scholarly journals Implications of Laboratory Tests in Disease Grading and Death Risk Stratification of COVID-19: A Retrospective Study in Wuhan, China

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Bai ◽  
Enxin Wang ◽  
Shoujie Zhao ◽  
Jing Li ◽  
Yejing Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Stratification ◽  
Laboratory Tests ◽  
Cox Regression ◽  
Laboratory Data ◽  
Clinical Severity ◽  
Prognostic Models ◽  
Time Activity ◽  
Death Risk ◽  
Severe Group

Background: Although laboratory tests have become an indispensable part in clinical practice, its application in severity classification and death risk stratification of COVID-19 remains unvalidated. This study aims to explore the significance of laboratory tests in the management of COVID-19.Methods: In 3,342 hospitalized patients with COVID-19, those of mild or moderate subtype were categorized into the non-severe group, while those of severe or critical subtype were categorized into the severe group. Initial laboratory data were analyzed and compared according to disease severity and outcome. Diagnostic models for the severe group were generated on risk factors identified by logistic regression and receiver operating characteristic (ROC) analyses. Cox regression and ROC analyses on risk factors were utilized to construct prognostic models.Results: In identification of patients in the severe group, while age, neutrophil-to-lymphocyte ratio, and α-hydroxybutyrate dehydrogenase were identified as independent predictors, the value of combination of them appears modest [area under the curve (AUC) = 0.694]. Further ROC analyses indicated that among patients in the severe group, laboratory indices had a favorable value in identifying patients of critical subtype rather than severe subtype. For death outcome, IL-6, co-existing cerebrovascular disease, prothrombin time activity, and urea nitrogen were independent risk factors. An IL-6 single-parameter model was finalized for distinguishing between fatal and recovered individuals (AUC = 0.953). Finally, a modified death risk stratification strategy based on clinical severity and IL-6 levels enables more identification of non-survivors in patients with non-critical disease.Conclusions: Laboratory screening provides a useful tool for COVID-19 management in identifying patients with critical condition and stratifying risk levels of death.

Genomic classifier to augment the role of pathological features in identifying optimal candidates for adjuvant radiation therapy in patients with prostate cancer: Development and internal validation of a multivariable prognostic model.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 142-142
Author(s):  
Firas Abdollah ◽  
Deepansh Dalela ◽  
Maria Santiago-Jimenez ◽  
Kasra Yousefi ◽  
Jeffrey Karnes ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Risk Stratification ◽  
Cox Regression ◽  
Adjuvant Radiation ◽  
Cumulative Number ◽  
Clinical Recurrence ◽  
Cox Regression Analysis ◽  
Initial Observation ◽  
Risk Stratification Tool

142 Background: Despite documented oncological benefit, postoperative adjuvant radiotherapy (aRT) utilization in prostate cancer (PCa) patients is still limited in the US. We aimed to develop and internally validate a risk stratification tool incorporating the Decipher score, along with routinely available clinicopathologic features, to identify patients who would benefit the most from aRT. Methods: Our cohort included a total of 512 PCa patients treated with RP at one of four US academic centers between 1990-2010. All patients had ≥ pT3a disease, positive margins, and/or pathologic lymph node invasion (LNI). Multivariable Cox regression analysis (MVA) tested the relationship between available predictors (including Decipher score) and clinical recurrence (CR), which were then used to develop a novel risk stratification tool. Our study adhered to the TRIPOD guidelines for development of prognostic models. Results: Overall, 21.9% patients received aRT. Median follow-up in censored patients was 8.3 years. The 10-year CR rate was 4.9% vs. 17.4% in patients treated with aRT vs. initial observation (p < 0.001). Pathological T3b/T4 stage, Gleason score 8-10, LNI and Decipher score > 0.6 were independent predictors of CR (all p < 0.01) Cumulative number of risk factors was 0, 1, 2, and 3-4 in respectively 46.5, 28.9, 17.2, and 7.4% of patients. Adjuvant RT was associated with decreased CR rate in patients with ≥ 2 risk factors (10-year CR rate 10.1% in aRT vs. 42.1% in initial observation, p = 0.008), but not in those with < 2 risk factors (p = 0.23). Conclusions: Utilizing the novel model to indicate aRT might reduce overtreatment, decrease unnecessary side effects, and reduce risk of CR in the subset of patients (~25% of all patients with aggressive pathological disease) who really benefit from this therapy.

