BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lack...BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.展开更多
Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The ...Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.展开更多
This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechani...This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.展开更多
BACKGROUND Some studies investigated the prognostic role of several blood biomarkers,including the neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),lymphocyte/monocyte ratio(LMR)and Glasgow prognostic s...BACKGROUND Some studies investigated the prognostic role of several blood biomarkers,including the neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),lymphocyte/monocyte ratio(LMR)and Glasgow prognostic score(GPS),in osteosarcoma,but their results were inconsistent with each other.AIM To identify the prognostic value of NLR,PLR,LMR and GPS in osteosarcoma patients through reviewing relevant studies.METHODS The PubMed,EMBASE,Web of Science and CNKI databases were searched up to October 2,2021.The primary and second outcomes were overall survival(OS)and disease-free survival(DFS),respectively.The hazard ratios(HRs)with 95%confidence intervals(CIs)were combined to assess the association between these indicators and prognosis of osteosarcoma patients.RESULTS A total of 13 studies involving 2087 patients were eventually included.The pooled results demonstrated that higher NLR and GPS were significantly associated with poorer OS(HR=1.88,95%CI:1.38-2.55,P<0.001;HR=2.19,95%CI:1.64-2.94,P<0.001)and DFS(HR=1.67,95%CI:1.37-2.04,P<0.001;HR=2.50,95%CI:1.39-4.48,P<0.001).However,no significant relationship of PLR and LMR and OS(P=0.085;P=0.338)and DFS(P=0.396;P=0.124)was observed.CONCLUSION Higher NLR and GPS were related with worse prognosis and might serve as novel prognostic indicators for osteosarcoma patients.展开更多
Objective: This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer unde...Objective: This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT). Methods: We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre- and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival. Results: The GPS changed in 72 (51.8%) patients, with worse scores observed post-CCRT in 65 (90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage. Conclusions: After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.展开更多
<strong>Objective</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To evaluate and compare the prognostic contribution of diffe...<strong>Objective</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To evaluate and compare the prognostic contribution of different UGIB prognostic scores. <b>Patients and Method</b>: Descriptive cross-sectional study with retrospective collection conducted from January 2014 to December 2019. Patients hospitalized in the Gastroenterology Department of Campus Teaching Hospital of Lome for upper gastrointestinal hemorrhage were included. The analytical component of this study had consisted of an evaluation of the sensitivity and specificity of different prognostic scores (GBS, mGBS, FRS, CRS, AIMS65) in predicting the occurrence of death and/or re-bleeding within 42 days. These different scores were compared using ROC (Receiver Operating Characteristic) curves. <b>Results</b>: We included 314 patients in our study. The male to female sex ratio was 2.48. Fibroscopy found non-related portal hypertension UGIB in 70.94% of the cases. The “FRS” was the most accurate score in predicting death or re-bleeding in all patients. The “FRS” was the most precise score in predicting the occurrence of spotting in all patients. The “FRS” was the most accurate score in predicting death among all patients. The mortality of patients at low risk of death (below the threshold value) was 2.2% for the “FRS”, 9.3% for the “CRS”, 0% for the “GBS” (p = 0.565), 50% for the “mGBS” and 11.4% for the “AIMS65”. Scores were more accurate for non-related portal hypertension UGIB. <b>Conclusion</b>: The “FRS” and the “CRS” are two precise scores in predicting the occurrence of an incident in the event of upper gastrointestinal hemorrhage. However, these scores were less effective in related portal hypertension UGIB</span></span></span><span><span><span style="font-family:;" "="">.</span></span></span>展开更多
BACKGROUND Hepatocellular carcinoma(HCC)represents the most common primitive liver malignancy.A relevant concern involves the lack of agreement on staging systems,prognostic scores,and treatment allocation algorithms....BACKGROUND Hepatocellular carcinoma(HCC)represents the most common primitive liver malignancy.A relevant concern involves the lack of agreement on staging systems,prognostic scores,and treatment allocation algorithms.AIM To compare the survival rates among already developed prognostic scores.METHODS We retrospectively evaluated 140 patients with HCC diagnosed between February 2006 and November 2017.Patients were categorized according to 15 prognostic scoring systems and estimated median survivals were compared with those available from the current medical literature.RESULTS The median overall survival of the cohort of patients was 35(17;67)mo,and it was statistically different in relation to treatment choice,ultrasound surveillance,and serum alpha-fetoprotein.The Italian Liver Cancer(ITA.LI.CA)tumor staging system performed best in predicting survival according to stage allocation among all 15 evaluated prognostic scores.Using the ITA.LI.CA prognostic system,28.6%,40.7%,22.1%,and 8.6%of patients fell within stages 0-1,2-3,4-5 and>5 respectively.The median survival was 57.9 mo for stages 0-1,43 mo for stages 2-3,21.7 mo for stages 4-5,and 10.4 mo for stage>5.The 1-,3-,and 5-year survival rates were respectively 95%,65%,and 20%,for stages 0-1;94.7%,43.9%and 26.3%for stages 2-3;71%,25.8%and 16.1%for stages 4-5;and 50%,16.7%and 8.3%for stage>5.At the same time,although statistically significant in prognostic stratification,the most commonly used Barcelona Clinic Liver Cancer system showed one of the most relevant differences in median survival,especially for stages A and C,when compared to the medical literature.In fact,10.7%,59.3%,27.1%,1.4%,and 0%of patients were stratified into stages 0,A,B,C,and D respectively.The median survival was>81.1 mo for stage 0,44.9 mo for stage A,21.3 mo for stage B,and 3.1 mo for stage C.The 1-,3-,and 5-year survival rates were respectively 86.7%,60%,and 46.7%for stage 0;91.6%,50.6%,and 20.5%for stage A;73.7%,23.7%and 13.2%for stage B;and 2%,0%and 0%for stage C.CONCLUSION Survival analysis shows excellent prognostic ability of the ITA.LI.CA scoring system compared to other staging systems.展开更多
BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after laparotomy.Staging laparoscopy may help av...BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after laparotomy.Staging laparoscopy may help avoid unnecessary laparotomy.However,which category of BTC is amenable with staging laparoscopy remains unclear.AIM To clarify the risk factors for occult metastasis in patients with BTC.METHODS Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively reviewed.The patients were divided into two groups,according to resection or exploratory laparotomy(EL).Preoperative laboratory data,including inflammation-based prognostic scores and tumor markers,were compared between the two groups.Prognostic importance of detected risk factors was also evaluated.RESULTS A total of 236 patients were enrolled in this study.Twenty-six(11%)patients underwent EL.Among the EL patients,there were 16 cases of occult metastasis(7 liver metastases and 9 abdominal disseminations).Serum carcinoembryonic antigen level,carbohydrate antigen 19-9 level,neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group,and these factors were prognostic.Among these factors,carcinoembryonic antigen>7 ng/mL was the most useful to predict occult metastasis in BTC.When patients have more than three of these positive factors,the rate of occult metastasis increases.CONCLUSION Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC;based on these factors,staging laparoscopy may reduce the rate of EL.展开更多
Objective:The lack of a simple criterion for gastric carcinoma creates a persistent challenge for clinicians trying to provide patients with useful prognostic information.The aim of this study was to identify baseline...Objective:The lack of a simple criterion for gastric carcinoma creates a persistent challenge for clinicians trying to provide patients with useful prognostic information.The aim of this study was to identify baseline prognostic factors,and use this information to establish a simple criterion to predict outcome in gastric carcinoma.Methods:Between 2005 and 2010, 155 patients with gastric carcinoma,were enrolled.Clinicopathologic prognostic factors were evaluated by univariate and multivariate analysis.Results:Of the 155 patients,48(30.9%)died.Three independent poor prognostic factors were identified by multivariate analysis:gross type>or=3(hazard ratio[HR],1.564;95%CI,1.067 to 2.294),peritoneal dissemination (HR,3.750;95%CI,1.760 to 7.989)and lymphatic duct invasion(HR,3.578;95%CI,1.422 to 9.004).One point was added for each category among three independent prognostic factors.Prognostic score(PS)was determined by an aggregate of these points for each category.There existed a significant difference between survival of patients with PS 0 or 1 and 2(P< 0.0001).Conclusion:Three poor prognostic factors were identified and a simple criteria was devised.Information from this analysis can be used to predict prognosis of gastric carcinoma with a strict stratification.展开更多
Background:The Naples prognostic score(NPS)is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors.The aim of this study was to investigate the clinical significanc...Background:The Naples prognostic score(NPS)is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors.The aim of this study was to investigate the clinical significance of preoperative NPS on short-and long-term outcomes after pancreatoduodenectomy(PD)for ampullary carcinoma.Methods:We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018.Preoperative NPS was calculated from serum albumin and total cholesterol concentrations,and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio(LMR).Patients were then divided into three groups according to their NPS.Clinicopathological variables,postoperative outcomes,and survival data were compared between the three groups.Univariate and multivariate Cox analysis of overall survival(OS)and recurrence-free survival(RFS)were also conducted,and time-dependent receiver operating characteristic(ROC)curves were created to evaluate the discriminatory ability of the prognostic scoring systems.Results:Patients with higher NPS had worse prognosis,and significant OS difference(group 0 vs.1,P=0.02;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001)and RFS difference(group 0 vs.1,P=0.088;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001).Multivariate analysis revealed that NPS was an independent significant predictor of OS(grade 2 vs.grade 1 or 0,hazard ratio:3.067;P<0.001)and RFS(grade 2 vs.grade 1 or 0,hazard ratio:2.732;P<0.001).The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models.Additionally,significant differences in the incidence of postoperative morbidity were observed between the three groups,and the NPS was an independent risk factor of overall postoperative complications(grade 2 vs.grade 1 or 0,odds ratio:1.692;P=0.02).Conclusions:The NPS was an independent predictor of overall-and RFS in patients undergoing PD for ampullary carcinoma,and was independently associated with the incidence of postoperative complications.展开更多
Background： The International Prognostic Score （IPS） was developed based on the data of Western advanced Hodgkin lymphoma （HL） patients treated before 1992. Only a few studies ever evaluated the application value...Background： The International Prognostic Score （IPS） was developed based on the data of Western advanced Hodgkin lymphoma （HL） patients treated before 1992. Only a few studies ever evaluated the application value of IPS in Chinese population or in patients treated in the contemporary era whose outcomes has improved significantly than before. Methods： We conducted a retrospective study involving 208 previously untreated Chinese advanced HL patients, who were admitted to Cancer Hospital Chinese Academy of Medical Sciences from January 1, 1999 to April 30, 2015 and received uniform first-line treatment. The prognostic value of both IPS and the seven IPS factors for freedom-from progression （FFP） and overall survival （OS） was assessed in this population. The statistical methods included Kaplan-Meier methodology, log-rank testing, and Cox proportional hazard regression analysis. Results： With a median follow-up time of 79 months （range, 15-210 months）, the 5-year FFP and OS were 78.8% and 86.0% respectively, which improved obviously compared with the original IPS study. The IPS remained prognostic for both FFP （P = 0.041 ） and OS （P = 0.013）, but the range narrowed obviously, with 5-year FFP ranging from 87.2% to 61.5%, 5-year OS ranging from 94.1% to 69.2%, and the separation of survival curves was not as good as before. Only two of the seven IPS factors showed a significant independent prognostic value in the multivariate analysis： Stage IV （for FFP, hazard ratio [HR] = 2.219, 95% confidence interval [CI]： 1.148-3.948, P = 0.016; for OS, HR = 2.491, 95% CI： 1.159-5.355, P = 0.019） and hemoglobin 〈105 g/L （for FFP, HR = 2.136, 95% CI： 1.123-4.060, P = 0.021; for OS, HR = 2.345, 95% CI： 1.099-5.042, P = 0.028）. A simple prognostic score calculated by adding one point each for any of the two factors was prognostic both for FFP （P 〈 0.001 ） and OS （P 〈 0.001 ） with the survival curves separating very well, but the range still narrowed. Conclusions： The IPS has decreased the prognostic value in Chinese advanced HL patients treated in the contemporary era. More prognostic factors are needed to supplement this original scoring system so as to identity different risk populations more accurately.展开更多
