The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study

Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care.Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality.Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%.Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality.

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Predictive Value of CRIB (Clinical Risk Index for Babies) for the Mortality Risk of Very Low Birth Weight Newborns (VLBW) in a Neonatal Intensive Care Unit. 964

Pediatric Research ◽

10.1203/00006450-199704001-00983 ◽

1997 ◽

Vol 41 ◽

pp. 163-163

Author(s):

Oscar T. Matsuoka ◽

Jesselina F. Santos ◽

Renata M. Proenca ◽

Elizete A. P. Prescinotti ◽

Martha M.G.B. Matoloun ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care Unit ◽

Mortality Risk ◽

Predictive Value ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Risk Index

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Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department

Revista Española de Quimioterapia ◽

10.37201/req/060.2020 ◽

2020 ◽

Vol 33 (4) ◽

pp. 267-273

Author(s):

Natalia F. Pascual Gómez ◽

Iván Monge Lobo ◽

Inmaculada Granero Cremades ◽

Angels Figuerola Tejerina ◽

Fernando Ramasco Rueda ◽

...

Keyword(s):

Emergency Department ◽

Mortality Risk ◽

Predictive Value ◽

Cross Sectional Study ◽

Clinical Severity ◽

Sectional Study ◽

Blood Cell Count ◽

Cross Sectional ◽

Predictors Of Mortality ◽

Multivariate Study

Objective. Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. Method. Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. Results. A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). Conclusions. Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

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Validation of an Automated Mortality Index using the Electronic Medical Record System in a Network of Acute Care Hospitals

Journal of Hospital Administration ◽

10.5430/jha.v8n3p8 ◽

2019 ◽

Vol 8 (3) ◽

pp. 8

Author(s):

Deborah Morris ◽

Brynn Sheehan ◽

Rajan Lamichahane ◽

Kathie Zimbro ◽

Merri K Morgan ◽

...

Keyword(s):

Hospital Admission ◽

Medical Record ◽

Electronic Medical Record ◽

Acute Care ◽

Mortality Risk ◽

Characteristic Curve ◽

Risk Index ◽

Acute Care Hospitals ◽

Risk Of Death ◽

Risk Of Mortality

Objective: Physicians struggle with prognostication for patients facing the final year of life. Practical tools which identify patients at the time of hospital admission who are at high risk of mortality would be helpful to provide timely access to supportive services, including palliative care and hospice. The PREDICT is a validated tool that predicts mortality risk but has not been implemented into electronic medical record (EMR) systems. The current study evaluated the validity of PREDICT within an EMR system and tracked patient mortality over 12 months.Methods: The study sample consisted of 3,488 adult patients admitted to a network of acute care hospitals. The PREDICT tool was evaluated for its ability to predict mortality within 6 and 12 months of hospitalization and was compared to the APR-DRG Mortality Risk Index (MRI).Results: A total of 299 patients (9%) were deceased within 12 months of hospital admission. Logistic regressions revealed that higher PREDICT scores were associated with greater risk of mortality within 6 and 12 months post-discharge. Receiver Operating Characteristic curve (ROC) analysis revealed that the overall PREDICT score significantly predicted mortality at 12 months (ROC = .767) and was a better predictor than the MRI.Conclusions: The PREDICT tool is a valid assessment of mortality risk and unlike the MRI, it can be readily automated in the EMR to help identify patients at greater risk of death. More research is needed to apply this tool in clinical practice and calibrate its performance across clinical settings.

