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Results for “Prognostic model”

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PubMed1992

Therapy of relapsed or refractory low-grade follicular lymphomas: factors associated with complete remission, survival and time to treatment failure.

Patients with relapsed low-grade follicular lymphomas (LGFL) frequently respond to subsequent therapy and can have long survival, but are rarely cured. Factors associated with complete remission (CR) rate, length of survival, and time to treatment failure (TTF) after relapse are not well known. We assessed such factors by multivariate analysis in a retrospective review of 95 patients with relapsed LGFL treated with investigational chemotherapy regimens at our institution. The CR rate after therapy was 22%; the likelihood of achieving CR was inversely associated with the number of previous treatment failures (P less than 0.001) and serum LDH level (P less than 0.05). Both the presence of constitutional symptoms and a history of more than two previous treatment failures were associated with shortened survival and TTF. Hemoglobin level was also significantly associated with survival. Prognostic models for survival and TTF were derived to define patient groups with different projected outcomes after therapy for relapsed disease. The results of this study can be used to select patients for new investigational treatments and to evaluate the outcome of such therapies.

Adult↗

PubMed1995

Multivariate risk factor analysis of clinical outcome 15 years after venous coronary artery bypass graft surgery.

BACKGROUND: Knowledge is still lacking about pre-operative and postoperative factors which predict the long-term prognosis of patients who undergo venous coronary artery bypass graft surgery. METHODS AND RESULTS: Four hundred and twenty-eight consecutive patients who underwent isolated venous coronary artery bypass graft surgery with or without left ventricular aneurysm surgery between 1 April 1976 and 1 April 1977, were followed prospectively. Follow-up was 99.8% complete and averaged 15.4 years for the survivors. Two prognostic models were set up to illustrate the influence of 21 variables, present at and, 5 years after, surgery, on the occurrence of six different clinical events. Multivariate analysis was performed using the Cox regression model. Age, left ventricular function, pre-operative severity of angina and diabetes mellitus are continuous incremental risk factors for one or more events. Revascularization with sequential grafts only, and obesity at operation are incremental risk factors for acute myocardial infarction. From the 'classical' risk factors present 5 years after surgery hypertension is an incremental risk factor for both overall and cardiac mortality, diabetes mellitus for cardiac mortality, myocardial infarction, balloon angioplasty and smoking for all clinical events except mortality. CONCLUSIONS: Well-known pre-operative factors including 'classical' risk factors, present late after surgery, influence the occurrence of clinical events. Treatment of these factors may result in better long-term prognosis after venous bypass graft surgery.

Adult↗

PubMed1992

"Thin" malignant melanoma: risk factors and clinical management.

Thin melanomas can metastasize and can be lethal. Six hundred eighty-one patients with melanomas less than 0.76 mm thick have been evaluated, and are reviewed in this study and discussed in the context of a literature review. Among those referred without metastatic disease (583 patients), 4.8% metastasized after a mean follow-up of 3.6 years. Among those referred with metastatic disease (98 patients), mortality was 35% after a mean follow-up of 5.9 years. Male patients (p less than 0.04) and patients with axial primary lesions (p less than 0.05) had increased risk of metastasis. Severe histological regression was present in 40% of primary lesions that metastasized and only 17% of similar lesions that did not (p less than 0.001). Increased age was associated with increased local skin metastases, but not with increased nodal or distant metastases. A prognostic model was designed that identifies a low-risk population with an actuarial risk of metastasis at 10 years that is less than 3%. High-risk patients have an actuarial risk of metastasis of 11% at 5 years and 22% at 10 years (p = 0.0084). Identifying high-risk and low-risk patients with thin melanomas may improve guidelines for the application of adjuvant therapies to this population. New approaches to this problem include use of molecular biology techniques, immunohistochemistry, and varied methods of histological sectioning.

Academic Medical Centers↗

PubMed2001

Sclerosing cholangitis.

Primary sclerosing cholangitis is a chronic cholestatic disease that may have an autoimmune basis. Most patients have a circulating antineutrophil cytoplasmic antibody that appears to be targeted against a 50-kD nuclear envelope protein. The clinical applications of this antibody have not yet been defined. Other autoantibodies directed against antigens, such as cathepsin G, elastase, and anticardiolipin, may also be detected in some patients. It is suggested that primary sclerosing cholangitis may have a bacterial cause. Helicobacter gene sequences have been detected in liver tissues in primary sclerosing cholangitis. The role of Helicobacter spp and other bacteria in the etiopathogenesis of primary sclerosing cholangitis remains to be determined. Primary sclerosing cholangitis may overlap with autoimmune hepatitis in some cases, although the real prevalence of this association remains to be determined. Many prognostic models have been created, but they lack cross-validation, and their clinical usefulness remains limited. Endoscopic retrograde cholangiography remains the gold standard for diagnosis, but magnetic resonance imaging may be a viable alternative in many cases. Clinical trials with cladibrine, pentoxifylline, and budesonide have failed to demonstrate benefits. Orthotopic liver transplantation remains the only effective treatment.