Background and Objectives:Both hypoalbuminemia and inflammation were common in patients with inflammatory bowel diseases(IBD),however,the combination of the two parameters on hospital duration remained unknown.Methods...Background and Objectives:Both hypoalbuminemia and inflammation were common in patients with inflammatory bowel diseases(IBD),however,the combination of the two parameters on hospital duration remained unknown.Methods and Study Design:This is a retrospective two-centre study performed in two tertiary hospitals in Shanghai,China.Serum levels of C-Reactive Protein(CRP)and albumin(ALB)were measured within 2 days of admission.Glasgow prognostic score(GPS),based on CRP and ALB,was calculated as follows:point"0"as CRP<10 mg/L and ALB≥35 g/L;point"1"as either CRP≥10 mg/L or ALB<35 g/L;point"2"as CRP≥10 mg/L and ALB<35 g/L.Patients with point“0”were classified as low-risk while point“2”as high-risk.Length of hospital stay(LOS)was defined as the interval between admission and discharge.Results:The proportion of low-risk and high-risk was 69.3%and 10.5%respectively among 3,009 patients(65%men).GPS was associated with LOS[β=6.2 d;95%CI(confidence interval):4.0 d,8.4 d]after adjustment of potential co-variates.Each point of GPS was associated with 2.9 days(95%CI:1.9 d,3.9 d;ptrend<0.001)longer in fully adjusted model.The association was stronger in patients with low prealbumin levels,hypocalcaemia,and hypokalaemia relative to their counterparts.Conclusions:GPS was associated with LOS in IBD patients.Our results highlighted that GPS could serve as a convenient prognostic tool associated with nutritional status and clinical outcome.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
Objective:Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is the only potentially curative method for treating myelodysplastic syndrome(MDS).Post-HSCT measurable residual disease(post-HSCT MRD)is associat...Objective:Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is the only potentially curative method for treating myelodysplastic syndrome(MDS).Post-HSCT measurable residual disease(post-HSCT MRD)is associated with inferior transplant outcomes.In this prospective study,we aimed to investigate the prognostic value of post-HSCT MRD in relapse prediction in MDS.Methods:A total of 166 patients diagnosed with MDS were prospectively enrolled in this study.The KaplanMeier method was used to calculate the survival probabilities.Potential risk factors for outcomes after transplantation were evaluated through univariate and multivariate Cox regression models.Results:For patients with negative and positive post-HSCT MRD,the cumulative incidence of relapse(CIR)and disease-free survival(DFS)at 3 years were 5.9%and 69.6%(P<0.001)and 82.7%and 26.1%(P<0.001),respectively.In the multivariate analysis,post-HSCT MRD(HR=22.801,P<0.001)and Revised International Prognostic Scoring System(IPSS-R)risk stratification(HR=4.346,P=0.003)were independently correlated with relapse.A scoring system for relapse prediction was built based on post-HSCT MRD and IPSS-R stratification.The cumulative incidence of relapse at 3 years was 1.1%,15.8%,and 91.7%for patients with scores of 0,1,and 2,respectively(P<0.001).Conclusions:Our results demonstrated both post-HSCT MRD and IPSS-R scores were independent prognostic factors for OS,DFS,and relapse for MDS patients after allo-HSCT.The risk score system could better predict transplant outcomes and refine the risk stratification than alone in patients with MDS.展开更多
Traditional tumor-node-metastasis staging overlooks key prognostic factors such as inflammation and nutrition,limiting individualized treatment in colorectal cancer.Integrating biochemical markers with artificial inte...Traditional tumor-node-metastasis staging overlooks key prognostic factors such as inflammation and nutrition,limiting individualized treatment in colorectal cancer.Integrating biochemical markers with artificial intelligence can significantly improve survival prediction and treatment personalization by analyzing complex,multimodal data.This evolving approach holds transformative potential for precision oncology.展开更多
BACKGROUND The combined index of hemoglobin,albumin,lymphocyte,and platelet(HALP)can reflect systemic inflammation and nutritional status simultaneously,with some evidence revealing its prognostic value for some tumor...BACKGROUND The combined index of hemoglobin,albumin,lymphocyte,and platelet(HALP)can reflect systemic inflammation and nutritional status simultaneously,with some evidence revealing its prognostic value for some tumors.However,the effect of HALP on recurrence-free survival(RFS)in patients with gastrointestinal stromal tumors(GISTs)has not been reported.AIM To investigate the prognostic value of HALP in GIST patients.METHODS Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included.Clinicopathological data,preoperative albumin,blood routine information,postoperative treatment,and recurrence status were recorded.To eliminate baseline inequivalence,the propensity scores matching(PSM)method was introduced.Ultimately,the relationship between RFS and preoperative HALP was investigated.RESULTS The optimal cutoff value for HALP was determined to be 31.5 by X-tile analysis.HALP was significantly associated with tumor site,tumor size,mitosis,Ki67,National Institutes of Health(NIH)risk category,and adjuvant therapy(all P<0.001).Before PSM,GIST patients with an increased HALP had a significantly poor RFS(P<0.001),and low HALP was an independent risk factor for poor RFS[hazard ratio(HR):0.506,95%confidence interval(95%CI):0.291-0.879,P=0.016].In NIH high-risk GIST patients,GIST patients with low HALP had a worse RFS than patients with high HALP(P<0.05).After PSM,458 GIST patients were identified;those with an increased HALP still had significantly poor RFS after PSM(P<0.001)and low HALP was still an independent risk factor for poor RFS(HR:0.558,95%CI:0.319-0.976,P=0.041).CONCLUSION HALP was significantly correlated with postoperative pathology and postoperative treatment.Furthermore,HALP showed a strong ability to predict RFS in GIST patients who underwent radical resection.展开更多
BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic ...BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.展开更多
Alcohol-associated hepatitis(AAH)is a severe form of liver disease caused by alcohol consumption.In the absence of confounding factors,clinical features and laboratory markers are sufficient to diagnose AAH,rule out a...Alcohol-associated hepatitis(AAH)is a severe form of liver disease caused by alcohol consumption.In the absence of confounding factors,clinical features and laboratory markers are sufficient to diagnose AAH,rule out alternative causes of liver injury and assess disease severity.Due to the elevated mortality of AAH,assessing the prognosis is a radical step in management.The Maddrey discriminant function(MDF)is the first established clinical prognostic score for AAH and was commonly used in the earliest AAH clinical trials.A MDF>32 indicates a poor prognosis and a potential benefit of initiating corticosteroids.The model for end stage liver disease(MELD)score has been studied for AAH prognostication and new evidence suggests MELD may predict mortality more accurately than MDF.The Lille score is usually combined to MDF or MELD score after corticosteroid initiation and offers the advantage of assessing response to treatment a 4-7 d into the course.Other commonly used scores include the Glasgow Alcoholic Hepatitis Score and the Age Bilirubin international normalized ratio Creatinine model.Clinical AAH correlate adequately with histologic severity scores and leave little indication for liver biopsy in assessing AAH prognosis.AAH presenting as acute on chronic liver failure(ACLF)is so far prognosticated with ACLF-specific scoring systems.New artificial intelligence-generated prognostic models have emerged and are being studied for use in AAH.Acute kidney injury(AKI)is one possible complication of AAH and is significantly associated with increased AAH mortality.Predicting AKI and alcohol relapse are important steps in the management of AAH.The aim of this review is to discuss the performance and limitations of different scoring models for AAH mortality,emphasize the most useful tools in prognostication and review predictors of recurrence.展开更多
Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed dia...Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed diagnosis,and limited access to cardiac surgery.Objective:To report the morbidity and mortality of a series of patients operated on for rheumatic valvular disease and to compare its correlation with Ambler’s prognostic score.Patients and Methods:Descriptive and analytical study of all patients operated on for rheumatic valvulopathy from 01/01/2019 to 31/12/2021.Results:160 patients were included.The mean age of patients was 23.93.Females predominated at 56.3%.Delay in treatment was between 1 and 3 years in 49.4%of patients.At preoperative assessment,Systolic Pulmonary Arterial Pressure was>60 mmHg in 43.1%of our patients.The mean Ambler score was 6.68,equivalent to a mean risk of peri-operative mortality of 4.1%.Mitral valve replacement was performed in 81.9%;aortic valve replacement in 18.8%.The average extubation time was between 3 and 5 hours in 43.1%of patients.We recorded a perioperative mortality of 6.9%and a late mortality of 8.1%(36 months).Postoperative hemodynamic complications were correlated with the time to management of valve disease:p=0.036;the presence of preoperative PAH was correlated with the post-operative occurrence of respiratory complications:p=0.029;the presence of preoperative complete arrhythmia due to atrial fibrillation(CAF)was correlated with the post-operative occurrence of renal failure p=0.017.There was no correlation between Ambler score and peri-operative mortality in our series.Conclusion:Cardiac surgery faces many difficulties in sub-Saharan Africa.Risk stratification scores in cardiac surgery are not adapted.The establishment of a pan-African exchange network would be a way of improving this surgical practice in our countries.展开更多
The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic...The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic scoring system(PSS)that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT.The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed.Age,pathologic classification,primary tumor extension,primary gross tumor volume(GTV-p),T and N categories,and baseline lactate dehydrogenase(LDH)level were analyzed.Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS.Independent prognostic factors for locoregional relapse included N2–3 stage,GTV-p≥26.8 mL,and involvement of one or more structures within cluster3.We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups:low risk(score 0),intermediate risk(score>0 and≤1),high risk(score>1 and≤2),and extremely high risk(score>2).The 5-year locoregional control rates for these groups were 97.4%,93.6%,85.2%,and 78.6%,respectively(P<0.001).We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.展开更多
文摘BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.
文摘Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.
文摘This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.
文摘BACKGROUND Some studies investigated the prognostic role of several blood biomarkers,including the neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),lymphocyte/monocyte ratio(LMR)and Glasgow prognostic score(GPS),in osteosarcoma,but their results were inconsistent with each other.AIM To identify the prognostic value of NLR,PLR,LMR and GPS in osteosarcoma patients through reviewing relevant studies.METHODS The PubMed,EMBASE,Web of Science and CNKI databases were searched up to October 2,2021.The primary and second outcomes were overall survival(OS)and disease-free survival(DFS),respectively.The hazard ratios(HRs)with 95%confidence intervals(CIs)were combined to assess the association between these indicators and prognosis of osteosarcoma patients.RESULTS A total of 13 studies involving 2087 patients were eventually included.The pooled results demonstrated that higher NLR and GPS were significantly associated with poorer OS(HR=1.88,95%CI:1.38-2.55,P<0.001;HR=2.19,95%CI:1.64-2.94,P<0.001)and DFS(HR=1.67,95%CI:1.37-2.04,P<0.001;HR=2.50,95%CI:1.39-4.48,P<0.001).However,no significant relationship of PLR and LMR and OS(P=0.085;P=0.338)and DFS(P=0.396;P=0.124)was observed.CONCLUSION Higher NLR and GPS were related with worse prognosis and might serve as novel prognostic indicators for osteosarcoma patients.
