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PubMed1997

Prognostic value of immunohistochemistry for p53 in primary soft-tissue sarcomas: a multivariate analysis of five antibodies.

Most changes of tumor suppressor p53 and its pathway involve a protein with prolonged half-life that permits immunohistochemical detection. The goal of this study was to compare the prognostic relevance of five different p53 antibodies in primary soft-tissue sarcomas (STS) with known p53 mutation status, using a multivariate Cox regression model (adjusted to tumor grading, staging, localization, tumor type, and therapy). A group of 198 primary STS of six types were investigated for p53 overexpression, using p53 antibodies DO-1, DO-7, Pab1801, Pab240, and CM-1. A positive marker frequency between 36.2% and 62.6% was detected. Out of 65 patients whose primary tumor reacted positively to all five antibodies, 52 (80%) died within the study period. Only the N-terminal-binding monoclonal antibodies DO-1, DO-7 and Pab1801 showed a multivariate correlation with survival (P = 0.0014, 0.0048 and 0.02). CM-1 and Pab240 had a univariate, but not a multivariate correlation, with a confounding effect of grading. The prognostic relevance for the five p53 antibodies was: DO-1 > Pab1801 > DO-7 > CM-1 > Pab240. This is the first study that investigates multivariately the prognostic relevance of p53 immunostaining in STS. If monoclonal antibodies with an epitope in the N-terminal region of the p53 protein (DO-1, Pab1801, DO-7) are applied, p53 immunohistochemistry provides an independent prognostic marker in STS.

Antibodies, Monoclonal↗
PubMed2006

Risk of cerebral vasopasm after subarachnoid hemorrhage reduced by statin therapy: A multivariate analysis of an institutional experience.

OBJECT: Impairment of endothelial nitric oxide synthase (eNOS), endothelium-dependent relaxation, and cerebrovascular autoregulation all occur in vasospastic cerebral arteries following subarachnoid hemorrhage (SAH). The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, both improve endothelial function and increase eNOS messenger RNA, protein, and enzymatic activity threefold. Increasing experimental evidence in animal models of SAH suggests that statins may ameliorate cerebral vasospasm. The authors hypothesized that patients chronically treated with statins would have a decreased risk of symptomatic vasospasm after SAH. METHODS: The authors retrospectively reviewed the charts of 115 patients with SAH who were consecutively admitted to the Neuroscience Intensive Care Unit of Duke University between 1998 and 2001. The independent association of statin therapy to symptomatic vasospasm was assessed using multivariate logistic regression analysis. Fifteen patients (13%) admitted with SAH were receiving statin therapy for at least 1 month before admission. Forty-nine patients (43%) experienced symptomatic vasospasm a mean of 5.8 +/- 3 days after onset of SAH. Current statin therapy on admission (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.01-0.77) was independently associated with an 11-fold reduction in the risk of symptomatic vasospasm. Fisher Grade 3 SAH (OR 2.82, 95% CI 1.50-5.71) and rupture of anterior cerebral or internal carotid artery aneurysm (OR 3.77, 95% CI 1.29-10.91) were independently associated with an increased risk of symptomatic vasospasm. CONCLUSIONS: In this retrospective case series, patients who received statin therapy for at least 1 month demonstrated an 11-fold decrease in the risk of developing symptomatic vasospasm after SAH.

Adult↗
PubMed1996

Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients.

OBJECTIVES: To identify factors that influence mortality in patients who are affected by intra-abdominal infections (IAIs) and to make a comparison among three different scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the sepsis score of Elebute and Stoner, and the Mannheim peritonitis index. DESIGN: Case series. SETTING: Both primary and referral hospital care. PATIENTS: The hospital records of 604 patients who consecutively underwent emergency operations for unequivocal IAIs, both spontaneous and postoperative, from 1981 to 1993, were retrospectively reviewed. Patients with IAIs that were related to peritoneal dialysis or infected ascites, those patients who were affected by primary peritonitis from a distant site, and those patients who underwent operations for acute appendicitis or acute cholecystitis without peritoneal contamination were excluded from the study. Univariate and multivariate analyses were used to calculate the prognostic significance of the following variables: age (< or = 70 vs > 70 years); sex; type (spontaneous vs postoperative) and extent (localized vs diffuse) of infection; preoperative serum levels of albumin, cholesterol, and hemoglobin; preoperative total lymphocyte count; amount of intraoperative blood loss; presence of preoperative organ impairment; the APACHE II score; the sepsis score of Elebute and Stoner; and the Mannheim peritonitis index. MAIN OUTCOME MEASURE: Death was the outcome variable that was studied. RESULTS: Multivariate logistic regression analysis showed that the APACHE II score, the Mannheim peritonitis index, hypoalbuminemia, hypocholesterolemia, and preoperative organ impairment were independent predictors of death. CONCLUSIONS: Results showed a significant dominance of host-related factors over the type and source of infection on the prognosis of patients with IAIs. Both the APACHE II score and the Mannheim peritonitis index correctly graded IAI severity and were strongly and independently associated with the outcome; however, the latter score has the advantage of being easier to calculate.

