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Multiple prognostic scores have been developed to predict morbidity and mortality in patients with spontaneous intracerebral hemorrhage(sICH). Since the advent of machine learning(ML), different ML models have also been developed for sICH prognostication. There is however a need to verify the validity of these ML models in diverse patient populations. We aim to create machine learning models for prognostication purposes in the Qatari population. By incorporating inpatient variables into model development, we aim to leverage more information. 1501 consecutive patients with acute sICH admitted to Hamad General Hospital(HGH) between 2013 and 2023 were included. We trained, evaluated, and compared several ML models to predict 90-day mortality and functional outcomes. For our dataset, we randomly selected 80% patients for model training and 20% for validation and used k-fold cross validation to train our models. The ML workflow included imbalanced class correction and dimensionality reduction in order to evaluate the effect of each. Evaluation metrics such as sensitivity, specificity, F-1 score were calculated for each prognostic model. Mean age was 50.8(SD 13.1) years and 1257(83.7%) were male. Median ICH volume was 7.5 ml(IQR 12.6). 222(14.8%) died while 897(59.7%) achieved good functional outcome at 90 days. For 90-day mortality, random forest(RF) achieved highest AUC(0.906) whereas for 90-day functional outcomes, logistic regression(LR) achieved highest AUC(0.888). Ensembling provided similar results to the best performing models, namely RF and LR, obtaining an AUC of 0.904 for mortality and 0.883 for functional outcomes. Random Forest achieved the highest AUC for 90-day mortality, and LR achieved the highest AUC for 90-day functional outcomes. Comparing ML models, there is minimal difference between their performance. By creating an ensemble of our best performing individual models we maintained maximum accuracy and decreased variance of functional outcome and mortality prediction when compared with individual models. Key points: • 1st Key Point: We are comparing different machine learning models for ICH prognostication. Random Forest was the most accurate model for mortality, and logistic regression was the most accurate model for functional outcomes. • 2nd Key Point: Ensembling models maintained accuracy and decreased variance. [ABSTRACT FROM AUTHOR]

To evaluate the prognostic stratification ability of 4C Mortality Score and COVID-19 Mortality Risk Score in different age groups. Retrospective study, including all patients, presented to the Emergency Department of the University Hospital Careggi, between February, 2020 and May, 2021, and admitted for SARS-CoV2. Patients were divided into four subgroups based on the quartiles of age distribution: patients < 57 years (G1, n = 546), 57–71 years (G2, n = 508), 72–81 years (G3, n = 552), and > 82 years (G4, n = 578). We calculated the 4C Mortality Score and COVID-19 Mortality Risk Score. The end-point was in-hospital mortality. In the whole population (age 68 ± 16 years), the mortality rate was 19% (n = 424), and increased with increasing age (G1: 4%, G2: 11%, G3: 22%, and G4: 39%, p < 0.001). Both scores were higher among non-survivors than survivors in all subgroups (4C-MS, G1: 6 [3–7] vs 3 [2–5]; G2: 10 [7–11] vs 7 [5–8]; G3: 11 [10–14] vs 10 [8–11]; G4: 13 [12–15] vs 11 [10–13], all p < 0.001; COVID-19 MRS, G1: 8 [7–9] vs 9 [9–11], G2: 10 [8–11] vs 11 [10–12]; G3: 11 [10–12] vs 12 [11–13]; G4: 11 [10–13] vs 13 [12–14], all p < 0.01). The ability of both scores to identify patients at higher risk of in-hospital mortality, was similar in different age groups (4C-MS: G1 0.77, G2 0.76, G3 0.68, G4 0.72; COVID-19 MRS: G1 0.67, G2 0.69, G3 0.69, G4 0.72, all p for comparisons between subgroups = NS). Both scores confirmed their good performance in predicting in-hospital mortality in all age groups, despite their different mortality rate. [ABSTRACT FROM AUTHOR]

A major worldwide health concern, chronic hepatitis B necessitates precise prognostic and diagnostic indicators for clinical guidance. This article highlights the clinical importance and current issues of the major markers used in both the detection and prognosis of chronic hepatitis B. An important indicator of an ongoing and persistent infection is the hepatitis B surface antigen. Hepatitis B virus DNA quantification monitoring aids in assessing viral load and hepatic cancer risk. While limited evidence of liver damage is provided by alanine aminotransferase levels, the hepatitis B core antibody verifies acute infection. Seroconversion to the hepatitis B e antibody is linked to a lower risk of disease development, and the hepatitis B e antigen status is a critical prognostic factor. Treatment choices are guided by a biopsy of the liver or minimally invasive liver fibrosis detection. Genotypes of the hepatitis B virus and host variables influence the prognosis by adding to the disease’s variability. Noninvasive techniques to evaluate the severity of the disease are provided by serum markers of fibrosis, such as the fibrosis score based on four criteria and the aspartate aminotransferase-to-platelet ratio index. The requirement for indicators that distinguish between distinct viral phases and increase specificity in evaluating liver damage is one of the challenges facing chronic hepatitis B research. Even though it is quite difficult to find reliable biomarkers for resistance especially when it comes to hepatocellular cancer risk estimation, there are advanced methods, which include imaging and omics that can help in improving the accuracy of the diagnostics and prognosis. Interventions early point that improve patient outcomes are made possible using diagnostics and prognostics as they are quite effective in managing the complicated landscape of chronic hepatitis B. Key in addressing these challenges today and improving the diagnostic and prognostic markers in the future, particularly those that would support the development of successful treatment plans for people living with chronic hepatitis B virus (HBV), are scientific research, technological advances and collaborations.

Simple Summary: The treatment of chronic lymphocytic leukemia (CLL) has dramatically changed following the availability of new drugs with targeted mechanisms of action. Traditional and new prognostic factors are being investigated to individualize and guide these new treatments. In this review, we discuss the clinical relevance of genomic factors including immunoglobulin heavy chain variable (IGHV) mutational status, TP53 abnormalities, complex karyotype, and prognostic scores in relation to new targeted agents. Novel drugs have profoundly changed the outcomes in chronic lymphocytic leukemia (CLL) patients, and the traditional prognostic factors that were identified in the era of chemoimmunotherapy need to be validated in the context of these new targeted therapies. Currently, the most important prognostic genetic biomarkers are the immunoglobulin heavy chain variable (IGHV) mutational status, genetic aberrations including del(17p)/TP53 abnormalities, and the complex karyotype. In this review, we discuss the prognostic role of these genomic markers in relation to novel treatments. Moreover, we present and discuss new scoring systems that were elaborated and validated in the era of new drugs. In routine clinical practice, the application of an extensive genomic work-up with validated prognostic markers could improve the identification of "very high-risk" CLL patients who could benefit from novel, more effective targeted treatments. [ABSTRACT FROM AUTHOR]

In evaluating the performance of different facilities or centers on survival outcomes, the standardized mortality ratio (SMR), which compares the observed to expected mortality has been widely used, particularly in the evaluation of kidney transplant centers. Despite its utility, the SMR may exaggerate center effects in settings where survival probability is relatively high. An example is one‐year graft survival among U.S. kidney transplant recipients. We propose a novel approach to estimate center effects in terms of differences in survival probability (ie, each center versus a reference population). An essential component of the method is a prognostic score weighting technique, which permits accurately evaluating centers without necessarily specifying a correct survival model. Advantages of our approach over existing facility‐profiling methods include a metric based on survival probability (greater clinical relevance than ratios of counts/rates); direct standardization (valid to compare between centers, unlike indirect standardization based methods, such as the SMR); and less reliance on correct model specification (since the assumed model is used to generate risk classes as opposed to fitted‐value based 'expected' counts). We establish the asymptotic properties of the proposed weighted estimator and evaluate its finite‐sample performance under a diverse set of simulation settings. The method is then applied to evaluate U.S. kidney transplant centers with respect to graft survival probability. [ABSTRACT FROM AUTHOR]

