Plasma Levels of Mid-Regional Proadrenomedullin Accurately Identify H1N1pdm09 Influenza Virus Patients with Risk of Intensive Care Admission and Mortality in the Emergency Department

Early identification of severe viral pneumonia in influenza virus A (H1N1pdm09) patients is extremely important for prompt admission to the ICU. The objective is to evaluate the usefulness of MR-proadrenomedullin (MR-proADM) compared to C reactive protein (CRP), procalcitonin (PCT), and ferritin in the prognosis of influenza A pneumonia. This prospective, observational, multicenter study included one hundred thirteen patients with confirmed influenza virus A (H1N1pdm09) admitted to an Emergency Department and ICUs of six hospitals in Spain. Measurements and Main Results: one-hundred thirteen patients with confirmed influenza virus A (H1N1pdm09) were enrolled. Seventy-five subjects (mortality 29.3%) with severe pneumonia caused by influenza A H1N1pdm09 virus (H1N1vIPN) were compared with 38 controls (CG).The median MR-proADM levels at hospital admission were 1.2 nmol/L (IQR (0.8–2.6) vs. 0.5 nmol/L (IQR 0.2–0.9) in the CG (p = 0.01), and PCT levels were 0.43 μg/L (IQR 0.2–1.2) in the H1N1vIPN group and 0.1 μg/L (IQR 0.1–0.2) in the CG (p < 0.01). CRP levels at admission were 15.5 mg/dL(IQR 9.2–24.9) in H1N1vIPN and 8.6 mg/dL(IQR 3–17.3) in the CG (p < 0.01). Ferritin levels at admission were 558.1 ng/mL(IQR 180–1880) in H1N1vIPN and 167.7 ng/mL(IQR 34.8–292.9) in the CG (p < 0.01). A breakpoint for hospital admission of MR-proADM of 1.1 nmol/L showed a sensitivity of 55% and a specificity of 90% (AUC-ROC0.822). Non-survivors showed higher MR-proADM levels: median of 2.5 nmol/L vs. 0.9 nmol/L among survivors (p < 0.01). PCT, CRP, and ferritin levels also showed significant differences in predicting mortality. The MR-proADM AUC-ROC for mortality was 0.853 (p < 0.01). In a Cox proportional hazards model, MR-proADM levels > 1.2 nmol/L at hospital admission were significant predictive factors for ICU and 90-day mortality (HR: 1.3). Conclusions: the initial MR-proADM, ferritin, CRP, and PCT levels effectively determine adverse outcomes and risk of ICU admission and mortality in patients with influenza virus pneumonia. MR-proADM has the highest potency for survival prediction.

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Prediction Model for Estimating the Survival Benefit of Adjuvant Radiotherapy for Gallbladder Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.14.7934 ◽

2008 ◽

Vol 26 (13) ◽

pp. 2112-2117 ◽

Cited By ~ 82

Author(s):

Samuel J. Wang ◽

C. David Fuller ◽

Jong-Sung Kim ◽

Dean F. Sittig ◽

Charles R. Thomas ◽

...

Keyword(s):

Prediction Model ◽

Gallbladder Cancer ◽

Adjuvant Radiotherapy ◽

Survival Benefit ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Survival Prediction ◽

