scholarly journals WILD FIRE RISK MAP IN THE EASTERN STEPPE OF MONGOLIA USING SPATIAL MULTI-CRITERIA ANALYSIS

2016 ◽  
Vol XLI-B1 ◽  
pp. 469-473 ◽  
Author(s):  
Elbegjargal Nasanbat ◽  
Ochirkhuyag Lkhamjav
Keyword(s):  
High Risk ◽  
Social Economic ◽  
Risk Index ◽  
Fire Risk ◽  
Low Risk ◽  
Moderate Risk ◽  
Validation Data ◽  
Risk Zone ◽  
Wildfire Risk ◽  
Very High

Grassland fire is a cause of major disturbance to ecosystems and economies throughout the world. This paper investigated to identify risk zone of wildfire distributions on the Eastern Steppe of Mongolia. The study selected variables for wildfire risk assessment using a combination of data collection, including Social Economic, Climate, Geographic Information Systems, Remotely sensed imagery, and statistical yearbook information. Moreover, an evaluation of the result is used field validation data and assessment. The data evaluation resulted divided by main three group factors Environmental, Social Economic factor, Climate factor and Fire information factor into eleven input variables, which were classified into five categories by risk levels important criteria and ranks. All of the explanatory variables were integrated into spatial a model and used to estimate the wildfire risk index. Within the index, five categories were created, based on spatial statistics, to adequately assess respective fire risk: very high risk, high risk, moderate risk, low and very low. Approximately more than half, 68 percent of the study area was predicted accuracy to good within the very high, high risk and moderate risk zones. The percentages of actual fires in each fire risk zone were as follows: very high risk, 42 percent; high risk, 26 percent; moderate risk, 13 percent; low risk, 8 percent; and very low risk, 11 percent. The main overall accuracy to correct prediction from the model was 62 percent. The model and results could be support in spatial decision making support system processes and in preventative wildfire management strategies. Also it could be help to improve ecological and biodiversity conservation management.

scholarly journals WILD FIRE RISK MAP IN THE EASTERN STEPPE OF MONGOLIA USING SPATIAL MULTI-CRITERIA ANALYSIS

2016 ◽  
Vol XLI-B1 ◽  
pp. 469-473
Author(s):  
Elbegjargal Nasanbat ◽  
Ochirkhuyag Lkhamjav
Keyword(s):  
High Risk ◽  
Social Economic ◽  
Risk Index ◽  
Fire Risk ◽  
Low Risk ◽  
Moderate Risk ◽  
Validation Data ◽  
Risk Zone ◽  
Wildfire Risk ◽  
Very High

Grassland fire is a cause of major disturbance to ecosystems and economies throughout the world. This paper investigated to identify risk zone of wildfire distributions on the Eastern Steppe of Mongolia. The study selected variables for wildfire risk assessment using a combination of data collection, including Social Economic, Climate, Geographic Information Systems, Remotely sensed imagery, and statistical yearbook information. Moreover, an evaluation of the result is used field validation data and assessment. The data evaluation resulted divided by main three group factors Environmental, Social Economic factor, Climate factor and Fire information factor into eleven input variables, which were classified into five categories by risk levels important criteria and ranks. All of the explanatory variables were integrated into spatial a model and used to estimate the wildfire risk index. Within the index, five categories were created, based on spatial statistics, to adequately assess respective fire risk: very high risk, high risk, moderate risk, low and very low. Approximately more than half, 68 percent of the study area was predicted accuracy to good within the very high, high risk and moderate risk zones. The percentages of actual fires in each fire risk zone were as follows: very high risk, 42 percent; high risk, 26 percent; moderate risk, 13 percent; low risk, 8 percent; and very low risk, 11 percent. The main overall accuracy to correct prediction from the model was 62 percent. The model and results could be support in spatial decision making support system processes and in preventative wildfire management strategies. Also it could be help to improve ecological and biodiversity conservation management.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

scholarly journals Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma

2020 ◽  
Vol 17 (24) ◽  
pp. 9233
Author(s):  
Cheng-Hsi Yeh ◽  
Shao-Chun Wu ◽  
Sheng-En Chou ◽  
Wei-Ti Su ◽  
Ching-Hua Tsai ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Risk Index ◽  
Risk Groups ◽  
Low Risk ◽  
Adult Patients ◽  
Nutritional Risk ◽  
Moderate Risk ◽  
Survival Group ◽  
Nutritional Risk Index

Background: Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. Methods: From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92–98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. Results: The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83–0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04–1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91–0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. Conclusions: This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.

