BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial...BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.展开更多
In this article,we discuss the recently published article by Yang et al.This retrospective analysis,which was conducted at a large urban tertiary care center,focused on comparing Lille model scores at days 3 and 7 wit...In this article,we discuss the recently published article by Yang et al.This retrospective analysis,which was conducted at a large urban tertiary care center,focused on comparing Lille model scores at days 3 and 7 with established scoring systems and identifying critical clinical predictors,such as renal dysfunction,nutritional status,and underlying cirrhosis.Alcoholic hepatitis(AH),a severe manifestation of alcohol-related liver disease,is associated with high morbidity and mortality,necessitating accurate prognostic tools and comprehensive clinical assessments.Prognostic tools are invaluable for early risk stratification,but they must be contextualized within the multifactorial nature of AH.Acute renal dysfunction and poor nutritional status,for example,are not just complications but pivotal markers of disease severity and systemic impact.Addressing these factors requires a holistic approach that extends beyond scoring systems to include targeted interventions and comprehensive patient care.This editorial emphasizes the need for a paradigm shift in AH management,where prognostic models are complemented by a deeper understanding of patient-specific factors.Such an approach can guide clinicians in tailoring therapies and improving outcomes for this high-risk population.展开更多
Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GID...Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?展开更多
Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patie...Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patient care and the timing of endoscopy. Several risk scores have been developed, most of which include endoscopic findings, although a minority do not. These scores were developed to identify various end-points including mortality, rebleeding or clinical intervention in the form of transfusion, endoscopic therapy or surgery. Recent studies have reported accurate identification of a very low risk group on presentation, using scores which require simple clinical or laboratory parameters only. This group may not require admission, but could be managed with early out-patient endoscopy. This article aims to describe the existing pre- and post-endoscopy risk scores for UGIH and assess the published data comparing them in the prediction of outcome. Recent data assessing their use in clinical practice, in particular the early identification of low-risk patients, are also discussed.展开更多
BACKGROUND Scoring systems have not been evaluated in oncology patients.We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation(APACHE)II,APACHE III,APACHE IV,Simplified Acute Physiology S...BACKGROUND Scoring systems have not been evaluated in oncology patients.We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation(APACHE)II,APACHE III,APACHE IV,Simplified Acute Physiology Score(SAPS)II,SAPS III,Mortality Probability Model(MPM)II0 and Sequential Organ Failure Assessment(SOFA)score in critically ill oncology patients.AIM To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.METHODS We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period.Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.RESULTS In our study,the overall intensive care unit and hospital mortality was 43.5%and 57.8%,respectively.All of the seven tested scores underestimated mortality.The mortality as predicted by MPM II0 predicted death rate(PDR)was nearest to the actual mortality followed by that predicted by APACHE II,with a standardized mortality rate(SMR)of 1.305 and 1.547,respectively.The best calibration was shown by the APACHE III score(χ^(2)=4.704,P=0.788).On the other hand,SOFA score(χ^(2)=15.966,P=0.025)had the worst calibration,although the difference was not statistically significant.All of the seven scores had acceptable discrimination with good efficacy however,SAPS III PDR and MPM II0 PDR(AUROC=0.762),had a better performance as compared to others.The correlation between the different scoring systems was significant(P<0.001).CONCLUSION All the severity scores were tested under-predicted mortality in the present study.As the difference in efficacy and performance was not statistically significant,the choice of scoring system used may depend on the ease of use and local preferences.展开更多