Published Data ◽

Net Survival

Purpose The benefit of adjuvant radiotherapy (RT) for gallbladder cancer remains controversial because most published data are from small, single-institution studies. The purpose of this study was to construct a survival prediction model to enable individualized predictions of the net survival benefit of adjuvant RT for gallbladder cancer patients based on specific tumor and patient characteristics. Methods A multivariate Cox proportional hazards model was constructed using data from 4,180 patients with resected gallbladder cancer diagnosed from 1988 to 2003 from the Surveillance, Epidemiology, and End Results database. Patient and tumor characteristics were included as covariates and assessed for association with overall survival (OS) with and without adjuvant RT. The model was internally validated for discrimination and calibration using bootstrap resampling. Results On multivariate regression analysis, the model showed that age, sex, papillary histology, stage, and adjuvant RT were significant predictors of OS. The survival prediction model demonstrated good calibration and discrimination, with a bootstrap-corrected concordance index of 0.71. The model predicts that adjuvant RT provides a survival benefit in node-positive or ≥ T2 disease. A nomogram and a browser-based software tool were built from the model that can calculate individualized estimates of predicted net survival gain attributable to adjuvant RT, given specific input parameters. Conclusion In the absence of large, prospective, randomized, clinical trial data, a regression model can be used to make individualized predictions of the expected survival improvement from the addition of adjuvant RT after gallbladder cancer resection.

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Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080902900210 ◽

2009 ◽

Vol 29 (2) ◽

pp. 163-170 ◽

Cited By ~ 7

Author(s):

Wei Fang ◽

Xiao Yang ◽

Joanne M. Bargman ◽

Dimitrios G. Oreopoulos

Keyword(s):

Peritoneal Dialysis ◽

Pulse Pressure ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cardiovascular Death ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Study Cohort ◽

Increased Risk

Background Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD. Methods All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model. Results A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 ± 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure ( p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 – 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 – 1.081; p = 0.035). Conclusion Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.

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Two-stage neural-network based prognosis models using pathological image and transcriptomic data: An application in hepatocellular carcinoma patient survival prediction

10.1101/2020.01.25.20016832 ◽

2020 ◽

Author(s):

Zhucheng Zhan ◽

Noshad Hossenei ◽

Olivier Poirion ◽

Maria Westerhoff ◽

Eun-Young Choi ◽

...

Keyword(s):

Neural Network ◽

Hepatocellular Carcinoma ◽

Proportional Hazards Model ◽

Patient Survival ◽

Complex Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

P Value ◽

Survival Prediction ◽

Two Stage

AbstractPathological images are easily accessible data type with potential as prognostic biomarkers. Here we extend Cox-nnet, a neural network based prognosis method previously used for transcriptomics data, to predict patient survival using hepatocellular carcinoma (HCC) pathological images. Cox-nnet based imaging predictions are more robust and accurate than Cox proportional hazards model. Moreover, using a novel two-stage Cox-nnet complex model, we are able to combine histopathology image and transcriptomics RNA-Seq data to make impressively accurate prognosis predictions, with C-index close to 0.90 and log-ranked p-value of 4e-21 in the testing dataset. This work provides a new, biologically relevant and relatively interpretable solution to the challenge of integrating multi-modal and multiple types of data, particularly for survival prediction.

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Abstract 14769: Outcomes of a Smartphone-based Application With Live Health-coaching Post-percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.142.suppl_3.14769 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Kaavya Paruchuri ◽

Phoebe Finneran ◽

Nicholas A Marston ◽

Emma W Healy ◽

John Andreo ◽

...

Keyword(s):

Hospital Readmission ◽

Proportional Hazards Model ◽

Digital Health ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Significant Difference ◽

Health Coaches ◽

Historical Controls

Introduction: The period between inpatient hospitalization for symptomatic CAD and post-discharge office consultation remains a vulnerable interval for adverse outcomes. Tools to help guide patients during this susceptible time are needed. Methods: We customized content on a digital health platform for hospitalized patients receiving PCI which included education, tracking, reminders and health coaches. We conducted a single-arm open-label pilot study of the application (app) to test feasibility and efficacy at two academic medical centers with 1:3 propensity-matched historical controls (NCT03416920). We assessed whether the app led to excess 30-day hospital readmission, improved outpatient cardiovascular follow up (CVFU) and increased cardiac rehabilitation (CR) enrollment in our health system (MGB). Differences were assessed by Cox Proportional Hazards model. Results: 118 of 324 eligible (36.4%) were enrolled during incident PCI admission 02/18-06/19. 68 of 118 (57.6%) underwent PCI for MI. Mean age was 62.4 (9.7) years, 87 (73.7%) were male, 40 (33.9%) had DM2, and 59 (50.0%) had previously known CAD. There was no significant difference in all-cause readmission within 30 or 90 days. However, rates of both 90-day CR enrollment and 1-month CVFU were increased. App engagement was high – mean 47% daily and 63% weekly engagement within the first 90 days. Spearman correlation analyses indicated similar engagement across age, sex, and cardiovascular risk factors. Conclusions: A post-PCI smartphone app, with live health coaches, deployed upon discharge is feasible with similar engagement across demographics. Compared to historical controls, use of the app did not affect short-term hospital readmission but was associated with two-fold increased attendance in CR. Prospective randomized controlled trials are necessary to test the hypothesis that this digital health platform post-PCI improves cardiovascular outcomes over longer follow-up.