Background: For mortality prediction models of decompensated liver cirrhosis to be valid, re-evaluations of score performances are needed. This study aimed to assess the prognostic scores performance in the prediction of mortality among decompensated cirrhotic patients admitted to the ICU, involving Acute Physiology and Chronic Health Evaluation II (APACHE II), sequential organ failure assessment (SOFA), Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF), Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), MELD lactate, Glasgow Coma scale (GCS). Methods: In an observational descriptive cohort study, we recruited 80 patients with decompensated liver cirrhosis who were critically ill and admitted to the ICU. Scores of the APACHE II, Child-Pugh, MELD, MELD-Na, and MELD-lactate were used to evaluate the severity of the disease. Results: Statistically significant differences were revealed between ICU outcomes and different prognostic scores; as the median of CTP score, MELD, MELD Na, MELD Lactate (MELD.L), S. Lactate, SOFA, APACHE II & CLIF-C ACLF were higher among deceased patients, while the median of GCS & MAP was lower among deceased patients. By Multivariate regression analysis, low GCS (Odd Ratio:0.4), high CTP (OR: 2.37), and high APACHE II (OR: 2.44) were independent predictors of mortality (p<0.001), whereas serum sodium, albumin, platelets, hemoglobin, and blood urea were not. Conclusions: When compared to previous models, SOFA and APACHE scores were superior in predicting the overall mortality among patients at the ICU with decompensated liver cirrhosis. [ABSTRACT FROM AUTHOR]

• The 30-day all-cause mortality of patients with acute pulmonary embolism (PE) was 3.5 %. • This study externally validated the simplified Pulmonary Embolism Severity Index (sPESI), RIETE score, Geneva score, modified FAST and Bova score for 30-day mortality of acute PE, based on the large Chinese nationwide prospective cohort. • Area under the curve for predicting 30-day mortality of sPESI was 0.712 (95 % CI, 0.680, 0.743), with the odds ratio of 4.743 for sPESI ⩾1 point (95 % CI, 3.427, 6.563, p < 0.001). • The sPESI also showed a high sensitivity of 0.809. • The implementation of sPESI in Chinese patients with PE can help to discriminate patients with extremely low risk of short-term mortality for home treatment or early discharge. The performance of existing prognostic scores including the simplified Pulmonary Embolism Severity Index (sPESI) for short-term mortality of non-high-risk PE in Chinese population has not been widely validated. Non-high-risk patients were included from the prospective cohort of the China pUlmonary Thromboembolism REgistry Study (CURES). The sPESI, RIETE, Geneva, modified FAST, and Bova score were validated. The discriminatory performance was measured by the area under the curve (AUC). We also compared the sensitivity, odds ratio, specificity, positive predictive value and negative predictive value of these scores. A total of 6,873 non-high-risk patients with acute PE were included and 241 (3.5 %) patients died within 30 days. Compared to the Geneva, modified FAST, and Bova score, the AUCs for predicting 30-day death of sPESI and RIETE score were higher at 0.712 (95 % CI, 0.680, 0.743) and 0.723 (95 % CI, 0.691, 0.755) respectively. The sPESI demonstrated the highest sensitivity at 0.809, while the RIETE score, Geneva, Modified FAST and BOVA score showed sensitivities of 0.622, 0.568, 0.477 and 0.502 respectively. A sPESI ⩾1 point was associated with a 4.7-fold increased risk of 30-day all-cause mortality (95 % CI, 3.427, 6.563, p < 0.001), while a RIETE score of ⩾1 point was associated with a 4.5-fold increased risk (95 % CI, 3.127, 6.341, p < 0.001). The Geneva score, modified FAST and Bova score showed inferior performance. The implementation of the fewer-parameter, easier-to-calculate sPESI in Chinese patients with PE can help to discriminate patients with extremely low risk of short-term mortality for home treatment or early discharge. [ABSTRACT FROM AUTHOR]

Summary: Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe. Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018–March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC). Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24–43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63–0.71), 0.68 (0.64–0.72), and 0.82 (0.79–0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p

This study aims to evaluate the clinical outcome of stereotactic radiosurgery as the sole treatment for brain metastases and to assess prognostic factors influencing survival. A total of 108 consecutive patients with 213 metastases were retrospectively analyzed. Treatment was determined with close-meshed MRI follow-up. Various prognostic factors were assessed, and several prognostic indices were compared regarding their reliability to estimate overall survival. Median overall survival was 15 months; one-year overall survival was 50.5%. Both one- and two-year local controls were 90.9%. The rate of new metastases after SRS was 49.1%. Multivariate analysis of prognostic factors revealed that the presence of extracranial metastases, male sex, lower KPI, and progressive extracranial disease were significant risk factors for decreased survival. Of all evaluated prognostic indices, the Basic Score for Brain Metastases (BSBMs) showed the best correlation with overall survival. A substantial survival advantage was found for female patients after SRS when compared to male patients (18 versus 9 months, p = 0.003). SRS of brain metastasis is a safe and effective treatment option when frequent monitoring for new metastases with MRI is performed. Common prognostic scores lack reliable estimation of survival times. Female sex should be considered as an additional independent positive prognostic factor influencing survival.

This study aims to evaluate the clinical outcome of stereotactic radiosurgery as the sole treatment for brain metastases and to assess prognostic factors influencing survival. A total of 108 consecutive patients with 213 metastases were retrospectively analyzed. Treatment was determined with close-meshed MRI follow-up. Various prognostic factors were assessed, and several prognostic indices were compared regarding their reliability to estimate overall survival. Median overall survival was 15 months; one-year overall survival was 50.5%. Both one- and two-year local controls were 90.9%. The rate of new metastases after SRS was 49.1%. Multivariate analysis of prognostic factors revealed that the presence of extracranial metastases, male sex, lower KPI, and progressive extracranial disease were significant risk factors for decreased survival. Of all evaluated prognostic indices, the Basic Score for Brain Metastases (BSBMs) showed the best correlation with overall survival. A substantial survival advantage was found for female patients after SRS when compared to male patients (18 versus 9 months, p = 0.003). SRS of brain metastasis is a safe and effective treatment option when frequent monitoring for new metastases with MRI is performed. Common prognostic scores lack reliable estimation of survival times. Female sex should be considered as an additional independent positive prognostic factor influencing survival. [ABSTRACT FROM AUTHOR]

Objectives: Treatment intensification (including consolidative high‐dose chemotherapy with autologous stem cell transplantation [HDT‐ASCT]) significantly improved outcome in primary central nervous system lymphoma (PCNSL) patients. Methods: We conducted a multicenter, retrospective analysis of newly diagnosed PCNSL patients, treated with intensified treatment regimens. The following scores were evaluated in terms of overall survival (OS) and progression‐free survival (PFS): Memorial Sloan‐Kettering Cancer Center (MSKCC), International Extranodal Lymphoma Study Group (IELSG), and three‐factor (3F) prognostic score. Further, all scores were comparatively investigated for model quality and concordance. Results: Altogether, 174 PCNSL patients were included. One hundred and five patients (60.3%) underwent HDT‐ASCT. Two‐year OS and 2‐year PFS for the entire population were 73.3% and 48.5%, respectively. The MSKCC (p =.003) and 3F score (p <.001), but not the IELSG score (p =.06), had the discriminatory power to identify different risk groups for OS. In regard to concordance, the 3F score (C‐index [0.71]) outperformed both the MSKCC (C‐index [0.64]) and IELSG (C‐index [0.53]) score. Moreover, the superiority of the 3F score was shown for PFS, successfully stratifying patients in three risk groups, which also resulted in the highest C‐index (0.66). Conclusion: The comparative analysis of established PCNSL risk scores affirm the clinical utility of the 3F score stratifying the widest prognostic spectrum among PCNSL patients treated with intensified treatment approaches. [ABSTRACT FROM AUTHOR]