Assessment of Heavy Metal Contamination in Sediments along the Jiangsu Lagoon

2013 ◽  
Vol 641-642 ◽  
pp. 211-214
Author(s):  
Zhao Xiang Han ◽  
Zhen Zhu ◽  
Dan Dan Wu
Keyword(s):  
High Risk ◽  
Ecological Risk ◽  
Heavy Metal Contamination ◽  
Risk Index ◽  
Potential Ecological Risk ◽  
Low Risk ◽  
Moderate Risk ◽  
Ecological Risk Index ◽  
Risk Indices ◽  
Medium Risk

Abstract: In this study we have worked on the evaluation of heavy metal contamination in the sediments taken from the Jiangsu lagoon and thereby used the Enrichment factor (EF), Pollution load index (PLI), Geoaccumulation index (Igeo), Potential ecological risk index (PERI), Potential ecological risk index (PERI), Potential toxicity response index (PTRI) and Risk assessment code (RAC) and the methods of statistical analysis. The average EF of Zn is found to be less than 2, and the average EF of Cu, Cr, Cd, Pb and Ni are found to be greater than 2 in Jiangsu lagoon.The EF for Pb, Cd and Cr are higher along the Jiangsu lagoon and harbor, which reveals the anthropogenic contribution to the increased content of the surface sediments of the Jiangsu coast. PLI values calculated for Yancheng suggest that this zone is appreciably less impacted by metal pollutants than Nantong. Zn (Igeo(mean)<0), as unpolluted to moderately polluted with Cu (0<Igeo(mean)<1), moderately polluted with Ni (1<Igeo(mean)<2), moderate to strongly polluted with Cd (2<Igeo(mean)<3), and strongly polluted with Cr and Pb (3<Igeo(mean)<4). The potential ecological risk indices of Cu, Zn and Ni in 9 stations in Lianyungang coast were lower than 40, which indicated slight potential ecological risk of three metals in 9 stations.Potential ecological risk indices of Cu, Zn and Cd in 9 stations in Yancheng lagoon were lower than 40, which indicated slight potential ecological risk of two metals in 9 stations. The sediments show a medium risk for Cu with PERI value greater than 40 indicating a moderate risk from sediments across the entire Nantong region. The amount of Cu and Ni with low risk, while Cd with moderate, with high risk in Lianyungang coast. Cu, Zn and Cd with low risk, while Cr and Ni with moderate risk, but, the Pb with very high risk in Yancheng coast. Cu and Zn with low risk, Cr and Ni with medium risk, Pb,Cd with high risk in Nantong coast.

scholarly journals Nutritional Risk and Health-Related Quality of Life in Older Adults Aging With HIV

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 954-954
Author(s):  
Nicole Viviano ◽  
Ann Gruber-Baldini ◽  
Sarah Schmalzle ◽  
Kristen Stafford ◽  
Sarah Chard ◽  
...  
Keyword(s):  
High Risk ◽  
Low Risk ◽  
Nutritional Risk ◽  
Moderate Risk ◽  
Related Quality ◽  
Health Related ◽  
Mental Hrqol ◽  
Physical Hrqol ◽  
Very High