Objective: To compare the scoring systems used in intensive care units in terms of predictingthe mortality in emergency patients and to determine the most appropriate scoring system forurgent care. Methods: This study...Objective: To compare the scoring systems used in intensive care units in terms of predictingthe mortality in emergency patients and to determine the most appropriate scoring system forurgent care. Methods: This study was carried out by retrospectively reviewing the files ofpatients admitted to Ankara Numune Training and Research Hospital emergency medicineclinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admittedto any service of the hospital. This study calculated automatically with the data obtained fromthe patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHEⅡ), Simplified Acute Physiology Score (SAPS Ⅱ), Modified Early Warning Score (MEW)and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files werereviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded.The obtained data were entered in SPSS 18 and compared with the scores of APACHE Ⅱ,SAPS Ⅱ, MEW and SOFA. Results: Based on area under the curve analysis, APACE Ⅱ (0.799;95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting thepatients mortality. However, there was no difference between four scoring system in terms ofpredicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025)and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors formortality. Conclusions: Scores such as APACHE Ⅱ, SAPS Ⅱ, and SOFA, can not be used tomake an urgent decision on the first encounter with the patient even though they are successfulin predicting mortality. In this case, MEW could be recommended as the most useful system.As a result, the use of scoring systems in emergency departments is useful and necessary. But,multi-centered and large patient group studies are needed.展开更多
Background:To evaluate the discriminatory ability of imaging modalities'scoring systems in the prediction of COVID-19 adverse outcomes like ICU admission,ventilatory support,or mortality.Methods:We searched PUBMED...Background:To evaluate the discriminatory ability of imaging modalities'scoring systems in the prediction of COVID-19 adverse outcomes like ICU admission,ventilatory support,or mortality.Methods:We searched PUBMED,EBSCO,WEB OF SCIENCE,and SCOPUS.Two authors independently screened the resulting papers for fulfillment criteria.Meta-DiSc version 1.4,RevMan version 5.4,and MedCalc version 19.1 were used for test accuracy analysis,sensitivity and specificity analysis,and pooling Area under the curve for discriminatory assessment,respectively.Results:Regarding mortality prediction,the computed tomography(CT)showed significantly higher sensitivity[80%;95%CI 0.74-0.85]and positive likelihood ratio(PLR)[4.4195%CI 2.94-6.61]relative to the Lung Ultrasound Score(LUS)approach,while the LUS approached the CT scan with specificity of 81%[95%CI 0.78-0.83]and negative likelihood ratio(NLR)of[0.32;95%CI 0.16-0.64].The pooled area under ROC for LUS was[AUC=0.777,95%CI 0.701-0.852;p<0.001,I2=74.86%,p=0.019]while the pooled area under ROC for CT severity score was[AUC=0.855,95%CI 0.78-0.93;p<0.001,I2=93.73%,p<0.001].Regarding adverse outcomes prediction,the LUS had a slightly higher specificity of[78%;95%CI 0.75-0.80]and PLR of[3.60;95%CI 2.28-5.68]compared to CT score.The pooled AUC using LUS was(0.77,95%CI 0.719-0.832;p<0.001),while using CT severity score was(0.843,95%CI 0.787-0.898;p<0.001),and using X-ray scores was(0.814,95%CI 0.751-0.878;p<0.001).Conclusion:CT severity score showed a better discriminatory ability in pre-dicting COVID-19 adverse outcomes,as in-hospital mortality,ICU admission,and need for ventilatory support compared to LUS and X-RAY scores,while the LUS,being more specific,had a slightly better prognostic value.展开更多
Postoperative pancreatic fistula(POPF)is a critical complication following pancreatic surgeries,marked by leakage of pancreatic fluid due to anastomotic or pancreatic duct failure.Recent advancements have refined its ...Postoperative pancreatic fistula(POPF)is a critical complication following pancreatic surgeries,marked by leakage of pancreatic fluid due to anastomotic or pancreatic duct failure.Recent advancements have refined its definition,risk classification and management strategies.This review emphasises discussing new definitions,classification updates,predictive factors(both pancreatic and non-pancreatic),comparisons of surgical techniques and therapeutic advancements.Emerging trials and innovations,such as robotic-assisted surgery and personalised stents,are also addressed.The evolving understanding of POPF underscores the need for holistic and patient-centred surgical strategies.展开更多
Artificial Intelligence(AI)constitutes a rapidly evolving set of technologies that offer significant economic,environmental,and societal benefits.However,the application of AI systems may also pose considerable risks ...Artificial Intelligence(AI)constitutes a rapidly evolving set of technologies that offer significant economic,environmental,and societal benefits.However,the application of AI systems may also pose considerable risks and inflict harm—whether material or immaterial,including physical,psychological,societal,or economic harm—to public interests and fundamental rights protected under Union law.展开更多