Journal Article↗

PubMed1993

Pathology and prognostic factors.

Cutaneous malignant melanoma and its precursors were the general subjects of the National Institutes of Health Consensus Conference held in January 1992. Particular emphasis was placed on the diagnosis of early melanoma, especially melanoma in situ, and the controversies surrounding dysplastic nevi. Recent studies of unusual nevi often confused with melanoma, eg, deep-penetrating (plexiform) nevus, combined nevus, desmoplastic melanocytic nevus, and Spitz nevus in childhood, provided detailed histologic criteria for their discrimination from melanoma. Rare or unusual forms of melanoma, including desmoplastic melanoma, neurotropic melanoma, a newly described variant angiotrophic melanoma, subungual melanoma, and balloon cell melanoma have been the subject of comprehensive histologic studies. Other histopathologic investigations have described the prevalence of histologic regression and intraepidermal pagetoid spread in melanomas and the histologic features of reexcision specimens of melanoma. New evidence suggests that the predominant cell type infiltrating melanoma is the monocyte-macrophage, and the expression of monocyte chemotactic protein-1 by melanoma may explain the recruitment of this cell type. Immunopathologic studies of melanocytic lesions were performed with various melanocyte-associated antigens (eg, HMB-45), proliferation antigens (eg, Ki-67), and progression markers (eg, epidermal growth factor receptor and HLA-DR). HMB-45 binding has been localized ultrastructurally to early melanosome formation. Various prognostic factors, including gender, high-risk anatomic sites (particularly the scalp), race (black vs white patients), microscopic satellites, tumor volume, indices of proliferation and tumor cell motility, volume-weighted mean nuclear volume, DNA ploidy, and nucleolar organizer regions have been the subject of recent investigations. Analysis of many patients with long-term follow-up has facilitated better prognostic modeling of melanoma.

Diagnosis, Differential↗

PubMed2001

TI-201 SPECT compared with histopathologic grade in the prognostic assessment of cerebral gliomas.

PURPOSE: Although TI-201 SPECT has been used to evaluate the malignant grade of cerebral gliomas, the gold standard continues to be histopathologic examination. The authors assessed and compared the prognostic abilities of the two studies using survival analysis. MATERIALS AND METHODS: Twenty-nine patients underwent 34 sessions of TI-201 SPECT plus surgery for primary or recurrent cerebral gliomas 12 to 78 months before this analysis. Using conventional survival analyses, such as the log-rank test, Cox regression, and the Akaike cross-tab method, the authors evaluated the prognostic significance of 10 variables: histopathologic grade, TI-201 SPECT, Tc-99m HMPAO SPECT, tumor cell viability, radionecrosis, neurologic defects, clinical improvement, surgery, chemotherapy, and external beam radiotherapy. RESULTS: TI-201 SPECT was most strongly related to prognosis, followed by histopathologic grade. The other variables had little prognostic value. The Cox stepwise selection procedure indicated that TI-201 SPECT was the only independent predictor of outcome, whereas histopathologic analysis was eliminated from the prognostic model. However, the Kaplan-Meier survival curve and the Akaike method indicated that histopathologically low-grade tumors were more closely associated with longer-term survival than were TI-201 low uptake tumors. CONCLUSIONS: TI-201 SPECT is not only closely correlated with the histopathologic grade of tumor but is a significantly better predictor of outcome than histopathologic grade. However, histopathologic examination may provide additional information on longer-term survival. TI-201 SPECT is a valuable procedure, especially in patients in whom a histologic diagnosis of possible glioma cannot be made.

Adolescent↗

PubMed2001

Acute liver failure.

Acute liver failure (ALF) is defined as hepatic encephalopathy complicating acute liver injury. The most common etiologies are acute viral hepatitis A and B, medication overdose (e.g., acetaminophen), idiosyncratic drug reactions, ingestion of other toxins (e.g., amanita mushroom poisoning), and metabolic disorders (e.g., Reye's syndrome). Despite advances in intensive care management, mortality continues to be high (40-80%) and is partly related to ALF's complications, such as cerebral edema, sepsis, hypoglycemia, gastrointestinal bleeding, and acute renal failure. Several prognostic models have been developed to determine which patients will spontaneously recover. Treatment is directed at early recognition of the complications and general supportive measures. The only proven therapy for those who are unlikely to recover is liver transplantation. Therefore, recognition of ALF is paramount, and urgent referral to a transplant center is critical to assess transplantation status.

