing of additional AML samples with validated markers are underway to confirm the top DMRs identified, which may serve as useful biomarkers to predict response to azacitidine and decitabine.Table 1Number of DMRsNumber with p-value < 0.01Normal blood VS at risk3768311Low-risk VS mid-risk156530Low-risk VS high-risk247573Mid-risk VS high-risk2651107Figure 1.Results from the CHARM analysis on AML patients stratified by cytogenetic risk, highlighting comparison between the high-risk and other risk groups. The top twelve differentially methylated regions ( DMRs) with p -value < 0.01 are shown. Box-and-whisker plots to the left of the dashed vertical line in each panel present the log2 methylation ratio of the high-risk group and the other two risk groups combined, in a single region of differential methylation. To the right of the dashed line the high-risk group is compared with each of the other groups. Each panel's header text identifies the genomic region.Figure 1. Results from the CHARM analysis on AML patients stratified by cytogenetic risk, highlighting comparison between the high-risk and other risk groups. The top twelve differentially methylated regions ( DMRs) with p -value < 0.01 are shown. Box-and-whisker plots to the left of the dashed vertical line in each panel present the log2 methylation ratio of the high-risk group and the other two risk groups combined, in a single region of differential methylation. To the right of the dashed line the high-risk group is compared with each of the other groups. Each panel's header text identifies the genomic region. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Risky Fertility Behavior, Breastfeeding Practices and Neonatal Mortality Risk: Evidence from Repeated Cross-Sectional Nationally Representative Data

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
Matthew A. Alabi ◽  
Grace E. Ihimekpen ◽  
Taofeek A. Hassan
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Neonatal Mortality ◽  
Risk Group ◽  
Fertility Behavior ◽  
High Risk Group ◽  
Health Seeking ◽  
Live Births ◽  
Breastfeeding Practices ◽  
Seeking Behavior

Background: Notwithstanding government efforts in improving maternal and child health, childhood mortality still remains a serious burden in the country, with neonatal mortality rate of 39 deaths and under-five mortality rate of 132 per 1,000 live births. This has implication on Sustainable Development Goals (SDGs) targeted towards reducing under-fiver mortality rate to 25 deaths per 1,000 live births by the year 2030. This study examined risky fertility behavior, breastfeeding practices, and neonatal mortality risk in Nigeria. Materials and methods: This study involved the analysis of secondary data, Nigeria Demographic and Health Survey (pooled dataset of the three most recent surveys, NDHS, 2008, 2013 and 2018). The sample size was a weighted sample of 94,062 women aged 15-49 years with 172, 252 live births for the ten years period. Descriptive statistics and cox-proportional hazard model were performed using Stata 14.1 software. Results: Nearly two thirds (64.0%) of births were high risk. The practice of breastfeeding among the women was quite poor, just (39.5%) initiated breastfeeding within one hour of childbirth, though (74.0%) reported breastfeeding their child for a minimum of 12 months. The independent effect of risky fertility behavior (RFB) was associated with elevated hazards of neonatal mortality, with the highest risk observed among births belonging to the multiple high-risk group (HR=2.1, p<0.01). Adjusting for breastfeeding practices, maternal/child characteristics and maternal health seeking behavior was associated with elevated hazard of neonatal mortality with the highest hazard observed among births belonging to the multiple high-risk group (HR=1.76, p<0.05). Other factors associated with elevated hazard for neonatal mortality are sex of the child, maternal level of education and breastfeeding duration. Conclusion: RFB was associated with elevated hazard for neonatal mortality, even after adjusting for breastfeeding practices, maternal and child characteristics and maternal health-seeking behavior thereby lending credence to Mosley and Chen theory.

scholarly journals Statistical Design of Phase II/III Clinical Trials for Testing Therapeutic Interventions in COVID-19 Patients

2020 ◽  
Author(s):  
Shesh Rai ◽  
Chen Qian ◽  
Jianmin Pan ◽  
Anand Seth ◽  
Deo Kumar Srivast ◽  
...  
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Sample Size ◽  
Risk Group ◽  
Primary Response ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Group Sequential Design ◽  
Interim Analyses ◽  
Toxicity Monitoring

