scholarly journals The Prognostic Value of Serum Soluble TREM-1 on Outcome in Adult Patients with Sepsis

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1979
Author(s):  
Chia-Te Kung ◽  
Chih-Min Su ◽  
Sheng-Yuan Hsiao ◽  
Fu-Cheng Chen ◽  
Yun-Ru Lai ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Sofa Score ◽  
Characteristic Curve ◽  
Severity Index ◽  
Clinical Severity ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Blood Samples ◽  
Therapeutic Outcomes ◽  
Healthy Control

Increased soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) levels have been reported in patients with sepsis. We tested the hypotheses that serum sTREM-1 levels increase in the early phase of sepsis and decrease after sepsis under appropriate treatment and that sTREM-1 levels can predict therapeutic outcomes. One hundred and fifty-five patients prospectively underwent blood samples including biochemical data, sTREM-1, and biomarkers on endothelial dysfunction as well as clinical severity index examinations. Blood samples from Days 1, 4, and 7 after admission were checked. For comparison, 50 healthy subjects were selected as healthy control. Those patients who had sepsis had significantly higher sTREM-1 levels than those of healthy control. sTREM-1 levels positively correlated with biomarkers for endothelial dysfunction (ICAM-1, VCAM-1, and E-selectin) and lactate level as well as clinical severity index (maximum 24 h APACHE score and Sequential Organ Failure Assessment (SOFA) score) upon admission. sTREM-1 concentrations were significantly higher from Day 1 to Day 7 in the non-survivors than in the survivors. A stepwise logistic regression analysis showed only sTREM-1 level and maximum 24 h SOFA score upon admission were significantly associated with fatality. Area under the receiver operating characteristic curve analysis for the diagnostic accuracy of sTREM-1 in sepsis-related fatality gave a value of 0.726, with a cutoff value of 384.6 pg/mL (sensitivity = 80.8% and specificity = 61.5%). sTREM-1 level may be valuable in auxiliary diagnosis, and it can serve as a useful biomarker as a screening service and follow-up therapeutic outcomes in sepsis.

Predicting Vaginal Delivery in Nulliparous Women Undergoing Induction of Labor at Term

2017 ◽  
Vol 35 (07) ◽  
pp. 660-668 ◽  
Author(s):  
U. M. Reddy ◽  
C. C. Huang ◽  
T. C. Auguste ◽  
D. Bauer ◽  
R. T. Overcash ◽  
...  
Keyword(s):  
Vaginal Delivery ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Induction Of Labor ◽  
Stepwise Logistic Regression ◽  
Chronic Hypertension ◽  
Stepwise Logistic Regression Analysis ◽  
Maternal Characteristics ◽  
Nulliparous Women

Objective We sought to develop a model to calculate the likelihood of vaginal delivery in nulliparous women undergoing induction at term. Study Design We obtained data from the Consortium on Safe Labor by including nulliparous women with term singleton pregnancies undergoing induction of labor at term. Women with contraindications for vaginal delivery were excluded. A stepwise logistic regression analysis was used to identify the predictors associated with vaginal delivery by considering maternal characteristics and comorbidities and fetal conditions. The receiver operating characteristic curve, with an area under the curve (AUC) was used to assess the accuracy of the model. Results Of 10,591 nulliparous women who underwent induction of labor, 8,202 (77.4%) women had vaginal delivery. Our model identified maternal age, gestational age at delivery, race, maternal height, prepregnancy weight, gestational weight gain, cervical exam on admission (dilation, effacement, and station), chronic hypertension, gestational diabetes, pregestational diabetes, and abruption as significant predictors for successful vaginal delivery. The overall predictive ability of the final model, as measured by the AUC was 0.759 (95% confidence interval, 0.749–0.770). Conclusion We identified independent risk factors that can be used to predict vaginal delivery among nulliparas undergoing induction at term. Our predictor provides women with additional information when considering induction.

scholarly journals Serum Biomarkers for Prediction of Response to Methotrexate Monotherapy in Early Rheumatoid Arthritis: Results from the SWEFOT Trial

