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PubMed1994

Mitral valve surgery combined with coronary bypass grafting: multivariate analysis of factors predicting early and late results.

Total of 123 patients (mean age: 63.8 +/- 7.3 years, (male/female 65/35 percent) underwent mitral valve surgery combined with coronary artery bypass grafting during a seven year period. Preoperatively 12% of them belonged to NYHA functional class II, 54% to class III, 29% to class IV and 3% was operated under emergency conditions. The mitral valve lesion was most frequently either ischaemic (45%) or rheumatic (33%) in origin. Left ventricle function was moderately decreased in 18% and severely damaged in 3% of the patients as documented by preoperative ventriculography. Coronary surgery was performed in all cases with an average number of distal anastomosis of 2.2 +/- 1.1 per patient. The hospital mortality was 13%. Risk factors for early and late mortality were determined by univariate and multivariate analysis. Advanced preoperative functional class and decreased left ventricular function or ischaemic etiology were identified as significant risk factors for early mortality. The patients were followed for an average of 33 +/- 25 months. The majority of them experienced significant functional improvement postoperatively with 69% belonging to NYHA class I or II. The late survival for the 107 hospital survivors was 94.7% at one year, and 84.7% at five years, respectively. Late survival was independently determined by preoperative functional class or previous myocardial infarction. Freedom from ischemic and valve related complications at five years was 95% and 71.2% respectively. 58.2% of the hospital survivors were in functional class I or II and free of any valve related or ischemic complications at the end of the fifth follow up year.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1988

Determinants of hepatic function in liver cirrhosis in the rat. Multivariate analysis.

We investigated the determinants of hepatic clearance functions in a rat model of liver cirrhosis induced by phenobarbital/CCl4. Aminopyrine N-demethylation (ABT), galactose elimination (GBT), and serum bile acids (SBA) were determined in vivo. The livers were then characterized hemodynamically: intrahepatic shunting (IHS) was determined by microspheres and sinusoidal capillarization by measuring the extravascular albumin space (EVA) by a multiple indicator dilution technique. The intrinsic clearance was determined by assaying the activity of the rate-limiting enzymes in vitro. Hepatocellular volume (HCV) was measured by morphometry. ABT and SBA, but not GBT, differentiated cirrhotic from normal liver. IHS ranged from normal to 10%; all cirrhotic livers showed evidence of sinusoidal capillarization (reduced EVA). The cirrhotic livers showed a bimodal distribution of HCV, HCV being decreased in 50% of the cirrhotic livers. Multivariate analysis showed EVA and portal flow to be the main determinants of microsomal (ABT) and cytosolic (GBT) clearance function; SBA, by contrast, were determined solely by IHS. We conclude that sinusoidal capillarization is the main determinant of hepatic clearance, while serum bile acids reflect intrahepatic shunting. These findings emphasize the importance of alterations of hepatic nutritional flow to explain reduced clearance function in cirrhosis of the liver.

Animals↗

PubMed2002

Differential actions of antiparkinson agents at multiple classes of monoaminergic receptor. I. A multivariate analysis of the binding profiles of 14 drugs at 21 native and cloned human receptor subtypes.

Because little comparative information is available concerning receptor profiles of antiparkinson drugs, affinities of 14 agents were determined at diverse receptors implicated in the etiology and/or treatment of Parkinson's disease: human (h)D(1), hD(2S), hD(2L), hD(3), hD(4), and hD(5) receptors; human 5-hydroxytryptamine (5-HT)(1A), h5-HT(1B), h5-HT(1D), h5-HT(2A), h5-HT(2B), and h5-HT(2C) receptors; halpha(1A)-, halpha(1B)-, halpha(1D)-, halpha(2A)-, halpha(2B)-, halpha(2C)-, rat alpha(2D)-, hbeta(1)-, and hbeta(2)-adrenoceptors (ARs); and native histamine(1) receptors. A correlation matrix (294 pK(i) values) demonstrated substantial "covariance". Correspondingly, principal components analysis revealed that axis 1, which accounted for 76% variance, was associated with the majority of receptor types: drugs displaying overall high versus modest affinities migrated at opposite extremities. Axis 2 (7% of variance) differentiated drugs with high affinity for hD(4) and H(1) receptors versus halpha(1)-AR subtypes. Five percent of variance was attributable to axis 3, which distinguished drugs with marked affinity for hbeta(1)- and hbeta(2)-ARs versus hD(5) and 5-HT(2A) receptors. Hierarchical (cluster) analysis of global homology generated a dendrogram differentiating two major groups possessing low versus high affinity, respectively, for multiple serotonergic and hD(5) receptors. Within the first group, quinpirole, quinerolane, ropinirole, and pramipexole interacted principally with hD(2), hD(3), and hD(4) receptors, whereas piribedil and talipexole recognized dopaminergic receptors and halpha(2)-ARs. Within the second group, lisuride and terguride manifested high affinities for all sites, with roxindole/bromocriptine, cabergoline/pergolide, and 6,7-dihydroxy-N,N-dimethyl-2-ammotetralin (TL99)/apomorphine comprising three additional subclusters of closely related ligands. In conclusion, an innovative multivariate analysis revealed marked heterogeneity in binding profiles of antiparkinson agents. Actions at sites other than hD(2) receptors likely participate in their (contrasting) functional profiles.