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Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-89548-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juhyun Song ◽

Dae Won Park ◽

Jae-hyung Cha ◽

Hyeri Seok ◽

Joo Yeong Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Icu Admission ◽

Hazards Model

AbstractWe investigated association between epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients and clinical outcomes in Korea. This nationwide retrospective cohort study included 5621 discharged patients with COVID-19, extracted from the Korea Disease Control and Prevention Agency (KDCA) database. We compared clinical data between survivors (n = 5387) and non-survivors (n = 234). We used logistic regression analysis and Cox proportional hazards model to explore risk factors of death and fatal adverse outcomes. Increased odds ratio (OR) of mortality occurred with age (≥ 60 years) [OR 11.685, 95% confidence interval (CI) 4.655–34.150, p < 0.001], isolation period, dyspnoea, altered mentality, diabetes, malignancy, dementia, and intensive care unit (ICU) admission. The multivariable regression equation including all potential variables predicted mortality (AUC = 0.979, 95% CI 0.964–0.993). Cox proportional hazards model showed increasing hazard ratio (HR) of mortality with dementia (HR 6.376, 95% CI 3.736–10.802, p < 0.001), ICU admission (HR 4.233, 95% CI 2.661–6.734, p < 0.001), age ≥ 60 years (HR 3.530, 95% CI 1.664–7.485, p = 0.001), malignancy (HR 3.054, 95% CI 1.494–6.245, p = 0.002), and dyspnoea (HR 1.823, 95% CI 1.125–2.954, p = 0.015). Presence of dementia, ICU admission, age ≥ 60 years, malignancy, and dyspnoea could help clinicians identify COVID-19 patients with poor prognosis.

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Efficacy of live attenuated and inactivated influenza vaccines among children in rural India: A 2-year, randomized, triple-blind, placebo-controlled trial

PLoS Medicine ◽

10.1371/journal.pmed.1003609 ◽

2021 ◽

Vol 18 (4) ◽

pp. e1003609

Author(s):

Anand Krishnan ◽

Lalit Dar ◽

Siddhartha Saha ◽

Venkatesh Vinayak Narayan ◽

Rakesh Kumar ◽

...

Keyword(s):

Influenza Virus ◽

Influenza Vaccine ◽

Proportional Hazards Model ◽

Controlled Trial ◽

Influenza Virus Infection ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Rural India ◽