Abstract Background Due to unknown features of the COVID-19 disease and complexity of the patient population, traditional clinical trial designs on treatments may not be optimal in such patients. We propose two independent clinical trials designs based on careful grouping of patient and outcome measures.Methods Using the World Health Organization ordinal scale on patient status, we classify treatable patients (Stages 3-7) into two risk groups. Patients in Stages 3, 4 and 5 are categorized as the intermediate-risk group while patients in Stages 6 and 7 are categorized as the high-risk group. To ensure that an intervention, if deemed efficacious, is promptly made available to vulnerable patients, we propose a group sequential design incorporating four factors stratification, two interim analyses, and a toxicity monitoring rule for the intermediate-risk group. The primary response variable (binary variable) is based on the proportion of patients discharged from hospital by the 15th day. The goal is to detect a meaningful improvement in this response rate. For the high-risk group, we propose a group sequential design incorporating three factors stratification, two interim analyses, and without toxicity monitoring. The primary response variable for this design is the 30 days mortality, and the goal is to detect a meaning reduction in mortality rate.Results Required sample size and toxicity boundaries are calculated for each scenario. Sample size requirements for the designs with interim analyses are marginally greater than the ones without. In addition, for both the intermediate-risk group and the high-risk group, conducting two interim analyses have almost identical required sample size compared with just one interim analysis. Conclusions We recommend using composite endpoints, with binary outcome for those in Stages 3, 4 and 5 with a power of 90% to detect an improvement of 20% in response rate, and 30 days mortality rate outcome for those in Stages 6 and 7 with a power of 90% to detect 15% (effect size) reduced mortality rate, in the trial design. For the intermediate-risk group, two interim analyses for efficacy evaluation along with toxicity monitoring are encouraged. For the high-risk group, two interim analyses without toxicity monitoring is advised.

scholarly journals Perioperative outcomes of segmentectomies versus lobectomies in high-risk patients: an ESTS database analysis

2020 ◽  
Author(s):  
Alessandro Brunelli ◽  
Herbert Decaluwe ◽  
Dominique Gossot ◽  
Francesco Guerrera ◽  
Zalan Szanto ◽  
...  
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Risk Group ◽  
Mortality Rates ◽  
High Risk Group ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
Database Analysis ◽  
Risk Of Mortality ◽  
Risk Patients

Abstract OBJECTIVES We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk. METHODS A total of 61 492 patients registered in the ESTS database (2007–2018) and submitted to lobectomy (55 353) or segmentectomy (6139) were divided into high risk or low risk according to a Eurolung-predicted mortality cut-off of 2.5% (corresponding in our population to the upper interquartile). Predicted versus observed mortalities were compared within each type of operation by using binomial test of proportion. Observed morbidity and mortality rates were compared between the 2 procedures using the χ2 test. RESULTS A total of 14 007 lobectomies and 1251 segmentectomies were classified as high risk. In the high-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 12% vs 17%, P &lt; 0.0001; mortality: 2.4% vs 3.7%, P = 0.018). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (2.4% vs 3.8%, P = 0.009), while in the lobectomy patients, there was no difference between observed and predicted mortality (3.7% vs 3.8%, P = 0.9). In the low-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 4.5% vs 7.8%, P &lt; 0.0001; mortality: 0.6% vs 1.0%, P = 0.01). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (0.6% vs 1.0%, P = 0.0003), while in the lobectomy patients, there was no difference between observed and predicted mortality (1.0% vs 1.1%, P = 0.06). CONCLUSIONS Segmentectomy was found associated with a 0.65 relative risk of mortality rate compared to lobectomy in patients deemed at higher surgical risk.

scholarly journals Statistical Design of Phase II/III Clinical Trials for Testing Therapeutic Interventions in COVID-19 Patients

2020 ◽  
Author(s):  
Shesh Rai ◽  
Chen Qian ◽  
Jianmin Pan ◽  
Anand Seth ◽  
Deo K Srivast ◽  
...  
Keyword(s):  
High Risk ◽  
Mortality Rate ◽  
Sample Size ◽  
Risk Group ◽  
Primary Response ◽  
High Risk Group ◽  
Intermediate Risk ◽  
Group Sequential Design ◽  
Interim Analyses ◽  
Toxicity Monitoring

