ACCI could be a poor prognostic indicator for the in-hospital mortality of patients with SFTS.

This study aims to evaluate the predictive role of age-adjusted Charlson comorbidity index (ACCI) scores for in-hospital prognosis of severe fever in thrombocytopenia syndrome (SFTS) patients. A total of 192 patients diagnosed with SFTS were selected as the study subjects. Clinical data were retrospectively collected. Receiver operating characteristic curves were used to evaluate the diagnostic value of ACCI for the mortality of SFTS patients, and Cox regression models were used to assess the association between predictive factors and prognosis. The 192 SFTS patients were divided into two groups according to the clinical endpoints (survivors/non-survivors). The results showed that the mortality of the 192 hospitalized SFTS patients was 26.6%. The ACCI score of the survivor group was significantly lower than that of the non-survivor group. Multivariate Cox regression analysis showed that the increased ACCI score was a significant predictor of poor prognosis in SFTS. Kaplan-Meier survival analysis showed that SFTS patients with an ACCI >2.5 had shorter mean survival times, indicating a poor prognosis. Our findings suggest that ACCI, as an easy-to-use clinical indicator, may offer a simple and feasible approach for clinicians to determine the severity of SFTS.

Age-adjusted Charlson Comorbidity Index (ACCI) is a significant factor for predicting survival after radical gastrectomy in patients with gastric cancer.

INTRODUCTION: To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC). METHOD: Data from patients with GC who underwent radical gastrectomy from January 2008 to December 2012 in Fujian Medical University Union Hospital were retrospectively analyzed. Patients were categorized into either high ACCI group or low ACCI group based on the effect of ACCI on long-term GC prognosis. 1:1 propensity score matching (PSM) was used to reduce confounding bias. To further analyze the impact of ACCI on the long-term prognosis of patients after radical gastrectomy, a nomogram was built based on the Cox proportional hazards regression model. RESULTS: A total of 1476 patients were included in the analysis. After PSM, there was no statistically significant differences in tumor location, tumor size and tumor stage between low ACCI group (429 cases) and high ACCI group (429 cases) (all P > 0.05). Before and after PSM, the incidence of postoperative complications in high ACCI group was significantly higher than that in low ACCI group (P < 0.05). The 5-year overall survival rate (OS) in low ACCI group was significantly higher than that in high ACCI group. Multivariate analysis showed that ACCI was an independent risk factor for OS (P < 0.05). The Harrell's C-statistics (C-index) of TNMA, a prognostic evaluation system combining ACCI and TNM staging system, was significantly higher than that of TNM staging system in both the modeling and validation groups (all P < 0.05). CONCLUSIONS: ACCI was an independent risk factor for the long-term prognosis of GC patients after radical gastrectomy that could effectively improve the predictive efficacy of the TNM staging system for GC.

Prognostic analysis and nomogram construction for older patients with IDH-wild-type glioblastoma.

As many countries face an ageing population, the number of older patients with glioblastoma (GB) is increasing. Thus, there is an urgent need for prognostic models to aid in treatment decision-making and life planning. A total of 98 patients with isocitrate dehydrogenase (IDH)-wild-type GB aged ≥65 years were analysed from January 2012 to January 2020. Independent prognostic factors were identified by prognostic analysis. Using the independent prognostic factors for overall survival (OS), a nomogram was constructed by R software to predict the prognosis of older patients with IDH-wild-type GB. The concordance index (C-index) and receiver operating characteristic (ROC) curve were used to assess model discrimination, and the calibration curve was used to assess model calibration. Prognostic analysis showed that the extent of resection (EOR), adjusted Charlson comorbidity index (ACCI), O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative radiotherapy, and postoperative temozolomide (TMZ) chemotherapy were independent prognostic factors for OS. MGMT methylation status and subventricular zone (SVZ) involvement were independent prognostic factors for progression-free survival (PFS). A nomogram was constructed based on EOR, ACCI, MGMT methylation status, postoperative radiotherapy and postoperative TMZ chemotherapy to predict the 6-month, 12-month and 18-month OS of older patients with IDH-wild-type GB. The C-index of the nomogram was 0.72, and the ROC curves showed that the areas under the curve (AUCs) at 6, 12 and 18 months were 0.874, 0.739 and 0.779, respectively. The calibration plots showed that the nomogram was in good agreement with the actual observations in predicting the OS of older patients with IDH-wild-type GB. Older patients with IDH-wild-type GB can benefit from gross total resection (GTR), postoperative radiotherapy and postoperative TMZ chemotherapy. A high ACCI score and MGMT nonmethylation are poor prognostic factors. We constructed a nomogram including the ACCI to facilitate clinical decision-making and follow-up interval selection.