文摘Objective: This study aims to evaluate the impact and potential prognostic roles of the pre- and post-treatment Glasgow prognostic score (GPS) and the change thereof in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy (CCRT). Methods: We collected GPS and clinicopathological data of 139 stage III, IVA, and IVB head and neck cancer patients who underwent CCRT between 2008 and 2011. Their GPSs pre- and post-CCRT and the change thereof were analyzed for correlations with recurrence and survival. Results: The GPS changed in 72 (51.8%) patients, with worse scores observed post-CCRT in 65 (90.3%) of the GPS changed patients. Patients in the improved GPS group showed a tendency toward better survival. From the multivariate analysis, the post-CCRT GPS level was an independent prognostic factor in addition to tumor stage. Conclusions: After CCRT, a high GPS was revealed to be an important predictor of survival for advanced head and neck cancer.
文摘<strong>Objective</strong><span><span><span style="font-family:;" "=""><strong>:</strong> To evaluate and compare the prognostic contribution of different UGIB prognostic scores. <b>Patients and Method</b>: Descriptive cross-sectional study with retrospective collection conducted from January 2014 to December 2019. Patients hospitalized in the Gastroenterology Department of Campus Teaching Hospital of Lome for upper gastrointestinal hemorrhage were included. The analytical component of this study had consisted of an evaluation of the sensitivity and specificity of different prognostic scores (GBS, mGBS, FRS, CRS, AIMS65) in predicting the occurrence of death and/or re-bleeding within 42 days. These different scores were compared using ROC (Receiver Operating Characteristic) curves. <b>Results</b>: We included 314 patients in our study. The male to female sex ratio was 2.48. Fibroscopy found non-related portal hypertension UGIB in 70.94% of the cases. The “FRS” was the most accurate score in predicting death or re-bleeding in all patients. The “FRS” was the most precise score in predicting the occurrence of spotting in all patients. The “FRS” was the most accurate score in predicting death among all patients. The mortality of patients at low risk of death (below the threshold value) was 2.2% for the “FRS”, 9.3% for the “CRS”, 0% for the “GBS” (p = 0.565), 50% for the “mGBS” and 11.4% for the “AIMS65”. Scores were more accurate for non-related portal hypertension UGIB. <b>Conclusion</b>: The “FRS” and the “CRS” are two precise scores in predicting the occurrence of an incident in the event of upper gastrointestinal hemorrhage. However, these scores were less effective in related portal hypertension UGIB</span></span></span><span><span><span style="font-family:;" "="">.</span></span></span>
文摘BACKGROUND Hepatocellular carcinoma(HCC)represents the most common primitive liver malignancy.A relevant concern involves the lack of agreement on staging systems,prognostic scores,and treatment allocation algorithms.AIM To compare the survival rates among already developed prognostic scores.METHODS We retrospectively evaluated 140 patients with HCC diagnosed between February 2006 and November 2017.Patients were categorized according to 15 prognostic scoring systems and estimated median survivals were compared with those available from the current medical literature.RESULTS The median overall survival of the cohort of patients was 35(17;67)mo,and it was statistically different in relation to treatment choice,ultrasound surveillance,and serum alpha-fetoprotein.The Italian Liver Cancer(ITA.LI.CA)tumor staging system performed best in predicting survival according to stage allocation among all 15 evaluated prognostic scores.Using the ITA.LI.CA prognostic system,28.6%,40.7%,22.1%,and 8.6%of patients fell within stages 0-1,2-3,4-5 and>5 respectively.The median survival was 57.9 mo for stages 0-1,43 mo for stages 2-3,21.7 mo for stages 4-5,and 10.4 mo for stage>5.The 1-,3-,and 5-year survival rates were respectively 95%,65%,and 20%,for stages 0-1;94.7%,43.9%and 26.3%for stages 2-3;71%,25.8%and 16.1%for stages 4-5;and 50%,16.7%and 8.3%for stage>5.At the same time,although statistically significant in prognostic stratification,the most commonly used Barcelona Clinic Liver Cancer system showed one of the most relevant differences in median survival,especially for stages A and C,when compared to the medical literature.In fact,10.7%,59.3%,27.1%,1.4%,and 0%of patients were stratified into stages 0,A,B,C,and D respectively.The median survival was>81.1 mo for stage 0,44.9 mo for stage A,21.3 mo for stage B,and 3.1 mo for stage C.The 1-,3-,and 5-year survival rates were respectively 86.7%,60%,and 46.7%for stage 0;91.6%,50.6%,and 20.5%for stage A;73.7%,23.7%and 13.2%for stage B;and 2%,0%and 0%for stage C.CONCLUSION Survival analysis shows excellent prognostic ability of the ITA.LI.CA scoring system compared to other staging systems.