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416 - Risk of Mortality Associated with Antipsychotics in Alzheimer's Disease

International Psychogeriatrics ◽

10.1017/s1041610220002690 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 132-132

Author(s):

Liliana P. Ferreira ◽

Núria Santos ◽

Nuno Fernandes ◽

Carla Ferreira

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Adverse Events ◽

Mortality Risk ◽

Antipsychotic Treatment ◽

Serious Adverse Events ◽

Risk Of Death ◽

Mesh Terms ◽

Risk Of Mortality ◽

Increased Risk

Objectives: Alzheimer's disease (AD) is the most common cause of dementia and it is associated with increased mortality. The use of antipsychotics is common among the elderly, especially in those with dementia. Evidence suggests an increased risk of mortality associated with antipsychotic use. Despite the short-term benefit of antipsychotic treatment to reduce the behavioral and psychological symptoms of dementia, it increases the risk of mortality in patients with AD. Our aim is to discuss the findings from the literature about risk of mortality associated with the use of antipsychotics in AD.Methods: We searched Internet databases indexed at MEDLINE using following MeSH terms: "Antipsychotic Agents" AND "Alzheimer Disease" OR "Dementia" AND "Mortality" and selected articles published in the last 5 years.Results: Antipsychotics are widely used in the pharmacological treatment of agitation and aggression in elderly patients with AD, but their benefit is limited. Serious adverse events associated with antipsychotics include increased risk of death. The risk of mortality is associated with both typical and atypical antipsychotics. Antipsychotic polypharmacy is associated with a higher mortality risk than monotherapy and should be avoided. The mortality risk increases after the first few days of treatment, gradually reducing but continues to increase after two years of treatment. Haloperidol is associated with a higher mortality risk and quetiapine with a lower risk than risperidone.Conclusions: If the use of antipsychotics is considered necessary, the lowest effective dose should be chosen and the duration should be limited because the mortality risk remains high with long-term use. The risk / benefit should be considered when choosing the antipsychotic. Further studies on the efficacy and risk of adverse events with antipsychotics are needed for a better choice of treatment and adequate monitoring with risk reduction.

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Diagnostic value of post-operative platelet-to-white blood cell ratio after splenectomy in patients with advanced ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000712 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1292-1297 ◽

Cited By ~ 4

Author(s):

Konstantinos Lathouras ◽

Georgios Panagakis ◽

Sarah Joanne Bowden ◽

Konstantinos Saliaris ◽

Srdjan Saso ◽

...

Keyword(s):

Ovarian Cancer ◽

Platelet Count ◽

Blood Cell ◽

Cell Count ◽

White Blood Cell Count ◽

White Blood Cell ◽

Predictive Value ◽

Blood Cell Count ◽

Cell Ratio ◽

Grade Iii

IntroductionSplenectomy-induced thrombocytosis and leukocytosis may obscure the early diagnosis of post-operative infection or sepsis. In trauma patients after splenectomy, a platelet-to-white blood cell ratio of <20 has been shown to reliably differentiate post-operative sepsis from transient physiological responses.ObjectiveTo determine whether the platelet-to-white blood cell ratio can be applied to differentiate between reactive post-operative changes and latent infection.MethodsAll consecutive patients with ovarian cancer who underwent splenectomy between January 2013 and October 2018 in two large European gynecological cancer centers were retrospectively evaluated. Main outcome measures were white blood cell count, platelet count, and platelet-to-white blood cell ratio on post-operative days 1, 5, and 7. These were correlated with surgical outcome and morbidity according to the Clavien-Dindo classification. A binomial logistic regression was applied to assess the predictive value of day 5 platelet-to-white blood cell ratio, white blood cell count, and platelet count for predicting grade III post-operative sepsis.ResultsNinety-five patients with ovarian cancer (mean age 54 years, range 18–75) were identified. Seventeen patients (17.9%) developed a grade III post-operative sepsis. In all post-operative patients, mean white blood cell count on day 5 decreased (from 15.4×103/μL to 11.4×103/μL), while the mean platelet count rose (from 260.7×103/μL to 385.3×103/μL). A high platelet count (>313×103/μL) failed to show any predictive value (OR=0.94; 95% CI 0.30 to 3.0; p=0.921). A low platelet-to-white blood cell ratio (<26) (OR=3.49; 95% CI 1.18 to 10.32; p=0.0241) and high white blood cell count (>14.5×103/μL) on day 5 (OR=11.0; 95% CI 3.3 to 36.2; p<0.001) were significant for predicting sepsis. Despite a significant OR, the sensitivity and specificity were low; day 5 platelet-to-white blood cell ratio at a cut-off point of 26 achieved a sensitivity of 72% and specificity of 53% (area under the curve 0.637, 95% CI 0.480 to 0.796) in predicting grade III post-operative sepsis.ConclusionsPlatelet-to-white blood cell ratio after cytoreductive surgery for ovarian cancer with splenectomy does not appear to have a strong predictive value in differentiating between sepsis and reactive splenectomy-induced changes. Leukocytosis, in combination with clinical assessment, may remain the most useful tool for prediction of sepsis after cytoreductive surgery with splenectomy.