2019 ◽  
Vol 46 (6) ◽  
pp. 555-563 ◽  
Author(s):  
Karen Hambardzumyan ◽  
Rebecca J. Bolce ◽  
Johan K. Wallman ◽  
Ronald F. van Vollenhoven ◽  
Saedis Saevarsdottir
Keyword(s):  
Rheumatoid Arthritis ◽  
Logistic Regression ◽  
Disease Activity ◽  
Early Rheumatoid Arthritis ◽  
Characteristic Curve ◽  
Serum Biomarkers ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Baseline Serum ◽  
Baseline Levels

Objective.To investigate baseline levels of 12 serum biomarkers that constitute a multibiomarker disease activity test, as predictors of response to methotrexate (MTX) in patients with early rheumatoid arthritis (eRA).Methods.In 298 patients from the Swedish Pharmacotherapy (SWEFOT) clinical trial, baseline serum levels of 12 proteins were analyzed for association with disease activity based on the 28-joint count Disease Activity Score (DAS28) after 3 months of MTX monotherapy using uni-/multivariate logistic regression. Primary outcome was low disease activity (LDA; DAS28 ≤ 3.2).Results.Of 298 patients, 104 achieved LDA after 3 months on MTX. Four of the 12 biomarkers [C-reactive protein (CRP), leptin, tumor necrosis factor receptor I (TNF-RI), and vascular cell adhesion molecule 1 (VCAM-1)] significantly predicted LDA based on stepwise logistic regression analysis. Dichotomization of patients using receiver-operating characteristic curve analysis-based cutoffs for these biomarkers showed significantly higher proportions with LDA among patients with lower versus higher levels of CRP or leptin (40% vs 23%, p = 0.004, and 40% vs 25%, p = 0.011, respectively), as well as among those with higher versus lower levels of TNF-RI or VCAM-1 (43% vs 27%, p = 0.004, and 41% vs 25%, p = 0.004, respectively). Combined score based on these biomarkers, adjusted for known predictors of LDA (smoking, sex, and age), associated with decreased chance of LDA (adjusted OR 0.45, 95% CI 0.32–0.62).Conclusion.Low baseline levels of CRP and leptin, and high baseline levels of TNF-RI and VCAM-1 were associated with LDA after 3 months of MTX therapy in patients with eRA. Combination of these 4 biomarkers increased accuracy of prediction. [Trial registration number: NCT00764725]

Use of Thromboelastography to Assess Haemostatic Changes during Paediatric Cardiac Surgery and to Predict Post-Operative Bleeding.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1038-1038
Author(s):  
Beverley J. Hunt ◽  
S. Moganansundram ◽  
S. M. Tibby ◽  
F. Holton ◽  
A. Durward ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Circulatory Arrest ◽  
Characteristic Curve ◽  
Clot Formation ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Paediatric Cardiac Surgery ◽  
Functional Measure ◽  
Ethical Committee Approval

Abstract The management of post-operative bleeding in paediatric cardiac surgery is difficult because the underlying haemostatic changes have been poorly studied. The thromboelastogram (TEG) provides a real-time, functional measure of haemostasis, quantifying clot formation, strength and lysis. We investigated the use of serial intra-operative TEG to assess perioperative haemostatic changes and as an adjunct to demographic and laboratory variables for the prediction of bleeding following cardiopulmonary bypass (CPB) surgery. Ethical committee approval was obtained to study fifty-one children, median (interquartile) age 6.8 months (0.5 to 10.5) prospectively through CPB and for the first 24 hours after intensive care unit admission. Significant post-operative blood loss was defined as more than 10ml/kg in the first four post-operative hours. TEG readings and traditional coagulation parameters were measured throughout CPB. Forward stepwise logistic regression analysis was used to predict bleeding. The incidence of bleeding was 37% (19/51), with a mean 4-hour blood loss of 24 ml/kg. Both groups showed abnormalities in all TEG parameters (apart from lysis) at the end of CPB, which were more marked among those who bled (all p<0.05). Hyperfibrinolysis was not seen. Addition of heparinase to the TEG samples taken after protamine administration demonstrated a small but consistent heparin effect for all TEG parameters only among patients who bled, however this group exhibited comparable protamine:heparin ratios to those who did not (p = 0.22). Significant multivariate predictors of bleeding included fibrinogen level at induction of anaesthesia; occurrence of circulatory arrest; and two TEG parameters taken at the end of CPB: “k” (the time to maximal clot formation) and “angle” (the rate of clot formation). The final model predicted bleeding well, producing an area under the receiver operating characteristic curve of 0.855 (95% CI 0.750 to 0.960). In summary, the aetiology of bleeding after paediatric cardiac surgery appears to be due to inadequate clot formation rather than fibrinolysis. TEG readings taken at the end of CPB, in conjunction with laboratory and demographic variables may provide a useful predictor of post-operative bleeding.