Can HALP score, a new prognostic tool, take the place of traditional scoring systems in Fournier's gangrene?

PURPOSE: Fournier's Gangrene (FG) is a fatal condition, therefore prognosis prediction is a crucial step before treatment planning. We aimed to investigate the predictive value of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score which is frequently employed in vascular disorders and malignancies, on disease severity and survival in FG patients and to compare HALP score with well-known scoring systems on this aspect. MATERIALS AND METHODS: Eighty-seven men who had surgical debridement for FG between December 2006 and January 2022 were included in this study. Their symptoms, physical examination findings, laboratory tests, medical histories, vital signs, extent and timing of the surgical debridement and antimicrobial therapies were noted. The HALP score, Age-adjusted Charlson Comorbidity Index (ACCI) and Fournier's Gangrene Severity Index (FGSI) were evaluated for their predictive values for survival. RESULTS: FG patients were grouped as survivors (Group 1, n = 71) and non-survivors (Group 2, n = 16) and the results were compared. The mean ages of survivors (59 ± 12.55 years) and non-survivors (64.5 ± 14.6 years) were similar (p = 0.114). The median size of necrotized body surface area was 3% in Group 1 and 4.8% in Group 2 (p = 0.013). On admission, hemoglobin, albumin and serum urea levels and white blood cell counts were significantly different in two study groups. Two study groups were similar for HALP scores. However, ACCI and FGSI scores were greater significantly in non-survivors. CONCLUSIONS: Our results indicated that HALP score does not predict a survival successfully in FG. However, FGSI and ACCI are successful outcome predictors in FG.

Optimal postoperative delirium prediction after coronary artery bypass grafting surgery: a prospective cohort study.

Background: Postoperative delirium (POD) presents as a serious neuropsychiatric syndrome in patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery. This is correlated with higher mortality, cognitive decline, and increased costs. The Age-adjusted Charlson Comorbidity Index (ACCI) is recognized as an independent predictor for mortality and survival rate. The purpose of our study is to estimate the predictive value of the ACCI on the POD in patients undergoing OPCABG surgery. Methods: This prospective cohort study enrolled patients undergoing OPCABG surgery between December 2020 and May 2021 in Qilu Hospital. Patients were divided into the low-ACCI group (score, 0-3) and the high-ACCI group (score ≥4) according to their ACCI scores. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and CAM were used to diagnose POD within 7 days after surgery. The general, laboratory, and clinical data of the patients were recorded and collected. The characteristic ROC curve was applied to further assess the predictive value of the ACCI for POD in patients following OPCABG surgery. Results: A total of 89 patients were enrolled, including 45 patients in the low-ACCI group and 44 patients in the high-ACCI group. The incidence of POD was higher in the high-ACCI group than in the low-ACCI group (45.5% vs. 15.6%, P = 0.003). Multivariate logistic regression analyses showed that the ACCI (OR, 2.433; 95% CI, 1.468-4.032; P = 0.001) was an independent risk factor for POD. The ACCI accurately predicted POD in patients following OPCABG surgery with an AUC of 0.738, and the Hosmer-Lemeshow goodness of fit test yielded X2 = 5.391 (P = 0.145). Conclusion: The high-ACCI group showed a high incidence of POD. The ACCI was an independent factor associated with POD in patients following OPCABG surgery. In addition, the ACCI could accurately predict POD in patients following OPCABG surgery. Clinical Trial Registration: ClinicalTrials.gov, identifier CHiCTR2100052811.