Animals↗

PubMed1988

Risk factors in renal cell carcinoma. II. Medical history, occupation, multivariate analysis, and conclusions.

Potential risk factors in renal cell carcinoma (RCC) were studied in a case-control study of 315 RCC cases and 313 hospital and 336 population controls. Risk factors included medical history, radiation exposure, predominant lifetime occupation, exposure to high-risk industries, and summary of important risk factors by a linear logistic regression model based on the comparison of RCC cases and controls selected from hospitals and the general population for 33 variables. A significant increase in urologic, cardiovascular, malignant, digestive, and metabolic disease was observed among cases over population controls. Exposure to radiation increased the risk, especially in females. A predominant lifetime occupation as a professional decreased the risk, whereas work as an operative increased the risk significantly. Work in petroleum-related and dry-cleaning industries were associated with elevated risk. Multivariate analysis comparing cases with each of the control groups for males and females identified obesity as the most important risk factor in RCC. Weight control at an early age might help to prevent the occurrence of a significant proportion of this rare but increasing malignant disease.

Carcinoma, Renal Cell↗

PubMed1989

[Prognosis of surgically treated colorectal neoplasms. Contribution of multivariate analysis].

Dukes' classification is the most usually used method of staging in colorectal carcinoma. However the pitfalls of this classification may be attested by the multitude of modifications of Dukes' staging during the last sixty years. The aim of our study was to evaluate the influence of 25 variables on survival in colorectal carcinoma using the Cox model. This study was performed in 321 patients operated on for colorectal carcinoma. In the 252 patients who had had a curative resection univariate analysis showed that survival was related to 6 variables: age, juxtatumoral lymph node involvement, an abdominal mass, complicated carcinoma, duration of symptoms, and depth of tumor penetration. Stepwise analysis showed the independent influence of 7 variables on survival: age, lymph node involvement, depth of tumor penetration, duration of symptoms, direct spread, preexisting deficiencies, and sex. A byproduct of the regression coefficient of Cox' model was a numerical value for each of these predictive factors. A single composite score was obtained by adding the individual scores of factors from which a prediction of outcome can be made. Applying this model to each of the 252 patients resected for cure, we established three prognostic groups. They predict survival more accurately than the Dukes' system. Our scoring system based on multivariate analysis must successfully defined prognostic groups of patients in other series. Then, it should be recommended for staging in curative resection for colorectal carcinoma.

Aged↗

PubMedDate not supplied

Ten-year survival following aortic valve replacement: A multivariate analysis of coronary bypass as a risk factor.

The additional risk of coronary bypass surgery was analysed in 664 patients over 40 years of age undergoing aortic valve replacement between 1969 and 1981. Four hundred sixty-seven patients underwent aortic valve replacement alone, while 197 patients with coronary artery disease underwent combined aortic valve replacement and coronary bypass surgery. There were no significant differences in the preoperative hemodynamic characteristics of the two groups of patients. There were 41 (9%) operative deaths following aortic valve replacement alone and 20 (10%) following aortic valve replacement with coronary bypass surgery. Since 1976, operative mortality has fallen to 5% and perioperative myocardial infarction to 2% following the combined procedure. Ten-year actuarial survival (standard error) was 56 (3%) following aortic valve replacement and 49 (6%) following aortic valve replacement and coronary bypass surgery. A multivariate analysis including both groups of patients revealed that age, functional class and year of operation significantly affected ten-year survival (p less than 0.05). The same analysis showed that coronary artery disease requiring coronary bypass surgery also decreased ten year survival in patients undergoing aortic valve replacement (p = 0.06).

