scholarly journals Biomarkers, shock index and modified early warning score among older medical hospital inpatients in Nigeria

2019 ◽  
Vol 61 (3) ◽  
pp. 78
Author(s):  
L. A. Adebusoye ◽  
M. O. Owolabi ◽  
A. Ogunniyi
Keyword(s):  
Blood Pressure ◽  
Pulse Rate ◽  
Early Warning ◽  
Cox Regression ◽  
Early Warning Score ◽  
Shock Index ◽  
Cox Regression Analysis ◽  
Cell Counts ◽  
Fat Deposits ◽  
Hospital Inpatients

Background: Biomarkers, shock index and modified early warning score (MEWS) are of public health importance because identification and prompt attention to them have been found to reduce mortality among older patients on admission.Objectives: A study was undertaken to determine the biomarkers, shock index and MEWS that predict mortality on admission among older medical hospital inpatients.Methods: This was a prospective study of 450 patients (≥ 60 years) on the medical wards of University College Hospital, Ibadan. Biomarkers recommended by the National Institute on Aging such as blood pressure, heart rate and pulse rate (cardiovascular functioning); cholesterol and triglycerides (metabolic processes); T-cell counts (immune system status) and weight, body mass index and waist-to-hip ratio (indicators of obesity, chronic metabolic disorders and fat deposits) were assessed. Vital signs were recorded on admission and used to calculate the shock index and MEWS. Multivariate and survival analyses were carried out at p 0.05.Results: Baseline temperature ≥ 39.0°c (p = 0.049), pulse rate ≥ 100 beats/minute (p = 0.034), systolic blood pressure (SBP) 120 mmHg (p = 0.048), shock index ≥1.0 (p = 0.041), age shock index (p = 0.032) and critical illness score (MEWS ≥5) p = 0.019 were significantly associated with mortality. Independent predictors of mortality on Cox regression analysis were temperature ≥ 39.0°C (HR = 3.317 [1.281–8.590]) and SBP 120 mmHg (HR = 1.845 [1.025–3.322]).Conclusion: Prompt identification and management of fever and low blood pressure should improve the survival of older medical hospital inpatients.

Abstract TP431: Association of Systolic Blood Pressure and Cardiovascularrisk According to Hemoglobin Concentration

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jun Young Chang ◽  
Se Young Jang ◽  
Sun-uck Kwon
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Cox Regression ◽  
Hemoglobin Concentration ◽  
Cardiovascular Death ◽  
Normal Range ◽  
Cox Regression Analysis ◽  
Hazard Ratios ◽  
Hb Concentration

Introduction: We evaluated whether the optimal cutoff of blood pressure to reduce cardiovascular risk is different according to hemoglobin (Hb) concentration and its changing pattern using the National Health Insurance Service-Health Screening Cohort. Methods: The study population consisted of individuals who underwent both 2002-2003 and 2004-2005 health examinations. Individuals who were diagnosed with cardiovascular disease or who died before index date of 1 January 2006 were excluded. The primary outcome of the study was the association between systolic blood pressure (SBP) and MACE (composite of myocardial infarction, stroke, and cardiovascular death) according to Hb concentration. Hazard ratios (HR) were calculated using Cox regression analysis adjusted for age and sex. Results: A total of 290573 were included in the analysis. During the follow up period from 1 January 2006 to 31 December 2013, a total of 18292 experienced MACE. There was a significant interaction between SBP and Hb concentration with regard to cardiovascular diseases (p for interaction= 0.07). Among the subjects with Hb <10, a significant increment of MACE was observed when SBP ≥140 mmHg. HR for MACE increased when SBP ≥130mmHg among the subjects with 10≤ Hb <11 and 11≤ Hb <12. HR for MACE increased when SBP ≥ 120 mmHg among the subjects with 12≤ Hb <13, 13≤ Hb <15, and 15≤ Hb. Cardiovascular risk was the lowest in SBP below 120mmHg and cut off value for increasing cardiovascular risk was 120 mmHg or above in subjects who maintain normal range of hemoglobin level and whose hemoglobin concentration changed from anemia to normal range. However, individuals who maintain anemic state and whose hemoglobin concentration changed from normal range to anemia, SBP threshold for increasing cardiovascular risk was equal or above 130 mmHg . Conclusion: The threshold of SBP which increases cardiovascular risk may be different according to the hemoglobin concentration and change pattern of hemoglobin.