Abstract Background Due to unknown features of the COVID-19 disease and complexity of the patient population, standard clinical trial designs on treatments may not be optimal in such patients. We propose two independent clinical trials designs based on careful grouping of patient and outcome measures.Methods Using the World Health Organization ordinal scale on patient status, we classify treatable patients (Stages 3-7) into two risk groups. Patients in Stages 3, 4 and 5 are categorized as the intermediate-risk group while patients in Stages 6 and 7 are categorized as the high-risk group. To ensure that an intervention, if deemed efficacious, is promptly made available to vulnerable patients, we propose a group sequential design incorporating four factors stratification, two interim analyses, and a toxicity monitoring rule for the intermediate-risk group. The primary response variable (binary variable) is based on the proportion of patients discharged from hospital by the 15th day. The goal is to detect a meaningful improvement in this response rate. For the high-risk group, we propose a group sequential design incorporating three factors stratification, two interim analyses, and without toxicity monitoring. The primary response variable for this design is the 30 days mortality, and the goal is to detect a meaning reduction in mortality rate.Results Required sample size and toxicity boundaries are calculated for each scenario. Sample size requirements for the designs with interim analyses are marginally greater than the ones without. In addition, for both the intermediate-risk group and the high-risk group, conducting two interim analyses have almost identical required sample size compared with just one interim analysis. Conclusions We recommend using binary outcome with composite endpoints for those in Stages 3, 4 and 5 with a power of 90% to detect an improvement of 20% in response rate, and 30 days mortality rate outcome for those in Stages 6 and 7 with a power of 90% to detect 15% (effect size) reduced mortality rate, in the trial design. For the intermediate-risk group, two interim analyses for efficacy evaluation along with toxicity monitoring are encouraged. For the high-risk group, two interim analyses without toxicity monitoring is advised.

scholarly journals TINGKAT KECEMASAN IBU HAMIL TRIMESTER III BERDASARKAN KELOMPOK FAKTOR RESIKO KEHAMILAN

2020 ◽  
Vol 2 (1) ◽  
pp. 16
Author(s):  
Ika Septiana Saputri ◽  
Ika Yudianti
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
P Value ◽  
Pregnancy Risk ◽  
Cross Sectional ◽  
Work Area ◽  
Anxiety Levels