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Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials?

Osteoporosis International ◽

10.1007/s00198-017-4281-z ◽

2017 ◽

Vol 29 (2) ◽

pp. 375-383 ◽

Cited By ~ 25

Author(s):

K. L. Ong ◽

D. P. Beall ◽

M. Frohbergh ◽

E. Lau ◽

J. A. Hirsch

Keyword(s):

Mortality Risk ◽

Cox Regression ◽

Compression Fracture ◽

Balloon Kyphoplasty ◽

Data Set ◽

Mortality Risks ◽

Medicare Data ◽

Kaplan Meier ◽

Risk Of Mortality ◽

Insight Into

Abstract Summary The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients. Introduction BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients. Methods BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005–2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors. Results The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007–2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3–4%; p < 0.001) greater in 2010–2014 versus 2005–2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19–19%; p < 0.001) and 7% (95% CI, 7–8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12–13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort. Conclusions Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.

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Bleeding after surgery and application bleeding assessment tool to surgical patients in Hanoi Medicine University Hospital

Tạp chí Sinh lý học Việt Nam ◽

10.54928/vjp.v25i2.17 ◽

2021 ◽

Vol 25 (2) ◽

pp. 94-101

Author(s):

Thi Minh Khue Nguyen ◽

Quang Tung Nguyen

Keyword(s):

Predictive Value ◽

Assessment Tool ◽

Bleeding Risk ◽

University Hospital ◽

Surgical Patients ◽

Risk Of Bleeding ◽

Patients At Risk ◽

Abnormal Bleeding ◽

Medical University ◽

Bleeding History

Objectives: Describe bleeding characteristics and evaluate the correlation between surgical-related bleeding and bleeding risk according by ISTH – BATs. Methods: Research was conducted on 340 surgical patients at Hanoi Medical University Hospital. Results: The percentage of patients with bleeding during and after surgery is 13.5%. The proportion of patients at risk of bleeding according to BATs is 1.8%. There was a correlation between bleeding risk according to ISTH - BAT with bleeding status during and after surgery with p = 0.004. The positive predictive value of ISTH - BATs is 66.7%, negative predictive value is 87.4%, the sensitivity is 8.7%, the specificity is 99.3%. Conclusions: Surgery has a high risk of abnormal bleeding. Bleeding history has important implications in assessing bleeding risk during and after surgery. The ISTH - BATs is a bleeding history assessment tool that can be used to assess the risk of bleeding before surgery.

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238 SERUM ALBUMIN EARLY DECREASE IS AN INDEPENDENT PREDICTOR OF MAJOR COMPLICATIONS AFTER ONCOLOGICAL ESOPHAGECTOMY; RESULTS FROM A LARGE EUROPEAN SERIES

Diseases of the Esophagus ◽

10.1093/dote/doab052.238 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Ismail Labgaa ◽

Styliani Mantziari ◽

Michael Winiker-Seeberger ◽

Jerôme Pasquier ◽

Marguerite Messier ◽

...