文摘BACKGROUND Radiological detection of small liver metastasis or peritoneal metastasis is still difficult,and some patients with biliary tract cancer(BTC)are unresectable after laparotomy.Staging laparoscopy may help avoid unnecessary laparotomy.However,which category of BTC is amenable with staging laparoscopy remains unclear.AIM To clarify the risk factors for occult metastasis in patients with BTC.METHODS Medical records of patients with BTC who underwent surgery at our institution between January 2008 and June 2014 were retrospectively reviewed.The patients were divided into two groups,according to resection or exploratory laparotomy(EL).Preoperative laboratory data,including inflammation-based prognostic scores and tumor markers,were compared between the two groups.Prognostic importance of detected risk factors was also evaluated.RESULTS A total of 236 patients were enrolled in this study.Twenty-six(11%)patients underwent EL.Among the EL patients,there were 16 cases of occult metastasis(7 liver metastases and 9 abdominal disseminations).Serum carcinoembryonic antigen level,carbohydrate antigen 19-9 level,neutrophil-lymphocyte ratio and modified Glasgow prognostic score were significantly higher in the EL group than in the resected group,and these factors were prognostic.Among these factors,carcinoembryonic antigen>7 ng/mL was the most useful to predict occult metastasis in BTC.When patients have more than three of these positive factors,the rate of occult metastasis increases.CONCLUSION Inflammation-based prognostic scores and tumor markers are useful in detecting occult metastasis in BTC;based on these factors,staging laparoscopy may reduce the rate of EL.
文摘Objective:The lack of a simple criterion for gastric carcinoma creates a persistent challenge for clinicians trying to provide patients with useful prognostic information.The aim of this study was to identify baseline prognostic factors,and use this information to establish a simple criterion to predict outcome in gastric carcinoma.Methods:Between 2005 and 2010, 155 patients with gastric carcinoma,were enrolled.Clinicopathologic prognostic factors were evaluated by univariate and multivariate analysis.Results:Of the 155 patients,48(30.9%)died.Three independent poor prognostic factors were identified by multivariate analysis:gross type>or=3(hazard ratio[HR],1.564;95%CI,1.067 to 2.294),peritoneal dissemination (HR,3.750;95%CI,1.760 to 7.989)and lymphatic duct invasion(HR,3.578;95%CI,1.422 to 9.004).One point was added for each category among three independent prognostic factors.Prognostic score(PS)was determined by an aggregate of these points for each category.There existed a significant difference between survival of patients with PS 0 or 1 and 2(P< 0.0001).Conclusion:Three poor prognostic factors were identified and a simple criteria was devised.Information from this analysis can be used to predict prognosis of gastric carcinoma with a strict stratification.
基金supported by grants from National Natural Science Foundation of China(No.81772950 and No.81874205).
文摘Background:The Naples prognostic score(NPS)is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors.The aim of this study was to investigate the clinical significance of preoperative NPS on short-and long-term outcomes after pancreatoduodenectomy(PD)for ampullary carcinoma.Methods:We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018.Preoperative NPS was calculated from serum albumin and total cholesterol concentrations,and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio(LMR).Patients were then divided into three groups according to their NPS.Clinicopathological variables,postoperative outcomes,and survival data were compared between the three groups.Univariate and multivariate Cox analysis of overall survival(OS)and recurrence-free survival(RFS)were also conducted,and time-dependent receiver operating characteristic(ROC)curves were created to evaluate the discriminatory ability of the prognostic scoring systems.Results:Patients with higher NPS had worse prognosis,and significant OS difference(group 0 vs.1,P=0.02;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001)and RFS difference(group 0 vs.1,P=0.088;group 1 vs.2,P<0.001;group 0 vs.2,P<0.001).Multivariate analysis revealed that NPS was an independent significant predictor of OS(grade 2 vs.grade 1 or 0,hazard ratio:3.067;P<0.001)and RFS(grade 2 vs.grade 1 or 0,hazard ratio:2.732;P<0.001).The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models.Additionally,significant differences in the incidence of postoperative morbidity were observed between the three groups,and the NPS was an independent risk factor of overall postoperative complications(grade 2 vs.grade 1 or 0,odds ratio:1.692;P=0.02).Conclusions:The NPS was an independent predictor of overall-and RFS in patients undergoing PD for ampullary carcinoma,and was independently associated with the incidence of postoperative complications.
文摘Background： The International Prognostic Score （IPS） was developed based on the data of Western advanced Hodgkin lymphoma （HL） patients treated before 1992. Only a few studies ever evaluated the application value of IPS in Chinese population or in patients treated in the contemporary era whose outcomes has improved significantly than before. Methods： We conducted a retrospective study involving 208 previously untreated Chinese advanced HL patients, who were admitted to Cancer Hospital Chinese Academy of Medical Sciences from January 1, 1999 to April 30, 2015 and received uniform first-line treatment. The prognostic value of both IPS and the seven IPS factors for freedom-from progression （FFP） and overall survival （OS） was assessed in this population. The statistical methods included Kaplan-Meier methodology, log-rank testing, and Cox proportional hazard regression analysis. Results： With a median follow-up time of 79 months （range, 15-210 months）, the 5-year FFP and OS were 78.8% and 86.0% respectively, which improved obviously compared with the original IPS study. The IPS remained prognostic for both FFP （P = 0.041 ） and OS （P = 0.013）, but the range narrowed obviously, with 5-year FFP ranging from 87.2% to 61.5%, 5-year OS ranging from 94.1% to 69.2%, and the separation of survival curves was not as good as before. Only two of the seven IPS factors showed a significant independent prognostic value in the multivariate analysis： Stage IV （for FFP, hazard ratio [HR] = 2.219, 95% confidence interval [CI]： 1.148-3.948, P = 0.016; for OS, HR = 2.491, 95% CI： 1.159-5.355, P = 0.019） and hemoglobin 〈105 g/L （for FFP, HR = 2.136, 95% CI： 1.123-4.060, P = 0.021; for OS, HR = 2.345, 95% CI： 1.099-5.042, P = 0.028）. A simple prognostic score calculated by adding one point each for any of the two factors was prognostic both for FFP （P 〈 0.001 ） and OS （P 〈 0.001 ） with the survival curves separating very well, but the range still narrowed. Conclusions： The IPS has decreased the prognostic value in Chinese advanced HL patients treated in the contemporary era. More prognostic factors are needed to supplement this original scoring system so as to identity different risk populations more accurately.