scholarly journals SAT-547 Aldosterone-Potassium Ratio Predicts Primary Aldosteronism Subtype

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Troy Puar ◽  
Wann Jia Loh ◽  
Dawn Shao Ting Lim ◽  
Meifen Zhang ◽  
Roger S Foo ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Prediction Models ◽  
Characteristic Curve ◽  
Multivariable Analysis ◽  
Predictive Ability ◽  
Cost Effective ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Bilateral Disease ◽  
Unilateral Disease

Abstract Objective Prediction models have been developed to predict either unilateral or bilateral primary aldosteronism, and these have not been validated externally. We aimed to develop a simplified score to predict both subtypes and validate this externally. Methods Our development cohort was taken from 165 patients who underwent adrenal vein sampling (AVS) in two Asian tertiary centres. Unilateral disease was determined using both AVS and post-operative outcome. Multivariable analysis was used to construct prediction models. We validated our tool in a European cohort of 97 patients enrolled in a clinical trial. Previously published prediction models were also tested in our cohorts. Results Backward stepwise logistic regression analysis yielded a final tool using baseline-aldosterone-to-lowest-potassium ratio (APR, ng/dL/mmol/L), with an area under receiver operating characteristic curve of 0.80 (95% CI: 0.70 - 0.89). In the Asian development cohort, probability of bilateral disease was 90.0% (with APR &lt;5) and probability of unilateral disease was 91.4% (with APR &gt;15). Similar results were seen in the European validation cohort. Combining both cohorts, probability of bilateral disease was 76.7% (with APR &lt;5), and probability for unilateral was 91.7% (with APR &gt;15). Other models had similar predictive ability but required more variables, and were less sensitive for identifying bilateral PA. Conclusion The novel aldosterone-potassium ratio (APR) is a convenient score to guide clinicians and patients of various ethnicities on the probability of PA subtype. Using APR to identify patients more likely to benefit from AVS may be a cost-effective strategy to manage this common condition.

The role of diffusion weighted magnetic resonance imaging for the characterisation of mediastinal lymphadenopathy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e23113-e23113
Author(s):  
Mandeep K Garg ◽  
Eniyavel Ramamoorthy ◽  
Paramjeet Singh ◽  
Ashutosh Nath Aggarwal ◽  
Nalini Gupta
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Characteristic Curve ◽  
Mean Value ◽  
Pathological Examination ◽  
Mediastinal Lymphadenopathy ◽  
Stepwise Logistic Regression ◽  
Resonance Imaging ◽  
Stepwise Logistic Regression Analysis ◽  
Diffusion Weighted

