[Prognostic scale for early detection of various postoperative complications after thoracic aortic surgery: post-hoc analysis of biomarkers]. / Prognosticheskaya shkala dlya rannego vyyavleniya oslozhnennogo techeniya posleoperatsionnogo perioda u patsientov, operirovannykh na grudnom otdele aorty: post-hoc analiz dinamiki biomarkerov.

OBJECTIVE: To create the prognostic scale based on some biomarkers after thoracic and thoracoabdominal aortic repair. MATERIAL AND METHODS: We analyzed 114 patients with aortic aneurysm/dissection. The following biomarkers were studied: proadrenomedullin, NT-proBNP, procalcitonin, interleukins 6, 8, 10, tumor necrosis factor, presepsin, highly sensitive troponin I. Stages of the study: before induction of anesthesia, at the end of surgery and 6 hours later. RESULTS: The most informative predictors of postoperative complications were identified using comparative and ROC analyses: baseline presepsin≥204 pg/ml and interleukin 6 ≥4.3 pg/ml. The scale based on assessment of presepsin and troponin I at the end of surgery and preoperative risk allows analysis of the risk of complicated postoperative period. If all three predictors are present, the risk of complicated postoperative period increases by 1.96 times. The equation based on serum presepsin, interleukin-8 and interleukin-6/interleukin-10 ratio in 6 hours after surgery is characterized by acceptable characteristics (AUC 0.785, 95% CI 0.700-0.870). CONCLUSION: An algorithm based on risk stratification consisting of 3 prognostic scales at various stages of perioperative period determines the probability of postoperative complications with sensitivity 67.2% and specificity 94.6%. The total share of correct predictions in this sample was 80.7±3.7%.

Prediction of Survival Outcome Using Chuang's Prognostic Scale in Metastatic Breast Cancer.

BACKGROUND: For physicians and patients, survival estimation is vital for the treatment plan, especially with frequent use of new therapeutic agents in metastatic breast cancer (MBC). The Chuang's Prognostic Scale (CPS) is a validated prognostic score that may be useful in the avoidance of unnecessary palliative systemic treatment. AIM: The present study aimed to evaluate the CPS in survival prediction in patients with MBC after at least two lines of palliative systemic chemotherapy protocols (PSCPs). METHODS: CPS was prospectively measured in 221 patients with MBC. The total score ranged from 0 to 8.5; the lower score refers to a good prognosis. The survival assessment was made by the Kaplan-Meier curve and the survival difference among the groups was estimated by log-rank test. RESULTS: Using the cutoff value of CPS 5.7, the patients were classified into two groups: Group A had score ≤5.7 (174 patients, 78.7%) and Group B had CPS score >5.7 (47 patients, 21.3%). About 86.2% of the patients in Group A survived >3 months (median survival was 165 days, 95% confidence interval [CI]: 77-261) compared with 21.3% of patients survived in Group B (median survival was 81 days, 95% CI: 55-123) (P = 0.00). The sensitivity, specificity, positive predictive value, and negative predictive value were 97.6% (95% CI: 87.4-99.9), 98.3% (95% CI: 95.2-99.7), 93.2% (95% CI: 81.6-97.7), and 99.4% (95% CI: 96.2-99.9), respectively, for the 3-month mortality prediction. CONCLUSION: CPS could be helpful in estimating the survival outcome in patients with MBC who received at least two PSCPs.

Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale. / Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D.

INTRODUCTION AND OBJECTIVES: Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term. PATIENTS AND METHOD: We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957). RESULTS: A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively. CONCLUSIONS: EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.

The Use of the Chuang's Prognostic Scale to Predict the Survival of Metastatic Colorectal Cancer Patients Receiving Palliative Systemic Anticancer Therapy.

