Role of Chest Tomography Combined With Prognostic Indices for Severity Classification in Patients With SARS-CoV2 Pneumonia. Beyond Vaccination There Are Disease.

The initial evaluation of patients with COVID-19 represents a challenge to regulate a decision in preventive and timely management. There are various proposals as support tools that deserve to be evaluated.Aim. Evaluation of Chest CT Score performance and prognostic indices in COVID-19 patients to predict progress to critical illness.Methods. This was a retrospective study run from April to December 2020. Patients of any age and gender and who required hospitalization due to a confirmed diagnosis of COVID-19 by RT-PCR and Chest CT, were included. Demographic, characteristics prognosis indexes and laboratory were analyzed. Patients with acute coronary ischemic syndrome (ACS), acute heart failure, those who developed critical illness in the first 24 hours, and those with no RT-PCR result were excluded. Critical illness was defined by the need for supplemental oxygen and / or death during the hospitalization.Results. 109 patients were included. The mean age was 53.88 ± 13.51 years. In 75% of them, there was at least one comorbidity and 30% developed critical illness. In 49.5% there was a CORADS-5 on admission, and in 50% there was a peripheral distribution of the interstitial infiltrate in the left lower lobe. The risk factors were FiO2, CT Score> 18 and the NRL index. The combination of the High risk qCSI plus CT score> 18 indices was the best prediction index for development of a critical condition. Average mortality was 10%.Conclusion. The combined use of indices in patients infected with SARSCoV2 shows diagnostic accuracy and predicts severity.

Prognostic Indices of Surgical Outcome in Cervical Spondylotic Myelopathy: A Clinical Prospective Study

BACKGROUND: One of the most common causes of spinal cord dysfunction is cervical spondylotic myelopathy (CSM) especially in the elderly. Prognostic indices can aid the surgeon preoperatively to detect the patients’ prognosis. AIM: The aim of the work is to better assess patients and to find possible indicators for post-operative improvement or deterioration in CSM patients. METHODS: Forty patients with multiple levels CSM, admitted and operated on in the Neurosurgery Department of Cairo University Hospitals, have been enrolled randomly in this study after fulfilling the criteria for CSM surgical intervention. The patient age, complaint duration, number of levels affected, signal intensity on T1-weighted and T2-weighted magnetic resonance (MR) images, Japan Orthopedic Association (JOA) scoring system, and Nurick’s score were evaluated before surgery and correlated with outcome after 1 year follow-up. RESULTS: About 80% of patients improved after operation with average pre- and post-operative JOA and Nurick scores about 11.23 and 3.12; 14.1 and 1.6, respectively. Patient age, sex, number of levels affected, and signal intensity on T1- weighted and T2-weighted MR images were not significantly associated with post-operative improvement, p > 0.05. However, the only significant prognostic factor was the duration of symptoms if less than 1 year with p < 0.05. CONCLUSION: Short complaint duration coupled with close intra-operative monitoring was directly correlated with good CMS operation outcome while age, sex, number of levels affected, presence of cord signal on MR imaging, and surgical approach appear to have no significant effect on outcome.

Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75

Rational and objective Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. Study design Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance (“c”)-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. Setting & participants Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. Established predictors Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality. Results In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. Limitations Small sample size, use of secondary data, need for imputation, homogeneous population. Conclusion Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.