Keyword(s):

Predictive Value ◽

Independent Predictor ◽

Multivariable Analysis ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Major Surgery ◽

Roc Curve Analysis ◽

Comprehensive Complication Index ◽

Major Complications ◽

Patients At Risk

Abstract The predictive value of postoperative albuminemia decrease (ΔAlb) has been increasingly evidenced in different types of major surgery but data on esophagectomy remain scarce. This study aimed to assess the predictive value of ΔAlb for adverse short-term outcomes after oncological esophagectomy. Methods Retrospective analysis of an international multicentric cohort of patients undergoing oncological esophagectomy between 2006–2017. Patients with missing pre- and postoperative albumin values were excluded from the analysis. Primary endpoint was postoperative morbidity according to Clavien classification. Secondary endpoints were Comprehensive Complication Index (CCI) and length of hospital stay (LoS). Results A total of 1046 patients were analyzed. Major complications were reported in 363 (34.7%) patients. Albuminemia showed a rapid postoperative decrease on postoperative day 1 (POD1) (ΔAlb POD1) with a median value of 11 g/L. ROC curve analysis determined a cut-off of 11 g/L for the prediction of overall complications. Patients with ΔAlb POD1 ≥ 11 g/L showed increased overall complications (p = 0.004), major complications (p = 0.009) and CCI (p = 0.006) while LoS was comparable (p = 0.099). On multivariable analysis, ΔAlb POD1 ≥ 11 g/L was an independent predictor of overall (OR: 1.55; 95% CI 1.09–2.21; p = 0.015) and major complications (OR: 1.43; 95% CI 1.09–1.89; p = 0.009). Conclusion Oncological esophagectomy induced a rapid decrease of albuminemia. ΔAlb POD1 ≥ 11 g/L was independently associated with the occurrence of overall and major postoperative complications. ΔAlb appears as a promising biomarker to detect patients at risk of adverse outcomes after oncological esophagectomy.

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PREOPERATIVE ASSESSMENT OF VARIABLES TO PREDICT DIFFICULT INTUBATION IN PATIENTS UNDERGOING SURGERIES UNDER GENERAL ANAESTHESIA

10.36106/4102204 ◽

2021 ◽

pp. 68-71

Author(s):

Veena Chatrath ◽

Leena Mahajan ◽

Gagandeep Kaur ◽

Ankita Taneja ◽

Ranjana Khetarpal ◽

...

Keyword(s):

General Anaesthesia ◽

Predictive Value ◽

Prospective Observational Study ◽

Risk Index ◽

Preoperative Assessment ◽

High Sensitivity ◽

Screening Tests ◽

Failed Intubation ◽

Upper Lip ◽

Number Of Patients

Background- Advance prediction of difcult airway provides us ample time for optimal preparation of equipment and participation of experienced anaesthesiologist to handle difcult airway. The present study was designed to evaluate the efcacy of Upper Lip Bite Test (ULBT), Ratio of neck circumference (NC) and thyromental distance (TMD) and Arne Risk Index in predicting difcult airway. Material and methods-This prospective observational study was conducted on 250 patients, aged 18-60 years of ASAgrade I and II scheduled for surgeries under general anaesthesia. Three screening tests i.e. ULBT, NC/TMD and Arne Risk Index were used to predict difcult airway. Number of patients successfully intubated, number of attempts taken for intubation and time taken for intubation was noted. Difcult intubation was calculated using Intubation Difculty Score (IDS). All the three screening tests were compared for their sensitivity, specicity, negative predictive value (NPV) and Positive predictive value (PPV) to predict difcult airway. Result- The incidence of difcult intubation was found to be 6.8%. 233 (95.2%) patients were intubated in rst attempt and 12 (4.8%) patients were intubated in second attempt and there was no failed intubation. Arne Risk Index had high sensitivity (88.23%), high specicity (88.84%), highest NPV (99.04%) and PPV of 36.58%. ULBThas sensitivity of 76.47%, specicity of 88.41%, NPV of 98.09% and PPV of 32.50% and NC/TMD has sensitivity of 47.05%, specicity of 87.98%, PPVof 22.22% and NPVof 95.79% in predicting difcult airway. Conclusion- Arne Risk index, a multivariate clinical risk index had highest sensitivity, specicity, NPVand PPVto predict difcult airway.

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