Abstract Due to antiretroviral treatment success, individuals with HIV are living longer. People aging with HIV (PAWH, 50+) may be more likely to experience nutritional risk compared to their HIV-negative counterparts due to biopsychosocial factors. The DETERMINE checklist measure accounts for social and economic factors as well as aspects of the aging process that are not typically considered when examining nutritional risk and are important for PAWH. The current study examined nutritional risk and health-related quality of life (HRQoL) in PAWH using the DETERMINE checklist and PROMIS t-scores (mental and physical HRQoL) through secondary analyses of 158 participants in the Strengthening Therapeutic Resources in Older patients agiNG with HIV (STRONG) study. DETERMINE nutritional risk scores (0-21) were separated into 4 groups (low-risk [0-2, n=13], moderate-risk [3-5, n=28], high-risk [6-12, n=78], very high-risk [13-21, n=39]). The sample was 55% male, 94% Black/African American and had a mean age=59 (SD=5.5). Most of the sample (74%) were at high or very high nutritional risk and low HRQoL t-score: physical M=43.7 (SD=9.5), and mental M=45.7 (SD=10.1). Mental and physical HRQoL were significantly (p&lt;.001) associated with nutritional risk group as tested through linear regressions. Means were as follows: physical HRQoL low-risk M=53.4 (SD=10.6), moderate-risk M=47.4 (SD=8.9), high-risk M=43.5 (SD=8.1), very high-risk M=38.4 (SD=8.9); mental HRQoL low-risk M=54.0 (SD=8.9), moderate-risk M=49.1(SD=7.9), high-risk M=46.1(SD=9.5), and very high-risk M=39.5 (SD=9.7). These associations remained significant after controlling for age and sex. Higher nutritional risk as measured by the DETERMINE checklist in PAWH was associated with poorer physical and mental HRQoL.

scholarly journals AB0613 FREQUENCY AND RISK OF FRAGILITY FRACTURES IN PATIENTS WITH SYSTEMIC SCLEROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1342.1-1342
Author(s):  
A. Efremova ◽  
O. Nikitinskaya ◽  
N. Toroptsova ◽  
O. Dobrovolskaya ◽  
N. Demin
Keyword(s):  
High Risk ◽  
Fracture Risk ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Low Risk ◽  
Moderate Risk ◽  
Major Osteoporotic Fractures ◽  
Fracture Risk Assessment Tool ◽  
History Of ◽  
Very High

Background:Objectives:To assess the frequency of fragility fractures and the 10-year risk of major osteoporotic fractures using the fracture risk assessment tool (FRAX) tool in patients with systemic sclerosis (SSc).Methods:The study included 136 patients with SSc who met the ACR/EULAR 2013 criteria: 110 (80.9%) postmenopausal women and 26 (19.1%) men over 50 years of age, mean age 59,3 + 7.5 years. The duration of the disease was 10,0 [6.0; 15.0] years in women and 6,0 [3.5; 9.0] years in men. A questionnaire was conducted and the risk of major osteoporotic fractures was calculated according to FRAX tool, as a result of which patients were divided into groups of low, moderate or high risk. Individuals at moderate risk underwent dual-energy X-ray absorptiometry (DXA) of the proximal femur, followed by a 10-year probability of major osteoporotic fractures recalculation with the inclusion of the femoral neck T-score. According to the obtained fracture risk assessment tool value, patients were assigned as having a low, high or very high risk.Results:Fragility fractures of various localization were found in 50 (36,7%) people: 41 (37,3%) women and 9 (34.6%) men. Vertebral and peripheral bone fractures occurred with the same frequency (19,8%) without significant differences depending on the patient’s gender. Only 1 (3,8%) male had a history of proximal femoral fracture. Fractures of both the vertebra and the peripheral bone occurred in 4 (2,9%) people: 3 (2,7%) women and 1 (3,8%) man.9 (8,2%) women and 16 (61,5%) men had a low risk of major osteoporotic fractures according to FRAX, 60 (54,5%) and 10 (38,5%) - a moderate risk, respectively, while 41 (37,3%) women were at high risk. Among 86 patients without a history of low-energy fractures (69 women and 17 men), 8 (11,6%) women and 16 (94,1%) men were at low risk of major osteoporotic fractures, and 57 (82,6%) and 1 (5,9%), respectively, were at moderate risk. Only 4 (5,8%) women were assigned to the high-risk group. After recalculation of the fracture risk assessment tool with inclusion of the femoral neck T-score in persons with moderate risk without a history of fragility fractures, 9 (13,0%) women and 1 (5,9%) man were found to be at high risk, 14 (20,3%) women - at very high risk and 34 (49,3%) women - at low risk.Among moderate-risk patients with prior fractures after FRAX recalculation 3 (7,3%) women and 7 (77,8%) men became at low risk, 1 (11,1%) male - at high and 1(11,1%) male – at very high risk. Thus, 55 (50,0%) women and 1 (3,8%) man were at very high, 12 (10,9%) and 2 (7,7%), respectively, - at high, and 43 (39,1%) and 23 (88,5%), respectively, - at low risk of major osteoporotic fractures.Conclusion:In the examined cohort of patients with SSc, the frequency of fragility fractures was 37,3% in women and 34,6% in men. A high and very high risk of major osteoporotic fractures was found in 60,9% of women and 11,5% of men. 3 (2,7%) women and 6 (23,1%) men with a history of previous fractures were in the low-risk group by FRAX, but they need to consider the appointment of anti-osteoporotic therapy as for patients at high and very high risk.Disclosure of Interests:None declared.

