جستجوی مقالات مرتبط با کلیدواژه "prognostic value" در نشریات گروه "پزشکی"

The COVID-19 pandemic has rapidly spread and remained poorly understood by clinicians. The present work aimed to study the association between laboratory biomarkers, prognosis, and disease severity.

This is a single-center cohort study. We included young patients admitted at Razi Hospital, Ghaemshar City, Iran, from April 2020 to June 2020, whose diseases were confirmed with reverse transcription real time-PCR (rRT-PCR) test. Laboratory biomarkers were analyzed on the same day of inpatient service and after five days of hospitalization. The patients’ results and the outcomes were compared with those of the control group.

In the present study, 70 patients were investigated; 53 were discharged, and 17 died. A significant correlation was observed between patients and healthy subjects in some laboratory biomarkers: C-reactive protein (CRP), lactate dehydrogenase (LDH), total protein level, albumin level, and absolute lymphocyte count. Furthermore, CRP, LDH, total protein, albumin, absolute lymphocyte count, 25-OH vitamin D, interleukin (IL)-6, ferritin, and D-dimer levels in patients with different outcomes had significant correlations. High CRP, LDH, IL-6, ferritin, and D-dimer were predictive of mortality (area under the curve >0.70), as were low absolute lymphocyte count and 25-OH vitamin D. After adjusting age, CRP, albumin, WBC, D-dimer, LDH, and 25 OH-vitamin D, the final model of multiple binary logistic regressions with IL-6 and ferritin had high accuracy for the prediction of fatal outcome.

This finding would facilitate the early stratification of hospitalized patients with COVID-19 and help make clinical decisions.

The aim of this study was to assess the prognostic value of pretreatment Positron emission tomography / computed tomography using 18F-fluorodeoxyglucose (FDG-PET/CT) in cervical cancer according to two major histologic types.

Eighty-three squamous cell carcinoma (SCC) patients and 35 adenocarcinoma (AC) patients who underwent pretreatment FDG-PET/CT were retrospectively analyzed. Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were calculated. Kaplan-Meier analyses were used to compare correlations between each PET parameter and overall survival (OS). The prognostic values of imaging and clinical parameters were assessed using uni- and multivariable Cox proportional hazard models.

SUVmax, SUVmean, and TLG were significantly higher in SCC than in AC (p<0.01 each). No significant difference in MTV was seen between the two groups (p=0.10). As for Kaplan-Meier analyses, in SCC, patients with SUVmax, SUVmean, MTV, and TLG exceeding cutoff values tended to show worse OS than patients with lower values (p=0.07, p=0.27, p<0.01, and p=0.01, respectively, for OS). On the other hand, in AC, patients with MTV and TLG exceeding cutoff values showed significantly worse PFS and OS (p<0.01 each for OS), while SUVmax and SUVmean were unrelated to OS (p=0.91 and p=0.83, respectively for OS). As for multivariable analyses, in SCC, TLG was identified as an independent prognostic factor for OS (p=0.01). In AC, MTV was identified as an independent prognostic factor for OS (p=0.02).

Our preliminary data suggest that FDG-PET/CT would be useful for predicting prognosis in cervical cancer, although the clinical significance of quantitative values may differ according to histopathological type.

Despite steps in lifestyle changes and preventive measures, the incidence of heart disease is still rising. Coronary artery disease (CAD) is the world’s leading cause of death; thus, the early detection of this disease can significantly reduce its mortality rate. We evaluated the diagnostic value and prognostic role of positive exercise stress echocardiography in CAD.

The present retrospective study was performed on 350 patients with symptoms of IHD referred for exercise stress echocardiography between 2004 and 2017. The obtained data were analyzed using the SPSS software.

Ischemic electrocardiographic (ECG) changes, the regional wall motion abnormality (RWMA) score index, the metabolic equivalent, and the peak left ventricular ejection fraction were associated with CAD (P=0.004, P=0.000, P=0.02, and P=0.000, respectively). The incidence of ventricular arrhythmias was associated with sudden cardiac death and myocardial infarction (P=0.00). Ischemic ECG changes were significantly associated with myocardial infarction and the need for percutaneous coronary interventions in the future (P=0.04 and P=0.03). The relationship between left ventricular dilation and sudden cardiac death was significant (P=0.01), and RWMAs were significantly associated with myocardial infarction (P=0.03). However, dyspnea and chest pain had no association with cardiac events.

Positive exercise stress echocardiography was associated with sudden cardiac death, myocardial infarction, and the need for future coronary revascularization, and its diagnostic and predictive role was observed in ischemic heart disease and predicting future cardiac events. 

Diagnosis and early treatment of the cardiac causes of chest pain are of particular importance. This study aimed to investigate the association between NT-pro-BNP levels as a cardiac marker and the prognosis of patients with chest pain.

All patients visiting the emergency department of a tertiary cardiovascular center with chest pain between October 2016 and March 2017 were evaluated for eligibility. Demographic data, proBNP levels, final diagnosis on angiography, echocardiography, and other symptoms were recorded.