Aim. To assess the prognostic value of current scales and indices for risk stratification of any surgical and cardiovascular complications (CVC) in patients undergoing non-cardiac surgical interventions.Material and methods. This single-center cohort retrospective study was conducted in patients who underwent non-cardiac surgery in 2018 and 2020. Surgical postoperative complications (POCs) were assessed according to the Clavien-Dindo classification. CVCs included any cardio-vascular events (CVEs), major adverse cardiac events (MACE), ST-T abnormalities on the electrocardiogram (ECG), decompensated heart failure (HF), arrhythmias, episodes of hypotension or hypertension, delirium, bleeding, thromboembolic events (TEEs). Risk stratification of POCs was carried out using recommended prognostic scales and indices. Their prognostic significance was assessed using ROC analysis with assessment of the area under the curve (AUC).Results. POC risk stratification was performed in 2937 patients. There was following prognostic value of scales and indices: Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) score — AUC of 0,990, 0,808, 0,825, 0,841, 0,808, 0,793, 0,701, 0,776, 0,744 in predicting Clavien-Dindo grade 5, 4, HF, delirium, TEEs, MACE, ST-T abnormalities, arrhythmias, bleeding, respectively; Surgical Outcome Risk Tool (SORT) — AUC of 0,973, 0,740, 0,890, 0,763, 0,721, 0,716, 0,700 in predicting Clavien-Dindo grade 5, 4, delirium, MACE, HF, arrhythmia, TEEs, respectively; American Society of Anesthesiologists (ASA) — AUC of 0,648, 0,600, 0,658 for HF, ST-T abnormalities, arrhythmias, respectively; Charlson comorbidity index — AUC of 0,819, 0,950, 0,789, 0,788, 0,706, 0,771, 0,898 in predicting Clavien-Dindo grade 5, 4, MACE, HF, ST-T abnormalities, arrhythmias, delirium; surgical risk score associated with the risk of cardiac events — AUC of 0,989, 0,887, 0,728 for Clavien-Dindo grade 3, 5, MACE, respectively; reconstructed Revised Cardiac Risk Index (rRCRI) — AUC of 0,916 and 0,979, 0,762, 0,741, 0,737 in predicting Clavien-Dindo grade 3, 5, HF, arrhythmia, delirium, respectively; National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) — AUC of 0,705, 0,757, 0,718 for arrhythmia, delirium, TEEs, respectively; total cardiovascular risk according to 2022 European Society of Cardiology (ESC) guidelines — AUC of 0,942, 0,726, 0,701, 0,748, 0,785 for Clavien-Dindo grade 5, MACE, ST-T abnormalities, arrhythmias, delirium, respectively; Caprini score — AUC of 0,718 and Venous ThromboEmbolism and Bleeding (VTE-Bleed) — AUC of 0,722 in predicting TEEs; simplified Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) index — AUC of 0,729 for stratification of bleeding. In assessment of total risk of Clavien-Dindo surgical complications and any CVEs, none of the scales showed a predictive value of >0,7.Conclusion. Any CVE stratification requires improvement of current tools and development of novel prognostic tools.

Abstract Background To test whether known prognosticators of COVID-19 maintained their stratification ability across age groups. Methods We performed a retrospective study. We included all patients (n = 2225), who presented to the Emergency Department of the Careggi University Hospital for COVID-19 in the period February 2020—May 2021, and were admitted to the hospital. The following parameters were analyzed as dichotomized: 1) SpO2/FiO2 ≤ or > 214; 2) creatinine 82). The primary end-point was in-hospital mortality. Results By the univariate analysis, the aforementioned dichotomized variables demonstrated a significant association with in-hospital mortality in all subgroups. We introduced them in a multivariate model: in G1 SpO2/FiO2 ≤ 214 (Relative Risk, RR 15.66; 95%CI 3.98–61,74), in G2 creatinine ≥ 1.1 mg/L (RR 2.87, 95%CI 1.30–6.32) and LDH ≥ 250 UI/L (RR 8.71, 95%CI 1,15–65,70), in G3 creatinine ≥ 1.1 mg/L (RR 1.98, 95%CI 1,17–3.36) and CRP ≥ 60 ng/L (RR 2.14, 95%CI 1.23–3.71), in G4 SpO2/FiO2 ≤ 214 (RR 5.15, 95%CI 2.35–11.29), creatinine ≥ 1.1 mg/L (RR 1.75, 95%CI 1.09–2.80) and CRP ≥ 60 ng/L (RR 1.82, 95%CI 1.11–2.98) were independently associated with an increased in-hospital mortality. Conclusions A mild to moderate respiratory failure showed an independent association with an increased mortality rate only in youngest and oldest patients, while kidney disease maintained a prognostic role regardless of age.

Introduction: Identifying which patient may benefit from immunotherapeutic early-phase clinical trials is an unmet need in drug development. Among several proposed prognostic scores, none has been validated in patients receiving immunomodulating agents (IMAs)-based combinations. Patients and methods: We retrospectively collected data of 208 patients enrolled in early-phase clinical trials investigating IMAs at our Institution, correlating clinical and blood-based variables with overall survival (OS). A retrospective cohort of 50 patients treated with IMAs at Imperial College (Hammersmith Hospital, London, UK) was used for validation. Results: A total of 173 subjects were selected for analyses. Most frequent cancers included non-small cell lung cancer (26%), hepatocellular carcinoma (21.5%) and glioblastoma (13%). Multivariate analysis (MVA) revealed 3 factors to be independently associated with OS: line of treatment (second and third vs subsequent, HR 0.61, 95% CI 0.40-0.93, p 0.02), serum albumin as continuous variable (HR 0.57, 95% CI 0.36-0.91, p 0.02) and number of metastatic sites (<3 vs =3, HR 0.68, 95% CI 0.48-0.98, p 0.04). After splitting albumin value at the median (3.84 g/dL), a score system was capable of stratifying patients in 3 groups with significantly different OS (p<0.0001). Relationship with OS reproduced in the external cohort (p=0.008). Then, from these factors we built a nomogram. Conclusions: Prior treatment, serum albumin and number of metastatic sites are readily available prognostic traits in patients with advanced malignancies participating into immunotherapy early-phase trials. Combination of these factors can optimize patient selection at study enrollment, maximizing therapeutic intent. [ABSTRACT FROM AUTHOR]

Background: To test whether known prognosticators of COVID-19 maintained their stratification ability across age groups. Methods: We performed a retrospective study. We included all patients (n = 2225), who presented to the Emergency Department of the Careggi University Hospital for COVID-19 in the period February 2020—May 2021, and were admitted to the hospital. The following parameters were analyzed as dichotomized: 1) SpO2/FiO2 ≤ or > 214; 2) creatinine < or ≥ 1.1 mg/dL; 3) Lactic dehydrogenase (LDH) < or ≥ 250 U/mL; 4) C Reactive Protein (CRP) < or ≥ 60 mg/100 mL. We divided the study population in four subgroups, based on the quartiles of distribution of age (G1 18–57 years, G2 57–71 years, G3 72–81 years, G4 > 82). The primary end-point was in-hospital mortality. Results: By the univariate analysis, the aforementioned dichotomized variables demonstrated a significant association with in-hospital mortality in all subgroups. We introduced them in a multivariate model: in G1 SpO2/FiO2 ≤ 214 (Relative Risk, RR 15.66; 95%CI 3.98–61,74), in G2 creatinine ≥ 1.1 mg/L (RR 2.87, 95%CI 1.30–6.32) and LDH ≥ 250 UI/L (RR 8.71, 95%CI 1,15–65,70), in G3 creatinine ≥ 1.1 mg/L (RR 1.98, 95%CI 1,17–3.36) and CRP ≥ 60 ng/L (RR 2.14, 95%CI 1.23–3.71), in G4 SpO2/FiO2 ≤ 214 (RR 5.15, 95%CI 2.35–11.29), creatinine ≥ 1.1 mg/L (RR 1.75, 95%CI 1.09–2.80) and CRP ≥ 60 ng/L (RR 1.82, 95%CI 1.11–2.98) were independently associated with an increased in-hospital mortality. Conclusions: A mild to moderate respiratory failure showed an independent association with an increased mortality rate only in youngest and oldest patients, while kidney disease maintained a prognostic role regardless of age. [ABSTRACT FROM AUTHOR]

