Gram-negative bacteremia: variable clinical course and useful prognostic factors.
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Biomedical subjects
Publications and source records attributed to J N Berrettoni.
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A survey of 60 patients who died from cardiac related causes after vein or artery bypass operations alone (1967 to 1973) was made with respect to 26 clinical, angiographic, and operative variables. These factors were compared with identical characteristics of 1,188 survivors operated upon in 1973. Through discriminant analysis, the various characteristics, isolated or multiple in any combination, have been converted into risk related to operative death. The distinctive features of the mortality group were vastly different from those in the surviving group. Ten patients (16.67 per cent) of the mortality group were in the ninety-ninth percentile of risk, whereas these factors or variables of similar weight produced an equivalent risk of only 0.34 per cent of the survivors; thus, operative death in these circumstances could be predicted with an estimated 98.0 per cent assurance. Each of 6 patients with mortality risks above 0.99999 had (1) marked cardimegaly, (2) uncompensated congestive heart failure (CHF), (3) triple vessel coronary artery disease and/or obstruction of the left main coronary artery, (4) generalized impairment of left ventricular contraction or segmental left ventricular scar, and (5) evelated left ventricular end-diastolic pressure. As a single factor, congestive heart failure (CHF) exerted the most influence on the probability of dying. A new and more desctiptive statistical interpretation of the factors presumed to affect risk is presented.
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Our results, based on the definition of coronary heart disease by cinearteriography, show that definite relationships exist among incidence of coronary heart disease (CHD), age, total cholesterol (TC), and total triglycerides, with less definite ones between free cholesterol, and phospholipids for a specific group of 450 male patients referred to the Cleveland Clinic because of suspected coronary heart disease. Equations and graphs of the association of incidence of CHD with these conditions are presented. The relationships were strong enough to be of aid in discriminating CHD from normal; the most useful being age, TC, and TG. Incidence determinations were presented in terms of total incidence and incidence associated with the variable itself. Coronary angiography demonstrated 350 CHD and 100 normals or a ratio of 3.5 to 1. This ratio is a reflection of the high accuracy with which physicians suspect CHD. Age and TC were good discriminators in these patients suspected of CHD. An improved relationship and better discrimination was obtained by relating incidence simultaneously to age, TC, and TG. The probability of having CHD is the total incidence corresponding to the patient's age, TC, and TG. The probability level of 0.90 gave 95% assurance of a correct prediction for the physician-selected group of patients. Twenty-nine per cent of them had probabilities above 0.90.