文摘Background and Objectives:Both hypoalbuminemia and inflammation were common in patients with inflammatory bowel diseases(IBD),however,the combination of the two parameters on hospital duration remained unknown.Methods and Study Design:This is a retrospective two-centre study performed in two tertiary hospitals in Shanghai,China.Serum levels of C-Reactive Protein(CRP)and albumin(ALB)were measured within 2 days of admission.Glasgow prognostic score(GPS),based on CRP and ALB,was calculated as follows:point"0"as CRP<10 mg/L and ALB≥35 g/L;point"1"as either CRP≥10 mg/L or ALB<35 g/L;point"2"as CRP≥10 mg/L and ALB<35 g/L.Patients with point“0”were classified as low-risk while point“2”as high-risk.Length of hospital stay(LOS)was defined as the interval between admission and discharge.Results:The proportion of low-risk and high-risk was 69.3%and 10.5%respectively among 3,009 patients(65%men).GPS was associated with LOS[β=6.2 d;95%CI(confidence interval):4.0 d,8.4 d]after adjustment of potential co-variates.Each point of GPS was associated with 2.9 days(95%CI:1.9 d,3.9 d;ptrend<0.001)longer in fully adjusted model.The association was stronger in patients with low prealbumin levels,hypocalcaemia,and hypokalaemia relative to their counterparts.Conclusions:GPS was associated with LOS in IBD patients.Our results highlighted that GPS could serve as a convenient prognostic tool associated with nutritional status and clinical outcome.
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.
基金partly supported by grants from the Beijing Municipal Science and Technology Commission(No.Z221100007422008)。
文摘Objective:Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is the only potentially curative method for treating myelodysplastic syndrome(MDS).Post-HSCT measurable residual disease(post-HSCT MRD)is associated with inferior transplant outcomes.In this prospective study,we aimed to investigate the prognostic value of post-HSCT MRD in relapse prediction in MDS.Methods:A total of 166 patients diagnosed with MDS were prospectively enrolled in this study.The KaplanMeier method was used to calculate the survival probabilities.Potential risk factors for outcomes after transplantation were evaluated through univariate and multivariate Cox regression models.Results:For patients with negative and positive post-HSCT MRD,the cumulative incidence of relapse(CIR)and disease-free survival(DFS)at 3 years were 5.9%and 69.6%(P<0.001)and 82.7%and 26.1%(P<0.001),respectively.In the multivariate analysis,post-HSCT MRD(HR=22.801,P<0.001)and Revised International Prognostic Scoring System(IPSS-R)risk stratification(HR=4.346,P=0.003)were independently correlated with relapse.A scoring system for relapse prediction was built based on post-HSCT MRD and IPSS-R stratification.The cumulative incidence of relapse at 3 years was 1.1%,15.8%,and 91.7%for patients with scores of 0,1,and 2,respectively(P<0.001).Conclusions:Our results demonstrated both post-HSCT MRD and IPSS-R scores were independent prognostic factors for OS,DFS,and relapse for MDS patients after allo-HSCT.The risk score system could better predict transplant outcomes and refine the risk stratification than alone in patients with MDS.
文摘Traditional tumor-node-metastasis staging overlooks key prognostic factors such as inflammation and nutrition,limiting individualized treatment in colorectal cancer.Integrating biochemical markers with artificial intelligence can significantly improve survival prediction and treatment personalization by analyzing complex,multimodal data.This evolving approach holds transformative potential for precision oncology.
基金Supported by National Natural Science Foundation of China,No.81572931The 1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC18034.
文摘BACKGROUND The combined index of hemoglobin,albumin,lymphocyte,and platelet(HALP)can reflect systemic inflammation and nutritional status simultaneously,with some evidence revealing its prognostic value for some tumors.However,the effect of HALP on recurrence-free survival(RFS)in patients with gastrointestinal stromal tumors(GISTs)has not been reported.AIM To investigate the prognostic value of HALP in GIST patients.METHODS Data from 591 untreated patients who underwent R0 resection for primary and localized GISTs at West China Hospital between December 2008 and December 2016 were included.Clinicopathological data,preoperative albumin,blood routine information,postoperative treatment,and recurrence status were recorded.To eliminate baseline inequivalence,the propensity scores matching(PSM)method was introduced.Ultimately,the relationship between RFS and preoperative HALP was investigated.RESULTS The optimal cutoff value for HALP was determined to be 31.5 by X-tile analysis.HALP was significantly associated with tumor site,tumor size,mitosis,Ki67,National Institutes of Health(NIH)risk category,and adjuvant therapy(all P<0.001).Before PSM,GIST patients with an increased HALP had a significantly poor RFS(P<0.001),and low HALP was an independent risk factor for poor RFS[hazard ratio(HR):0.506,95%confidence interval(95%CI):0.291-0.879,P=0.016].In NIH high-risk GIST patients,GIST patients with low HALP had a worse RFS than patients with high HALP(P<0.05).After PSM,458 GIST patients were identified;those with an increased HALP still had significantly poor RFS after PSM(P<0.001)and low HALP was still an independent risk factor for poor RFS(HR:0.558,95%CI:0.319-0.976,P=0.041).CONCLUSION HALP was significantly correlated with postoperative pathology and postoperative treatment.Furthermore,HALP showed a strong ability to predict RFS in GIST patients who underwent radical resection.
基金Supported by National Natural Science Foundation of China,No.81871946 and No.82072708Suzhou Medical Key Discipline,No.SZXK202109+1 种基金Suzhou Clinical Key Diseases Project,No.LCZX202111Project of Gusu School of Nanjing Medical University,No.GSKY20210233.