Relative Efficacy ◽

Indian Children

Background Influenza is a cause of febrile acute respiratory infection (FARI) in India; however, few influenza vaccine trials have been conducted in India. We assessed absolute and relative efficacy of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) among children aged 2 to 10 years in rural India through a randomized, triple-blind, placebo-controlled trial conducted over 2 years. Methods and findings In June 2015, children were randomly allocated to LAIV, IIV, intranasal placebo, or inactivated polio vaccine (IPV) in a 2:2:1:1 ratio. In June 2016, vaccination was repeated per original allocation. Overall, 3,041 children received LAIV (n = 1,015), IIV (n = 1,010), nasal placebo (n = 507), or IPV (n = 509). Mean age of children was 6.5 years with 20% aged 9 to 10 years. Through weekly home visits, nasal and throat swabs were collected from children with FARI and tested for influenza virus by polymerase chain reaction. The primary outcome was laboratory-confirmed influenza-associated FARI; vaccine efficacy (VE) was calculated using modified intention-to-treat (mITT) analysis by Cox proportional hazards model (PH) for each year. In Year 1, VE was 40.0% (95% confidence interval (CI) 25.2 to 51.9) for LAIV and 59.0% (95% CI 47.8 to 67.9) for IIV compared with controls; relative efficacy of LAIV compared with IIV was −46.2% (95% CI −88.9 to −13.1). In Year 2, VE was 51.9% (95% CI 42.0 to 60.1) for LAIV and 49.9% (95% CI 39.2 to 58.7) for IIV; relative efficacy of LAIV compared with IIV was 4.2% (95% CI −19.9 to 23.5). No serious adverse vaccine-attributable events were reported. Study limitations include differing dosage requirements for children between nasal and injectable vaccines (single dose of LAIV versus 2 doses of IIV) in Year 1 and the fact that immunogenicity studies were not conducted. Conclusions In this study, we found that LAIV and IIV vaccines were safe and moderately efficacious against influenza virus infection among Indian children. Trial registration Clinical Trials Registry of India CTRI/2015/06/005902.

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Abstract 17011: Impact of Donor Cardiopulmonary Resuscitation Duration on Survival After Heart Transplantation

Circulation ◽

10.1161/circ.142.suppl_3.17011 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Morgan Harloff ◽

Laura Piechura ◽

Farhang Yazdchi ◽

Mohamed Keshk ◽

Hunbo Shim ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Heart Transplantation ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Smoking History ◽

Orthotopic Heart Transplantation ◽

Donor Pool ◽

Kaplan Meier

Introduction: Prolonged cardiopulmonary resuscitation (CPR) duration remains a source of apprehension with regards to the acceptance of donor hearts for orthotopic heart transplantation (OHT). Unfortunately, many of these organs are declined due to concern for adverse outcomes after OHT, further straining an already limited donor pool. Nevertheless, donor hearts with a history of prolonged CPR may represent an opportunity to expand the donor pool for patients with end-stage heart failure on the waiting list for OHT. Therefore, we sought to examine the duration of donor CPR and its impact on recipient survival after OHT. Methods: The United Network of Organ Sharing (UNOS) database was retrospectively quarried to identify all adult patients who underwent first-time OHT between 2000 and 2019 from a donor who had experienced cardiac arrest with a quantified downtime duration. The population was divided into five groups with a granular focus on longer downtimes: donors with CPR < 30 minutes, 30-39 minutes, 40-49 minutes, 50-59 minutes, and ≥ 60 minutes. Primary outcome of interest was post-transplant survival. Kaplan-Meier analysis was used to compare recipient survival between groups after OHT. Results: In total, 7,470 patients were identified during the study period. Overall survival by Kaplan-Meier analysis was not statistically different among the five groups (p=0.69) (Figure 1). In a Cox proportional-hazards model, duration of CPR was found to have no influence on survival (HR 1.00, p=0.56). Significant predictors of mortality included donor age (HR 1.01, p=0.013), donor smoking history (HR 1.11, p<0.005), and recipient diabetes (HR 1.27, p<0.0001). Conclusions: These findings suggest that, for hearts determined appropriate for transplant, duration of CPR performed on the donor heart does not significantly impact survival after OHT. Therefore, donor hearts with a prolonged downtime should be fully evaluated for OHT to maximize the donor pool.