Background: It is not known whether anatomical scores perform better than general critical care scores for trauma patients admitted to the intensive care unit (ICU). We compare the predictive performance for hospital mortality of general critical care scores (SAPS 3 and SOFA) with anatomical injury-based scores (Injury Severity Score [ISS] and New ISS [NISS]). Methods: Retrospective cohort study of patients admitted to a specialized trauma ICU from a tertiary hospital in São Paulo, Brazil between May, 2012 and January, 2016. We retrieved data from the ICU database for critical care scores and calculated ISS and NISS from chart data and whole body computed tomography results. We compared the predictive performance for hospital mortality of each model through discrimination, calibration, and decision-curve analysis. Results: The sample comprised 1053 victims of trauma admitted to the ICU, with 84.2% male patients and mean age of 40 (±18) years. Main injury mechanism was blunt trauma (90.7%). Traumatic brain injury was present in 67.8% of patients; 43.3% with severe TBI. At the time of ICU admission, 846 patients (80.3%) were on mechanical ventilation and 644 (64.3%) on vasoactive drugs. Hospital mortality was 23.8% (251). Median SAPS 3 was 41; median maximum SOFA within 24 h of admission, 7; ISS, 29; and NISS, 41. AUROCs (95% CI) were: SAPS 3 = 0.786 (0.756-0.817), SOFA = 0.807 (0.778-0.837), ISS = 0.616 (0.577-0.656), and NISS = 0.689 (0.649-0.729). In pairwise comparisons, SAPS 3 and SOFA did not differ, while both outperformed the anatomical scores (p <.001). Maximum SOFA within 24 h of admission presented the best calibration and net benefit in decision-curve analysis. Conclusions: Trauma-specific anatomical scores have fair performance in critically ill trauma patients and are outperformed by SAPS 3 and SOFA. Illness severity is best characterized by organ dysfunction and physiological variables than anatomical injuries. [ABSTRACT FROM AUTHOR]

Non-small cell lung cancer (NSCLC) is the second most common cancer worldwide, resulting in 1.8 million deaths per year. Most patients are diagnosed with a metastatic disease. Brain metastases are one of the most common metastatic sites and are associated with severe neurological symptoms, shorter survival, and the worst clinical outcomes. Brain radiotherapy and systemic oncological therapies are currently used for controlling both cancer progression and neurological symptoms. Brain radiotherapy includes stereotactic brain ablative radiotherapy (SBRT) or whole brain radiotherapy (WBRT). SBRT is applied for single or multiple (up to ten) small (diameter less than 4 cm) lesions, whereas WBRT is usually applied for multiple (more than ten) and large (diameter greater than 4 cm) brain metastases. In both cases, radiotherapy application may be viewed as an overtreatment which causes severe toxicities without achieving a significant clinical benefit. Thus far, a number of scoring systems to define the potential clinical benefits derived from brain radiotherapy have been proposed. However, most are not well established in clinical practice. In this article, we present a clinical case of a patient with advanced NSCLC carrying a BRAFV600E mutation and brain metastases. We review the variables in addition to applicable scoring systems considered to have potential for predicting clinical outcomes and benefits of brain radiotherapy in patients with advanced NSCLC and brain metastases. Lastly, we highlight the unmet need of specific scoring systems for advanced NSCLC patients with brain metastases carrying oncogene alterations including BRAFV600E mutations. [ABSTRACT FROM AUTHOR]

Background: Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy for which multiagent chemotherapy is the mainstay of treatment resulting in limited survival and symptomatic benefit. Treatment with immune checkpoint inhibitors (ICI) has proven effective in a growing number of solid tumors but has yet to show clinical benefit in patients with PDAC. Given the growing number of ICI-based clinical trials in development for patients with PDAC and lack of clinical benefit thus far with ICI-based therapies in these patients, we sought to (1) determine the outcomes of patients with PDAC treated with ICI-based therapies as part of an early phase clinical trial, (2) validate the utility of established prognostic scoring systems, and (3) identify novel prognostic factors in an attempt to better identify patients that would benefit from enrollment onto an ICI-based early phase clinical trial. Methods: We conducted a single-center retrospective analysis of patients with advanced PDAC who were treated with ICI-based therapy as part of an early-phase clinical trial. Results: Patients were only able to stay on study for a limited time due to disease progression and/or a change in performance status and had a poor overall survival. Established prognostic scoring systems were not effective in predicting outcomes in this patient population, but factors such as pre-treatment albumin neutrophil to lymphocyte ratio (NLC) may be helpful in patient selection. Conclusions: This study underscores the need for larger studies to help identify patient and tumor intrinsic factors that predict response to ICI-based therapies in patients with PDAC. [ABSTRACT FROM AUTHOR]

Non-small cell lung cancer (NSCLC) is the second most common cancer worldwide, resulting in 1.8 million deaths per year. Most patients are diagnosed with a metastatic disease. Brain metastases are one of the most common metastatic sites and are associated with severe neurological symptoms, shorter survival, and the worst clinical outcomes. Brain radiotherapy and systemic oncological therapies are currently used for controlling both cancer progression and neurological symptoms. Brain radiotherapy includes stereotactic brain ablative radiotherapy (SBRT) or whole brain radiotherapy (WBRT). SBRT is applied for single or multiple (up to ten) small (diameter less than 4 cm) lesions, whereas WBRT is usually applied for multiple (more than ten) and large (diameter greater than 4 cm) brain metastases. In both cases, radiotherapy application may be viewed as an overtreatment which causes severe toxicities without achieving a significant clinical benefit. Thus far, a number of scoring systems to define the potential clinical benefits derived from brain radiotherapy have been proposed. However, most are not well established in clinical practice. In this article, we present a clinical case of a patient with advanced NSCLC carrying a BRAFV600E mutation and brain metastases. We review the variables in addition to applicable scoring systems considered to have potential for predicting clinical outcomes and benefits of brain radiotherapy in patients with advanced NSCLC and brain metastases. Lastly, we highlight the unmet need of specific scoring systems for advanced NSCLC patients with brain metastases carrying oncogene alterations including BRAFV600E mutations.

IntroductionIdentifying which patient may benefit from immunotherapeutic early-phase clinical trials is an unmet need in drug development. Among several proposed prognostic scores, none has been validated in patients receiving immunomodulating agents (IMAs)-based combinations.Patients and methodsWe retrospectively collected data of 208 patients enrolled in early-phase clinical trials investigating IMAs at our Institution, correlating clinical and blood-based variables with overall survival (OS). A retrospective cohort of 50 patients treated with IMAs at Imperial College (Hammersmith Hospital, London, UK) was used for validation.ResultsA total of 173 subjects were selected for analyses. Most frequent cancers included non-small cell lung cancer (26%), hepatocellular carcinoma (21.5%) and glioblastoma (13%). Multivariate analysis (MVA) revealed 3 factors to be independently associated with OS: line of treatment (second and third vs subsequent, HR 0.61, 95% CI 0.40-0.93, p 0.02), serum albumin as continuous variable (HR 0.57, 95% CI 0.36–0.91, p 0.02) and number of metastatic sites (