scholarly journals Wildfire Risk Zonation of Sudurpaschim Province, Nepal

2020 ◽  
Vol 17 ◽  
pp. 155-173
Author(s):  
Bikram Singh ◽  
Menuka Maharjan ◽  
Mahendra Singh Thapa
Keyword(s):  
Deciduous Forest ◽  
Temporal Distribution ◽  
Fire Risk ◽  
Moderate Risk ◽  
Wildfire Management ◽  
Risk Zone ◽  
Wildfire Risk ◽  
Risk Zonation ◽  
Risk Zones ◽  
Physiographic Regions

Wildfire is one of the major destructive hazards which have significant effect on environment, society, and economy. However, limited studies have been carried out on spatial and temporal distribution of wildfire, especially in developing countries like Nepal. The objective of this study was to assess wildfire risk zonation of Sudurpaschim province of Nepal by applying Remote Sensing and GIS. Sudurpaschim province has been divided into four fire risk zones i.e., high, moderate, low and no risk zone. In Sudurpaschim province, about 30.84% area falls under high fire risk zone followed by moderate risk (58.30%), low risk (10.13%) and no risk (0.72%). Among five physiographic regions, Siwalik region is more susceptible to fire due to various factors, such as deciduous forest, topography, terrain, etc. From 2012 to 2019, about 44,342 fire incidences were reported in this province. Approximately 88% wildfire was recorded in spring, the season being dry. Overall, geographically Siwalik region and temporarily spring season should be in high priority for developing and implementing wildfire management activities in Sudurpaschim province.

Impact of Refined Disease Risk Index after Single and Double Umbilical Cord Blood Transplantation in Adults with Hematological Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3484-3484
Author(s):  
Annalisa Paviglianiti ◽  
Annalisa Ruggeri ◽  
Guillermo Sanz ◽  
Noel Milpied ◽  
Didier Blaise ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Risk ◽  
Risk Index ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Large Cohort ◽  
Low Risk ◽  
Advisory Committees ◽  
Blood Transplantation ◽  
Very High