Aged↗

PubMed2006

ATR microspectroscopy with multivariate analysis segregates grades of exfoliative cervical cytology.

Although cervical cancer screening in the UK has led to reductions in the incidence of invasive disease, this programme remains flawed. We set out to examine the potential of infrared (IR) microspectroscopy to allow the profiling of cellular biochemical constituents associated with disease progression. Attenuated total reflection-Fourier Transform IR (ATR) microspectroscopy was employed to interrogate spectral differences between samples of exfoliative cervical cytology collected into liquid based cytology (LBC). These were histologically characterised as normal (n = 5), low-grade (n = 5), high-grade (n = 5) or severe dyskaryosis (? carcinoma) (n = 5). Examination of resultant spectra was coupled with principal component analysis (PCA) and subsequent linear discriminant analysis (LDA). The interrogation of LBC samples using ATR microspectroscopy with PCA-LDA facilitated the discrimination of different categories of exfoliative cytology and allowed the identification of potential biomarkers of abnormality; these occurred prominently in the IR spectral region 1200 cm(-1) - 950 cm(-1) consisting of carbohydrates, phosphate, and glycogen. Shifts in the centroids of amide I (approximately 1650 cm(-1)) and II (approximately 1530 cm(-1)) absorbance bands, indicating conformational changes to the secondary structure of intracellular proteins and associated with increasing disease progression, were also noted. This work demonstrates the potential of ATR microspectroscopy coupled with multivariate analysis to be an objective alternative to routine cytology.

Female↗

PubMed1998

Prospective multivariate analysis of donor monoethylglycine xylidide (MEGX) testing in liver transplantation. Transplantation Society of Michigan Scientific Studies Committee.

Measurement of the metabolism of lidocaine to MEGX by the hepatic cytochrome P450 system has been proposed as a means to assess liver function and metabolic activity of cadaveric organ donors. This prospective study of 102 potential liver donors from the State of Michigan sought to determine the role of MEGX determinations alone and in conjunction with traditional measures of donor acceptability. High MEGX values (> 80 microg/L) did not correlate with the acceptability of donor livers, and had no significant association with early posttransplant graft function, as determined by SGOT, SGPT, alkaline phosphatase, bilirubin, prothrombin time, or bile production. However, livers procured from donors with high MEGX values had improved actuarial graft survival when compared to low MEGX donors at 30 d (95% vs. 84%) and at 1 yr (68% vs. 43%) (p < 0.04). Multivariate analysis demonstrated a significant independent association of both shorter cold ischemic time and high MEGX value with improved graft survival (p < 0.002). We conclude that the MEGX test offers limited incremental value in predicting early function of donor livers when used in conjunction with traditional criteria of clinical evaluation, laboratory tests, and histology. However, knowledge of the results of MEGX determinations may be of value in predicting graft survival after liver transplantation.

Adult↗

PubMed1987

Prognostic value of steroid hormone receptors: multivariate analysis of systemically untreated patients with node negative primary breast cancer.

The value of estrogen and progesterone receptor (ER and PgR, respectively) determinations in predicting the recurrence-free survival (RFS) has been evaluated in a group of 807 node negative breast cancer patients. All of these patients are enrolled in the Danish Breast Cancer Cooperative Group (DBCG) 77-1a and 82-a protocols for low risk patients, and none of them have received systemic adjuvant therapy. At a median observation time of 50 months and in an evaluation of the total patient population as an entity, ER+ patients had only a marginally significant (P = 0.07) longer RFS than ER- patients while PgR+ patients experienced a significant advantage (P = 0.02). Among patients subgrouped according to menopausal status, both ER and PgR statuses were found to be significant prognostic factors for predicting RFS in the premenopausal women (less than 50 years) but not in peri- or postmenopausal women. Using Cox's multivariate analysis, nuclear pleomorphy was found to be the only significant prognostic variable, while the value of PgR status as a prognostic factor approached significance (P = 0.065). Although knowledge of ER status did not significantly improve distinction between patients with good and poor prognoses in the relatively small subgroup of premenopausal patients (n = 120) when PgR status was known, ER+PgR- patients have a lower risk of recurrence or death than ER-PgR- patients. Using a log-likelihood model, significant and distinct cut-off limits for the definition of receptor positivity were found for premenopausal patients: these were 5 fmol/mg cytosol protein for ER and 10 fmol/mg cytosol protein for PgR. These cut-off levels may reflect the ability of the ligand binding assay method used to discriminate between tissues with and without receptor proteins. Qualitative assessment of receptor status was as valuable as quantitative expression of receptor concentrations in predicting the RFS of the natural course of the disease among node negative premenopausal patients.