Heart failure (HF) is a clinical syndrome due to heart dysfunction, but in which other organs are also involved, resulting in a complex multisystemic disease, burdened with high mortality and morbidity. This article focuses on the mutual relationship between the heart and liver in HF patients. Any cause of right heart failure can cause hepatic congestion, with important prognostic significance. We have analyzed the pathophysiology underlying this double interaction. Moreover, we have explored several biomarkers and non-invasive tests (i.e., liver stiffness measurement, LSM) potentially able to provide important support in the management of this complex disease. Cardiac biomarkers have been studied extensively in cardiology as a non-invasive diagnostic and monitoring tool for HF. However, their usefulness in assessing liver congestion in HF patients is still being researched. On the other hand, several prognostic scores based on liver biomarkers in patients with HF have been proposed in recent years, recognizing the important burden that liver involvement has in HF. We also discuss the usefulness of a liver stiffness measurement (LSM), which has been recently proposed as a reliable and non-invasive method for assessing liver congestion in HF patients, with therapeutic and prognostic intentions. Lastly, the relationship between LSM and biomarkers of liver congestion is not clearly defined; more research is necessary to establish the clinical value of biomarkers in assessing liver congestion in HF patients and their relationship with LSM. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: Determining among 6 different scores which one most accurately predicted short-and long-term mortality in hospitalized COVID-19 patients above 60 years old. Findings: Among 6 different prognostic scales, the 4C Mortality Score (4CMS) was the best to predict intrahospital mortality and mortality at 30 days and 6 months. To predict 12-month mortality, the Charlson Comorbidity Index (CCI) had the best performance. Message: This study reflects the importance of considering comorbidities for short and long-term mortality after COVID-19. Background and objectives: Multiple scoring systems were used for risk stratification in COVID-19 patients. The objective was to determine among 6 scores which performed the best in predicting short-and long-term mortality in hospitalized COVID-19 patients ≥ 60 years. Methods: An observational, retrospective cohort study conducted between 21/10/2020 and 20/01/2021. 6 scores were calculated (Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), 4C Mortality Score (4CMS), NEWS score (NEWS), quick-SOFA score (qSOFA), and Quick COVID-19 Severity Index (qCSI)). We included unvaccinated hospitalized patients with COVID-19 ≥ 60 years old in Brugmann hospital, detected by PCR and/or suggestive CT thorax images. Old and nosocomial infections, and patients admitted immediately at the intensive care unit were excluded. Results: 199 patients were included, mean age was 76.2 years (60–99). 47.2% were female. 56 patients (28%) died within 1 year after the first day of hospitalization. The 4CMS predicted the best intrahospital, 30 days and 6 months mortality, with area under the ROC curve (AUROC) 0.695 (0.58–0.81), 0.76 (0.65–0.86) and 0.72 (0.63–0.82) respectively. The CCI came right after with respectively AUROC of 0.69 (0.59–0.79), 0.74 (0.65–0.83) and 0.71 (0.64–0.8). To predict mortality at 12 months after hospitalization, the CCI had the highest AUROC with 0.77 (0.69–0.85), before the 4CMS with 0.69 (0.60–0.79). Discussion: Among 6 scores, the 4CMS was the best to predict intrahospital, 30-day and 6-month mortality. To predict mortality at 12 months, CCI had the best performance before 4CMS. This reflects the importance of considering comorbidities for short- and long-term mortality after COVID 19. Registration: This study was approved by the ethical committee of Brugmann University Hospital (reference CE 2020/228). [ABSTRACT FROM AUTHOR]

Lung cancer and lung cancer related metastatic spine disease had for many years a poor prognosis. However, after the introduction of molecule targeted agents into the treatment of lung cancer the survival has been prolonged. The prognostic scores, mainly represented by the revised Tokuhashi Score, that have been used in the last decades to predict the survival of the patients and guide the choice of the optimal treatment, classify the patients into short term (<6 months), intermediate (6-12 months) and long term (>12 months) survivors and recommend conservative or surgical treatment accordingly. These scores have not been revised lately and there is a great concern that this improvement in survival of lung cancer patients is not reflected in the calculated scores. This is a review of the literature concerning the accuracy and validity of the current metastatic spine surgery scores in relation to lung cancer derived spinal metastases. Broad consensus exists about the need to revise the current scores and develop new ones specifically for lung cancer. [ABSTRACT FROM AUTHOR]

We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.DesignWe analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours.SettingA multisite international inpatient trial.PatientsA total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia.InterventionsAdaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment.Measurements and main resultsFor mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60-0.68), and improved with addition of age (c-index, 0.66-0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65-0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68-0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59-0.69) and improved with addition of age (c-index, 0.63-0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05).ConclusionsIn the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.

Aim: The course of acute pancreatitis is variable with patients at risk of poor outcomes. The purpose of this study was to compare Modified Glasgow-Imrie, Ranson, and APACHE II scoring systems in predicting the severity of acute pancreatitis. Material and Methods: After a brief history, clinical examination and qualifying inclusion criteria, 70 patients (41 women, 29 men) diagnosed with acute pancreatitis were included in the study. The three scores were calculated for each patient and evaluated for their role in the assessment of specific outcomes. Results: 34.3% patients were diagnosed with severe acute pancreatitis, while 65.7% patients had mild acute pancreatitis. A strong positive correlation was found between all the prognostic scores and the severity of disease. In the prediction of the severity of disease according to AUC, it was found that Glasgow-Imrie score had an AUC of 0.864 (0.756–0.973), followed very closely by APACHE II score with an AUC of 0.863 (0.758–0.968). APACHE II had the highest sensitivity (79.17%) in predicting severity while Glasgow-Imrie score was the most specific (97.83%) of all the scores. Patients with a Glasgow-Imrie score above the cut-off value of 3 had more complications and a longer hospital stay. Conclusion: The Glasgow-Imrie score was comparable to APACHE II score and better than Ranson score statistically in predicting the severity of acute pancreatitis. Its administration in predicting the severity of acute pancreatitis is recommended. [ABSTRACT FROM AUTHOR]

The performance of prognostic scores of status epilepticus (SE) has been reported in very heterogeneous cohorts. We aimed to provide a summary of the available evidence on their respective performance. PubMed and EMBASE were searched for relevant articles. Studies were reviewed for eligibility for meta‐analysis of the area under the receiver‐operating characteristic curve (AUC) and for meta‐analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in predicting in‐hospital mortality with scores in which at least two external evaluations had been published. This study was registered with PROSPERO (international prospective register of systematic reviews) (CRD42022325766). Study quality was assessed using Prediction model Risk Of Bias ASsessment Tool (PROBAST). In the meta‐analysis of AUC, 21 studies were pooled for STESS (Status Epilepticus Severity Score), five for EMSE‐EAC (Epidemiology‐based Mortality Score in Status Epilepticus ‐ Etiology, Age, level of Consciousness), five for EMSE‐EACE (EMSE ‐ Etiology, Age, level of Consciousness, EEG), and two for ENDIT (Encephalitis, nonconvulsive status epilepticus, Diazepam resistance, Imaging abnormalities, Tracheal intubation). The pooled AUC of STESS, EMSE‐EAC, EMSE‐EACE, and ENDIT was 0.74 (95% CI: 0.71–0.78), 0.68 (95% CI 0.63–0.72), 0.77 (95% CI: 0.72–0.81), and 0.78 (95% CI: 0.70–0.87), respectively. The pooled sensitivity of STESS‐3, STESS‐4, EMSE‐EACE‐64, and ENDIT‐4 was 0.83 (95% CI: 0.80–0.86), 0.60 (95% CI: 0.55–0.65), 0.76 (95% CI: 0.67–0.83), and 0.70 (95% CI: 0.55–0.82), respectively. Their pooled specificity was 0.50 (95% CI: 0.48–0.52), 0.74 (95% CI: 0.72–0.76), 0.63 (95% CI: 0.59–0.67), and 0.65 (95% CI: 0.61–0.70), respectively. Their pooled PPV was 0.27 (95% CI: 0.24–0.30), 0.35 (95% CI: 0.29–0.41), 0.33 (95% CI: 0.24–0.43), and 0.20 (95% CI: 0.13–0.27). Their pooled NPV was 0.94 (95% CI: 0.93–0.96), 0.90 (95% CI: 0.89–0.92), 0.89 (95% CI: 0.80–0.98), and 0.95 (95% CI: 0.92–0.98). Variations in performance were observed in patients' subgroups, such as critically ill patients and refractory cases. Investigated scores only have acceptable AUC, sensitivity, and specificity for predicting in‐hospital mortality, with the EMSE‐EAC having a lower discriminative power. STESS‐3 has the highest sensitivity, and STESS‐4 the highest specificity, but neither combines acceptable sensitivity and specificity. All these scores had high NPV but very low PPV. Caution should be exercised in their clinical use. Further studies are required to develop more accurate scores. [ABSTRACT FROM AUTHOR]

In acute severe autoimmune hepatitis (AS-AIH), the early identification of predictors of non-response to corticosteroids and the optimal timing for liver transplantation (LT) remains controversial. To determine early predictors of non-response to corticosteroids and to assess the usefulness of severity scores, namely the recently developed SURFASA. Retrospective multicentre cohort study including consecutive patients admitted for AS-AIH between 2016 and 2020. Definitions- response to corticosteroids: LT-free survival at 90 days (D90); SURFASA score: -6.8 + 1.92x(D0-INR)+1.94xINR[(D3-D0)/D0]+1.64xbilirubin[(D3-D0)/D0]. We included 26 patients [median age 56 (45–69) years; 22 (84.6%) women]. All patients underwent corticosteroid therapy. Overall survival reached 73%. amongst the non-responders, 2 (7.8%) underwent LT and 5 (19.2%) died. The interval between admission and initiation of corticosteroids was not different between responders and non- responders [13 (7–23) vs. 8 (3–10), P:0.06], respectively. SURFASA and MELD-Na+ (D3) scores showed an AUROC of 0.96 (0.87–1) and 0.92 (0.82–0.99), respectively, for prediction of non-response. SURFASA >-2.5 had a sensitivity of 85.7% and a specificity of 100% and MELD-Na+ (D3) >26 had sensitivity of 85.7% and a specificity of 78% for the prediction of non-response. SURFASA and MELD-Na+ at D3 scores are useful in early identification of non-responders to corticosteroids. [ABSTRACT FROM AUTHOR]