Abstract Identifying pre-transplant risk factor before allogeneic transplantation (HSCT) is important, regardless of the graft source. Nonetheless, it has been demonstrated that disease type and status at the time of HSCT significantly affect outcome. Disease risk index (DRI) has been recently defined for stratifying large and heterogeneous cohorts of patients (pts) undergoing HSCT. The original DRI included all hematological malignancies (except very rare diseases) and was able to define 4 distinct groups with different outcomes, dividing patients by disease type and status and considering cytogenetics that turned to be determinant for acute myeloid leukemia and myelodysplastic syndromes (MDS). Recently, DRI was refined by including rare diseases and improving MDS stratification by blast percentage, cytogenetics and response to prior therapy. DRI has been demonstrated to be applicable to pts undergoing HSCT regardless of age, conditioning regimen and graft source, and it has also been validated in pts undergoing T-cell depleted HSCT. Currently, there are no available reports on large cohort of pts undergoing umbilical cord blood transplantation (UCBT). Our aim was to determine the impact of DRI after UCBT. We retrospectively analyzed 2337 adults who underwent UCBT between 2004 and 2014, were reported to Eurocord and had available data for DRI scoring. Diagnosis was acute leukemia (AL) in 66% of the cases; 56% of AL were transplanted in first complete remission (CR), 39% in CR2 and 6% in >CR2. The median age at UCBT was 43 (range 18-76) years. Cytomegalovirus (CMV) serology was positive in 62% of pts; 45% of pts were female. Performance status at UCBT was <90% in 56% of pts and >90% in 44%. Fifty-two percent of pts received double and 48% single UCBT. Conditioning regimen was reduced intensity (RIC) for 52% of pts, and the most common regimen was cyclophosphamide+fludarabine+low dose total body irradiation (2Gy) for 72% of pts. Cyclosporine A (CsA) and mycophenolate mofetil (MMF) were used for graft-versus-host-disease (GVHD) prophylaxis in 61% of the pts. Anti-thymocyte globulin (ATG) was given in 41% of pts. Median TNC at cryopreservation was 4.2 x 107/Kg (range 0.4-13) and 56% of pts received a graft with 2or more HLA mismatches.The median follow-up was 30 (range 1-120) months. Overall survival (OS) and progression free survival (PFS) were 44% and 38% at 2 years, respectively. Refined DRI stratified pts in 4 subgroup (low risk, n=352, intermediate, n=1303, high, n=544, and very high-risk, n=138). OS was 56±3% for pts with low-risk DRI, 48±2% for intermediate-risk DRI, 31±2% for pts with high-risk DRI and 26±4% for pts with very high-risk DRI (p <0.0001). PFS was 46±3%, 42±2%, 25±2%, 22±4% for low, intermediate, high and very-high risk, respectively (p <0.0001). According toconditioning intensity regimen and DRI, OS was 49% (for low risk), 47% (for intermediate), 29% (for high risk) and 20% (for very high risk) (p< 0.0001) for myeloablative (MAC) regimen and 60% (for low risk), 49% (for intermediate), 33% (for high risk) and 32% (for very high risk) for RIC (p < 0.0001). DRI was also statistically associated with different PFS stratifying for type of conditioning regimen (MAC and RIC)(p <0.0001). In multivariate analysis adjusted for ATG use, CMV serology, DRI, median age at UCBT, median TNC at cryopreservation and type of UCBT (single or double), ATG use (HR=1.52, CI 95%=1.3-1.7, p< 0.0001), age at UCBT (median) (HR=1.4, CI 95%=1.2-1.6, p <0.001), very-high DRI (HR=2.7, CI 95%=2-3.7, p< 0.001), positive CMV serology (HR=1.2, CI 95%=1.07-1.4, p 0.03) were associated with a decreased OS. Furthermore, ATG use (HR=1.4, CI 95%=1.2-1.5, p< 0.0001), age at UCBT (median) (HR=1.3, CI 95%=1.2-1.5, p <0.0001), very-high DRI (HR=2.2, CI 95%=1.6-3, p< 0.0001), positive CMV serology (HR=1.2, CI 95%=1.04-1.4, p 0.008) were associated with decreased PFS. Refined DRI is a valid system for risk-stratifying pts with different diseases undergoing UCBT in retrospective large cohort studies. This index represents a simple and robust means of stratifying large cohort of pts in the UCBT setting, complementary to other existing pre-transplant index. Our results confirm the prognostic value of refined DRI in UCBT and support the use of this simple tool for prospective trials in the future. Disclosures Bloor: Janssen: Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; GSK: Consultancy, Speakers Bureau; Gilead: Honoraria; Abbvie: Membership on an entity's Board of Directors or advisory committees.