APACHE↗
PubMed2006

Multivariate analysis of integrated and full-resolution 1H-NMR spectral data from complex pharmaceutical preparations: St. John's wort.

Commercial herbal preparations are typically very complex mixtures and the relationship between content of various constituents and pharmacological action of the formulation is usually unclear. Such formulations are nevertheless standardized using a single marker constituent or a group of closely related constituents, which provides no information about other abundant constituents present in the extract. In this study, principal component analysis of 600 MHz 1H-NMR spectra of extracts of commercial formulations of St. John's wort (Hypericum perforatum), acquired in methanol-d4 and DMSO-d6, was shown to be able to discriminate between various preparations according to their global composition, including differentiation between various batches from the same supplier, while no clustering into classes of tablets and capsules was observed. This suggests that the plant extract variability rather than the manufacturing process accounts for the data clustering. Major variations in the content of flavonoids, recently linked to the antidepressant activity of St. John's wort extracts, were detected. Use of two NMR solvents provided complementary data sets, allowing assessment of various aspects of sample composition from separate PCA models. Both integrated (about 200 variables) and full-resolution NMR data (about 30,000 variables) have been used. The latter approach, applied for the first time in analysis of a herbal preparation, provided via loading plots more precise information about constituents responsible for data clustering, and may be generally preferable for PCA analysis of NMR data of plant extracts and herbal medicines.

Humans↗
PubMed1991

Survival from out-of-hospital cardiac arrest. A multivariate analysis.

A recursive estimation model is used to investigate the roles of cardiopulmonary resuscitation (CPR) and advanced life support in improving survival from out-of-hospital cardiac arrest. The importance of life support measures is clearly evidenced in the analysis: Fewer elapsed minutes between the cardiac arrest and the start of CPR increase the probabilities of both a favorable cardiac rhythm and defibrillation and the probability of survival. Similarly, a shorter elapsed time between the start of CPR and defibrillation is significantly related to a higher probability of survival of the cardiac arrest. Personal characteristics also contribute to survival, but primarily via their association with a favorable initial postarrest cardiac rhythm and the probability of defibrillation. The initial postarrest cardiac rhythm is shown to be an indicator of the heart's condition, but when other factors associated with survival are included in the analysis, it does not independently influence an individual's probability of survival.

Aged↗
PubMed1990

Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors.

We evaluated the courses of 115 consecutive cases of pediatric acute leukemia treated with induction chemotherapy. Seventy-two patients developed fever associated with neutropenia; 15 developed systemic fungal infections. We reviewed multiple demographic and treatment characteristics of these patients in an attempt to identify potential risk factors for the development of invasive fungal disease (IFD). Risk factors identified in a univariate analysis included duration of neutropenia after first fever (P less than .0001), diagnosis of acute nonlymphocytic leukemia (ANLL) (P = .003), onset of fever and neutropenia within 5 days of starting induction chemotherapy (P = .009), and multiple (greater than one) surveillance culture sites positive for fungal organisms (P = .02). In a multiple logistic regression analysis, duration of neutropenia (P less than .001) remained a significant risk factor. The study group of patients had a significantly higher risk of fungal infections than a matched group of leukemia patients developing fever with neutropenia due to postremission consolidation chemotherapy (P = .003). In the first 48 patients, 14 (29%) developed IFD. In the subsequent patients (n = 24), intravenous miconazole (5 mg/kg every 8 hours) was begun at the time of the first fever. One of the 24 patients (4%) given miconazole developed IFD. The use of miconazole was a negative risk factor for the development of IFD in univariate (P = .01) and multivariate (P = .05) analysis. We conclude that pediatric leukemia patients who develop fever associated with neutropenia during induction chemotherapy are at high risk for developing IFD. The role of intravenous miconazole at the time of the first fever in this group deserves further study.