scholarly journals Renal dysfunction in patients with pulmonary embolism: data from the SIRENA register

2021 ◽  
Vol 26 (2S) ◽  
pp. 4422
Author(s):  
M. V. Menzorov ◽  
V. V. Filimonova ◽  
A. D. Erlikh ◽  
O. L. Barbarash ◽  
S. A. Berns ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Renal Dysfunction ◽  
Cox Regression ◽  
Russian Population ◽  
Hospital Death ◽  
Death Risk ◽  
Risk Of Death

Aim. To assess the prevalence, severity and prognostic value of renal dysfunction (RD) in patients with pulmonary embolism (PE) of the Russian population, as well as to determine the RD significance as a marker that improves the predictive ability of current risk stratification systems.Material and methods. From April 2018 to April 2019, patients hospitalized due to PE were sequentially included in the Russian multicenter observational prospective registry SIRENA. RD was diagnosed at a glomerular filtration rate (GFR) <60 ml/ min/1,73 m2. Risk of early (hospital or 30-day) death was stratified in accordance with the current 2019 ESC Clinical Guidelines. During the study, we analyzed inpatient mortality and complication rate.Results. A total of 604 patients (men, 293 (49%); women, 311 (51%)) were in the study. RD was detected in 320 (53%) patients, while severe dysfunction — in 63 (10%) ones. In addition, 71 (12%) patients had high death risk, 364 (61%) — intermediate, 164 (27%) — low. During hospitalization, 107 (18%) patients died, including 32% from the high-risk group, 20% — moderate, and 7% — low. RD in the deceased patients was diagnosed more often, while GFR <50 ml/min/1,73 m2 reliably predicted hospital mortality (sensitivity, 67%; specificity, 72%; AUC=0,72; p<0,001). In patients with simplified Pulmonary Embolism Severity Index (sPESI) of 0 and ≥ 1, the presence of RD led to at least a 2-fold increase in mortality. Multivariate Cox regression revealed that RD is a predictor of in-hospital mortality (hazard ratio (HR), 3,41; 95% confidence interval (CI): 2,15-5,41; p<0,001), regardless of the presence of death risk reclassifies, such as high troponin (HR, 1,31; 95% CI: 0,80-2,14; p=0,28) and right ventricular dysfunction (HR, 1,23; 95% CI: 0,74-2,04; p=0,42).Conclusion. In patients with PE of the Russian population, there is a high incidence of RD, which is diagnosed in every second patient and is severe in 10% of cases. The presence of RD is associated with a significant increase in in-hospital mortality, while the risk of death increases with a decrease in GFR. The addition of RD, considered as a decrease in the estimated GFR <60 ml/min/1,73 m2, to the sPESI improves risk stratification and allows identification of patients at high risk of in-hospital death.

scholarly journals Electrocardiographic Risk Stratification in COVID-19 Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Ehud Chorin ◽  
Matthew Dai ◽  
Edward Kogan ◽  
Lalit Wadhwani ◽  
Eric Shulman ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Laboratory Finding ◽  
Laboratory Data ◽  
Clinical Severity ◽  
Troponin Elevation ◽  
T Wave ◽  
St Depression ◽  
Wave Inversion ◽  
St Elevation ◽  
Ecg Abnormalities