Validation and Refinement Of The Disease Risk Index For Stratification Of Patients Undergoing Allogeneic Stem Cell Transplantation: A Study Of 13,131 Patients From The Center For International Blood & Marrow Transplant Research

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 548-548
Author(s):  
Philippe Armand ◽  
Haesook T. Kim ◽  
Brent R. Logan ◽  
Zhiwei Wang ◽  
Edwin P. Alyea ◽  
...  
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
High Risk ◽  
Hodgkin Lymphoma ◽  
Disease Risk ◽  
Early Stage ◽  
Risk Index ◽  
Low Risk ◽  
Advanced Stage ◽  
Very High

Abstract Disease type and status at the time of allogeneic hematopoietic stem cell transplantation (HSCT) dominantly influence HSCT outcome. It is therefore important to stratify patients by disease risk in any retrospective or prospective transplantation study that enrolls patients across multiple disease types or status. We previously proposed a Disease Risk Index for this purpose, based on a retrospective study of patients transplanted at 2 institutions (Armand et al, Blood 2012;120:905). Here we present the results of a study designed to validate and refine the DRI in a larger multicenter population. We included 13,131 adult patients who underwent HSCT for hematologic malignancies, excluding very rare diseases, between 2008 and 2010 and were reported to the CIBMTR. Their median age was 52 (range, 18-80) years. The cohort included a broad representation of diseases, disease status, donor types, and graft sources. 53% of patients were conditioned with a myeloablative regimen. The median follow-up for survivors was 24 months. The original DRI stratified patients into 4 groups with 2y OS of 64% in the low-risk, 51% in the intermediate, 34% in the high, and 24% in very high risk group (p<0.0001). DRI group was the most important prognostic factor in multivariable analysis, with a hazard ratio (HR) for mortality of 1.5, 2.3 and 3.0 for the intermediate, high and very high risk groups respectively compared to the low risk group (p<0.0001 for all). In addition, the DRI retained its discriminatory ability across all graft source, age, donor type, and conditioning intensity groups. The large cohort size also allowed us to examine each possible disease/status combination, which we used to refine the original DRI. We created 4 broad risk groups based on a multivariable model containing all possible such combinations, with cutoffs based on proportional increments in the hazard for mortality in comparison to AML with intermediate cytogenetics in 1stcomplete remission. Each broad group, except for the very high risk one, could be further divided into 2 subgroups with significantly different OS, yielding a 7-group index for use with larger cohorts. This revised DRI (Table and Figure) outperformed the original DRI and other existing stratification systems based on a calculation of the c-statistic. We propose that this revised DRI could be used for risk stratification in retrospective studies, in the analysis of clinical trial results, and in the adjustment of disease risk for the Stem Cell Therapeutic Outcomes Database. Table DISEASE and STAGE DRI Subgroup % pts 2yOS (95CI) DRI Group % pts 2yOS (95CI) Hodgkin Lymphoma, Indolent B-NHL, MCL or CLL, any CR Low-1 4% 74% (69-78) Low 14% 66% (63-68) Indolent B-NHL or CLL, PR Low-2 10% 62% (59-65) AML Favorable cyto ,any CR CML, Chronic Phase T-NHL, any CR Int-1 51% 52% (51-54) Int 62% 51% (50-52) ALL, 1st CR AML Intermediate cyto, any CR Myeloproliferative neoplasms, Any Stage Low-risk MDS, Any cyto, Early Stage* Multiple myeloma, CR/VGPR/PR Aggressive B-NHL, any CR Hodgkin lymphoma or MCL, PR Aggressive B-NHL or T-NHL, PR Int-2 11% 46% (43-49) Low-risk MDS Int cyto ,Advanced Stage or High-risk MDS Int cyto, Early Stage CML, Advanced Phase Indolent B-NHL or CLL, Advanced Stage* Aggressive NHL, PR High-risk MDS Int cyto, Advanced Stage* High-1 6% 39% (36-43) High 20% 33% (31-35) AML Favorable cyto, Advanced Stage* Burkitt lymphoma, CR AML Adverse cyto, CR ALL, 2nd CR High-risk MDS Adv cyto, Any Stage or Low-risk MDS Adv cyto Advanced Stage* High-2 14% 31% (28-33) Hodgkin Lymphoma, MCL or T-cell NHL, Advanced Stage* ALL, 3rd or higher CR Multiple myeloma, Advanced Stage* AML Intermediate cyto, Advanced Stage* CML, Blast Phase Very High 4% 23% (20-27) Very High 4% 23% (20-27) ALL, Advanced Stage* Aggressive NHL, Advanced Stage* AML Adv cyto, Advanced Stage* Burkitt lymphoma, PR or Advanced Stage* * Advanced stage is induction failure or active relapse, including stable or progressive disease for lymphoma and CLL; for MDS, early stage is untreated, CR, or improvement with therapy without CR. MCL, mantle cell lymphoma; cyto, cytogenetics (classified as in original DRI except that complex karyotype was defined as >3 abnormalities for both MDS and AML and t(8;21) was favorable for AML); int, intermediate; adv, adverse; pts, patients; OS, overall survival. Figure Overall Survival in the Entire Cohort, Stratified by revised DRI. A. DRI overall groups; B. DRI subgroups. Figure. Overall Survival in the Entire Cohort, Stratified by revised DRI. A. DRI overall groups; B. DRI subgroups. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Key factor cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults: the role of physical fitness, body composition, physical activity, health condition, and environmental hazards