Non-alcoholic Steatohepatitis in Asians: Current Perspectives and Future Directions.

Non-alcoholic steatohepatitis (NASH) is a subset of non-alcoholic fatty liver disease (NAFLD), which, apart from excess fat in the liver, may be characterised by some level of inflammatory infiltration and fibrogenesis, occasionally progressing to liver cirrhosis or hepatocellular carcinoma (HCC). The objective of the current review is to elucidate the rising prevalence, the role of microbiome and genetics in pathogenesis, diagnostic challenges, and novel treatment alternatives for NASH. Newer diagnostic techniques are being developed since using liver biopsy in a larger population is not a reasonable option and is primarily restricted to clinical research, at least in developing countries. Besides these technical challenges, another important factor leading to deviation from guideline practice is the lack of health insurance coverage in countries like India. It leads to reluctance on the part of physicians and patients to delay required tests to curb out-of-pocket expenditure. There is no cure for NASH, with liver transplantation remaining the last option for those who progress to end-stage liver disease (ESLD) or are detected with early-stage HCC. Thus, lifestyle modification remains the only viable option for many, but compliance and long-term adherence remain major challenges. In obese individuals, bariatric surgery and weight reduction have shown favourable results. In patients with less severe obesity, endoscopic bariatric metabolic therapies (EBMT) are rapidly emerging as less invasive therapies. However, access and acceptability remain poor for these weight reduction methods. Therefore, intense research is being conducted for potential newer drug classes with several agents currently in phase II or III of clinical development. Some of these have demonstrated promising results, such as a reduction in hepatic fat content, and attenuation of fibrosis with an acceptable tolerability profile in phase II studies. The developments in the management of NASH have been fairly encouraging. Further well-designed long-term prospective studies should be undertaken to generate evidence with definitive results.

Novel Use Of Age-Adjusted Charlson Comorbidity Index (ACCI) As A Risk Stratification Tool For Development Of Postoperative SARS-COV-2 Infection In Surgical Patients.

BACKGROUND: Current study documents the role of Age adjusted Charlson Comorbidity Index (ACCI) as a stratification tool for the development of postoperative SARS-CoV-2 infection in surgical patients. METHODS: This prospective cohort study was conducted over the period of 8 weeks starting on 1st of March 2020. Sampling was convenience and purposive and included all consecutive patients who underwent any surgical procedure. Follow up period was 30 days. Outcomes included postoperative SARS-CoV-2 infection, morbidity and 30-day mortality. Risk factors for development of infection were detected by univariate and multivariate analysis. RESULTS: Postoperative SARS-CoV-2 infection developed in 37 cases while 131cases remained confirmed negative. Of 37 patients, 18 were male while 19 were female. Postoperative complications developed in 17 patients (45.9%). In-hospital 30-day mortality was 16.2% (n=6). The factors that increased the chances of postoperative SARS-CoV-2 infection (p<0·00) included increasing age, higher ACCI Score, emergency surgery, trauma, orthopaedic and vascular procedures, spinal anaesthesia, and surgeries of complex nature. In adjusted analyses, predictors of postoperative infection included ACCI score of 4 or more (5.54 [1·51-20.34], p<0·01), and orthopaedics or vascular procedures versus others (12.32 [1.98-76.46], p<0·007). Based on infection rates across the different scores of ACCI, cohort was divided into 3 groups. ACCI score of zero had postoperative SARS-CoV-2 infection rate of 1.9 % (negative predictive value, 98.1%) compared with 36.26% in patients with score of 4 or more (sensitivity, 89.19%). CONCLUSIONS: Low risk surgical patients (ACCI=0) should have universal precautions, while intermediate risk group (ACCI=1- 3) should have extra precautions. The options for high-risk patients (ACCI ≥4) include cancellation of nonurgent surgery; delaying the surgery till optimization of modifiable factors; or reverse isolation/ shielding in perioperative period if surgery cannot be cancelled.

Age-adjusted Charlson Comorbidity Index predicts survival in intrahepatic cholangiocarcinoma patients after curative resection.