Background: The COVID-19 pandemic has resulted in worldwide morbidity at unprecedented scale. Troponin elevation is a frequent laboratory finding in hospitalized patients with the disease, and may reflect direct vascular injury or non-specific supply-demand imbalance. In this work, we assessed the correlation between different ranges of Troponin elevation, Electrocardiographic (ECG) abnormalities, and mortality.Methods: We retrospectively studied 204 consecutive patients hospitalized at NYU Langone Health with COVID-19. Serial ECG tracings were evaluated in conjunction with laboratory data including Troponin. Mortality was analyzed in respect to the degree of Troponin elevation and the presence of ECG changes including ST elevation, ST depression or T wave inversion.Results: Mortality increased in parallel with increase in Troponin elevation groups and reached 60% when Troponin was &gt;1 ng/ml. In patients with mild Troponin rise (0.05–1.00 ng/ml) the presence of ECG abnormality and particularly T wave inversions resulted in significantly greater mortality.Conclusion: ECG repolarization abnormalities may represent a marker of clinical severity in patients with mild elevation in Troponin values. This finding can be used to enhance risk stratification in patients hospitalized with COVID-19.

scholarly journals Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study

2020 ◽  
Author(s):  
Qiao Shi ◽  
Xiaoyi Zhang ◽  
Fang Jiang ◽  
Xuanzhe Zhang ◽  
Chibu Bimu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Retrospective Study ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Laboratory Data ◽  
Cox Proportional Hazards ◽  
Hospital Death ◽  
Regression Analyses ◽  
Patients With Diabetes

<div><b>OBJECTIVE: </b>Diabetes is common in COVID-19 patients and associated with unfavorable outcomes. We aimed to describe the characteristics, outcomes and analyze the risk factors for in-hospital mortality of COVID-19 patients with diabetes.</div><div><b><br></b></div><div><b>RESEARCH DESIGN AND METHODS: </b>This two-center, retrospective study was performed at two tertiary hospitals in Wuhan, China. Confirmed COVID-19 patients with diabetes (N=153) who were discharged or died from January 1, 2020, to March 8, 2020, were identified. One sex- and age-matched COVID-19 patient without diabetes was randomly selected for each patient with diabetes. Demographic, clinical, and laboratory data were abstracted. Cox proportional hazards regression analyses were performed to identify the risk factors associated with the mortality in these patients.</div><div><br></div><div><b>RESULTS:</b> Of 1561 COVID-19 patients, 153 (9.8%) had diabetes, with a median age of 64.0 (IQR, 56.0-72.0) years. A higher proportion of ICU admission (17.6% vs 7.8%, P=0.01) and more fatal cases (20.3% vs 10.5%, P=0.017) were identified in COVID-19 patients with diabetes than in the matched patients. Multivariable Cox regression analyses of these 306 patients showed that hypertension (hazards ratio [HR] 2.50, 95% CI 1.30-4.78), cardiovascular disease (HR 2.24, 95% CI 1.19-4.23) and chronic pulmonary disease (HR 2.51, 95% CI 1.07-5.90) were independently associated with in-hospital death. Diabetes (HR 1.58, 95% CI 0.84-2.99) was not statistically significantly associated with in-hospital death after adjustment. Among patients with diabetes, nonsurvivors were older (76.0 vs 63.0 years), most were male (71.0% vs 29.0%), and were more likely to have underlying hypertension (83.9% vs 50.0%) and cardiovascular disease (45.2% vs 14.8%) (all P-values<0.05). Age ≥70 years (HR 2.39, 95% CI 1.03-5.56) and hypertension (HR 3.10, 95% CI 1.14-8.44) were independent risk factors for in-hospital death of patients with diabetes.</div><div><br></div><div><b>CONCLUSIONS: </b>COVID-19 patients with diabetes had worse outcomes compared with the sex- and age-matched patients without diabetes. Older age and comorbid hypertension independently contributed to in-hospital death of patients with diabetes.</div>

LABORATORY TESTS OF THYROID FUNCTION IN HYPERTHYROIDISM I.