BACKGROUND: With the increasing number of agents active against cancer, advanced cancer patients including metastatic colorectal cancer (mCRC) patients may continue receiving palliative systemic anticancer therapy (PSAT) near the end-of-life. Validated palliative prognostic models, such as the Chuang's prognostic scale (CPS), may be helpful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT. AIM: To test the ability of the CPS to predict the survival of mCRC under treatment with PSAT. METHODS: CPS was prospectively assessed in 36 mCRC patients who were receiving PSAT. The scale is based on eight items: ascites, edema, cognitive impairment, liver and lung metastases, performance status, tiredness, and weight loss. The total CPS score ranges from 0 to 8.5 with the higher score indicating worse prognosis. RESULTS: Patients were divided into two groups using a CPS cutoff score of 5, Group 1 with a CPS score ≤5 and Group 2 with a CPS score >5. Using this cutoff value, 3-month mortality was predicted with a positive predictive value of 71%, a negative predictive value of 77%, a sensitivity of 67%, a specificity of 81% and an overall accuracy of 75%. Group 1 patients had a longer median survival of 149 days (95% confidence interval [CI]: 82-216) in comparison to Group 2 patients who had a median survival of 61 days (95% CI: 35-87). The difference in survival was statistically significant (P = 0.01). CONCLUSION: CPS may be useful in identifying mCRC patients with limited survival who are unlikely to benefit from PSAT.

Development and adaptations of the Graded Prognostic Assessment (GPA) scale: a systematic review.

The Graded Prognostic Assessment (GPA) score has the best accuracy among prognostic scales for patients with brain metastases (BM). A wide range of GPA-derived scales have been established to different types of primary tumor BM. However, there is a high variability between them, and their characteristics have not been described altogether yet. We aim to summarize the features of the existent GPA-derived scales and to compare their predictor factors and their uses in clinical setting. Medline was searched from inception until January 2023 to identify studies related to the development, update, or validation of GPA. The initial search yielded 1,083 results. 16 original studies and 16 validation studies were included, comprising a total of 33,348 patients. 13 different scales were assessed, including: GPA, Diagnosis-Specific GPA, Extracranial Score, Lung-molGPA, Updated Renal GPA, Updated Gastrointestinal GPA, Modified Breast GPA, Integrated Melanoma GPA, Melanoma Mol GPA, Sarcoma GPA, Hepatocellular Carcinoma GPA, Colorectal Cancer GPA, and Uterine Cancer GPA. The most prevalent prognostic predictors were age, Karnofsky Performance Status, number of BM, and presence or absence of extracranial metastases. Treatment modalities consisted of whole brain radiation therapy, stereotactic radiosurgery, surgery, cranial radiotherapy, gamma knife radiosurgery, and BRAF inhibitor therapy. Median survival rates with no treatment and with a specific treatment ranged from 6.1 weeks to 33 months and from 3.1 to 21 months, respectively. Original GPA and GPA-derived scales are valid prognostic tools, but with heterogeneous survival results when compared to each other. More studies are needed to improve scientific evidence of these scales.

Validation and comparison of prognostic scales in Chinese patients with ischemic stroke: a prospective study from CATIS.

BACKGROUND: : Various tools are currently available to quantify the risks of adverse clinical outcomes after an ischemic stroke. This study aimed to validate and compare prognostic scales among Chinese patients with ischemic stroke. METHODS: : We compared three stroke prognostic scales (Stroke Prognostication using Age and the National Institutes of Health Stroke Scale-100 [SPAN-100], Totaled Health Risks in Vascular Events [THRIVE], and Acute Stroke Registry and Analysis of Lausanne [ASTRAL]) in 3870 Chinese patients with ischemic stroke from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The 2-year primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3). RESULTS: : Among all the scales, the ASTRAL score had the best accuracy for predicting 2-year prognosis in Chinese patients with ischemic stroke. The C-statistic of the ASTRAL score for the 2-year primary outcome was 0.79 (95% confidence interval [CI]: 0.78-0.80), and the Hosmer-Lemeshow goodness-of-fit test showed that the ASTRAL score fitted Chinese patients with ischemic stroke well (χ2 = 9.83, P = 0.277). The incidences of the primary outcome in the <5%, 5%-9.9%, 10%-19.9%, and ≥20% risk groups based on the ASTRAL scores were 3.93%, 7.55%, 14.29%, and 41.81%, respectively (odds ratio: 1.23; 95% CI: 1.21-1.26; P < 0.001). CONCLUSION: : The ASTRAL score had higher efficacy than the SPAN-100 and THRIVE scores in predicting 2-year adverse outcomes among Chinese patients with ischemic stroke, suggesting that it could be a valuable risk assessment tool for the 2-year prognosis of such patients.