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
Catarina Pereira ◽  
Guida Veiga ◽  
Gabriela Almeida ◽  
Ana Rita Matias ◽  
Ana Cruz-Ferreira ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Physical Fitness ◽  
Reference Values ◽  
Fall Risk ◽  
Community Dwelling ◽  
Low Risk ◽  
Moderate Risk ◽  
Community Dwelling Older Adults ◽  
Very High

Abstract Background Fall risk assessment and determination of older adults’ individual risk profiles are crucial elements in fall prevention. As such, it is essential to establish cutoffs and reference values for high and low risk according to key risk factor outcomes. This study main objective was to determine the key physical fitness, body composition, physical activity, health condition and environmental hazard risk outcome cutoffs and interval reference values for stratified fall risk assessment in community-dwelling older adults. Methods Five-hundred community-dwelling Portuguese older adults (72.2 ± 5.4 years) were assessed for falls, physical fitness, body composition, physical (in) activity, number of health conditions and environmental hazards, and sociodemographic characteristics. Results The established key outcomes and respective cutoffs and reference values used for fall risk stratification were multidimensional balance (low risk: score > 33, moderate risk: score 32–33, high risk: score 30–31, and very high: score < 30); lean body mass (low risk: > 44 kg, moderate risk: 42–44 kg, high risk: 39–41 kg, and very high: < 39 kg); fat body mass (low risk: < 37%, moderate risk: 37–38%, high risk: 39–42%, and very high: > 42%); total physical activity (low risk: > 2800 Met-min/wk., moderate risk: 2300–2800 Met-min/wk., high risk: 1900–2300 Met-min/wk., and very high: < 1900 Met-min/wk); rest period weekdays (low risk: < 4 h/day, moderate risk: 4–4.4 h/day, high risk: 4.5–5 h/day, and very high: > 5 h/day); health conditions (low risk: n < 3, moderate risk: n = 3, high risk: n = 4–5, and very high: n > 5); and environmental hazards (low risk: n < 5, moderate risk: n = 5, high risk: n = 6–8, and very high: n > 8). Conclusions Assessment of community-dwelling older adults’ fall risk should focus on the above outcomes to establish individual older adults’ fall risk profiles. Moreover, the design of fall prevention interventions should manage a person’s identified risks and take into account the determined cutoffs and respective interval values for fall risk stratification.

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