Several hepatocellular carcinoma(HCC) staging systems have been established, and a variety of countryspecific treatment strategies are also proposed. The barcelona- clinic liver cancer(BCLC) system is the most widely ...Several hepatocellular carcinoma(HCC) staging systems have been established, and a variety of countryspecific treatment strategies are also proposed. The barcelona- clinic liver cancer(BCLC) system is the most widely used in Europe. The Hong Kong liverCancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization(TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC(BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.展开更多
Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,an...Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,and compared for their efficacy and accuracy.An ideal score should be rapid,reliable,and validated in different patient populations and geographical areas and should not lose relevance over time.A combination of scores or serial monitoring of a single score may increase their efficacy.展开更多
Non-classical manifestations of autoimmune hepatitis can delay diagnosis and treatment. Our aims were to describe the clinical phenotypes that can confound the diagnosis, detail scoring systems that can ensure their r...Non-classical manifestations of autoimmune hepatitis can delay diagnosis and treatment. Our aims were to describe the clinical phenotypes that can confound the diagnosis, detail scoring systems that can ensure their recognition, and outline advances in treatment that can improve their outcome. Prime source and review articles in English were selected throuqh Medline from 1970-2008 and assimilated into personal libraries spanning 32 years. Acute severe or asymptomatic presentations and atypical histological findings,including centrilobular zone 3 necrosis and concurrent bile duct changes, are compatible with the diagnosis. Cholangiographic abnormalities may be present in children and adults with the disease, and autoimmune hepatitis must be considered in patients without autoantibodies or with antimitochondrial antibodies and no other cholestatic features. Asymptomatic patients frequently become symptomatic; mild disease can progress; and there are no confident indices that justify withholding treatment. Two diagnostic scoring systems with complementary virtues have been developed to evaluate patients with confusing features. Normal liver tests and tissue constitute the optimal end point of treatment, and the first relapse is an indication for long- term azathioprine therapy. Cyclosporine, tacrolimus and mycophenolate mofetil are promising salvage therapies,and budesonide with azathioprine may be a superior frontline treatment. We conclude that the non-classical phenotypes of autoimmune hepatitis can be recognized promptly, diagnosed accurately, and treated effectively.展开更多
AIM： To evaluate the effect of interferon alpha （IFN-α） treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histolo...AIM： To evaluate the effect of interferon alpha （IFN-α） treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histology in this group of patients. METHODS： Fibrosis stage and inflammation grade were assessed according to Batts and Ludwig, Ishak et al., and IETAVIR （only fibrosis stage） before and 12 mo after IFN-α treatment termination in 93 children aged 2-16 years with chronic hepatitis B. RESULTS： None of the three numerical scoring systems for liver fibrosis showed statistically significant differences in liver fibrosis, while evolution of inflammatory activity revealed statistically significant improvement in the whole group of children with chronic hepatitis B treated with IFN-α and in responders. Significantly positive correlations were found between fibrosis stage and inflammation grade in the respective scoring systems. CONCLUSION： Treatment with IFN-α did not improve histological fibrosis but decreased inflammatory activity in children with chronic hepatitis B. The three semiquantitative scoring systems seem to be comparable in the estimation of the inflammation grade and fibrosis stage in this group of children.展开更多
Although various complex definitions of acute-on-chronic liver failure(ACLF)have been suggested in relation to adult patients,there is currently no universal definition of the syndrome in pediatric patients.In simplif...Although various complex definitions of acute-on-chronic liver failure(ACLF)have been suggested in relation to adult patients,there is currently no universal definition of the syndrome in pediatric patients.In simplified terms,ACLF is characterized by the acute deterioration of the liver functions due to the effects of a precipitating factor on the basis of a chronic liver disease.Acute events and underlying liver diseases are very different in children from those seen in adults.Moreover,acute events and underlying chronic liver diseases vary among geographical regions,although it seems that the most common such diseases and acute events are autoimmune hepatitis,Wilson’s disease,and their flares.ACLF is associated with a poor prognosis.While no scoring systems have been developed to predict the prognosis for children with ACLF,modified versions of the Asian Pacific Association for the Study of the liver’s acute-on-chronic liver failure scoring system and the Chronic Liver Failure-Sequential Organ Failure Assessment criteria can be used in children until specific and validated scoring systems are available.Aside from liver transplantation,there is no proven treatment for ACLF.Thus,the early recognition of ACLF prior to the development of extrahepatic organ failure is important.展开更多