Basic Predictive Risk Factors for Cytokine Storms in COVID-19 Patients.

Objective: A critical role in coronavirus disease 2019 (COVID-19) pathogenesis is played by immune dysregulation that leads to a generalized uncontrolled multisystem inflammatory response, caused by overproduction of proinflammatory cytokines, known as "a cytokine storm" (CS), strongly associated with a severe course of disease. The aim of this study is to identify prognostic biomarkers for CS development in COVID-19 patients and integrate them into a prognostic score for CS-associated risk applicable to routine clinical practice. Materials and Methods: The authors performed a review of 458 medical records from COVID-19 patients (241 men and 217 women aged 60.0 ± 10.0) who received treatment in the St. Petersburg State Budgetary Institution of Healthcare City Hospital 40 (City Hospital 40, St. Petersburg), from Apr. 18, 2020 to Nov. 21, 2020. The patients were split in two groups: one group included 100 patients with moderate disease symptoms; the other group included 358 patients with progressive moderately severe, severe, and extremely severe disease. The National Early Warning Score (NEWS) score was used alongside with clinical assessment, chest computed tomographic (CT) scans, electrocardiography (ECG), and lab tests, like ferritin, C-reactive protein (CRP), interleukin (IL)-6, lactate dehydrogenase (LDH), and D-dimer. Results: The basic risk factors for cytokine storms in COVID-19 patients are male gender, age over 40 years, positive test result for replicative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, absolute lymphocyte count, dynamics in the NEWS score, as well as LDH, D-dimer, ferritin, and IL-6 levels. These clinical and instrumental findings can be also used as laboratory biomarkers for diagnosis and dynamic monitoring of cytokine storms. The suggested prognostic scale (including the NEWS score dynamics; serum IL-6 greater than 23 pg/ml; serum CRP 50 mg/L or greater; absolute lymphocyte count less than 0.72 × 109/L; positive test result for replicative coronavirus (SARS-CoV-2) RNA; age 40 years and over) is a useful tool to identify patients at a high risk for cytokine storm, requiring an early onset of anti-inflammatory therapy.

Mortality risk in dilated cardiomyopathy: the accuracy of heart failure prognostic models and dilated cardiomyopathy-tailored prognostic model.

AIMS: The aims of this paper were to investigate the analytical performance of the nine prognostic scales commonly used in heart failure (HF), in patients with dilated cardiomyopathy (DCM), and to develop a unique prognostic model tailored to DCM patients. METHODS AND RESULTS: The hospital and outpatient records of 406 DCM patients were retrospectively analysed. The information on patient status was gathered after 48.2 ± 32.0 months. Tests were carried out to ascertain the prognostic accuracy in DCM using some of the most frequently applied HF prognostic scales (Barcelona Bio-Heart Failure, Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity, Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure, Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, Meta-Analysis Global Group in Chronic Heart Failure, MUerte Subita en Insuficiencia Cardiaca, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, Seattle Heart Failure Model) and one dedicated to DCM, that of Miura et al. At follow-up, 70 DCM patients (17.2%) died. Most analysed scores substantially overestimated the mortality risk, especially in survivors. The prognostic accuracy of the scales were suboptimal, varying between 60% and 80%, with the best performance from Barcelona Bio-Heart Failure and Seattle Heart Failure Model for 1-5 year mortality [areas under the receiver operating curve 0.792-0.890 (95% confidence interval 0.725-0.918) and 0.764-0.808 (95% confidence interval 0.682-0.934), respectively].Based on our accumulated data, a self-developed DCM prognostic model was constructed. The model consists of age, gender, body mass index, symptoms duration, New York Heart Association class, diabetes mellitus, prior stroke, abnormal liver function, dyslipidaemia, left bundle branch block, left ventricle end-diastolic diameter, ejection fraction, N terminal pro brain natriuretic peptide, haemoglobin, estimated glomerular filtration rate, and pharmacological and resynchronisation therapy. This newly created prognostic model outperformed the analysed HF scales. CONCLUSIONS: An analysis of various HF prognostic models found them to be suboptimal for DCM patients. A self-developed DCM prognostic model showed improved performance over the nine other models studied. However, further validation of the prognostic model in different DCM populations is required.

Thinking About the Future: A Review of Prognostic Scales Used in Acute Stroke.