文摘BACKGROUND Remnant gastric cancer(GC)is defined as GC that occurs five years or more after gastrectomy.Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer(RGC)patients are crucial.A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively.Prognostic nutritional index(PNI),controlled nutritional status(CONUT),and Naples prognostic score(NPS)were calculated by preoperative blood indicators,including absolute lymphocyte count,lymphocyte to monocyte ratio,neutrophil to lymphocyte ratio,serum albumin,and serum total cholesterol.Patients with RGC were divided into groups according to the immune-nutritional risk.The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed.Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival(OS)rate between various immune-nutritional score groups.RESULTS The median age of this cohort was 70.5 years(ranging from 39 to 87 years).No significant correlation was found between most pathological features and immune-nutritional status(P>0.05).Patients with a PNI score<45,CONUT score or NPS score≥3 were considered to be at high immune-nutritional risk.The areas under the receiver operating characteristic curves of PNI,CONUT,and NPS systems for predicting postoperative survival were 0.611[95%confidence interval(CI):0.460–0.763;P=0.161],0.635(95%CI:0.485–0.784;P=0.090),and 0.707(95%CI:0.566–0.848;P=0.009),respectively.Cox regression analysis showed that the three immunenutritional scoring systems were significantly correlated with OS(PNI:P=0.002;CONUT:P=0.039;NPS:P<0.001).Survival analysis revealed a significant difference in OS between different immune-nutritional groups(PNI:75 mo vs 42 mo,P=0.001;CONUT:69 mo vs 48 mo,P=0.033;NPS:77 mo vs 40 mo,P<0.001).CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC,in which the NPS system has relatively effective predictive performance.
文摘Alcohol-associated hepatitis(AAH)is a severe form of liver disease caused by alcohol consumption.In the absence of confounding factors,clinical features and laboratory markers are sufficient to diagnose AAH,rule out alternative causes of liver injury and assess disease severity.Due to the elevated mortality of AAH,assessing the prognosis is a radical step in management.The Maddrey discriminant function(MDF)is the first established clinical prognostic score for AAH and was commonly used in the earliest AAH clinical trials.A MDF>32 indicates a poor prognosis and a potential benefit of initiating corticosteroids.The model for end stage liver disease(MELD)score has been studied for AAH prognostication and new evidence suggests MELD may predict mortality more accurately than MDF.The Lille score is usually combined to MDF or MELD score after corticosteroid initiation and offers the advantage of assessing response to treatment a 4-7 d into the course.Other commonly used scores include the Glasgow Alcoholic Hepatitis Score and the Age Bilirubin international normalized ratio Creatinine model.Clinical AAH correlate adequately with histologic severity scores and leave little indication for liver biopsy in assessing AAH prognosis.AAH presenting as acute on chronic liver failure(ACLF)is so far prognosticated with ACLF-specific scoring systems.New artificial intelligence-generated prognostic models have emerged and are being studied for use in AAH.Acute kidney injury(AKI)is one possible complication of AAH and is significantly associated with increased AAH mortality.Predicting AKI and alcohol relapse are important steps in the management of AAH.The aim of this review is to discuss the performance and limitations of different scoring models for AAH mortality,emphasize the most useful tools in prognostication and review predictors of recurrence.
文摘Introduction:Rheumatic heart disease remains a major public health problem worldwide.African populations pay a heavy price for this condition because of socio-economic and health conditions responsible for delayed diagnosis,and limited access to cardiac surgery.Objective:To report the morbidity and mortality of a series of patients operated on for rheumatic valvular disease and to compare its correlation with Ambler’s prognostic score.Patients and Methods:Descriptive and analytical study of all patients operated on for rheumatic valvulopathy from 01/01/2019 to 31/12/2021.Results:160 patients were included.The mean age of patients was 23.93.Females predominated at 56.3%.Delay in treatment was between 1 and 3 years in 49.4%of patients.At preoperative assessment,Systolic Pulmonary Arterial Pressure was>60 mmHg in 43.1%of our patients.The mean Ambler score was 6.68,equivalent to a mean risk of peri-operative mortality of 4.1%.Mitral valve replacement was performed in 81.9%;aortic valve replacement in 18.8%.The average extubation time was between 3 and 5 hours in 43.1%of patients.We recorded a perioperative mortality of 6.9%and a late mortality of 8.1%(36 months).Postoperative hemodynamic complications were correlated with the time to management of valve disease:p=0.036;the presence of preoperative PAH was correlated with the post-operative occurrence of respiratory complications:p=0.029;the presence of preoperative complete arrhythmia due to atrial fibrillation(CAF)was correlated with the post-operative occurrence of renal failure p=0.017.There was no correlation between Ambler score and peri-operative mortality in our series.Conclusion:Cardiac surgery faces many difficulties in sub-Saharan Africa.Risk stratification scores in cardiac surgery are not adapted.The establishment of a pan-African exchange network would be a way of improving this surgical practice in our countries.
基金supported by grants from the Natural Science Foundation of China(No.81071836)Sun Yat-sen University 5010 projects(No.050243)
文摘The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma(NPC)has decreased with the extensive use of intensity-modulated radiotherapy(IMRT).We aimed to develop a prognostic scoring system(PSS)that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT.The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed.Age,pathologic classification,primary tumor extension,primary gross tumor volume(GTV-p),T and N categories,and baseline lactate dehydrogenase(LDH)level were analyzed.Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS.Independent prognostic factors for locoregional relapse included N2–3 stage,GTV-p≥26.8 mL,and involvement of one or more structures within cluster3.We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups:low risk(score 0),intermediate risk(score>0 and≤1),high risk(score>1 and≤2),and extremely high risk(score>2).The 5-year locoregional control rates for these groups were 97.4%,93.6%,85.2%,and 78.6%,respectively(P<0.001).We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.