The present letter to the editor corresponds to the article entitled“Comprehensive literature review on the radiographic findings,imaging modalities,and the role of radiology in the coronavirus disease 2019(COVID-19)...The present letter to the editor corresponds to the article entitled“Comprehensive literature review on the radiographic findings,imaging modalities,and the role of radiology in the coronavirus disease 2019(COVID-19)pandemic”by Pal et al,published in World J Radiol.2021;13(9):258-282.With zero to unknown prevalence,COVID-19 has created a heterogeneous and unforeseen situation across the world.Healthcare providers encountered new challenges in image interpretation,characterization,and prognostication of the disease.Pal et al delineated the radiological findings,which would guide the radiologists to identify the early signs of severe infection.展开更多
Objective:To evaluate the effect of the modified systemic inflammation score(mSIS)on prognosis in patients diagnosed with COVID-19.Methods:In this retrospective cross-sectional study,181 patients were selected and div...Objective:To evaluate the effect of the modified systemic inflammation score(mSIS)on prognosis in patients diagnosed with COVID-19.Methods:In this retrospective cross-sectional study,181 patients were selected and divided into two groups:patients with and without admission to the intensive care unit(ICU).An albumin level of≥4.0 g/dL and lymphocyte-to-monocyte ratio(LMR)of≥3.4 was scored 0,an albumin level of<4.0 g/dL or LMR of<3.4 was scored 1,and an albumin level of<4.0 g/dL and LMR of<3.4 was scored 2.Results:A total of 242 COVID-19 positive patients were initially included in this study.Of these patients,61 were excluded and 181 patients remained.Among the 181 participants,94(51.9%)were female,and the median age was 61(51,75)years.The mSIS scale ranged from 0 to 2.After analysis,the median score was 0(0,0)in the non-ICU group and 2(0,2)in the ICU group(P<0.001).The median white blood cell,lymphocyte counts,and albumin levels were lower in the ICU group(P<0.001,P<0.001,and P<0.001,respectively).In logistic regression analysis lymphocytopenia(OR=5.158,95%CI=1.249-21.304,P=0.023),hypoalbuminemia(OR=49.921,95%CI=1.843-1352.114,P=0.020),AST elevation(OR=3.939,95%CI=1.017-15.261,P=0.047),and mSIS=2(OR=5.853,95%CI=1.338-25.604,P=0.019)were identified as independent predictors of ICU admission.Conclusion:The mSIS can be used as an independent parameter for establishing the intensive care needs of patients with COVID-19.展开更多
文摘BACKGROUND Acute pancreatitis(AP)is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment.An accurate assessment and precise staging of severity are essential in initial intensive therapy.AIM To explore the prognostic value of inflammatory markers and several scoring systems[Acute Physiology and Chronic Health Evaluation II,the bedside index of severity in AP(BISAP),Ranson’s score,the computed tomography severity index(CTSI)and sequential organ failure assessment]in severity stratification of earlyphase AP.METHODS A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study.Inflammation marker and scoring system levels were calculated and compared between different severity groups.Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models.Predictive ability was estimated using receiver operating characteristic curves.RESULTS Of the 463 patients,50(10.80%)were classified as having severe AP(SAP).The results revealed that the white cell count significantly increased,whereas the prognostic nutritional index measured within 48 hours(PNI48)and calcium(Ca^(2+))were decreased as the severity of AP increased(P<0.001).According to multivariate logistic regression,C-reactive protein measured within 48 hours(CRP_(48)),Ca^(2+)levels,and PNI48 were independent risk factors for predicting SAP.The area under the curve(AUC)values for the CRP_(48),Ca^(2+),PNI48,Acute Physiology and Chronic Health Evaluation II,sequential organ failure assessment,BISAP,CTSI,and Ranson scores for the prediction of SAP were 0.802,0.736,0.871,0.799,0.783,0.895,0.931 and 0.914,respectively.The AUC for the combined CRP_(48)+Ca^(2+)+PNI48 model was 0.892.The combination of PNI48 and Ranson achieved an AUC of 0.936.CONCLUSION Independent risk factors for developing SAP include CRP_(48),Ca^(2+),and PNI48.CTSI,BISAP,and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.