BACKGROUND: Comorbidity among cancer patients is prevalent and influential to prognosis after operation. Limited data are available on comorbidity evaluations in patients with intrahepatic cholangiocarcinoma (ICC). This study aimed to assess the comorbidity distribution in ICC patients and to adapt the Charlson Comorbidity Index (CCI) or the age-adjusted CCI (ACCI) for survival prediction. METHODS: The study cohort included 268 ICC patients treated with curative surgery from January 2000 to December 2007 at the Department of Liver Surgery, Zhongshan Hospital. The association between the comorbidity index and overall survival (OS) or disease-free survival (DFS). was analyzed by the Kaplan-Meier method. Multivariable analysis was established to select the determinant parameters. RESULTS: Major comorbid conditions of ICC patients included liver disease, hypertension, diabetes and ulcer. The median follow-up time was 25.5 months in the whole data set. Among the entire cohort, the 1-, 3- and 5-year OS rates were 55.3%, 26.0% and 15.6%, respectively. In multivariate analysis, the ACCI correlated with OS, and higher scores were associated with poorer prognosis (hazard ratio =1.134, 95% confidence interval: 1.015-1.267 and P value =0.026). CCI was not an independent predictive factor for OS or DFS. CONCLUSIONS: In contrast to CCI, ACCI was a more promising model to accurately predict OS in ICC patients who underwent liver resection. Further research should be focused on the impact of comorbidity therapies.

Validation of Asthma Control Assessment Among Urban Adolescents Using the Asthma Control and Communication Instrument.

BACKGROUND: The National Institutes of Health guidelines recommend questionnaires to assess asthma control, but there are few self-reported asthma morbidity surveys validated among urban, African American, Hispanic, and/or poor adolescents. The Asthma Control and Communication Instrument (ACCI) is a 12-item self-reported questionnaire previously validated among a diverse adult population, but not among adolescents. OBJECTIVE: To assess the ability of the ACCI to accurately describe asthma control in an urban adolescent population. METHODS: Between November 13, 2014, and March 2, 2017, we collected information using the ACCI, the Asthma Control Test, the Pediatric Asthma Quality of Life Questionnaire, and lung function among adolescents enrolled in a school-based asthma intervention study. The ACCI measure of asthma control was validated by evaluating accuracy (on the basis of receiver operating characteristic curve), internal reliability, and concurrent and discriminative validity. RESULTS: We collected information on 280 adolescents (mean age, 13.4 years; 56% males; and 51% African American). ACCI control showed good internal reliability and strong concurrent and discriminative validity with the Asthma Control Test and the Pediatric Asthma Quality of Life Questionnaire. The accuracy of the ACCI in classifying adolescents with uncontrolled asthma was good (area under the curve, 0.83; 95% CI, 0.79-0.88). CONCLUSION: The ACCI, a clinical tool developed to assist communication about asthma control, has demonstrated strong construct validity as a self-reported questionnaire within an urban, African American, and Hispanic sample of adolescents. It has the potential to assist in the assessment of asthma control in urban, minority, and/or poor adolescents.

Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study.

BACKGROUND: Previous studies have indicated traumatic brain injury (TBI) as a risk factor for stroke and myocardial injury. Whether TBI increases new onset of major adverse cardiovascular and cerebrovascular events (MACCE) is not well established. METHODS: Patients with a diagnosis of TBI from 2000 to 2012 were 1:2 age-, sex-, and age-adjusted comorbidities matched with normal population cohorts. The MACCE, which included coronary artery disease, heart failure and arrhythmia, ischemic and hemorrhagic stroke, and death, was defined as one inpatient admission with MACCE diagnosis. The maximum follow-up duration to MACCE after the initial TBI diagnosis was 5 years. The baseline comorbidities before TBI, including hypertension, diabetes mellitus, renal disease, and liver disease, also were considered to estimate the risk of MACCE. RESULTS: In total, 16,211 patients with TBI and 32,422 people from the control group were enrolled in the current study. Our results showed that patients with TBI had a 2.77-fold risk of MACCE, 1.72-fold risk of cardiovascular disease, 2.10-fold risk of ischemic stroke, 6.02-fold risk of hemorrhagic stroke, and 3.13-fold risk of mortality compared with the control group (all P < 0.0001) after adjusting the confounding factors. In addition, the trend of cumulated incidence risk among MACCE, cardiovascular disease, ischemic and hemorrhagic stroke, and mortality presented the greatest incidence within the first year after diagnosis and persisted during the 5 years of follow-up. CONCLUSIONS: Our results showed that patients with TBI have a significantly greater risk of MACCE than the control group. We hope this information will remind critical-care physicians and neurosurgeons to keep in mind the long-term effects of TBI on MACCE.