Background: There are many prognostic scales that aim to predict functional outcome following acute stroke. Despite considerable research interest, these scales have had limited impact in routine clinical practice. This may be due to perceived problems with internal validity (quality of research), as well as external validity (generalizability of results). We set out to collate information on exemplar stroke prognosis scales, giving particular attention to the scale content, derivation, and validation. Methods: We performed a focused literature search, designed to return high profile scales that use baseline clinical data to predict mortality or disability. We described prognostic utility and collated information on the content, development and validation of the tools. We critically appraised chosen scales based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modeling Studies (CHARMS). Results: We chose 10 primary scales that met our inclusion criteria, six of which had revised/modified versions. Most primary scales used 5 input variables (range: 4-13), with substantial overlap in the variables included. All scales included age, eight included a measure of stroke severity, while five scales incorporated pre-stroke level of function (often using modified Rankin Scale), comorbidities and classification of stroke type. Through our critical appraisal, we found issues relating to excluding patients with missing data from derivation studies, and basing the selection of model variable on significance in univariable analysis (in both cases noted for six studies). We identified separate external validation studies for all primary scales but one, with a total of 60 validation studies. Conclusions: Most acute stroke prognosis scales use similar variables to predict long-term outcomes and most have reasonable prognostic accuracy. While not all published scales followed best practice in development, most have been subsequently validated. Lack of clinical uptake may relate more to practical application of scales rather than validity. Impact studies are now necessary to investigate clinical usefulness of existing scales.

Clinical Burden of Modified Glasgow Prognostic Scale in Colorectal Cancer.

BACKGROUND/AIM: This study aimed to clarify the potential of modified Glasgow Prognostic Score (mGPS) as a prognostic biomarker and reveal the significance of fish oil (FO)-enriched nutrition in colorectal cancer (CRC). PATIENTS AND METHODS: A total of 738 CRC patients from three different patient cohorts, including 670 patients in the biomarker study and 68 patients in the nutrition-intervention study, were analyzed. RESULTS: High preoperative mGPS was significantly correlated with well-recognized disease progression factors and advanced UICC stage classification. In addition, high mGPS was an independent prognostic factor in both cohorts, especially in stage III and IV patients. These statuses were maintained in postoperative course and correlated with sarcopenia. Furthermore, FO-enriched nutrition suppressed systemic inflammatory reaction and improved skeletal muscle mass and prognosis, especially in CRC patients with mGPS 1 or 2. CONCLUSION: Assessment of mGPS could identify patients with high-risk CRC, who might be candidates for FO-enriched nutrition.

Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system.

CONTEXT: The ability to preoperatively predict the outcome in cervical spondylotic myelopathy (CSM) helps in planning management and counseling the patient and family. AIMS: A simple prognostic scale, namely, the Madras Institute of Neurology Prognostic Scale (MINPS) for CSM has been proposed. SETTINGS AND DESIGN: Six well-known prognostic factors, namely, age, duration of symptoms, neurological disability (Nurick's grade), number of levels of compression, effective canal diameter, and intrinsic cord changes, have been taken into account. Each factor has been divided into three subgroups and allotted a score. The total score in this scale ranges from a maximum of 18 to a minimum of 6. MATERIALS AND METHODS: This scale has been evaluated in a group of 85 patients operated for CSM. STATISTICAL ANALYSIS USED: The usefulness of MINPS was statistically assessed using ANOVA test. RESULTS: It has been found that majority of patients with a score of 14 or more improved; those with a score of 9 or less deteriorated; those with a score between 10 and 13 remained static. CONCLUSIONS: The MINPS for CSM is a very practical scale which can be applied easily with the available clinical and radiological data, with good accuracy of outcome prediction. This is the first scale of its kind.

Development of a prognostic scale for severely hemiplegic stroke patients in a rehabilitation hospital.