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Emergency department crowding and mortality in 14 Swedish emergency departments, a cohort study leveraging the Swedish Emergency Registry (SVAR)

PLoS ONE ◽

10.1371/journal.pone.0247881 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247881

Author(s):

Björn af Ugglas ◽

Per Lindmarker ◽

Ulf Ekelund ◽

Therese Djärv ◽

Martin J. Holzmann

Keyword(s):

Emergency Department ◽

Cohort Study ◽

Subgroup Analysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

National Registry ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Multicenter Studies ◽

Ed Crowding

Objectives There is evidence that emergency department (ED) crowding is associated with increased mortality, however large multicenter studies of high quality are scarce. In a prior study, we introduced a proxy-measure for crowding that was associated with increased mortality. The national registry SVAR enables us to study the association in a more heterogenous group of EDs with more recent data. The aim is to investigate the association between ED crowding and mortality. Methods This was an observational cohort study including visits from 14 EDs in Sweden 2015–2019. Crowding was defined as the mean ED-census divided with expected ED-census during the work-shift that the patient arrived. The crowding exposure was categorized in three groups: low, moderate and high. Hazard ratios (HR) for mortality within 7 and 30 days were estimated with a cox proportional hazards model. The model was adjusted for age, sex, triage priority, arrival hour, weekend, arrival mode and chief complaint. Subgroup analysis by county and for admitted patients by county were performed. Results 2,440,392 visits from 1,142,631 unique patients were analysed. A significant association was found between crowding and 7-day mortality but not with 30-day mortality. Subgroup analysis also yielded mixed results with a clear association in only one of the three counties. The estimated HR (95% CI) for 30-day mortality for admitted patients in this county was 1.06 (1.01–1.12) in the moderate crowding category, and 1.11 (1.01–1.22) in the high category. Conclusions The association between crowding and mortality may not be universal. Factors that influence the association between crowding and mortality at different EDs are still unknown but a high hospital bed occupancy, impacting admitted patients may play a role.

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Patients Hospitalized in General Wards via the Emergency Department: Early Identification of Predisposing Factors for Death or Unexpected Intensive Care Unit Admission—A Historical Prospective

Emergency Medicine International ◽

10.1155/2014/203747 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Thierry Boulain ◽

Isabelle Runge ◽

Nathalie Delorme ◽

Angèle Bouju ◽

Antoine Valéry

Keyword(s):

Emergency Department ◽

Intensive Care ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Predisposing Factors ◽

Psychoactive Drug ◽

Cox Proportional Hazards Model ◽

Unexpected Death ◽

Oxygen Administration ◽

High Dependency

Background.To identify, upon emergency department (ED) admission, predictors of unexpected death or unplanned intensive care/high dependency units (ICU/HDU) admission during the first 15 days of hospitalization on regular wards.Methods.Prospective cohort study in a medical-surgical adult ED in a teaching hospital, including consecutive patients hospitalized on regular wards after ED visit, and identification of predictors by logistic regression and Cox proportional hazards model.Results.Among 4,619 included patients, 77 (1.67%) target events were observed: 32 unexpected deaths and 45 unplanned transfers to an ICU/HDU. We identified 9predictors of the target eventincluding the oxygen administration on the ED, unknown current medications, and use of psychoactive drug(s). All predictors put the patients at risk during the first 15 days of hospitalization. A logistic model forhospital mortality prediction(death of all causes) still comprised oxygen administration on the ED, unknown current medications, and the use of psychoactive drug(s) as risk factors.Conclusion.The “use of oxygen therapy on the ED,” the “current use of psychoactive drug(s)”, and the “lack of knowledge of current medications taken by the patients” were important predisposing factors to severe adverse events during the 15 days of hospitalization on regular wards following the ED visit.

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Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Crisis ◽

10.1027/0227-5910/a000468 ◽

2018 ◽

Vol 39 (1) ◽

pp. 27-36 ◽

Cited By ~ 5

Author(s):

Kuan-Ying Lee ◽

Chung-Yi Li ◽

Kun-Chia Chang ◽

Tsung-Hsueh Lu ◽

Ying-Yeh Chen

Keyword(s):

Young People ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Birth Registry ◽

Data Set ◽

Parental Suicide ◽

The Impact ◽

Age At Exposure

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

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