e23113 Background: To assess the diagnostic performance and additional value of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the characterization of mediastinal lymphadenopathy. Methods: This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 43 patients [23 males and 20 females with mean age of 49 years] with mediastinal lymphadenopathy underwent DW and T2 weighted MRI and pathological examination in the period of January 2015 to June 2016. Diffusion restriction pattern, apparent diffusion coefficient (ADC) mean value, size and T2 heterogeneous signal intensity of the nodes were evaluated. Receiver operating characteristic curve analysis was used to determine ADC mean threshold values. The best predicting combinations of these four parameters were selected by means of stepwise logistic regression analysis. Results: ADC mean value of malignant lymphadenopathy (0.873±0.109×10−3 mm2/s) was significantly different from that of benign lymphadenopathy (1.663±0.311×10−3 mm2/s) (P < 0.001). When an ADC mean value of 1.0955×10−3 mm2/s was used as a threshold value for differentiating malignant from benign nodes, the best results were obtained with a sensitivity of 94%, a specificity of 96% and area under the curve of 0.996. The three other predictor variables didn’t add anything statistically significant to the regression equation with ADC mean. Conclusions: ADC mean value of malignant mediastinal lymphadenopathy was significantly different from the benign lymphadenopathy. The ADC mean value was the strongest independent predictor of malignancy.

The Role of a Decision Rule in Symptomatic Pulmonary Embolism Patients with a Non-high Probability Ventilation-perfusion Scan

1997 ◽  
Vol 78 (02) ◽  
pp. 794-798 ◽  
Author(s):  
Bowine C Michel ◽  
Philomeen M M Kuijer ◽  
Joseph McDonnell ◽  
Edwin J R van Beek ◽  
Frans F H Rutten ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Decision Rule ◽  
Predictive Value ◽  
Patient Population ◽  
High Probability ◽  
Characteristic Curve ◽  
Stepwise Logistic Regression ◽  
Pulmonary Angiogram ◽  
Symptomatic Pulmonary Embolism ◽  
Perfusion Scan

Summary Background: In order to improve the use of information contained in the medical history and physical examination in patients with suspected pulmonary embolism and a non-high probability ventilation-perfusion scan, we assessed whether a simple, quantitative decision rule could be derived for the diagnosis or exclusion of pulmonary embolism. Methods: In 140 consecutive symptomatic patients with a non- high probability ventilation-perfusion scan and an interpretable pulmonary angiogram, various clinical and lung scan items were collected prospectively and analyzed by multivariate stepwise logistic regression analysis to identify the most informative combination of items. Results: The prevalence of proven pulmonary embolism in the patient population was 27.1%. A decision rule containing the presence of wheezing, previous deep venous thrombosis, recently developed or worsened cough, body temperature above 37° C and multiple defects on the perfusion scan was constructed. For the rule the area under the Receiver Operating Characteristic curve was larger than that of the prior probability of pulmonary embolism as assessed by the physician at presentation (0.76 versus 0.59; p = 0.0097). At the cut-off point with the maximal positive predictive value 2% of the patients scored positive, at the cut-off point with the maximal negative predictive value pulmonary embolism could be excluded in 16% of the patients. Conclusions: We derived a simple decision rule containing 5 easily interpretable variables for the patient population specified. The optimal use of the rule appears to be in the exclusion of pulmonary embolism. Prospective validation of this rule is indicated to confirm its clinical utility.

The Use of Total Contact Orthoses in Patients with Foot Problems in Foot Clinic, Siriraj Hospital

2020 ◽  
Vol 103 (12) ◽  
pp. 1292-1299
Keyword(s):  
Odds Ratio ◽  
Univariate Analysis ◽  
Stepwise Logistic Regression ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Stepwise Logistic Regression Analysis ◽  
Cross Sectional ◽  
Siriraj Hospital ◽  
Foot Problems ◽  
Foot Clinic