Adult↗

PubMed1987

[Antiemetic effects of MS-5080 associated with cisplatin chemotherapy--an attempt in assessment based on the sample score system using multivariate analysis].

Effect of a new antiemetic drug, MS-5080 was evaluated against nausea and vomiting induced by chemotherapy including cisplatin. Fifty patients with various urological malignancies were registered into this study, which were distributed to the aliquot number with a respective dose schedule of 2, 3, 4 and 5 mg/kg body weight of MS-5080. Forty-seven patients with a total of 73 chemotherapeutic courses were eligible for evaluation of antiemetic efficacy, whereas the side effect of MS-5080 were evaluated in 48 patients with a total of 74 courses. Antiemetic efficacy was evaluated in terms of duration of nausea, duration of vomiting, duration of food intolerance, and the number of vomiting episodes. No statistically significant difference was observed in relation to the dose dependency of MS-5080. In assessment of the side effects, a relatively high incidence of diarrhea was observed compared to the other known antiemetic drugs. In the present study, we attempted an evaluation based on the sample score system using multivariate analysis. The results were correlated well with results of a grading system of efficacy that were determined by each physician who treated the patients.

Adult↗

PubMed1990

Detection of malignant tumours by multivariate analysis of proton magnetic resonance spectra of serum.

Proton magnetic resonance spectra of blood serum have been subjected to multivariate data analysis to discriminate between samples from cancer patients and from controls. The main feature was the use of digitally defined resonance profiles. The methyl and methylene lipoprotein signals centred at 1.3 and 0.9 parts per million are non-lorentzian composite peaks that cannot be described properly by the line width at half-height. Instead 71 and 76 data points were used to describe the methylene and methyl peak profiles, respectively. These data points were used as input to a principal component analysis to distinguish between malignant (n = 29) and control samples (n = 55). At a probability level of 0.01 (F-test) modelling classified all patients except 2 correctly, while 1 control was slightly above the predictive level for malignancy.

Female↗

PubMed1988

Multivariate analysis for clinical prognostic factors in 163 patients with soft tissue sarcoma.

Clinical and histologic findings in 163 patients with localized soft tissue sarcoma (STS) in the extremities and trunk were reviewed. There were 91 male patients and 72 female patients ranging in age from 2 to 84 years (median, 46 years). The histologic status of the tumors was as follows: low grade, 29 cases; intermediate grade, 52 cases; and high grade, 82 cases. The primary tumors were treated by intralesional excision (two cases), marginal (88), wide local (52), or amputation (21). Subsequent adjuvant therapy was given to 61 patients; 17 had radiotherapy (RT), 27 had chemotherapy (CH), and 17 had combined RT and CH. The overall survival (P less than 0.1) and disease-free survival (P less than 0.001) were better in the group that received multimodal treatment (radical surgery and adjuvant chemotherapy with or without radiotherapy) than in the group treated only by surgery. This suggests the favorable role of adjuvant therapy. The univariate and the Cox multivariate analysis for prognosis revealed that sex, tumor-related symptoms, tumor size, tumor depth, and histologic grade were the significant factors. Among the treatment schemes, adjuvant chemotherapy was the only one that affected survival, especially for the intermediate-grade tumors. Initial surgical treatment (marginal versus wide local excision) significantly contributed to the local control of the primary tumors.

Actuarial Analysis↗

PubMed2000

A multivariate analysis of factors affecting patency of femoropopliteal and femorodistal bypass grafting.