Acute pulmonary embolism (PE) is a disease with a serious prognosis and a high probability of death in the emergency department.To investigate the prediction of PE-related mortality and intensive care admission (ICU) of Qanadli (Qscore), Bova, and simplified Pulmonary Embolism Severity Index (sPESI) scores.This retrospective observational study consisted of all patients diagnosed with acute PE who were imaged under computed tomography pulmonary angiography (CTPA) for a total of 5 years between 1 June 2018 and 1 June 2023. The prediction of radiological and clinical scores for mortality and ICU admission was examined.A total of 95 patients were analyzed. Patients who died and those who were admitted to the ICU had a significantly higher frequency of being found to have a high-risk (≥1) sPESI score (P = 0.04 and P = 0.016, respectively). For mortality, the sPESI score was found to be significant; the sensitivity and specificity were observed as 54% and 66% (area under the curve [AUC]=0.670, 95% confidence interval [CI]=0.527–0.814; P = 0.020). For ICU admission, the sensitivity and specificity of the Qscore, sPESI, and Bova scores were 35%, 77%, and 58%, and 78%, 65%, and 84% respectively (AUC=0.626, 95% CI=0.511–0.740, P = 0.031; AUC=0.769, 95% CI=0.674–0.865, P < 0.001; and AUC=0.767, 95% CI=0.671–0.862, P < 0.001, respectively).It was found that the sPESI score was effective at predicting mortality in patients with acute PE. Qscore, sPESI, and Bova scores have been shown to be useful in predicting ICU admission. [ABSTRACT FROM AUTHOR]

Objective  The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C. Methods  This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores. Results  Vit D levels were significantly lower in patients with versus without MIS-C [9 (2–18) vs. 19 (10–43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2–17) vs. 9 (5–18) ng/mL, p  = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9–82) vs. 1.7 (0.2–42) ng/mL, p  = 0.030] and troponin [211 (4.8–4,545) vs. 14.2 (2.4–3,065) ng/L, p  = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p  = 0.004). Conclusion  Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis. [ABSTRACT FROM AUTHOR]

To test the prognostic performance of different scores, both specifically designed for patients with COVID-19 and generic, in predicting in-hospital mortality and the need for mechanical ventilation (MV). We retrospectively collected clinical data of patients admitted to the Emergency Department of the University Hospital AOU Careggi, Florence, Italy, between February 2020 and January 2021, with a confirmed infection by SARS-CoV2. We calculated the following scores: Sequential Organ Failure Assessment (SOFA) score, CALL score, 4C Mortality score, QUICK score, CURB-65 and MuLBSTA score. The end-points were in-hospital mortality and the need for MV. We included 1208 patients, mean age 60 ± 17 years, 57% male sex. Compared to survivors, non-survivors showed significantly higher values of all the prognostic scores (4C: 13 [10–15] vs 8 [4–10]; CALL: 11 [10–12] vs 9 [7–11]; QUICK: 4 [1–6] vs 0 [0–3]; SOFA: 5 [4–6] vs 4 [4–5]; CURB: 2 [1–3] vs 1 [0–1]; MuLBSTA: 11 [9–13] vs 9 [7–11], all p < 0.001). Discriminative ability evaluated by the Receiver Operating Curve analysis showed the following values of the Area under the Curve: 0.83 for 4C, 0.74 for CALL, 0.70 for QUICK, 0.68 for SOFA, 0.76 for CURB and 0.64 for MuLBSTA. The mortality rate significantly increased in increasing quartiles of 4C and CALL score (respectively, 2, 8, 24 and 54% for the 4C score and 1, 17, 33 and 68% for the CALL score, both p < 0.001). 4C and CALL score allowed an early and good prognostic stratification of patients admitted for pneumonia induced by SARS-CoV2. [ABSTRACT FROM AUTHOR]

We report on long-term outcomes of 267 patients (pts) with chronic myeloid leukemia (CML) treated with imatinib administered as initial therapy. The median follow-up time was 11.4 years. 38 (14.2%) pts attempted to discontinue imatinib therapy after achieving sustained deep molecular response (≥MR4), 15 of them achieved treatment-free remission (TFR). 144 pts (53.9%) have been switched to other TKI during the follow-up period. The estimated OS for 267 pts for 10, 15 and 18 years was 98.8%, 75.6% and 52.1%. According to prognostic scores (Sokal, Euro, ELTS), OS and PFS were significantly better in low-risk pts than in high-risk pts. According to ELTS, low-risk pts have a better chance of achieving MR4 than both intermediate (p = 0.03) and high-risk (p = 0.04) groups. It suggests that a specific ELTS-adapted treatment could help to optimize treatment results. In the study population, imatinib has demonstrated sustained efficacy and an acceptable rate of late toxic effects. [ABSTRACT FROM AUTHOR]

Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe., Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018-March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC)., Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24-43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63-0.71), 0.68 (0.64-0.72), and 0.82 (0.79-0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p < 0.001) and qSOFA (p < 0.001)., Interpretation: We showed that the UVA score performed best in predicting mortality among febrile participants by the time follow-up compared with MEWS and qSOFA, across all four study sites. The UVA score could be a valuable tool for early identification, triage, and initial treatment guidance of high-risk patients in resource-limited clinical settings., Funding: FCDO., Competing Interests: HH reports royalties from Wolters Kluwer Health as the primary author and maintainer of the “Laboratory tools for diagnosis of malaria” clinical decision support tool., (© 2024 The Author(s).)

A number of scoring systems were developed to prospectively predict the severity of acute pancreatitis so that early aggressive therapy can be initiated. The present study aimed to establish the role of red cell distribution width (RDW) and neutrophil lymphocyte ratio (NLR) as severity predictors of acute pancreatitis by comparing these parameters with the well-established Acute Physiological and Chronic Health Evaluation II (APACHE II) score. A prospective observational single-center cohort study was conducted on adult patients of acute pancreatitis. RDW, NLR, and APACHE II score were calculated at the time of admission. RDW and NLR were repeated at 24 h, 48 h, 72 h, and at 96 h. The primary outcome studied was the association of RDW and NLR with severity of acute pancreatitis. The sample size was 57 patients. The mean scores of RDW and NLR at admission, at 24 h, at 48 h, at 72 h, and at 96 h, were significantly greater than in moderately severe and severe acute pancreatitis, and the same was true for APACHE II score at admission. On comparing sensitivity, no significant difference was seen between RDW, NLR, and APACHE II score. Specificity of APACHE II was significantly higher when compared to RDW and NLR. Our study showed that RDW and NLR can be used as independent prognostic markers for predicting the severity of acute pancreatitis. However, APACHE II score continues to be the gold standard in this regard. [ABSTRACT FROM AUTHOR]

Quick Pitt (qPitt), which includes temperature, systolic blood pressure, respiratory rate, cardiac arrest, and mental status, is a new prognostic score derived from the Pitt Bacteremia score. The aim of our study is to compare qPitt with quick SOFA (qSOFA) and SOFA for scoring of severity in patients with urinary tract infection (UTI). Prospective observational study of patients diagnosed with UTI. Area under the ROC curve, sensibility, and specificity to predict 30-day mortality were calculated for qPitt, qSOFA and SOFA and compared. 382 UTI cases were analyzed. Thirty-day mortality (18.8% vs. 5.9%, p < 0.001) and longer hospital stay (6 [1–11] vs. 4 [1–7] days, p < 0.001) were associated with qPitt ≥ 2. However, qPitt had a worse performance to predict 30-day mortality compared to qSOFA and SOFA (AUROC 0.692 vs. 0.832 and 0.806, respectively, p = 0.010 and p = 0.041). The sensitivity of qPitt was lower than the sensitivity of qSOFA and SOFA (70.45 vs. 84.09 for both qSOFA and SOFA, p < 0.001), with a specificity lower than qSOFA and similar to SOFA (60.36 vs. 82.25 and 63.61, p < 0.001 and p = 0.742, respectively). Quick Pitt had moderate prognostic accuracy and performed worse than qSOFA and SOFA scores for predicting mortality in patients with UTI. [ABSTRACT FROM AUTHOR]