Adolescent↗
PubMed1988

Adherence to lithium prophylaxis: II. Multivariate analysis of clinical, social, and psychosocial predictors of nonadherence.

The purpose of this prospective study of 133 affective disorder patients, consecutively referred to start long-term lithium therapy, was to identify predictors of importance for nonadherence. The nonadherent group was defined as the 31 (23.3%) patients who stopped treatment within the first six months. In the multivariate logistic analysis the most informative clinical, social, and psychosocial predictors were, in rank order: many admissions to mental hospitals, death or divorce of parent in childhood, heavy smoking, short duration of the mental disorder diagnosed as affective, not married, never economically active, and early onset of the affective disorder. The logical consequence of the results is to offer the subgroup of patients with an individually calculated high probability of nonadherence intensive control and support during the first month of lithium treatment.

Adult↗
PubMed2004

Multivariate analysis of the factors affecting duration of acute inpatient rehabilitation after hip and knee arthroplasty.

OBJECTIVE: To determine which factors predict length of stay at a rehabilitation hospital for total hip and knee arthroplasty patients. DESIGN: Length of stay at an acute rehabilitation hospital was analyzed with respect to demographic, surgical, and comorbidity factors using univariate and multivariate statistical techniques. Data were retrospectively collected of 808 hip and knee arthroplasty rehabilitation patients from years 2000 and 2001 at a large, urban, university-affiliated acute rehabilitation hospital. Demographic factors included age, insurance, marital status, sex, race, and body mass index. Surgical factors included knee/hip arthroplasty, unilateral/bilateral arthroplasty, and indication for surgery. Also, the 22 most prevalent comorbid illnesses for the patient group were analyzed for their association with length of stay. RESULTS: Significant factors for predicting length of stay were indication for surgery, number of comorbid illnesses, unmarried marital status, and black race. Also, advanced age and male sex approached significance. CONCLUSION: Length of stay in rehabilitation for total hip arthroplasty and total knee arthroplasty can be statistically modeled using various factors. These findings will help clinicians address prolonged length of stay and resource allocation issues.

Age Factors↗
PubMed2000

Multivariate analysis of patients with head injury using quantification theory type II--with special reference to prediction of patient outcome.

Quantification theory type II was used to predict the outcome of 63 patients with head injury. Age, sex, two factors based on neurological examination, and seven factors based on findings of skull radiography and computed tomography of the head were selected as predictors. Patient outcome was evaluated 6 months after injury and assigned to good recovery, severe disability, or death. Discriminant analysis of patient outcomes was performed using the 11 factors. Two category scores were obtained for each category, since the highest correlation ratios were 0.869 and 0.252, and others were less than 10(-15). For each patient, a pair of sample scores was then obtained by simple summation of the 11 category scores. Pairs of sample scores were plotted, and the three groups of patient outcomes were clearly distinguishable without exception. These findings show that the outcome of patients with head injury can be accurately discriminated by quantitative analysis of qualitative data.

Adolescent↗
PubMed1987

Classification of geniculo-cortical relay cells of albino rat dorsal lateral geniculate nucleus by means of multivariate analysis.

It was tested if responses of geniculo-cortical relay (GCR-) cells in rat dorsal lateral geniculate nucleus (dLGN) to diffuse light flashes contain features permitting a separation of the cell population into slow and fast cells like the response latency to stimulation of optic chiasm (OX-latency). The location of neurons within the dLGN found additional consideration. Using hierarchical cluster analysis two clusters were obtained for on- as well as off-like neurons, which reflected to a high degree the classification into slow and fast cells by OX-latency. Two subgroups were detected in the cluster of slow cells. Multivariate discriminance analysis made it possible to separate the cell population into two classes. The latency of primary excitation to flash (primary inhibition for off-cells), the number of impulses in the first excitation peak (duration of inhibitory period) and the location of the cells within the dLGN were suited for this separation differing in 11 up to 17% from that achieved by OX-latency classification.

Animals↗
PubMed2002

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors.

OBJECTIVE: The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients. METHODS: The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis. RESULTS: The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were II cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13-46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01-30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01-13.9) were significantly associated with reflux esophagitis. CONCLUSIONS: Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.

Adult↗