Brain Edema↗

PubMedDate not supplied

Prognostic assessment and evaluation of the benefits of treatment.

Prognosis estimation in patients with hepatocellular carcinoma (HCC) can provide information at diagnosis and can indicate therapy. Because cirrhosis underlies HCC in most individuals, their outcome is related to both entities, which determine the applicability and efficacy of therapy. Accordingly, prognostic modelling should consider tumor stage, liver function impairment, the patient's general condition, and treatment efficacy. We have developed a system that stratifies patients into four categories, simultaneously setting prognosis and guiding the therapy. Patients with HCC (single HCC < or =5 cm or three or fewer nodules < or =3 cm) benefit from curative/effective therapies (resection, transplantation, and percutaneous ablation), expert application of which provides a 50% to 75% 5-year survival. Those with more advanced disease present a heterogenous outcome. Patients who do not present with cancer-related symptoms and whose tumor has not invaded vascular vessels or disseminated outside the liver may reach 50% survival at 3 years, and they benefit from chemoembolization. Those who present with symptoms (pain, deterioration of physical condition) and/or an aggressive tumor pattern do not reach a 10% survival at 3 years, and there is no effective therapy for them. Finally, those with severe liver function or health status impairment constitute the end-stage category and cannot be expected to survive more than 1 year.

Carcinoma, Hepatocellular↗

PubMed2002

Comparison of Ranson, APACHE II and APACHE III scoring systems in acute pancreatitis.

INTRODUCTION: Acute pancreatitis runs an unpredictable course. The early prediction of the severity of an acute attack has important implications for management and timely intervention. AIM: To assess the prognostic accuracy of Ranson and APACHE II and III scoring systems in predicting the severity of acute pancreatitis. METHODS: One hundred fifty-three patients with acute pancreatitis (67.3% gallstone-related, 9.2% alcoholic, 17% idiopathic, and 6.5% of miscellaneous causes) were studied prospectively. Data conforming to the scoring systems were recorded 24 (the APACHE scores) and 48 hours (the Ranson score) after admission. Analysis was performed by using receiver operating characteristic curves (ROC), area under a curve (AUC), and by comparing likelihood ratios of positive test (LRPT). RESULTS: One hundred nineteen cases of pancreatitis were classified as mild, and 34 were classified as severe. The mortality rate was 3.2%. All three scores correlated with length of stay and disease severity. AUC for Ranson was found to be significantly larger than AUC for APACHE II and APACHE III score (0.817, cut-off > or =3; 0.618, cut-off, > or =10; and 0,676, cut-off > or =42 respectively). The Ranson score achieved the highest sensitivity and the lowest false-negative rate, but the positive and negative predictive values and LRPT were of similar extent for all three scores. CONCLUSION: The APACHE III offers little, if any, advantage over the APACHE II score. Ranson criteria proved to be as powerful a prognostic model as the more complicated APACHE II and III scoring systems, but with the disadvantage of a 24-hour delay.

APACHE↗

PubMed2000

Prognostic factors for time receiving workers' compensation benefits in a cohort of patients with low back pain.

STUDY DESIGN: Prospective inception cohort study. OBJECTIVE: To develop a prognostic model that predicts time receiving workers' compensation benefits for low back pain claimants. SUMMARY OF BACKGROUND DATA: As the cost and difficulty of managing low back pain escalate, any predictor of outcome is advantageous. METHODS: To obtain the outcome and predictor variables, patient data from two separate databases were linked: a clinical database and an administrative (Ontario workers' compensation) database. Claimants injured between January 1 and December 31, 1994, were included and observed for 1 year from the date of accident. The outcome variable was cumulative number of calendar days receiving benefits. RESULTS: Multivariable Cox proportional hazards regression (forward stepwise) showed eight significant predictors; five were associated with increased time receiving benefits compared with their reference groups: 1) working in the construction industry, 2) older age, 3) lag time from injury to treatment, 4) pain referred into the leg, and 5) three or more positive Waddell nonorganic signs. Three predictors were associated with reduced time receiving benefits: 1) higher values of questionnaire score, 2) intermittent pain, and 3) a previous episode of back pain. A predictive score was calculated to categorize claimants as at high or low risk for chronicity. When an arbitrary cutoff point was set at the 75th percentile of predictive score, negative predictive value was 94%. CONCLUSION: This research identified eight factors for time receiving workers' compensation benefits among claimants with low back pain. This model discriminates between high- and low-risk claimants. Few low-risk claimants continued to receive benefits for more than 3 months.