BACKGROUND: The most important factors that determine the outcome after femoropopliteal and femorodistal arterial reconstruction are still controversial. This report analysis the factors that determine the early and late patency of distal arterial reconstruction. PATIENTS AND METHODS: A retrospective analysis of patency after femorodistal arterial reconstruction with a new method for evaluation of angiographic runoff was performed for 336 arterial reconstructions. The different pre-, per- and postoperative risk factors were analysed in a Cox proportional hazards model. RESULT: The patency was significantly better for vein grafts in comparison to composite grafts and prosthetic grafts. It was 74% for vein, 46% for composite and 43% for prosthetic reconstructions, respectively, at 12 months after arterial reconstruction. The cumulative life table patency rate in extremities with good, intermediate and poor runoff was 62, 30 and 10%, respectively at 36 months. The patency rates for extremities operated on for claudication was significantly better than for extremities operated on for critical ischaemia. The multivariate analysis of different factors in a Cox analysis revealed that only the status of distal runoff, the graft material and the site of the distal anastomosis independently and significantly influenced the patency rates. CONCLUSIONS: A new model for evaluation of distal runoff proved to predict the patency rate of femoropopliteal and femorodistal arterial reconstructions reasonably well in this retrospective analysis.

Aged↗

PubMed1994

Multivariate analysis of factors affecting survival in pelvic exenteration.

Of 153 patients with primary or recurrent pelvic malignancy referred for consideration of exenteration, only 40.6% (62 patients) were found to be suitable for exenteration after full assessment. Thirty percent (46 patients) were found to be inoperable on examination under anesthesia. Of the remaining 107 patients, 33% (35 patients) were found to be inoperable at laparotomy, 9% (10 patients) underwent radical hysterectomy and 58% (62 patients) had an exenterative procedure. One patient had no active disease found on final histologic review of the exenteration surgical specimen and was excluded, as the aim of this study was to look at the prognostic factors affecting survival. There remained 61 patients in the exenteration group who were analyzed. The 2-year survival rate was less than 2% for patients with inoperable disease, 48% for patients who underwent radical hysterectomy and 54.1% for patients who underwent exenteration. The 5-year survival rate for all patients undergoing exenteration for pelvic malignancies was 44% and that for cervical cancer only was 52%. Multivariate analysis of patients who had undergone exenteration showed four significantly poor prognostic factors influencing survival. They were: (a) aged older than 69 years, (b) recurrence of the tumor within 3 years, (c) persistent recurrence, and (d) positive resection margins.

Journal Article↗

PubMed1987

[Operative risk in coronary bypass. A multivariate analysis of prognostic factors].

In order to determine the predictors of operative risk in coronary bypass surgery, we have studied 2112 consecutive patients who underwent isolated coronary bypass surgery between January 1979 and September 1984. The overall operative mortality (OM) was 4.4 percent (3.5 percent during the last 3 years). OM increases significantly with age (from O before the age of 30 to 12.3 percent after 70), the functional class (FC) of angina, the FC of dyspnea (NYHA), the creatinine blood level (23.5 percent if greater than 200 mumol/l), the left ventricular end-diastolic pressure and in case of reoperation (16.7 percent), as well as in women (11.6 percent). There is a trend toward higher OM in case of past history of ventricular tachycardia or arterial hypertension, atherosclerotic disease of the lower extremities, left ventricular dysfunction or severe stenosis of the left main coronary artery. OM is not increased in patients with multivessel disease, diabetes or with a past history of myocardial infarction, and is even decreased in obese patients. The variables selected by multivariate analysis were: creatinine blood level, then angina FC, sex, dyspnea FC, age, the absence os obesity, left ventricular dysfunction, the year of surgery and finally reoperation. These results, mainly based on simple clinical variables, should facilitate the therapeutic decisions in borderline indications of coronary bypass surgery.

Aged↗

PubMed1989

Multivariate analysis of prognostic factors in acute myeloid leukemia: value of clonogenic leukemic cell properties.

