RESUMO
BACKGROUND: Accurately predicting postoperative outcomes is fundamental to informed clinical decision-making, and alignment of patient and family expectations. The AMPREDICT Decision Support Tool is a predictive tool designed to assess the probability of mortality 1 year after major and minor amputations. We aimed to evaluate the prognostic accuracy of AMPREDICT in our Veteran patient population. METHODS: Retrospective review of lower extremity amputations completed at the West Los Angeles Veterans Affairs hospital from 2000 to 2020. Staged open amputations and previous minor amputations were excluded. Using the AMPREDICT tool, the probability of mortality 1 year postsurgery for single-stage transfemoral and transtibial amputations was calculated, then compared with observed patient outcomes. Observed to predicted mortality was compared through boxplots, at 1 year after surgery, confidence intervals were calculated, and group means were compared using Student's t-test. Receiver operator curves were constructed to assess discriminatory capacity of the tool. Significance was set at P < 0.05. RESULTS: Four hundred twenty three patients underwent 650 lower extremity amputations during our study period. Two hundred sixty seven patients underwent single-stage transfemoral or transtibial amputations comprising our study cohort. The average age at amputation was 66 years with an average age of death at 71 years. AMPREDICT tool's prognostic capability varied across the 2 amputations studied. For single-staged transfemoral amputations, prediction aligned closely with observed outcomes, as indicated by a significant P value of 0.0002 (confidence interval 12.73-36.37). For single-stage transtibial amputations, the predictions were also significant, P value 0.0017 (confidence interval 5.25-21.20), although had a wider prediction range. CONCLUSIONS: Our study confirms the reliability of the AMPREDICT tool in predicting 1-year mortality for patients undergoing major lower limb amputations. The predictive accuracy was found to be statistically significant for both single-staged transfemoral and transtibial amputations. These findings suggest that AMPREDICT may be a valuable tool in the clinical setting for patients undergoing major lower limb amputation.
RESUMO
Two colorimetric broth microdilution antifungal susceptibility tests were compared, Sensititre YeastOne and MICRONAUT-AM for nine antifungal agents. One hundred clinical Candida isolates were tested, representing a realistic population for susceptibility testing in daily practice. The reproducibility characteristics were comparable. Only for fluconazole, caspofungin, 5-flucytosine and amphotericin B, an essential agreement of ≥90% could be demonstrated. Sensititre minimal inhibitory concentrations (MICs) were systematically higher than MICRONAUT MICs for all antifungals, except for itraconazole. CLSI clinical breakpoints (CBPs) and epidemiological cut-off values (ECVs) were used for Sensititre MICs while for MICRONAUT the EUCAST CBPs and ECVs were used. Only fluconazole, micafungin, and amphotericin B had a categorical agreement of ≥90%. For fluconazole, micafungin, and amphotericin B the susceptibility proportions were comparable. Susceptibility proportion of posaconazole and voriconazole was higher using the MICRONAUT system. For itraconazole and anidulafungin, the susceptibility proportion was higher using Sensititre. It was not possible to determine the true MIC values or the correctness of a S/I/R result since both commercial systems were validated against a different reference method. These findings show that there is a significant variability in susceptibility pattern and consequently on use of antifungals in daily practice, depending on the choice of commercial system.