1969 ◽  
Vol 62 (4_Suppla) ◽  
pp. S7-S21
Author(s):  
B.-A. Lamberg ◽  
O. P. Heinonen ◽  
M. Viherkoski ◽  
A. Aro ◽  
K. Liewendahl ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Laboratory Tests ◽  
Laboratory Data ◽  
Free Thyroxine ◽  
Clinical Severity ◽  
Hormone Concentration ◽  
Mean Values ◽  
Significant Difference ◽  
Thyroid Uptake ◽  
The Mean

ABSTRACT For the elaboration of a computer programme for the diagnosis of thyroid diseases the pattern of the results of laboratory tests was studied after dividing 125 hyperthyroid patients into different clinical entities and further also according to the severity of the hyperfunction of the thyroid gland. Comparison of variables was made between different clinical entities and, within these, between different grades of severity. All these groups were compared with the controls. Furthermore, the correlation between the results of laboratory tests was studied. The patients were divided into the following groups: toxic diffuse goitre (TDG; 50 cases), toxic multinodular goitre (TNG; 52 cases) and toxic adenoma (TA; 23 cases), and according to clinical severity of hyperfunction of the thyroid gland, into the following grades: »borderline» (I; 16 cases), mild (II; 35 cases) and moderate to severe (III; 74 cases). The laboratory tests studied were: protein-bound iodine in the serum (PBI), uptake of triiodothyronine by Sephadex (T3U), »free thyroxine index» (T3I), free proportionate and absolute thyroxine (PFT4, AFT4), serum cholesterol, serum and urinary hydroxyproline (HOP), glucose-6-phosphate dehydrogenase activity in red blood cells (G-6-PD), 2.5 h and 24 h thyroid uptake of radioiodine, 24 and 48 h urinary excretion, protein-bound radioactive iodine in the blood (PBRI) and the 24 h conversion ratio (CR). There was a statistically significant difference between TDG and TNG with regard to the thyroid uptake of radioiodine and the free thyroxine, the mean values being lower in the latter group of patients. The TA group differed significantly from the combined TDG-TNG group, the mean values deviating towards the normal range. The TA group did not differ from the controls with regard to PFT4, cholesterol and E0–24. This group evidently represented a separate population. In the TDG and TNG groups the laboratory data correlated well with the clinical assessment of severity. In most cases the differences were statistically significant. Grade I, however, differed from the controls only with respect to the variables of the hormone concentration in the blood. The variables of the measurement of hormone concentration in the blood had a strong linear correlation (r = 0.6—0.9) to each other and to the 2.5 h uptake. A significant correlation (r = 0.5—0.6) was also found between the variables mentioned and the urinary HOP and G-6-PD. The correlation between HOP and G-6-PD was of the same order. The fact that the pattern of PFT4—AFT4 and T3U—T3I differed may indicate variations in the ratios between triiodothyronine and thyroxine in different clinical entities of hyperthyroidism.

A new predictive indicator for development of pressure ulcers in bedridden patients based on common laboratory tests results

2008 ◽  
Vol 61 (4) ◽  
pp. 514-518 ◽  
Author(s):  
N Hatanaka ◽  
Y Yamamoto ◽  
K Ichihara ◽  
S Mastuo ◽  
Y Nakamura ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Pressure Ulcers ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Clinical Implementation ◽  
Clinical Tool ◽  
Braden Scale ◽  
Hospitalised Patients

Background:Various scales have been devised to predict development of pressure ulcers on the basis of clinical and laboratory data, such as the Braden Scale (Braden score), which is used to monitor activity and skin conditions of bedridden patients. However, none of these scales facilitates clinically reliable prediction.Aims:To develop a clinical laboratory data-based predictive equation for the development of pressure ulcers.Methods:Subjects were 149 hospitalised patients with respiratory disorders who were monitored for the development of pressure ulcers over a 3-month period. The proportional hazards model (Cox regression) was used to analyse the results of 12 basic laboratory tests on the day of hospitalisation in comparison with Braden score.Results:Pressure ulcers developed in 38 patients within the study period. A Cox regression model consisting solely of Braden scale items showed that none of these items contributed to significantly predicting pressure ulcers. Rather, a combination of haemoglobin (Hb), C-reactive protein (CRP), albumin (Alb), age, and gender produced the best model for prediction. Using the set of explanatory variables, we created a new indicator based on a multiple logistic regression equation. The new indicator showed high sensitivity (0.73) and specificity (0.70), and its diagnostic power was higher than that of Alb, Hb, CRP, or the Braden score alone.Conclusions:The new indicator may become a more useful clinical tool for predicting presser ulcers than Braden score. The new indicator warrants verification studies to facilitate its clinical implementation in the future.