Kecemasan pada ibu bahkan yang mempunyai resiko kehamilan yang tinggi dapat memicu terjadinya rangsangan kontraksi rahim sehingga mampu mengakibatkan preeklampsi dan keguguran, kelahiran Bayi Berat Lahir Rendah dan bayi prematur. Perlunya melakukan pengkajian tingkat kecemasan sehingga tidak mengakibatkan komplikasi dalam kehamilan. Tujuan dari penelitian ini yaitu untuk mengetahui perbedaan tingkat kecemasan ibu hamil trimester III berdasarkan kelompok faktor resiko kehamilan Desain penelitian menggunakan analitik komparasi dengan pendekatan cross-sectional. Penelitian ini menggunakan teknik Purposive sampling. Sampel berjumlah 51 orang yang memenuhi kriteria inklusi yaitu tercatat didalam kohort dengan usia kehamilan 28-37 minggu di Wilayah Kerja Puskesmas Gribig, mengetahui faktor resiko kehamilannya, dapat membaca dan menulis, serta bersedia menjadi responden. Analisis data menggunakan uji Kruskall Wallis. Pengumpulan data menggunakan kuesioner ZSAS yang telah dimodifikasi. Hasil uji statistik p value (0,000) < α = (0,05) maka Ho ditolak yang berarti terdapat perbedaan antara Tingkat Kecemasan Ibu Hamil Trimester III berdasarkan Kelompok Faktor Resiko Kehamilan di Wilayah Kerja Puskesmas Gribig Kecamatan Kedungkandang Kota Malang. Mayoritas responden yang termasuk kelompok resiko rendah (88,9%) mengalami tingkat kecemasan ringan, kelompok resiko tinggi (86,7%) mengalami tingkat kecemasan sedang, dan kelompok resiko sangat tinggi (66,7%) mengalami tingkat kecemasan berat. Dari hasil penelitian tersebut, menunjukkan bahwa semakin tinggi faktor resiko yang dialami akan semakin tinggi pula tingkat kecemasan. Sehingga diharapkan bidan dapat memberikan KIE tentang hasil skrinning kelompok faktor resiko kehamilan, serta meningkatkan perhatian dan empati pada ibu hamil yang sangat membutuhkan infomasi lebih mengenai kehamilan guna dapat mengatasi kecemasan yang terjadi. Anxiety in mothers even who have a high risk of pregnancy can trigger stimulation of uterine contractions so that it can lead to preeclampsia and miscarriage, low birth weight birth (LBW) and premature babies. The need to assess anxiety levels so that they do not cause complications in pregnancy. The purpose of this study is to determine differences in anxiety levels of third trimester pregnant women based on pregnancy risk factor groups. The study design uses comparative analytics with cross-sectional approaches. This research uses purposive sampling technique. A sample of 51 people who met the inclusion criteria was recorded in a cohort with 28-37 weeks' gestation in the Gribig Community Health Center Work Area, knew the risk factors for pregnancy, could read and write, and was willing to be respondents. Data analysis using the Kruskall Wallis test. Data collection uses a modified ZSAS questionnaire. Statistical test results p value (0,000) <α = (0.05) then Ho is rejected, which means there is a difference between the Anxiety Levels of Trimester III Pregnancy based on Pregnancy Risk Factors in Gribig Puskesmas Work Area in Kedungkandang District, Malang. The majority of respondents who belong to the low risk group (88.9%) experienced mild anxiety levels, the high risk group (86.7%) experienced moderate anxiety levels, and the very high risk group (66.7%) experienced severe anxiety levels. From the results of the study, showed that the higher the risk factors experienced the higher the level of anxiety. It is hoped that midwives can provide IEC about the screening results of pregnancy risk factor groups, and increase the attention and empathy of pregnant women who really need more information about pregnancy in order to overcome the anxiety that occurs.

scholarly journals The COVID-19 lab score: an accurate dynamic tool to predict in-hospital outcomes in COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pablo Jose Antunez Muiños ◽  
Diego López Otero ◽  
Ignacio J. Amat-Santos ◽  
Javier López País ◽  
Alvaro Aparisi ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Multivariate Logistic Regression Model ◽  
P Value ◽  
Clinical Model ◽  
High Risk Patients ◽  
Mechanical Ventilation Support ◽  
Risk Patients ◽  
Laboratory Biomarkers

AbstractDeterioration is sometimes unexpected in SARS-CoV2 infection. The aim of our study is to establish laboratory predictors of mortality in COVID-19 disease which can help to identify high risk patients. All patients admitted to hospital due to Covid-19 disease were included. Laboratory biomarkers that contributed with significant predictive value for predicting mortality to the clinical model were included. Cut-off points were established, and finally a risk score was built. 893 patients were included. Median age was 68.2 ± 15.2 years. 87(9.7%) were admitted to Intensive Care Unit (ICU) and 72(8.1%) needed mechanical ventilation support. 171(19.1%) patients died. A Covid-19 Lab score ranging from 0 to 30 points was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included haemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, creatinine, C-reactive protein, interleukin-6, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. Three groups were established. Low mortality risk group under 12 points, 12 to 18 were included as moderate risk, and high risk group were those with 19 or more points. Low risk group as reference, moderate and high patients showed mortality OR 4.75(CI95% 2.60–8.68) and 23.86(CI 95% 13.61–41.84), respectively. C-statistic was 0–85(0.82–0.88) and Hosmer–Lemeshow p-value 0.63. Covid-19 Lab score can very easily predict mortality in patients at any moment during admission secondary to SARS-CoV2 infection. It is a simple and dynamic score, and it can be very easily replicated. It could help physicians to identify high risk patients to foresee clinical deterioration.

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