Objective: To study the use rate, outcome, and concomitant factors of the use of the total contact orthoses (TCO) in the Foot Clinic, Siriraj Hospital Materials and Methods: The present study was a cross-sectional descriptive study collecting data from patient medical records and questionnaires. Patients who had foot problems without impairment of foot sensation and received the TCO from the Foot Clinic between July 2015 and April 2016 were interviewed before and after using the latest TCO for one month. Results: One hundred seven participants were recruited. Most were female (84.1%) with a median age of 59.3 years. The majority had chronic plantar fasciitis (26.2%), posterior tibial tendon dysfunction (PTTD) (25.2%), hallux valgus (21.5%), or metatarsalgia (21.5%). The TCO user was defined as a participant who had to use the TCO for more than three days per week and for more or equal to 50% of daily walking and standing duration. The use rate was 67.3%. The TCO provides standing and walking stability (p=0.008). For patients with metatarsalgia, using the TCO could significantly reduce pain (p=0.002). Using univariate analysis, many factors were found to be associated with the use of the TCO including having level of convenience of putting on or taking off shoes with TCO at 9 or more (odds ratio 2.66, 95% CI 1.16 to 6.12), having difficulty to find proper shoes that fit with the TCO (odds ratio 0.36, 95% CI 0.15 to 0.89), receiving more than one pair of TCO (odds ratio 4.09, 95% CI 1.51 to 11.05), and having level of comfort satisfaction during the TCO use at 9 or more (odds ratio 3.61, 95% CI 1.55 to 8.40). The latter two factors were found to be associated with the use of the TCO from stepwise logistic regression analysis (adjusted odds ratio 3.39, 95% CI 1.18 to 9.71 and 3.02, 95% CI 1.07 to 8.47, respectively). Conclusion: The use of the TCO in the Foot Clinic, Siriraj Hospital was 67.3%. Using the TCO could promote walking stability. Factors affecting the use of the TCO included receiving more than the first pair of TCO and having comfort satisfaction level of 9 or more. Keywords: Use, Total contact orthoses, Total contact insole, Foot problems

Patterns of care in Italian psychiatric services and psychosocial outcome of schizophrenic patients. A three-year prospective study

1989 ◽  
Vol 4 (1) ◽  
pp. 23-31 ◽  
Author(s):  
D. Kemali ◽  
M. Maj ◽  
B. Carpiniello ◽  
R.D. Giurazza ◽  
M. Impagnatiello ◽  
...  
Keyword(s):  
Psychosocial Adjustment ◽  
Ad Hoc ◽  
Social Withdrawal ◽  
Skills Training ◽  
Favourable Outcome ◽  
Stepwise Logistic Regression ◽  
Psychosocial Outcome ◽  
Stepwise Logistic Regression Analysis ◽  
Schizophrenic Patients ◽  
The Difference

Summary141 patients with an ICD-9 diagnosis of schizophrenic psychosis were followed up prospectively for 3 years in 7 Italian centres, representative of the different degrees of application of the psychiatric reform law (Law 180) passed in 1978. It was agreed that each centre would treat the patients according to its routine, and that all contacts with the patients and each intervention performed would be carefully recorded in an ad hoc schedule. The baseline evaluation of psychosocial adjustment was performed by the Disability Assessment Schedule (DAS), and this assessment was then repeated every 6 months during the follow-up period. At the end of this period, the rating on the DAS section 5 was taken as a global measure of patients’ psychosocial outcome. On a stepwise logistic regression analysis, 2 variables were found to be significantly predictive of psychosocial outcome, that is the use of social and/or vocational skills training (associated with a favourable outcome) and the number of days/year of full hospitalization (associated with a poor outcome). Trieste and Arezzo were the only centres in which a significant improvement of the score on some DAS subscales (namely, “occupational role, interest” and “social withdrawal”) was detected. In the whole patient sample, the difference between the final and the baseline score on these subscales correlated significantly with the number/year of outpatient contacts and of home visits. These findings confirm the favourable impact of the community-oriented care provided in some Italian centres on the Psychosocial outcome of schizophrenic patients.

scholarly journals Objective Assessment of Walking Impairments in Myotonic Dystrophy by Means of a Wearable Technology and a Novel Severity Index

Electronics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 708
Author(s):  
Giovanni Saggio ◽  
Alessandro Manoni ◽  
Vito Errico ◽  
Erica Frezza ◽  
Ivan Mazzetta ◽  
...  
Keyword(s):  
Myotonic Dystrophy ◽  
Plantar Flexion ◽  
Objective Assessment ◽  
Endocrine System ◽  
Severity Index ◽  
Motor Tasks ◽  
Sensing Technology ◽  
Fast Pace ◽  
Dominant Disease ◽  
Healthy Control