Adult↗

PubMed1986

Use of a prognostic index in evaluation of liver transplantation for primary biliary cirrhosis.

In the Cambridge/King's College Hospital program, one of the main criteria for recommendation of a liver transplant for a patient with primary biliary cirrhosis (PBC), as in other types of end-stage liver disease, has been the overall assessment that survival was likely to be less than one year. In the present study, a recently developed prognostic model, based on six variables, was used retrospectively to estimate the likely survival without transplantation of the first 29 patients receiving a transplant for PBC. Median estimated survival time for the complete group of patients was five months and in only four patients was survival in the absence of transplantation estimated to be more than one year. Comparison of actual survival curves after transplantation with the estimated survival in the absence of such a procedure shows that, despite an initial higher mortality related to surgery and the immediate postoperative period, grafting was associated with a statistically significant improvement in overall survival. No correlation between the outcome after transplantation and the severity of preexisting liver disease, (as assessed by the expected survival) could be determined, but further assessment of preoperative variables is warranted.

Adult↗

PubMed1989

Prognosis after liver transplantation for primary biliary cirrhosis.

Timing of transplantation for patients with primary biliary cirrhosis (PBC) requires identification not only of individual risk factors for the operation but estimation of survival with and without transplantation. To identify those risk factors and develop a prognostic model, 82 patients grafted for PBC since 1980 in the Birmingham and Cambridge/King's College Hospital series have been analyzed. Using logrank tests it was found that treatment with diuretics, hemoglobin above 10 g/dl, prothrombin time less than 5 sec prolonged, serum sodium above 130 mmol/L and serum bilirubin less than 350 mumol/L were all individually associated with a better prognosis. Using Cox regression analysis to identify independent variables, it was found that year of transplant, serum bilirubin, serum urea, and diuretic responsive ascites had a significant association with survival. Using these four variables, it was possible to develop a model to identify those patients with a good and a poor probability of survival after transplantation.

Bilirubin↗

PubMed2003

Low back pain after traffic collisions: a population-based cohort study.

STUDY DESIGN: A population-based, incidence cohort study was conducted. OBJECTIVE: To measure the incidence and prognosis for collision-related low back pain before and after a change in the insurance compensation system. SUMMARY OF BACKGROUND DATA: Low back pain is a common and costly occupational injury. It also occurs after traffic collisions, but less is known about its frequency and recovery in this setting. METHODS: An incidence cohort of 4473 low back pain injury claims was formed between July 1, 1994 and December 31, 1995 in Saskatchewan. On January 1, 1995 the public insurance system changed from a tort system to a no-fault system, eliminating compensation for pain and suffering. The incidence of claims and the time to claim closure were calculated before and after this change. Prognostic models were built using baseline and follow-up data. RESULTS: The 6-month incidence of claims decreased from 256 to 176 per 100,000 after the insurance change. The median time to claim closure dropped from 505 days for tort claims to 210 days and 216 days for claims made during the first and second 6 months of the no-fault period. Improvements in bodily pain and physical functioning and the absence of depressive symptoms were associated with faster claim closure. High pain intensity, female gender, full-time employment, concentration problems, and lawyer involvement early in the claim process delayed claim closure. CONCLUSIONS: Low back pain is a common traffic injury with a prolonged recovery. Its incidence and prognosis are affected by multiple factors, including the type of compensation system. Our study suggests that biopsychosocial factors are important in determining prognosis.

Accidents, Traffic↗

PubMed2005

Prognostic factors in chronic obstructive pulmonary disease.

PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Its epidemiology has changed over the years and the key changes are a rising mortality rate and a greater incidence among women. Predicting survival time of patients with COPD is difficult. Reliable prognostic markers are useful and important information for patients, their families, and for the physician. The purpose of this review is to examine traditional and newer prognostic factors of COPD. RECENT FINDINGS: Loss of fat free mass (FFM), need and frequency of hospitalization for acute exacerbation, and symptom score are now recognized as important parameters to supplement the traditional prognostic markers of age, forced expiratory volume in 1 second (FEV1), hypoxemia, and hypercapnia. SUMMARY: A prognostic model based on office practice data now affords a means of more reliably predicting outcome for patients with COPD.

Critical Care↗

PubMed2006

Cognitive function following stroke and vascular cognitive impairment.