文摘In this article,we discuss the recently published article by Yang et al.This retrospective analysis,which was conducted at a large urban tertiary care center,focused on comparing Lille model scores at days 3 and 7 with established scoring systems and identifying critical clinical predictors,such as renal dysfunction,nutritional status,and underlying cirrhosis.Alcoholic hepatitis(AH),a severe manifestation of alcohol-related liver disease,is associated with high morbidity and mortality,necessitating accurate prognostic tools and comprehensive clinical assessments.Prognostic tools are invaluable for early risk stratification,but they must be contextualized within the multifactorial nature of AH.Acute renal dysfunction and poor nutritional status,for example,are not just complications but pivotal markers of disease severity and systemic impact.Addressing these factors requires a holistic approach that extends beyond scoring systems to include targeted interventions and comprehensive patient care.This editorial emphasizes the need for a paradigm shift in AH management,where prognostic models are complemented by a deeper understanding of patient-specific factors.Such an approach can guide clinicians in tailoring therapies and improving outcomes for this high-risk population.
文摘Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal(GI)injury in critically ill patients[the GI Dysfunction Score(GIDS)and the Acute Gastroin-testinal Injury(AGI)grade].The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mor-tality at 28 days from intensive care unit(ICU)admission.Shen et al retrospec-tively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score,using electronic healthcare records and ICU flowsheets.Where these physicians disagreed about the scores,the final decision as to the scores was made by an associate chief physician,or chief physician.We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction,with minimal subjectivity or inter-operator variability.The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021.By ensuring consensus between physicians administering the AGI,Shen et al have controlled for one of this grading systems biggest issues.We have concerns,however,that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS,and wonder if this arbitration process had not been instituted,would the two scoring systems remain equivalent in terms of predicted mortality?
文摘Upper gastrointestinal haemorrhage (UGIH) remains a common medical emergency worldwide. It is increasingly recognised that early risk assessment is an important part of management, which helps direct appropriate patient care and the timing of endoscopy. Several risk scores have been developed, most of which include endoscopic findings, although a minority do not. These scores were developed to identify various end-points including mortality, rebleeding or clinical intervention in the form of transfusion, endoscopic therapy or surgery. Recent studies have reported accurate identification of a very low risk group on presentation, using scores which require simple clinical or laboratory parameters only. This group may not require admission, but could be managed with early out-patient endoscopy. This article aims to describe the existing pre- and post-endoscopy risk scores for UGIH and assess the published data comparing them in the prediction of outcome. Recent data assessing their use in clinical practice, in particular the early identification of low-risk patients, are also discussed.
基金Approved by Institutional Scientific Committee of Max Super Speciality Hospital,No.1944105991.