2231HsCRP predicts mortality beyond troponin in 102,337 patients with suspected acute coronary syndrome (CRP-RISK study)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kaura ◽  
A Hartley ◽  
V Panoulas ◽  
B Glampson ◽  
J Davies ◽  
...  
Keyword(s):  
Real World ◽  
Health Informatics ◽  
Cox Regression ◽  
White Cell ◽  
Research Centre ◽  
Troponin Level ◽  
Cox Regression Analysis ◽  
Cumulative Mortality ◽  
Coronary Syndrome ◽  
Cell Counts

Abstract Background The incremental long-term prognostic value of high-sensitivity C-reactive protein (hsCRP) above troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndromes (ACS) is unknown. Purpose We hypothesised that a mildly elevated hsCRP is associated with mortality risk in patients with suspected ACS, independent of troponin level. Methods We used the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients who had a troponin measured at 5 cardiac centres. We excluded patients with clinically abnormal white cell counts and hsCRP >15 mg/L to try limiting the population to those without overt infections, malignancies or systemic inflammatory conditions that may confound our analyses. Patients were divided into four hsCRP groups (<2, 2–4.9, 5–9.9 and 10–15 mg/L) and the association between hsCRP levels and all-cause mortality assessed. Results There were 102,337 patients included in the analysis (hsCRP <2 mg/L (n=38,390), 2–4.9 mg/L (n=27,397), 5–9.9 mg/L (n=26,957) and 10–15 mg/L (n=9,593)). Figure 1A displays cumulative mortality per hsCRP group, revealing increasing mortality with each consecutive group. Figure 1B further stratifies the groups according to dichotomised peak troponin level as positive or negative. This shows the greatest mortality for patients in the highest hsCRP group who also had a positive troponin assay (36.0% at 3 years). In Cox regression analysis with time-dependent covariates, even mildly raised hsCRP was an independent predictor of mortality over time, after adjusting for age, gender, haemoglobin, white cell count, platelet count, creatinine and troponin positivity. There was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3-years (hazard ratio (95% CI) of 1.32 (1.18–1.48) for those with hsCRP 2.0–4.9mg/L, and 1.40 (1.26–1.57), and 2.00 (1.75–2.28) for those with hsCRP 5–9.9 mg/L and 10–15 mg/L, respectively. We explored whether inclusion of hsCRP could better reclassify the population into at-risk mortality groups. The association with 30-day, 1-year and 3-year mortality was assessed using three different risk models (model 1: age, gender, haemoglobin, creatinine; model 2: model 1 plus troponin (positivity versus negativity); model 3: model 2 plus hsCRP groups. For cumulative mortality at each time point, each successive model was better able to discriminate risk than its precursor (p<0.0001); such that inclusion of troponin and hsCRP gave the most robust risk discrimination. Model 3 achieved an AUROC >0.8 at 30 days, 1-year and 3-year mortality, surpassing the use of troponin on its own. Figure 1. Kaplan-Meier mortality curves Conclusions These multi-centre, real-world data from a large cohort of patients with suspected ACS identify hsCRP as a clinically meaningful prognostic marker in addition to troponin levels and point to its potential utility in selecting patients for novel treatments targeting inflammation. Acknowledgement/Funding Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs

Intensification of Mercaptopurine/Methotrexate Maintenance Chemotherapy May Increase the Risk of Relapse for Some Children With Acute Lymphoblastic Leukemia

2003 ◽  
Vol 21 (7) ◽  
pp. 1332-1339 ◽  
Author(s):  
Kjeld Schmiegelow ◽  
Olle Björk ◽  
Anders Glomstein ◽  
Göran Gustafsson ◽  
Niels Keiding ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Maintenance Therapy ◽  
Cox Regression ◽  
Lymphoblastic Leukemia ◽  
Tpmt Activity ◽  
Control Group ◽  
Cox Regression Analysis ◽  
Cell Counts ◽  
Increased Risk ◽  
Risk Of Relapse

Purpose: Thioguanine nucleotides (TGNs) mediate the cytotoxicity of mercaptopurine (MP). Methylated MP metabolites (formed by thiopurine methyltransferase [TPMT]) and methotrexate (MTX) polyglutamates can inhibit de novo purine synthesis. We explored whether dose adjustment of MP and MTX by erythrocyte (E) levels of TGN and MTX (including polyglutamates) could improve outcome in childhood acute lymphoblastic leukemia (ALL). Patients and Methods: A total of 538 children with ALL were randomly assigned to have their oral MP/MTX maintenance therapy adjusted by white cell counts (WBC), E-TGN, and E-MTX (pharmacology group), or by WBC only (control group). Results: After a median follow-up of 7.8 years, 79 patients had relapsed. Cox regression analysis showed an increased risk of relapse for boys (P = .00003), high WBC at diagnosis (P = .03), pharmacology arm (6.6 times increased relapse hazard for girls), high TPMT activity (P = .002), and high average neutrophil counts during maintenance therapy (P = .0009), with a significant interaction between sex and randomization group (P = .0007). For girls, the relapse risk was 5% in the control group and 19% in the pharmacology group (P = .001) because of an increased relapse hazard during the first year after cessation of therapy. TPMT activity was the most significant predictor of relapses among girls in the pharmacology arm (P < .0001). Overall, the TPMT activity was higher for patients who relapsed after cessation of therapy compared with those who stayed in remission (girls 19.5 v 17.4 U/mL, P = .03; boys 19.3 v 18.0 U/mL, P = .04). Conclusion: Adding pharmacologically guided treatment intensification to dose adjustments by blood counts may not be warranted for girls, whereas new approaches to optimize maintenance therapy are needed for boys.