• Comparison of 17 known prognostic scores for patients with brain metastases. • Evaluation in 470 patients treated with upfront radiosurgery for brain metastases. • Comprehensive performance analysis of all prognostic scores. • Performance status alone shows impressive efficacy in overall survival prediction. Numerous prognostic scores (PS) for patients with brain metastases (BM) have been developed. Recently, PS based on laboratory parameters were introduced to better predict overall survival (OS). A comprehensive comparison of the wide range of scores in a modern patient collective is still missing. Twelve PS considering clinical parameters only at the time of BM diagnosis were calculated for 470 patients receiving upfront SRS between January 2014 and March 2020. In a subcohort of 310 patients where a full laboratory dataset was available five additional prognostic scores were compared. Restricted mean survival time (RMST), partial likelihood and c-index were calculated as metrics for performance evaluation. Univariable and multivariable analysis were used to identify prognostic factors for OS. The median OS of the whole cohort was 15.8 months (95% C.I.: 13.4–20.1). All prognostic scores performed well in separating patients into different prognostic groups. RPA achieved the highest c-index, whereas GGS achieved highest partial likelihood with evaluation in the total cohort. With incorporation of the laboratory scores the recently suggested EC-GPA achieved highest c-index and highest partial likelihood. A prognostic score solely based on the assessment of performance status achieved considerable high performance as either 3- or 4-tiered score. Multivariable analysis revealed performance status, systemic disease status and laboratory parameters to be significantly associated with OS among variates included in prognostic scores. Although recent PS incorporating laboratory parameters show convincing performance in predicting overall survival, older scores relying on clinical parameters only are still valid and appealing as they are easier to calculate, and as overall performance is almost equal. Moreover, a score just based on performance status is not significantly inferior and should at least be assessed for informed decision making. [ABSTRACT FROM AUTHOR]

The performance of health care facilities (e.g. hospitals, transplant centers, etc.) is often evaluated through time-to-event outcomes. In this paper, we consider the case where, for each subject, the failure event is due to one of several mutually exclusive causes (competing risks). Since the distribution of patient characteristics may differ greatly by the center, some form of covariate adjustment is generally necessary in order for center-specific outcomes to be accurately compared (to each other or to an overall average). We propose a weighting method for comparing facility-specific cumulative incidence functions to an overall average. The method directly standardizes each facility's non-parametric cumulative incidence function through a weight function constructed from a multivariate prognostic score. We formally define the center effects and derive large-sample properties of the proposed estimator. We evaluate the finite sample performance of the estimator through simulation. The proposed method is applied to the end-stage renal disease setting to evaluate the center-specific pre-transplant mortality and transplant cumulative incidence functions from the Scientific Registry of Transplant Recipients. [ABSTRACT FROM AUTHOR]

Numerous burn mortality indicators and prognostic scores are necessary to classify with priorities severely burned patients in order to predict outcome. The purpose of this paper is to evaluate mortality predictors on admission, in order to determine Lethal Area 50 and to validate burn prognostic scores. The study is retrospective, clinical and analytical. The data utilized were accessed by investigating the medical charts of 5033 patients hospitalized with severe burns within the Intensive Care Unit of the Service of Burns in Tirana, Albania over the period 1992-2019. Descriptive and inferential statistics were performed using PSS 23 software. Statistical significance is defined as p<0.05. The incidence rate of hospitalization of patients with severe burns initially increased from 4.1 to 7.9 persons per 100,000 population/year in the period 1992 to 1999, followed by a decrease from 7.9 to 4.8 in 2019. Mortality was 12.2% and the average burn crude death rate was 0.7 patients per 100,000 population/year. Lethal Area 50 for the second decade (2010-2019) was 82.2%. All tested burn prognostic scores had good predictive values. In addition to the commonly used outcome predictors such as age, burn size and inhalation burn, we concluded that additional determinants like depth of burn and etiology of burns determined an unfavorable outcome. Fatality risk was 4 times higher in patients with full-thickness burns, 2.6 times higher in patients with flame burns, and 4 times higher in patients with inhalation injury. [ABSTRACT FROM AUTHOR]

Introduction: Managing burn patients is a challenge requiring a multidisciplinary team with the ability to predict complications and act early to avoid them. There are few studies characterizing the population of critically ill burn patients in need of ventilatory support. This study aimed to describe the population of burn patients in need of invasive mechanical ventilation support and assess in-hospital mortality and the factors associated with it., Material and Methods: A longitudinal retrospective study was conducted, including burn patients admitted to a tertiary hospital burn unit over five consecutive years, who required invasive mechanical ventilation support during their hospitalization. Demographic data, comorbidities, characteristics of the injury scene, etiology, and characteristics of the burn were collected. Length of mechanical ventilation and hospitalization as well as mortality rate were evaluated. The determination of mortality predictors and the prognostic performance of mortality prediction scores were analyzed. A one-year follow-up was performed to evaluate the survival of discharged patients., Results: A total of 141 patients were included in this study; 68.1% patients were male with a median age of 58 years. The mean percentage of total body surface area (TBSA) burned was 24.5%. Home incidents were the most frequent, and fire was the most common cause of burns (80.9% of patients). The mean Abbreviated Burn Severity Index Score (ABSI) was 7.83, with an area under the curve in receiver operating characteristic curve (ROC) analysis (AUC&#95;ROC) of 0.725; the mean Belgium Outcome of Burn Injury (BOBI) score was 3.45, with AUC&#95;ROC of 0.740 and mean R-Baux of 89.1 and AUC&#95;ROC of 0.834. The mean duration of invasive mechanical ventilation was 16.9±19.3 days. Age (p<0.001), length of mechanical ventilation (p<0.001), length of hospitalization (p<0.001), higher degree of burn (p=0.001), TBSA (p=0.040), and the presence of buttock burn (0.006) were associated with mortality in this sample. In-hospital mortality was 29.8%. The survival group had a 12% death rate at one-year follow-up, mostly in the first three months after discharge., Conclusion: Age, duration of mechanical ventilation, length of hospitalization, higher degree of burn, TBSA, and the presence of buttock burn were associated with mortality in this sample. R-Baux score was the most accurate test score to predict mortality in this challenging group of patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Costa et al.)

Background Galectin-3 (gal-3) has been proposed as a marker of established renal impairment, with predictive value in stable decompensated cirrhosis. Methods 150 stable decompensated patients were assessed in 2 transplant centers. Patients' renal function was assessed using 51Chromium-EDTA ("true" glomerular filtration rate). We measured basic laboratory variables and gal-3 in serum samples. Factors associated with patients' outcomes were determined. Results Our patients were followed up for 12 months (range 1-48, interquartile range [IQR] 6, 95% confidence interval [CI] 10-13.5) and their mean prognostic scores were Child-Turcotte-Pugh (CTP) 7±2 and model for end-stage liver disease and sodium (MELD-Na) 15±6. Median gal-3 levels were 22 ng/mL. In a multivariate analysis of 94 patients (training group), gal-3 (hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.011-1.041; P=0.003) and serum sodium (HR 1.032, 95%CI 1.006-1.062; P=0.05) were the only factors independently associated with patients' outcomes. Kaplan-Meier analysis using the median gal-3 values revealed different times of survival (log-rank P=0.006). We derived a new prognostic score, (0.026) × serum gal-3+ (-0.079) × serum sodium, with very good discriminative accuracy for the outcome (area under the curve [AUC] 0.71, 95%CI 0.63-0.88), similar to that of the MELD-Na score (AUC 0.69, 95%CI 0.67-0.89; P=0.73), while its diagnostic accuracy was validated in the remaining 56 decompensated patients (AUC 0.81, 95%CI 0.65-0.97). Conclusions Gal-3 proved to be an accurate and plausible biomarker of renal dysfunction in patients with decompensated cirrhosis. A new prognostic model incorporating gal-3 and sodium was derived, with very good discriminative accuracy for the outcome. [ABSTRACT FROM AUTHOR]

