prognostic scoring systems
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2021 ◽  
Vol 14 (4) ◽  
pp. 1941-1953
Author(s):  
Nahla A. Mohamed ◽  
Eman Refaat Youness

Sepsis is a systemic inflammatory disorder that may be associated with higher rate of morbidity and mortality in pediatric patients admitted to intensive care unit with sepsis. Usage of different biomarkers may be helpful for early detection and appropriate management of sepsis. Our objectives was to investigate the role of serum lactate dehydrogenase in prediction of sepsis in critical pediatric patients, and its relation with prognostic scoring systems. A prospective cohort study was conducted at El Galaa teaching hospital between January 2020 and December 2020. A total of 168 pediatric patients were divided into the septic group (84) critically ill patients with sepsis from the pediatric intensive care unit (PICU)] and control group (84 stable patients admitted to the inpatient word). Demographic and clinical data were collected, routine laboratory investigation including LDH on admission and after 24 hours were performed. Pediatric Risk of Mortality III (PRISMIII) and Sequential Organ Failure Assessment (pSOFA) were assessed. Serum LDH level was significantly higher in septic group than control (P=0.000) and in non-survivor than survivor group (P=0.000). Also there was statistically significant correlation between survivor and non-survivor as regarding length of hospitality, pSOFA score and PRISMIII score. There was statistically significant positive correlation between LDH, PRISMIII (r=0.842, P<0.001) and pSOFA (r=0.785, P<0.001). We concluded that LDH is a useful marker in predicting of sepsis in critically ill pediatric patients especially when combined with prognostic scoring systems.


Hematology ◽  
2021 ◽  
Vol 2021 (1) ◽  
pp. 428-434
Author(s):  
Amy E. DeZern

Abstract Risk stratification is crucial to the appropriate management of most cancers, but in patients with myelodysplastic syndromes (MDS), for whom expected survival can vary from a few months to more than a decade, accurate disease prognostication is especially important. Currently, patients with MDS are often grouped into higher-risk (HR) vs lower-risk (LR) disease using clinical prognostic scoring systems, but these systems have limitations. Factors such as molecular genetic information or disease characteristics not captured in the International Prognostic Scoring System–Revised (IPSS-R) can alter risk stratification and identify a subset of patients with LR-MDS who actually behave more like those with HR-MDS. This review describes the current identification and management of patients with LR-MDS whose condition is likely to behave in a less favorable manner than predicted by the IPSS-R.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4574-4574
Author(s):  
Marilia Gomes ◽  
Sara Duarte ◽  
Carolina Afonso ◽  
Dulcelena Neves ◽  
Bárbara Almeida Marques ◽  
...  

Abstract Background: Diffuse large B cell Lymphoma (DLBCL), the most common non-Hodgkin lymphoma, is a clinical and biological heterogeneous entity. R-CHOP is the standard treatment, however 30%-40% of DLBCL patients will have primary refractory or relapsed disease. Several prognostic scoring systems, that include simple clinical parameters, have been developed to assist risk stratification and treatment decisions, namely the International Prognostic Index (IPI), the National Comprehensive Cancer Network IPI (NCCN-IPI) and the GELTAMO-IPI. However, the accurate identification of very high-risk patients is not accomplished by these scores. Recently, the Kyoto Prognostic Index (KPI) was able to identify an extremely poor prognostic group in a Japanese cohort and was proposed as a new robust prognostic model for DLBCL. Our aim was to assess the discriminative performance of IPI, NCCN-IPI and GETALMO-IPI in overall survival (OS) and progression-free survival (PFS) and compare them with the new score KPI, in a cohort of DLBCL patients treated with immunochemotherapy. Methods: Retrospective analysis of HIV-negative DLBCL patients, newly diagnosed between 2010 and 2019 in a single tertiary center, treated with R-CHOP/R-CHOP-like protocol. The Kaplan-Meier method was used to estimate the probabilities of OS and PFS. Stratified models for each of the risk scores (IPI, NCCN-IPI, GELTAMO-IPI and KPI) were compared using Akaike's information criterion (AIC) and the Harrell's concordance index (C-index). The inter-score classification concordance was evaluated by Cohen's kappa test. P-value&lt;0.05 was considered statistically significant. Results: We included 232 patients, 52.6% (n=122) male, with a median age of 64 years (22-87). According to IPI, patients classified as Low (L), Low-Intermediate (LI), High-Intermediate (HI) and High (H) were 73 (31.47%), 59 (25.43%), 63 (27.16%) and 37 (15.95%), respectively. According to NCCCN-IPI, patients classified as L, LI, HI and H were 23 (9.91%), 94 (40.52%), 89 (38.46%) and 26 (11.21%), respectively. GETALMO-IPI was calculated in 170 of 232 patients, classified as L, LI, HI and H in 14 (8.24%), 119 (70.0%), 22 (12.94%) and 15 (8.82%), respectively. According to KPI, patients classified as L, LI, HI and H were 67 (28.88%), 122 (52.59%), 31 (13.36%) and 12 (5.17%), respectively. Between KPI and IPI, a fair concordance was observed (kappa 0.363; with only 10 [27%] IPI-H patients classified as KPI-H, and 10 [83.3%] patients KPI-H as IPI-H). Slight concordance was observed between KPI and NCCN-IPI (kappa 0.115; 9 [34.6%] patients NCNN-IPI-H classified as KPI-H, and 9 [75%] patients KPI-H as NCCN-IPI-H), as well as between KPI and GELTALMO-IPI-H (kappa 0.175; 6 [40%] patients GELTALMO-IPI-H classified as KPI-H, and 6 [60%] patients KPI-H as GELTALMO-IPI-H). With a median follow-up of 55.2 months, 5-year median OS and PFS for the global cohort were not reached (NR) and 128.2 months, respectively. All the scores identify different prognosis groups for OS and PFS, although with modest ability to distinguish between intermediate and high-risk groups (Table 1; Figure 1). GELTAMO-IPI provided the best fit for the data in both OS and PFS (AIC 479.4 and 631.0, respectively) followed by NCCN-IPI (AIC 727.3 and 933.8) and IPI (AIC 738.3 and 937.9), while KPI had the worst performance (AIC 745.6 and 943.7). NCCN-IPI discriminated better between patients with poor and favorable OS (C-index 0.667), compared with the remaining scores (C-index for IPI, GELTAMO-IPI and KPI 0.653, 0.647 and 0.612, respectively). Concerning PFS, IPI had the best discrimination capacity (C-index 0.6313), followed by NCCN-IPI (C-index 0.6232), GELTAMO-IPI (C-index 0.6086) and KPI (C-index 0.5940). Conclusions: In our cohort, GELTAMO-IPI had the best fit to the observed data regarding OS and PFS. NCCN-IPI and IPI discriminated better between patients with poor and favorable OS and PFS, respectively, although the differences in the C-index were small, and all scores exhibited an acceptable difference between short and long survival times. KPI did not seem to improve the capacity for predicting OS and PFS in our population, which could be explained by differences in pathophysiology and genetics of DLBC of Asian and Western patients. Novel risk scores that integrate molecular tumor features might help improve risk stratification, especially in high-risk group. Figure 1 Figure 1. Disclosures Gomes: Takeda: Consultancy; Gilead: Consultancy; Janssen: Consultancy.


Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5324
Author(s):  
Rita Campanelli ◽  
Margherita Massa ◽  
Vittorio Rosti ◽  
Giovanni Barosi

Primary myelofibrosis (PMF) is a myeloproliferative neoplasm due to the clonal proliferation of a hematopoietic stem cell. The vast majority of patients harbor a somatic gain of function mutation either of JAK2 or MPL or CALR genes in their hematopoietic cells, resulting in the activation of the JAK/STAT pathway. Patients display variable clinical and laboratoristic features, including anemia, thrombocytopenia, splenomegaly, thrombotic complications, systemic symptoms, and curtailed survival due to infections, thrombo-hemorrhagic events, or progression to leukemic transformation. New drugs have been developed in the last decade for the treatment of PMF-associated symptoms; however, the only curative option is currently represented by allogeneic hematopoietic cell transplantation, which can only be offered to a small percentage of patients. Disease prognosis is based at diagnosis on the classical International Prognostic Scoring System (IPSS) and Dynamic-IPSS (during disease course), which comprehend clinical parameters; recently, new prognostic scoring systems, including genetic and molecular parameters, have been proposed as meaningful tools for a better patient stratification. Moreover, new biological markers predicting clinical evolution and patient survival have been associated with the disease. This review summarizes basic concepts of PMF pathogenesis, clinics, and therapy, focusing on classical prognostic scoring systems and new biological markers of the disease.


Author(s):  
Omer M. Farhan-Alanie ◽  
Taegyeong Tina Ha ◽  
James Doonan ◽  
Ashish Mahendra ◽  
Sanjay Gupta

Abstract Introduction Limb-sparing surgery with negative margins is possible in most soft tissue sarcoma (STS) resections and focuses on maximising function and minimising morbidity. Various risk factors for surgical site infections (SSIs) have been reported in the literature specific to sarcoma surgery. The aim of this study is to determine whether systemic inflammatory response prognostic scoring systems can predict post-operative SSI in patients undergoing potentially curative resection of STS. Methods Patients who had a planned curative resection of a primary STS at a single centre between January 2010 and December 2019 with a minimum follow-up of 6 months were included. Data were extracted on patient and tumour characteristics, and pre-operative blood results were used to calculate inflammatory prognostic scores based on published thresholds and correlated with risk of developing SSI or debridement procedures. Results A total of 187 cases were included. There were 60 SSIs. On univariate analysis, there was a statistically significant increased risk of SSI in patients who are diabetic, increasing specimen diameter, American Society of Anaesthesiology (ASA) grade 3, use of endoprosthetic replacement, blood loss greater than 1 L, and junctional tumour location. Modified Glasgow prognostic score, C-reactive protein/albumin ratio and neutrophil–platelet score (NPS) were statistically associated with the risk of SSI. On multivariate analysis, ASA grade 3, junctional tumour location and NPS were independently associated with the risk of developing a SSI. Conclusion This study supports the routine use of simple inflammation-based prognostic scores in identifying patients at increased risk of developing infectious complications in patients undergoing potentially curative resection of STS.


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