scholarly journals Neutrophil Percentage and Neutrophil-to-Monocyte Ratio as Independent Risk Factors in the Severity of COVID-19

2020 ◽  
Author(s):  
Fei Peng ◽  
Si Lei ◽  
Chenfang Wu ◽  
Bo Yu ◽  
Yanjun Zhong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Roc Curve ◽  
Inflammatory Responses ◽  
Laboratory Data ◽  
Clinical Severity ◽  
White Blood Count ◽  
Neutrophil Percentage ◽  
Related Risk ◽  
Potential Risk Factors ◽  
Independent Risk Factors

Abstract BackgroundInflammation plays an important role in progression of the various viral pneumonia containing COVID-19, severe inflammatory responses could lead to an imbalance of immune response. The purpose of this study was to explore the possibility of the white blood count, neutrophil percentage, neutrophil-to-monocyte ratio (NMR) and neutrophil-to-lymphocyte ratio (NLR) at admission to reflect the clinical severity in patients with COVID‐19.MethodsClinical and laboratory data of adult COVID-19 patients in Changsha, China, were collected and analyzed on admission. A logistic regression model was adopted to analyze the association between the disease severity and related risk factors. The receiver operating characteristic (ROC) curve was utilized to analyze the abilities of potential risk factors in the prediction of COVID-19 severity.ResultsCompared with non-severe patients, the severe ones had significantly higher levels of neutrophil percentage (74.9% vs. 62.1%; P < 0.001), NLR (4.1 vs. 2.1; P < 0.001) and NMR (12.4 vs. 8.0; P < 0.001). A regression analysis showed that neutrophil percentage (OR,1.113; 95% CI, 1.020-1.213; P=0.016) and NMR (OR, 1.110; 95% CI, 1.002-1.230; P = 0.046) were significantly associated with severity of COVID-19 patients. ROC curve showed that the area under the curves of neutrophil percentage, NMR and the combination of them were 0.842 (95% confidence interval (CI), 0.782-0.902), 0.790 (95% CI, 0.710-0.871) and 0.851 (95% CI, 0.790-0.911), respectively.ConclusionsNeutrophil percentage and NMR may act as independent risk factors in the severity of COVID-19.

scholarly journals Preoperative prealbumin-to-fibrinogen ratio predict Survival Outcomes in hepatocellular carcinoma patients after hepatic resection

2021 ◽  
Author(s):  
Yan Haixi ◽  
Chen Shuaishuai ◽  
Yang Qiong ◽  
Cai Linling
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Cox Regression ◽  
Laboratory Data ◽  
Disease Free Survival ◽  
Factors Affecting ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Clinicopathologic Factors ◽  
Independent Risk Factors

Objective: This study aims to evaluate the clinical application of preoperative prealbumin-to-fibrinogen ratio (PFR) in the clinical diagnosis and prognostic value of hepatocellular carcinoma (HCC) patients. Methods: The clinical and laboratory data of 269 HCC patients undergoing surgical treatment from January 2012 to January 2017 in Taizhou Hospital were retrospectively analyzed. The Cox regression model was used to analyze the correlation between PFR and other clinicopathologic factors in overall survival (OS) and disease-free survival (DFS). Results: Cox regression analysis showed that PFR (hazard ratios [HR] = 2.123; 95% confidence interval [95% CI], 1.271–3.547; P = 0.004)was independent risk factors affecting the OS of HCC patients. Furthermore, a nomogram was built based on these risk factors. The C indices statistics for the OS nomogram was 0.715. Conclusion: Nomograms based on PFR can be recommended as the correct and actual model to evaluate prognosis for patients with HCC.

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