To investigate predictive value of preradiosurgery leukocyte-based prognostic ratios in a selected cohort of non–small cell lung cancer (NSCLC) patients with radiosurgery-treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT). We performed a retrospective analysis of 166 patients with NSCLC BM treated with Gamma Knife radiosurgery. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were assessed within 14 days before radiosurgery. In radiosurgically treated patients with NSCLC BM with concomitant IT or TT, estimated median survival after first Gamma Knife radiosurgery treatment was significantly longer in patients with NLR cutoff value <5 (P = 0.038). Consequently, the Cox regression model for NLR cutoff value groups revealed a significant hazard ratio of 1.519 (95% confidence interval 1.020–2.265, P = 0.040). In addition, each increase in NLR of 1 equaled an increase of 5.4% in risk of death (hazard ratio 1.054, 95% confidence interval 1.024–1.085, P < 0.001). After adjusting for sex, age, Karnofsky performance scale, and presence of extracranial metastases, NLR remained a significant and independent predictor for survival (hazard ratio 1.047, 95% confidence interval 1.017–1.078, P = 0.002). In contrast, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio did not exhibit the same predictive value among patients with radiosurgery-treated BM with concomitant IT or TT. In patients with NSCLC BM treated with radiosurgery with concomitant IT or TT, preradiosurgery NLR represents a simple prognostic predictor for survival and is superior to other leukocyte-based ratios. NLR may be relevant for clinical decision making, therapeutic evaluation, patient counseling, and appropriate stratification of future clinical trials among patients with radiosurgery-treated BM. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical value of the inflammation based prognostic scores for patients with radiosurgically treated brain metastases (BM) originating from non-pulmonary primary tumor (PT). Methods: A retrospective analysis of 340 BM patients of different PT origin (melanoma, breast, gastrointestinal, or genitourinary cancer) was performed. Pre-radiosurgical laboratory prognostic scores, such as the Neutrophil-to-Lymphocyte Ratio (NLR), the Platelet-to-Lymphocyte Ratio (PLR), Lymphocyte-to-Monocyte Ratio (LMR), and the modified Glasgow Prognostic Score (mGPS), were investigated within 14 days before the first Gamma Knife radiosurgical treatment (GKRS1). Results: In our study cohort, the estimated survival was significantly longer in patients with NLR < 5 (p < 0.001), LMR > 4 (p = 0.001) and in patients with a mGPS score of 0 (p < 0.001). Furthermore, univariate and multivariate Cox regression models revealed NLR ≥ 5, LMR < 4 and mGPS score ≥ 1 as independent prognostic factors for an increased risk of death even after adjusting for age, sex, KPS, extracranial metastases status, presence of neurological symptoms and treatment with immunotherapy (IT) or targeted therapy (TT). Conclusions: Summarizing previously published and present data, pre-radiosurgical mGPS and NLR groups seem to be the most effective and simple independent prognostic factors to predict clinical outcome in radiosurgically treated BM patients. [ABSTRACT FROM AUTHOR]

Introduction and aim. Acute-on-chronic liver failure (ACLF) is defined by the development of acute deterioration of liver function associated with failure of other organs and high short-term mortality in patients with chronic liver disease (CLD). There is no consensus on the diagnostic criteria, and its independence from ordinary decompensation of CLD has frequently been questioned. This study aimed to identify and characterize this condition and to test the CLIF-C OF score comparing it to the 2016-MELD (with sodium) and the Child-Pugh.Material and methods. 18-month prospective observational study with systematic inclusion of admitted patients with CLD decompensation.Results. 39 patients had ACLF (33.1%). These patients experienced higher 28-day and 90-day mortality, when compared to patients without ACLF (43.6% and 64.1% vs. 2.5% and 7.6% respectively, p < 0.0001). ACLF was linked with a higher acute infection rate (74.4%). For all patients (N = 118), the scores 2016-MELD, CLIF-C OF and Child-Pugh showed an area under the curve (AUC) for 28-day mortality of 0.908, 0.844, 0.753 and for 90-day of 0.902, 0.814, 0.724 respectively, p < 0.0001 for all scores. The 90-day mortality 2016-MELD AUC was greater than the CLIF-C OF AUC, p = 0.021. Within ACLF patients, the 2016-MELD, CLIF-C ACLF and Child-Pugh scores showed an AUC of 0.774, 0.734, 0.584 (28-day) and 0.880, 0.771, 0.603 (90-day); for 2016-MELD p = 0.004 (28-day) and p < 0.0001 (90-day).Conclusion. ACLF is a frequent and relevant condition, associated with high mortality. The CLIF-C OF score revealed good accuracy and diagnoses ACLF when it is present. However, the 2016-MELD performed better for 90-day mortality prediction.

Abstract Background The early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision. Results Index tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%. Conclusions In this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.

Introduction: Prognostic scores are important tools in oncology to facilitate clinical decision-making based on patient characteristics. To date, classic survival analysis using Cox proportional hazards regression has been employed in the development of these prognostic scores. With the advance of analytical models, this study aimed to determine if more complex machine-learning algorithms could outperform classical survival analysis methods.Methods: In this benchmarking study, two datasets were used to develop and compare different prognostic models for overall survival in pan-cancer populations: a nationwide EHR-derived de-identified database for training and in-sample testing and the OAK (phase III clinical trial) dataset for out-of-sample testing. A real-world database comprised 136K first-line treated cancer patients across multiple cancer types and was split into a 90% training and 10% testing dataset, respectively. The OAK dataset comprised 1,187 patients diagnosed with non-small cell lung cancer. To assess the effect of the covariate number on prognostic performance, we formed three feature sets with 27, 44 and 88 covariates. In terms of methods, we benchmarked ROPRO, a prognostic score based on the Cox model, against eight complex machine-learning models: regularized Cox, Random Survival Forests (RSF), Gradient Boosting (GB), DeepSurv (DS), Autoencoder (AE) and Super Learner (SL). The C-index was used as the performance metric to compare different models.Results: For in-sample testing on the real-world database the resulting C-index [95% CI] values for RSF 0.720 [0.716, 0.725], GB 0.722 [0.718, 0.727], DS 0.721 [0.717, 0.726] and lastly, SL 0.723 [0.718, 0.728] showed significantly better performance as compared to ROPRO 0.701 [0.696, 0.706]. Similar results were derived across all feature sets. However, for the out-of-sample validation on OAK, the stronger performance of the more complex models was not apparent anymore. Consistently, the increase in the number of prognostic covariates did not lead to an increase in model performance.Discussion: The stronger performance of the more complex models did not generalize when applied to an out-of-sample dataset. We hypothesize that future research may benefit by adding multimodal data to exploit advantages of more complex models.

We compared the performance of six prognostic scores (Royal Marsden Hospital, MDACC: MD Anderson Clinical Center and MDACC + NLR: neutrophil-to-lymphocyte ratio, MD Anderson - immune checkpoint inhibitors (MDA-ICI), GRIm: Gustave Roussy Immune Score and LIPI: Lung Immune Prognostic Index) in predicting overall survival (OS) in phase I trial patients treated with immune checkpoint inhibitors (ICI). Medical records of patients with advanced solid tumors enrolled in ICI phase I trials between 2015 and 2018 at Institut Universitaire du Cancer de Toulouse-Oncopole were reviewed. The performance of prognostic scores on OS was compared using different criteria. A total of 259 patients were included. Median age was 63 years (range: 18-83). Main primary cancers were melanoma (19%), head and neck (16%), lung (13%) and bladder (10%). With a median follow-up of 15 months (95% confidence interval [CI] = [11.6;17.5]), median OS was 12.5 months (95% CI = [10.3;16.0]). All scores were associated with OS. The MDACC, LIPI and GRIm scores performed better than the others. Concordance of risk group assignment between the scoring systems was poor. According to our results, the MDACC, GRIm and LIPI scores better suited to ICI phase I settings. Adequate scoring would allow better patient selection in early ICI trials, especially during the critical period of dose escalation, and in proof-of-concept expansion cohorts [ABSTRACT FROM AUTHOR]