Trends in co-morbidities and survival for in-hospital cardiac arrest -A Swedish cohort study.

OBJECTIVES: Co-morbidities affect survival after in-hospital cardiac arrests (IHCA). The risk population for IHCA, i.e. the hospitalised patients, have a doubled increase in co-morbidities over time. A similar increase in co-morbidities among IHCAs might explain the relatively poor survival ratios despite improved care. AIM: To assess changes in the burden of baseline age-adjusted Charlson co-morbidity index (ACCI) scores among IHCAs as well as to assess its impact on survival in three time periods. MATERIAL AND METHODS: All patients ≥18 years suffering an IHCA at Karolinska University Hospital between 1st January 2007 and 31st December 2015 were included. Data regarding the IHCA, patient characteristics, ACCI and 30 day survival were obtained from electronic patient records. Parameters included in ACCI were assessed as ICD-10 codes in the medical file at admission to hospital. The median ACCI with interquartile range (IQR) was presented per year. ACCI was categorised into low 0-2points, moderate 3-5points, high 6-8 points and very high ≥9 points. Differences in survival between 2007 and 2009 and 2010-2012 as well as 2013-2015 were stratified per ACCI category and assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI). Adjustments included hospital site, sex, first rhythm, ECG-surveillance, witnessed or not, and location of the IHCA. RESULTS: In all, 1373 patients suffered an IHCA, of whom 376 (27%) survived at least 30 days. The ACCI remained almost constant over time at median 4, IQR 3-6. Patients with low or moderate ACCI more than doubled their survival in 2013-2015 compared to 2007-2009 (adjusted OR 2.61 95% CI1.38-4.94 and OR 1.87 95% CI 1.14-3.09 respectively). CONCLUSION: This cohort study illuminates an almost constant burden of co-morbidities over time among patients suffering an IHCA. Further, the study highlights that 30-day survival has almost doubled from 2007 to 2009 to 2013-2015 among those with low to moderate AccI.

Survival after in-hospital cardiac arrest is highly associated with the Age-combined Charlson Co-morbidity Index in a cohort study from a two-site Swedish University hospital.

BACKGROUND: In-hospital cardiac arrest (IHCA) has a poor prognosis and clinicians often write "Do-Not-Attempt-Resuscitation" (DNAR) orders based on co-morbidities. AIM: To assess the impact of the Age-combined Charlson Co-morbidity Index (ACCI) on 30-days survival after IHCA. MATERIAL AND METHODS: All patients suffering IHCA at Karolinska University Hospital between 1st January and 31st December 2014 were included. Data regarding patient characteristics, co-morbidities and survival were drawn from the electronic patient records. Co-morbidities were assessed prior to the IHCA as ICD-10 codes according to the ACCI. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with an ACCI of 0-4 points versus those with 5-7 points, as well as those with ≥8 points. Adjustments included hospital site, heart rhythm, ECG surveillance, witnessed status and place of IHCA. RESULTS: In all, 174 patients suffered IHCA, of whom 41 (24%) survived at least 30 days. Patients with an ACCI of 5-7 points had a minor chance and those with an ACCI of ≥8 points had a minimal chance of surviving IHCA compared to those with an ACCI of 0-4 points (adjusted OR 0.10, 95% CI 0.04-0.26 and OR 0.04, 95% CI 0.03-0.42, respectively). CONCLUSION: Patients with a moderate or severe burden of ACCI have a minor chance of surviving an IHCA. This information could be used as part of the decision tools during ongoing CPR, and could be an aid for clinicians in planning care and discussing DNAR orders.