OBJECTIVES: For patients with severe hemiplegia in a rehabilitation hospital, early prediction of the functional prognosis and outcomes is challenging. The purpose of this study was to create and verify a prognostic scale in severely hemiplegic stroke patients and allowing for prediction of (1) the ability to walk at the time of hospital discharge, (2) the ability to carry out activities of daily living (ADL), and (3) feasibility of home discharge. PATIENTS AND METHODS: The study was conducted on 80 severely hemiplegic stroke patients. A prognostic scale was created as an analysis method using the following items: mini-mental state examination (MMSE) at the time of admission, modified NIH stroke scale (m-NIHSS); trunk control test (TCT); and the ratio of the knee extensor strength on the non-paralyzed side to the body weight (KES/BW-US). We verified the reliability and validity of this scale. RESULTS: We established a prognostic scale using the MMSE, m-NIHSS, TCT, and KES/BW-US. A score of 56.8 or higher on the prognostic scale suggested that the patient would be able to walk and that assistance with ADL would be unnecessary at the time of hospital discharge. In addition, a score of 41.3 points indicated that the patient's return home was feasible. The reliability and the results were in good agreement. These findings showed that the ability or inability to walk was predictable in 85%, the need of assistance with ADL in 82.5%, and the feasibility of home return in 76.3% of cases. CONCLUSION: At the time of admission, four evaluation items permitted the prediction of three outcomes at time of discharge. Our formula predicts three outcomes with an accuracy of more than 76%.

Evaluación funcional de pacientes con accidente cerebrovascular en el Hospital Dr. Gustavo Fricke / Funcional evaluation of cerebrovascular, patients at Hospital Dr. Gustavo Fricke

El accidente cerebrovascular (ACV) es una enfermedad prevalente, correspondiendo a una de las principales causas de incapacidad. Uno de los métodos usados para evaluar la capacidad funcional de los pacientes es la Escala pronóstica de Orpington (EPO). Este es un estudio prospectivo que evalúa la capacidad funcional de pacientes con ACV. Se incluyeron 41 pacientes con ACV hospitalizados en el Servicio de Medicina del Hospital Dr. Gustavo Fricke durante el período del 2 de septiembre y 2 de noviembre de 2007. Se obtuvo que: 26 ACV fueron en hombres y 15 en mujeres, con una edad promedio de 75 años (rango 47 a 94 años); 37 presentaban alguna comorbilidad asociada y 26 de éstos más de una comorbilidad; en 32 de los casos el déficit se manifestó como una parálisis faciobraquiocrural. Al aplicar la EPO se obtuvo que 6 casos tenían buen pronóstico, 23 moderado y 12 mal pronóstico funcional, siendo el equilibrio (33 casos) y el déficit motor (34 casos) los parámetros que más se afectaron. Así mismo, se obtuvo que el antecedente de ACV previo tiene un riesgo individual del 100 por ciento de tener un ACV de mal pronóstico (p<0,05), con un riesgo atribuible de un 76,32 por ciento. Por lo anterior, se entiende que debido a la gran prevalencia de comorbilidades asociadas, sumado al déficit inherente de esta patología, los convierten en pacientes muy demandantes de cuidados, tanto hospitalizados como en sus hogares, dificultando su traslado. Cabe destacar la importancia de la prevención secundaria de los ACV, debido al incremento del riesgo que tienen estos pacientes de que este evento sea de mal pronóstico funcional.

Stroke is a prevalent disease, corresponding to one of the leading causes of disability. One of the methods used to assess the functional status of patients is the Orpington Prognostic Scale (OPS). This is a prospective study that assesses the functional ability of stroke patients. Forty-one stroke patients admitted to Hospital Dr. Gustavo Fricke's medicine service between September 2nd and November 2nd 2007, were included. The following results were obtained; 26 cases were male and 15 cases were female, with a mean age of 75 years (range, 47 to 94); 37 had comorbidities and 26 of them had more than one. In 32 cases the deficit presented as faciobrachiocrural paresis. The OPS was administered to patients, obtaining a good prognostic score in 6 cases, intermediate score in 23 cases, and a poor prognosis in 12 cases. The most affected parameters were balance (33 cases) and motor function (34 cases). It was also found that a history of prior stroke has an individual risk of 100 per cent for having a stroke with poor prognosis (P<0.05), with an attributable risk of 76.32 per cent. Therefore, due to the high prevalence of associated comorbidities, and the inherent deficiency of stroke, this patients have high needs of care both in the hospital and their homes, difficulting their transport. The importance of secondary prevention in stroke patients is to be emphasized, considering their increased risk of having a new event with bad functional prognosis.