文摘BACKGROUND Scoring systems have not been evaluated in oncology patients.We aimed to assess the performance of Acute Physiology and Chronic Health Evaluation(APACHE)II,APACHE III,APACHE IV,Simplified Acute Physiology Score(SAPS)II,SAPS III,Mortality Probability Model(MPM)II0 and Sequential Organ Failure Assessment(SOFA)score in critically ill oncology patients.AIM To compare the efficacy of seven commonly employed scoring systems to predict outcomes of critically ill cancer patients.METHODS We conducted a retrospective analysis of 400 consecutive cancer patients admitted in the medical intensive care unit over a two-year period.Primary outcome was hospital mortality and the secondary outcome measure was comparison of various scoring systems in predicting hospital mortality.RESULTS In our study,the overall intensive care unit and hospital mortality was 43.5%and 57.8%,respectively.All of the seven tested scores underestimated mortality.The mortality as predicted by MPM II0 predicted death rate(PDR)was nearest to the actual mortality followed by that predicted by APACHE II,with a standardized mortality rate(SMR)of 1.305 and 1.547,respectively.The best calibration was shown by the APACHE III score(χ^(2)=4.704,P=0.788).On the other hand,SOFA score(χ^(2)=15.966,P=0.025)had the worst calibration,although the difference was not statistically significant.All of the seven scores had acceptable discrimination with good efficacy however,SAPS III PDR and MPM II0 PDR(AUROC=0.762),had a better performance as compared to others.The correlation between the different scoring systems was significant(P<0.001).CONCLUSION All the severity scores were tested under-predicted mortality in the present study.As the difference in efficacy and performance was not statistically significant,the choice of scoring system used may depend on the ease of use and local preferences.
文摘Objective: To compare the scoring systems used in intensive care units in terms of predictingthe mortality in emergency patients and to determine the most appropriate scoring system forurgent care. Methods: This study was carried out by retrospectively reviewing the files ofpatients admitted to Ankara Numune Training and Research Hospital emergency medicineclinic between October 1, 2010 and October 31, 2010 for non-traumatic reasons and admittedto any service of the hospital. This study calculated automatically with the data obtained fromthe patients files and records, and Acute Physiology and Chronic Health Evaluation (APACHEⅡ), Simplified Acute Physiology Score (SAPS Ⅱ), Modified Early Warning Score (MEW)and Sequential Organ Failure Assessment (SOFA) scores via internet. Patient files werereviewed and their outcomes (hospitalization, discharge, referral and mortality) were recorded.The obtained data were entered in SPSS 18 and compared with the scores of APACHE Ⅱ,SAPS Ⅱ, MEW and SOFA. Results: Based on area under the curve analysis, APACE Ⅱ (0.799;95% CI: 0.746 to 0.845) showed the biggest area under the curve in terms of predicting thepatients mortality. However, there was no difference between four scoring system in terms ofpredicting the mortality. Age (P<0.001, odd's ratio 1.055) pulse (P<0.007, odd's ratio 1.025)and SO2 (P<0.003, odd's ratio 0.952) variables were found to be independent risk factors formortality. Conclusions: Scores such as APACHE Ⅱ, SAPS Ⅱ, and SOFA, can not be used tomake an urgent decision on the first encounter with the patient even though they are successfulin predicting mortality. In this case, MEW could be recommended as the most useful system.As a result, the use of scoring systems in emergency departments is useful and necessary. But,multi-centered and large patient group studies are needed.