Myotonic dystrophy type 1 (DM1) is a genetic inherited autosomal dominant disease characterized by multisystem involvement, including muscle, heart, brain, eye, and endocrine system. Although several methods are available to evaluate muscle strength, endurance, and dexterity, there are no validated outcome measures aimed at objectively evaluating qualitative and quantitative gait alterations. Advantageously, wearable sensing technology has been successfully adopted in objectifying the assessment of motor disabilities in different medical occurrences, so that here we consider the adoption of such technology specifically for DM1. In particular, we measured motor tasks through inertial measurement units on a cohort of 13 DM1 patients and 11 healthy control counterparts. The motor tasks consisted of 16 meters of walking both at a comfortable speed and fast pace. Measured data consisted of plantar-flexion and dorsi-flexion angles assumed by both ankles, so to objectively evidence the footdrop behavior of the DM1 disease, and to define a novel severity index, termed SI-Norm2, to rate the grade of walking impairments. According to the obtained results, our approach could be useful for a more precise stratification of DM1 patients, providing a new tool for a personalized rehabilitation approach.

scholarly journals Raised TSH is associated with endothelial dysfunction in Metabolic Syndrome: A case control study

2017 ◽  
Vol 55 (4) ◽  
pp. 212-221 ◽  
Author(s):  
Ashok Kumar Ahirwar ◽  
Archana Singh ◽  
Anju Jain ◽  
Surajeet Kumar Patra ◽  
Binita Goswami ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Endothelial Dysfunction ◽  
Subclinical Hypothyroidism ◽  
Serum Insulin ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Healthy Controls ◽  
Healthy Control ◽  
Study Population ◽  
Serum Tsh

AbstractIntroduction. Endothelial dysfunction has been considered as one of the important factors in pathogenesis of Metabolic Syndrome (Met S). Subclinical hypothyroidism (SCH) has also been reported to be associated with Met S. The aim of our study is to evaluate the association of raised TSH with mediators of endothelial dysfunction in Met S with Subclinical hypothyroidism as compared to healthy controls.Methods. Study population consisted of 100 subjects, out of which 50 were cases of Met S and 50 were healthy controls. Met S group were further divided into two, based on the presence & absence of SCH. Serum insulin, T3, T4, TSH were measured by chemiluminescence based immunoassay (CLIA). Serum nitric oxide (NO) levels were measured by Modified Griess’s method and serum endothelin-1 (ET-1) levels were measured by ELISA.Results. Out of 50 cases of Met S, SCH was diagnosed in 22. The mean serum TSH levels were significantly higher in Met S cases as compared to healthy controls (5.7 ± 1.2 μIU/mL vs. 2.3 ± 1.6 μIU/mL, P <0.0001). Mean serum NO levels were significantly lower in Met S cases as compared to healthy control (15.4 ± 10 μM vs. 21 ± 10 μM, p = 0.009). Mean serum ET-1 levels were significantly higher in Met S cases as compared to healthy controls (2.68 ± 1.7 fmol/mL vs. 2.1 ± 0.84 fmol/mL, p = 0.011). On Pearson’s correlation analysis, TSH showed positive correlation with ET-1 (r = 0.341, p = 0.001) and negative correlation with NO (r = −0.331, p = 0.001). Binary logistic regression analysis showed that TSH, NO and ET-1 has significant odd’s ratio for predicting Met S.Conclusion. Met S cases were screened for thyroid abnormalities and found to have 44% of SCH along with co-existing endothelial dysfunction. Raised TSH in SCH could cause endothelial dysfunction which may lead to Met S and associated co-morbidities. Present study gives new insight in linking endothelial dysfunction and raised TSH in Met S. Therefore, Met S cases should be screened for SCH and treated appropriately to attenuate endothelial dysfunction and associated comorbidities in Met S.

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