scholarly journals High incidence and mortality of Pneumocystis jirovecii infection in anti-MDA5-antibody-positive dermatomyositis: experience from a single center

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Linlin Huang ◽  
Qiong Fu ◽  
Yan Ye ◽  
Yanwei Lin ◽  
Qingran Yan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Rheumatic Diseases ◽  
Cox Regression ◽  
Opportunistic Infections ◽  
Unmet Need ◽  
Pneumocystis Jirovecii ◽  
Cox Regression Analysis ◽  
Cell Counts ◽  
Incidence And Mortality ◽  
High Incidence

Abstract Background Idiopathic inflammatory myopathies (IIM) are associated with a significantly higher risk of opportunistic infections including Pneumocystis jirovecii pneumonia (PJP), a potentially fatal opportunistic infection. However, no prior studies have evaluated PJP infection in subtypes of IIM. Objectives To investigate the prevalence and mortality rate of PJP infection in subgroups of IIM patients stratified according to myopathy-specific antibodies. Methods In the first part of the study, 463 consecutive patients with IIM were prospectively followed for a period of at least 1 year to analyze the incidence of PJP. In the second part of the study, we enrolled 30 consecutive PJP patients with any rheumatic disease in order to identify the mortality rate and risk factors by Cox regression analysis. The Kaplan-Meier method with log-rank testing was used to assess differences in survival. Results The prevalence of PJP in IIM patients was found to be 3.0/100 person-years, while in MDA5+ DM patients it was 7.5/100 person-years and in MDA5− IIM patients 0.7/100 person-years (P < 0.05). PJP typically occurred in the first 2 months in the case of MDA5+ DM patients who had a significant decrease in their CD4+ T cell counts and lymphocyte counts (P < 0.05). In PJP patients, 3-month mortality was higher for MDA5+ DM patients than in those with other rheumatic diseases (83.3% vs 38.9%, P < 0.05). Alarmingly, MDA5+ DM patients seemed not to benefit from prompt anti-PJP treatment, unlike patients with other rheumatic diseases whose survival improved when anti-PJP treatment was started within 6 days (P < 0.05). Conclusion PJP has an alarming high incidence and mortality in MDA5+ DM patients. Timely treatment for PJP seems not to improve the prognosis of patients with this particular subtype. Hence, there remains a crucial unmet need to develop PJP prophylaxis for MDA5+ DM patients.

scholarly journals Lymphocyte subsets as a predictor of severity and prognosis in COVID-19 patients

2021 ◽  
Vol 35 ◽  
pp. 205873842110485
Author(s):  
Peng Zhang ◽  
Wei Du ◽  
Ting Yang ◽  
Lei Zhao ◽  
Richeng Xiong ◽  
...  
Keyword(s):  
T Cells ◽  
Blood Cell ◽  
Lymphocyte Subsets ◽  
Cox Regression ◽  
Hematological Parameters ◽  
Characteristic Curve ◽  
Hospital Death ◽  
Cox Regression Analysis ◽  
Cell Counts ◽  
Blood Cell Counts

Background Coronavirus disease 2019 (COVID-19) had become a worldwide health threat. Early prediction of the severity of COVID-19 patients was important for reducing death rate and controlling this disease. Methods and materials A total of 301 patients confirmed with COVID-19 in Wuhan from 8 February to 10 April 2020 were included. Clinical data were collected and analyzed. Diagnostic and prognostic utility of blood cell counts and lymphocyte subsets in COVID-19 patients were investigated. The receiver operator characteristic curve (ROC) was used in discriminating the mild and severe/critical cases. Results There were difference in blood cell counts and lymphocyte subsets among mild, severe and critical patients, which were also influenced by comorbidities and duration of disease. The area under the ROC of lymphocyte, CD3+ T cells, CD4+ T cells, and CD8+ T cells were 0.718, 0.721, 0.718, and 0.670, which were higher than that of other hematological parameters. The optimal threshold was 1205, 691, 402, and 177 per μl, respectively. Patients with higher counts of lymphocyte, CD3+ T cells, CD4+ T cells, or CD8+ T cells were correlated with shorter length of stay in hospital ( p < 0.05). Multivariable Cox regression analysis showed disease severity, CD3+ T cells counts and time when the nucleic acid turned negative were independent risk factors for in-hospital death of COVID-19 patients ( p < 0.05). Conclusion Blood cell counts and lymphocyte subsets correlated with severity of COVID-19.