The initial clinical and biological parameters, including clonogenic leukemic cell (CFU-L) assay, were reviewed for their prognostic significance in a cohort of 188 adult patients with newly diagnosed untreated acute myeloid leukemia (AML). Almost all patients received induction therapy with daunorubicin (DNR) and cytarabine (Ara-C) according to the European Organization for Research and Treatment of Cancer (EORTC) AML 5 to AML 9 trials. Bone marrow samples from 116 representative patients were obtained for CFU-L assay with an efficiency percentage of 89.6%; 76 patients had a measurement of the CFU-L self-renewal capacity (second plating efficiency [PE2]) and 91 patients had CFU-L inhibition test after exposure to DNR and/or Ara-C. The prognostic significance of parameters such as age, hematological antecedent, WBC count, liver enlargement, and Auer rods is confirmed in the present study. Moreover, high platelet and polymorphonuclear counts appeared to be related to resistance to induction course. However, through multivariate analysis, CFU-L sensitivity to drugs and self-renewal capacity appeared to be major independent prognostic factors in AML. A low CFU-L inhibition in the presence of the DNR and Ara-C combination correlates with a poorer complete remission (CR) rate, but not with CR duration. Patients with the lower PE2 values experienced both higher CR rate and longer CR duration. The practical interest of CFU-L study remains to be defined but, at least, PE2 measurement could be considered in the future as a major variable in determining therapeutic aggressiveness.

Adolescent↗

PubMed2004

[Multivariate analysis of the parameters related to recurrence of laryngeal papilloma in adult].

OBJECTIVE: To investigate the clinical and pathological characteristics of astrocytoma and the factors related to pathological gradings as well as recurrence in laryngeal papilloma in adult. METHOD: Fifty samples from patients were selected and 10 cases of normal tissue or inflammation tissue were used as control group. The expression of Pgp, GST-pi, Topo II and Ki-67 and VEGF by immunohistochemical stain and the microvessel density by morphometry were studied. RESULT: (1) The positive rates of Pgp, GST-pi and Topo II were not correlated with the age, sex, tumor size and the recurrence (P > 0.05). (2) Both recurrent tissue and current tissue showed various positivity for Ki-67. The difference were significant (P < 0.01). Taking 39% of Ki-67 expression as threshold, there was significant difference between two curves indicating favorable recurrence in the tumor group respectively (P < 0.01). (3) Microvascular changes,such as the density of blood vessels demonstrated significantly difference between the two tumor group (P < 0.01). An average vessel count of more than 19 (x 200) suggested an easier recurrence. CONCLUSION: Use of the cox-regression model in multivariate analysis shows that there are five parameters closely related to the recurrence of laryngeal papilloma in adult, of which the Ki-67 is the most critical factor, second the microvessel density, while Pgp, Topo II and GST-pi in tumor are independent favorable factors for laryngeal papilloma of adult.

Adolescent↗

PubMed1993

Risk factors for primary dysfunction after liver transplantation--a multivariate analysis.

In a retrospective analysis on 323 orthotopic liver transplant procedures performed between July 1984 and October 1991 the incidence of two forms of primary dysfunction (PDF) of the liver: primary nonfunction (PNF), and initial poor function (IPF) were studied. The incidence of PDF was 22% (73/323) with 6% PNF (20/323) and 16% IPF (53/323), while 78% (250/323) had immediate function (IF). Occurrence of both IPF and PNF resulted in a higher graft failure rate (P < 0.001), retransplantation rate (P < 0.001), and patient mortality (P < 0.003) within the first three months after OLTx. Univariate analyses of donor and recipient factors and their influence on PDF demonstrated that longer donor hospitalization (> 3 days), older donor age (> 49 years), extended preservation times (> 18 hr), and fatty changes in the donor liver biopsy, as well as reduced-size livers, younger recipient age, and renal insufficiency prior to OLTx, significantly affected the incidence of IPF and PNF. Multivariate analysis of potential risk factors showed that reduced-size liver (P = 0.0001), fatty changes on donor liver biopsy (P = 0.001), older donor age (P = 0.009), retransplantation (P = 0.01), renal insufficiency (P = 0.02), and prolonged cold ischemia times (P = 0.02) were independently associated with a higher incidence of IPF and PNF. No statistical correlation was found between PDF and etiology of ESLD, nutritional status of the recipient, UNOS status, and Child-Pugh classification in this study. We conclude that PNF and IPF are both separate clinical entities that have a significant effect on outcome after OLTx. Routine donor liver biopsies are recommended to decrease the rate of IPF and PNF. The combination of risk factors shown to be significant for PDF should be avoided--and, if that is not possible, the only variable that can be controlled, the preservation time, should be kept as short as possible.

Adolescent↗