PURPOSE OF REVIEW: This review of the cognitive status following stroke and vascular cognitive impairment starts by questioning the concept of vascular dementia and related concepts. Our position is that in many cases these labels promote a superficial conceptualization of an inherently complex and heterogeneous phenomenon hampering a more detailed understanding. RECENT FINDINGS: After stroke or disease of the cerebral vasculature, the cognitive and emotional outcome is dependent on a combination of three factors with the relative importance differing between causes. First, focal damage may lead to selective impairments that are dependent on the localization of the (grey matter) lesion. Second, diffuse neuronal dysfunction produces a more uniform profile of a decrease in mental speed, memory problems, and reduced executive functioning. Third, cognitive outcome is further modulated - notably in terms of severity - by patient variables such as age, sex, premorbid level of functioning, and comorbidity (e.g. hypertension). SUMMARY: The complex character of the cognitive repercussions of stroke can be better harnessed by employing modern neuropsychological assessment procedures. This allows both a detailed categorization of the patients for the selection and effectiveness of therapeutic intervention, as well as the construction of reliable prognostic models.

Brain↗

PubMed1981

Cost-benefit aspects of post-myocardial infarction intervention.

After myocardial infarction the mortality during the first post hospital year declines from approximately 10 per cent to 5 per cent during the second year. The rates of non-fatal recurrencies are similar. Mortality is related to age but not to the same extent to sex. Non-fatal recurrencies are, however, not related to age. Prediction of mortality is feasible by several prognostic models. Factors related to size of myocardial damage stand out as the important secondary risk factors for the years immediately after infarction. Most of these factors are not generally related to risk of non-fatal recurrencies. The proportion of cardiovascular deaths is 90 per cent during the first years and declines thereafter. Simplistically it may be said that the prognosis during the first years is related to the extent of the myocardial damage and thereafter primary risk factors become more important. Thus, it seems logical in the short-term perspective to influence myocardial factors and related arrhythmias and in the long-term perspective to influence primary risk factors which more likely operate on the vascular factors. Three preventive methods have demonstrated a positive benefit: 1) chronic beta-blockade, 2) cessation of smoking, 3) by-pass surgery in certain categories. After careful calculations it may be argued that at least half of the total mortality may be inhibited by beta-blockade and cessation of smoking. The impact of coronary surgery, lipid lowering and reduction of high blood pressures is more difficult to assess.

Adrenergic beta-Antagonists↗

PubMed2005

Review article: current management of primary sclerosing cholangitis.

The management of primary sclerosing cholangitis (PSC) is hindered by incomplete understanding of the pathogenesis of the disease and the lack of good prognostic models. Few large randomized controlled trials of drug therapy have been published. Best practice in the management of PSC is currently based therefore on careful interpretation of the available evidence, close observation of individual patients and clinical experience of the disease. Drug therapy is useful for alleviating symptoms. Ursodeoxycholic acid may slow progression of the disease and reduce the frequency of complications. Consensus is emerging on the issues of screening for the malignant complications of PSC and the indications for liver transplantation are becoming broader and encompassing the earliest stages of cholangiocarcinoma. In view of the rarity of the disease in the general population, large international collaborations to study PSC are necessary to provide clearer answers in areas of uncertainty, and these are now beginning to emerge.

Cholagogues and Choleretics↗

PubMed1991

Terminal transferase expression in acute myeloid leukaemia: biology and prognosis.

Clinical and biological features were assessed in 114 consecutive previously untreated adult acute myeloid leukaemia (AML) patients whose diagnosis was based on FAB criteria and detailed immunophenotyping. All patients received standard intensive chemotherapy. The main purpose of this study was to establish the prognostic value, if any, of terminal transferase (TdT) expression in myeloid leukaemia. TdT positive cells (7-80% of total blast cells) were detected in 40% of the cases. Among clinical characteristics, a low lactate dehydrogenase (LDH) (less than 250 I.U.) (P = 0.003), a low initial white blood cell count (less than 10 x 10(9)/l) (P = 0.002), and an absolute neutrophil count (less than 5 x 10(9)/l) (P = 0.02) were associated with TdT-positivity. FAB classification was not predictive of TdT expression, and there was no difference in the distribution of FAB subtypes between the groups. Multivariate analysis combining clinical and laboratory data indicated that a low expression of the monocytic antigen CD14 was predictive of TdT positivity in AML (P = 0.01). Karyotyping showed no difference in the pattern of occurrence of specific abnormalities between the TdT+ and the TdT- group. When clinical and immunophenotype data were included in a prognostic model, the patient's age was highly predictive of response (P less than 0.001), and only the CDw65 antigen contributed to the response model (P = 0.07). TdT+ patients with a low expression of CD11b achieved a higher frequency of response at a borderline level of significance (P = 0.06). Frequency of response to chemotherapy, the response duration or overall survival were not influenced by TdT expression.

Acute Disease↗