scholarly journals Clinical Impact of the Maximum Mean Value of Home Blood Pressure on Cardiovascular Outcomes: A Novel Indicator of Home Blood Pressure Variability

Hypertension ◽  
2021 ◽  
Author(s):  
Takeshi Fujiwara ◽  
Satoshi Hoshide ◽  
Hiroshi Kanegae ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cox Regression ◽  
Mean Value ◽  
Home Blood Pressure ◽  
Antihypertensive Medications ◽  
Unique Identifier ◽  
Cox Regression Analysis ◽  
The Mean

We assessed the relationship between maximum mean home blood pressure (HBP) and incident cardiovascular disease risks in the general practice population of the J-HOP study (Japan Morning Surge-Home Blood Pressure), which recruited 4231 patients with cardiovascular risk factors (mean [SD] age: 65 [11] years; 53% women; 79% on antihypertensive medications) who measured their HBP in the morning and evening for 14 days. The first day’s HBPs were excluded. The average of morning and evening (the average of morning and evening value [MEave]) BP was defined as the average of all HBP values. The maximum mean HBP was defined as the highest value of mean HBP on one occasion. The variability independent of the mean of MEave BP was assessed. The MEave BP was 134/76 mm Hg; the maximum mean HBP was 156/88 mm Hg. Over a median 3.9-year follow-up (16 762 person-years), 72 stroke, and 76 coronary heart disease events occurred. A Cox regression analysis showed that the hazard ratios of a 1-SD increase in maximum mean home systolic BP (SBP; 95% CI) for incident stroke events were (1) 1.89 (1.23–2.89) including MEave SBP and (2) 1.68 (1.33–2.14) including the variability independent of the mean of MEave SBP. These significant associations were not observed for coronary heart disease events. Adding the maximum mean home SBP to the stroke prediction model significantly improved the discrimination: (1) MEave SBP: C statistics difference (95% CI), 0.019 (0.002–0.038); and (2) variability independent of the mean of MEave SBP: 0.031 (0.008–0.056). The maximum mean HBP could be a useful marker for evaluating the stroke risk of patients. REGISTRATION: URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000000894

scholarly journals Using a Local Early Warning Scoring System as a Model for the Introduction of a National System

2012 ◽  
Vol 11 (2) ◽  
pp. 66-73
Author(s):  
Charlotte Austen ◽  
◽  
Caroline Patterson ◽  
Alan Poots ◽  
Stuart Green ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Early Warning ◽  
Early Warning Score ◽  
Physiological Data ◽  
Convenience Sample ◽  
Assessment Unit ◽  
Conscious Level ◽  
Potential Failure ◽  
National Early Warning Score ◽  
And Training

Background: Chelsea and Westminster Hospital introduced the Chelsea Early Warning Score (CEWS) in 2007 to aid the recognition of acutely unwell patients. The Royal College of Physicians subsequently recommended a National Early Warning Score (NEWS) for implementation across the NHS. The aim of this study was to evaluate local adherence to CEWS to identify potential obstacles to the consistent implementation of NEWS. Method: Emergency Department (ED) and Acute Assessment Unit (AAU) notes were retrospectively reviewed for a convenience sample of 102 patients admitted to the AAU. Outcome measures were completeness of documentation of CEWS parameters, documentation and accuracy of aggregate CEWS scores. Aggregate NEWS scores were calculated from the documented observations and the calculated CEWS and NEWS scores were compared. Results: Physiological observations were documented for all patients attending the ED and AAU. Heart rate, blood pressure, respiratory rate, oxygen saturation and conscious level were documented in over 95% of ED and AAU patients. Urine output was recorded for only 48% of ED and 69% of AAU patients. Aggregate CEWS scores were documented for 66% of ED and 84% of AAU patients. These were calculated accurately in 73% of ED and 79% of AAU patients. Calculation errors were eleven times more likely to result in under-scoring than over-scoring. NEWS scores were significantly higher than CEWS for the same observations and would have resulted in a 71% increase in patients requiring escalation of care in the ED and a 116% increase in AAU. Conclusion: Concerns highlighted with CEWS were the incomplete and inaccurate recording of aggregate scores, with underscoring resulting in the potential failure to recognise deteriorating patients. It is anticipated that NEWS will be accompanied by standardised documentation and training across the NHS which will support more complete and accurate recording of physiological data. Furthermore, NEWS appears from this study to be more sensitive than CEWS, thereby minimising the chance of missed deterioration.

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