文摘Background:To evaluate the discriminatory ability of imaging modalities'scoring systems in the prediction of COVID-19 adverse outcomes like ICU admission,ventilatory support,or mortality.Methods:We searched PUBMED,EBSCO,WEB OF SCIENCE,and SCOPUS.Two authors independently screened the resulting papers for fulfillment criteria.Meta-DiSc version 1.4,RevMan version 5.4,and MedCalc version 19.1 were used for test accuracy analysis,sensitivity and specificity analysis,and pooling Area under the curve for discriminatory assessment,respectively.Results:Regarding mortality prediction,the computed tomography(CT)showed significantly higher sensitivity[80%;95%CI 0.74-0.85]and positive likelihood ratio(PLR)[4.4195%CI 2.94-6.61]relative to the Lung Ultrasound Score(LUS)approach,while the LUS approached the CT scan with specificity of 81%[95%CI 0.78-0.83]and negative likelihood ratio(NLR)of[0.32;95%CI 0.16-0.64].The pooled area under ROC for LUS was[AUC=0.777,95%CI 0.701-0.852;p<0.001,I2=74.86%,p=0.019]while the pooled area under ROC for CT severity score was[AUC=0.855,95%CI 0.78-0.93;p<0.001,I2=93.73%,p<0.001].Regarding adverse outcomes prediction,the LUS had a slightly higher specificity of[78%;95%CI 0.75-0.80]and PLR of[3.60;95%CI 2.28-5.68]compared to CT score.The pooled AUC using LUS was(0.77,95%CI 0.719-0.832;p<0.001),while using CT severity score was(0.843,95%CI 0.787-0.898;p<0.001),and using X-ray scores was(0.814,95%CI 0.751-0.878;p<0.001).Conclusion:CT severity score showed a better discriminatory ability in pre-dicting COVID-19 adverse outcomes,as in-hospital mortality,ICU admission,and need for ventilatory support compared to LUS and X-RAY scores,while the LUS,being more specific,had a slightly better prognostic value.
文摘Postoperative pancreatic fistula(POPF)is a critical complication following pancreatic surgeries,marked by leakage of pancreatic fluid due to anastomotic or pancreatic duct failure.Recent advancements have refined its definition,risk classification and management strategies.This review emphasises discussing new definitions,classification updates,predictive factors(both pancreatic and non-pancreatic),comparisons of surgical techniques and therapeutic advancements.Emerging trials and innovations,such as robotic-assisted surgery and personalised stents,are also addressed.The evolving understanding of POPF underscores the need for holistic and patient-centred surgical strategies.
文摘Artificial Intelligence(AI)constitutes a rapidly evolving set of technologies that offer significant economic,environmental,and societal benefits.However,the application of AI systems may also pose considerable risks and inflict harm—whether material or immaterial,including physical,psychological,societal,or economic harm—to public interests and fundamental rights protected under Union law.
文摘Several hepatocellular carcinoma(HCC) staging systems have been established, and a variety of countryspecific treatment strategies are also proposed. The barcelona- clinic liver cancer(BCLC) system is the most widely used in Europe. The Hong Kong liverCancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization(TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC(BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.
文摘Clinical scoring systems are required to predict complications,severity,need for intensive care unit admission,and mortality in patients with acute pancreatitis.Over the years,many scores have been developed,tested,and compared for their efficacy and accuracy.An ideal score should be rapid,reliable,and validated in different patient populations and geographical areas and should not lose relevance over time.A combination of scores or serial monitoring of a single score may increase their efficacy.
文摘Non-classical manifestations of autoimmune hepatitis can delay diagnosis and treatment. Our aims were to describe the clinical phenotypes that can confound the diagnosis, detail scoring systems that can ensure their recognition, and outline advances in treatment that can improve their outcome. Prime source and review articles in English were selected throuqh Medline from 1970-2008 and assimilated into personal libraries spanning 32 years. Acute severe or asymptomatic presentations and atypical histological findings,including centrilobular zone 3 necrosis and concurrent bile duct changes, are compatible with the diagnosis. Cholangiographic abnormalities may be present in children and adults with the disease, and autoimmune hepatitis must be considered in patients without autoantibodies or with antimitochondrial antibodies and no other cholestatic features. Asymptomatic patients frequently become symptomatic; mild disease can progress; and there are no confident indices that justify withholding treatment. Two diagnostic scoring systems with complementary virtues have been developed to evaluate patients with confusing features. Normal liver tests and tissue constitute the optimal end point of treatment, and the first relapse is an indication for long- term azathioprine therapy. Cyclosporine, tacrolimus and mycophenolate mofetil are promising salvage therapies,and budesonide with azathioprine may be a superior frontline treatment. We conclude that the non-classical phenotypes of autoimmune hepatitis can be recognized promptly, diagnosed accurately, and treated effectively.