The effect of preoperative clinical variables on the 30- and 90-day morbidity and mortality after radical cystectomy: A single-centre study.

OBJECTIVE: To analyse the effect of preoperative clinical variables and comorbidity on the early, late and cumulative 90-day morbidity and mortality rates, as well as hospital re-admissions, after radical cystectomy (RC), in one centre. PATIENTS AND METHODS: All patients undergoing RC over a period of 3 months were included. Preoperative investigations included measurements of serum albumin, a complete blood analysis, body mass index (BMI), Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI). We recorded the length of hospital stay (LOS) and all postoperative events for 90 days, and graded them according to the five-grade modification of the original Clavien system. RESULTS: In all there were 31 patients undergoing RC (mean age 58.4 years). The mean preoperative serum albumin and haemoglobin level, BMI, CCI and ACCI were 3.82 g/dL, 12.53 g/dL, 29.29 kg/m(2), 3.0 and 4.58, respectively. The mean LOS was 20.03 days; seven patients needed re-admission and three died within the 90 days. There were postoperative complications in 20 patients. The age, CCI and ACCI were significantly associated with complications (P = 0.009, 0.001 and < 0.001, respectively). Preoperative haemoglobin, BMI and smoking had no effect on the morbidity or mortality rate. The LOS increased in older patients (P = 0.031) and those with a higher ACCI (P = 0.042). Postoperative mortality increased among patients with a lower serum albumin level (P = 0.048). CONCLUSIONS: Age, CCI and ACCI are related to early postoperative complications. Older patients and patients with a higher ACCI have a longer LOS. A low preoperative albumin level needs to be evaluated more thoroughly.

Accidentes de tránsito con heridos en Colombia según fuentes de información: caracterización gene-ral y tipologías de accidentes / Road traffic accidents with injured in Colombia according to information sources: General characterization and accident typologies

El objetivo de esta investigación es conocer las dinámicas sociales de la accidentalidad vial -formas de ocurrencia, tipos de consecuencias, tipos de víctimas- y su relación con variables socio-demográficas. Se analizan datos procedentes de dos fuentes: una encuesta de victimización vial (accidentalidad subjetiva) a una muestra no aleatoria de estudiantes de ciclos superiores de 20 ciudades capitales (n=2292) de Colombia y estadísticas oficiales de heridos en tránsito (accidentalidad objetiva) en Bogotá en el año 2009 (n=2300). Mediante un análisis de clasificación jerárquica y combinando características del vehículo, del daño causado y del conductor -edad, sexo- y otros actores de la vía, los resultados mostraron cuatro tipologías de accidentes: 1) conductor particular, atropello, víctima peatón de 61 años o más, 2) víctima peatón de 0 a 10 años por atropello y lesión por trauma facial, 3) víctima pasajero o mujer, por caída desde el automóvil o bus de transporte público, y lesiones en el cuello, 4) víctima conductor de moto o cicla, entre 21 y 30 años, varón, por colisión, y daños en las extremidades. Las implicaciones de los resultados se discuten con relación a políticas de prevención de la accidentalidad vial.

The aim of this paper is to describe the social dynamics of road traffic accidents - occurrence forms, consequences of accidents, victim typologies - and their relations with socio demographic variables. Data of two types were analyzed: the driving victimization survey (subjective traffic acci-dents) by a non-randomized sample of high school students (n =2292) from 20 main Colombian cities and official statistics of traffic injured (objective traffic accidents) in Bogotá during 2009 (n=2300). Through a cluster analysis and combining vehicle characteristics, caused damage and driver age- sex- and other actors of the road, the results showed four types of accidents: 1) per-sonal vehicle driver, 61 year-old or older pedestrian fatality. 2) Pedestrian victim from 0 to 10 years old, injury by facial trauma. 3) Passenger or woman victim from public transportation or vehicle falling, neck injuries. 4) 21-30 year-old driver man of moto or bicycle, crash victim, leg and hand injured.