文摘AIM： To evaluate the effect of interferon alpha （IFN-α） treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histology in this group of patients. METHODS： Fibrosis stage and inflammation grade were assessed according to Batts and Ludwig, Ishak et al., and IETAVIR （only fibrosis stage） before and 12 mo after IFN-α treatment termination in 93 children aged 2-16 years with chronic hepatitis B. RESULTS： None of the three numerical scoring systems for liver fibrosis showed statistically significant differences in liver fibrosis, while evolution of inflammatory activity revealed statistically significant improvement in the whole group of children with chronic hepatitis B treated with IFN-α and in responders. Significantly positive correlations were found between fibrosis stage and inflammation grade in the respective scoring systems. CONCLUSION： Treatment with IFN-α did not improve histological fibrosis but decreased inflammatory activity in children with chronic hepatitis B. The three semiquantitative scoring systems seem to be comparable in the estimation of the inflammation grade and fibrosis stage in this group of children.
文摘Although various complex definitions of acute-on-chronic liver failure(ACLF)have been suggested in relation to adult patients,there is currently no universal definition of the syndrome in pediatric patients.In simplified terms,ACLF is characterized by the acute deterioration of the liver functions due to the effects of a precipitating factor on the basis of a chronic liver disease.Acute events and underlying liver diseases are very different in children from those seen in adults.Moreover,acute events and underlying chronic liver diseases vary among geographical regions,although it seems that the most common such diseases and acute events are autoimmune hepatitis,Wilson’s disease,and their flares.ACLF is associated with a poor prognosis.While no scoring systems have been developed to predict the prognosis for children with ACLF,modified versions of the Asian Pacific Association for the Study of the liver’s acute-on-chronic liver failure scoring system and the Chronic Liver Failure-Sequential Organ Failure Assessment criteria can be used in children until specific and validated scoring systems are available.Aside from liver transplantation,there is no proven treatment for ACLF.Thus,the early recognition of ACLF prior to the development of extrahepatic organ failure is important.
文摘The present letter to the editor corresponds to the article entitled“Comprehensive literature review on the radiographic findings,imaging modalities,and the role of radiology in the coronavirus disease 2019(COVID-19)pandemic”by Pal et al,published in World J Radiol.2021;13(9):258-282.With zero to unknown prevalence,COVID-19 has created a heterogeneous and unforeseen situation across the world.Healthcare providers encountered new challenges in image interpretation,characterization,and prognostication of the disease.Pal et al delineated the radiological findings,which would guide the radiologists to identify the early signs of severe infection.
文摘Objective:To evaluate the effect of the modified systemic inflammation score(mSIS)on prognosis in patients diagnosed with COVID-19.Methods:In this retrospective cross-sectional study,181 patients were selected and divided into two groups:patients with and without admission to the intensive care unit(ICU).An albumin level of≥4.0 g/dL and lymphocyte-to-monocyte ratio(LMR)of≥3.4 was scored 0,an albumin level of<4.0 g/dL or LMR of<3.4 was scored 1,and an albumin level of<4.0 g/dL and LMR of<3.4 was scored 2.Results:A total of 242 COVID-19 positive patients were initially included in this study.Of these patients,61 were excluded and 181 patients remained.Among the 181 participants,94(51.9%)were female,and the median age was 61(51,75)years.The mSIS scale ranged from 0 to 2.After analysis,the median score was 0(0,0)in the non-ICU group and 2(0,2)in the ICU group(P<0.001).The median white blood cell,lymphocyte counts,and albumin levels were lower in the ICU group(P<0.001,P<0.001,and P<0.001,respectively).In logistic regression analysis lymphocytopenia(OR=5.158,95%CI=1.249-21.304,P=0.023),hypoalbuminemia(OR=49.921,95%CI=1.843-1352.114,P=0.020),AST elevation(OR=3.939,95%CI=1.017-15.261,P=0.047),and mSIS=2(OR=5.853,95%CI=1.338-25.604,P=0.019)were identified as independent predictors of ICU admission.Conclusion:The mSIS can be used as an independent parameter for establishing the intensive care needs of patients with COVID-19.