A total of 222 patients at a mean age of 59.0±14.8 years were studied. Totally, 127 patients (57.2%) were male. A significant inverse relationship was found between proBNP levels and the left ventricular ejection fraction (r= -0.316; P<0.001). NT-proBNP levels showed a significant elevation in patients with abnormal size and function of the right ventricle, with regional wall motion abnormalities, and with valvular heart diseases (P<0.05). The BNP level in patients with abnormal angiographic results was 1148.5 (405.3–3214.0), significantly higher than that in patients with normal results (545.0: 90.3–2807.8; P=0.009). The level of this marker in patients with obstructive coronary artery disease (1192.0: 438.8–3233.0) was significantly higher than that in patients with non-obstructive coronary artery disease (620.0: 108.0–2792.0; P=0.001). BNP>841 pg/mL had a sensitivity of 92.9% and a specificity of 47.9% in identifying cases at risk of complications.

NT-proBNP could be a good diagnostic and prognostic marker for patients with chest pain complaints. Measuring this marker upon arrival can help identify patients with cardiac diseases. It is recommended to evaluate patients with elevated levels of this marker for earlier diagnosis and treatment. 

 To the best of our knowledge, a new emerging viral infection induced by SARS-CoV-2 was named COVID-19 with high morbidity and mortality on a global scale. To date, COVID-19 is implied as a respiratory disease with varied manifestations from asymptomatic to long-standing complications. In this regard, discerning a potential prognostic value of critical outcomes in the early stages would be more appreciable to stratify the risk of disease severity and 28-day mortality. In this clinical study, we aimed to evaluate distinct laboratory biomarkers, including neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), and lactate dehydrogenase (LDH), as reliable indicators to predict disease severity in COVID-19 patients admitted in a medical referral center.

 Following the COVID-19 diagnosis, all consecutive patients (n=685) with confirmed SARS-CoV-2 infection were included since September 2020 for one year. Data were collected using electronic medical records.

 Based on obtained results, NLR and serum level of LDH showed a positive correlation with length of hospital stay. Moreover, the mortality rate and MV required in patients with either positive CRP or the high levels of LDH were remarkably greater than that of the non-severe group (P=0.01). Finally, we could not find significant differences between female and male patients regarding the evaluated parameters.

 Our findings highlighted those high values of NLR, CRP, and LDH can be considered valuable clinical prognostic aids for risk stratification, identification of disease severity, and triage of patients at the time of admission.

Ventricular repolarization measurement by QTc interval and QT dispersion can recognize high-risk patients. Previous research tended to evaluate the act of repolarization indicators alone but this study aimed to elucidate their prognostic utility before and after modifying confounding parameters in risk stratification of different aspects of prognosis in decompensated heart failure patients with systolic dysfunction.

Data of 98 variables were evaluated to determine their predictive value concerning arrhythmic events, in-hospital, and long-term mortality.

From 858 cases that presented with acute heart failure, 19.2% (n=165) were enrolled in the study. During hospitalization, arrhythmic events and cardiac-related mortality occurred in 56(33.9%) and 11(7%) patients, respectively. QTc and QT dispersion were independent predictors of arrhythmia and in-hospital mortality after adjustment of the variables (arrhythmic events: QTc interval OR 1.085, P=0.007, QT dispersion OR 1.077, P=0.007, in-hospital mortality: QTc interval OR 1.116, P=0.009, QT dispersion OR 1.067, P=0.011). After being discharged, they were tracked for 181 ± 56 days. Within the 16 deaths in follow-up time, 6 sudden cardiac deaths were documented. Cox regression, defined QTc as the predictor of all-cause and sudden death mortality (all-cause: HR 1.041, 95% CI 1.015-1.067, P=0.002; sudden death: HR 1.063, 95% CI 1.023-1.105, P=0.002); nevertheless, efforts to demonstrate QT dispersion as the predictor failed.

The predictive nature of QT parameters was significant after modification of the variables; therefore, they should be measured for risk stratification of ventricular repolarization arrhythmia and death in decompensated heart failure patients.

The endocrine therapy is effective for patients with advanced prostate cancer, but the disease eventually becomes refractory to treatment. The aim of this study was to investigate prognostic factors and to develop a risk stratification model for survival in patients with advanced prostate cancer undergoing endocrine therapy.

This study included 197 patients with stage IV prostate cancer who were treated with endocrine therapy as primary treatment at Tokyo Medical University, Tokyo, Japan, between January 1999 and November 2012. Prognostic values including baseline clinical laboratory values before endocrine therapy for stage IV prostate cancer were examined. Patients (n = 30) who were not followed or for whom data were unavailable or who were treated with radiotherapy were excluded from the study. Excluding these patients, we retrospectively analyzed 167 patients who were treated with endocrine therapy as the primary treatment. Disease-specific survival (DSS) was evaluated using the Kaplan-Meier method, and prognostic factors were identified using the Cox proportional hazard model analysis.

In univariate analyses, patients with a performance status (PS) ≥ 2, platelet count ≥ 3.0× 105 µ/L, prostate specific antigen (PSA) > 50 ng/mL, alkaline phosphatase (ALP) > 350 U/L, lactate dehydrogenase (LDH) > 240 IU/L, and Gleason score (GS) ≥ 8, hemoglobin (Hb) < 12 g/dL, extent of disease (EOD) ≥ 3 and poorly differentiated adenocarcinoma showed significantly lower DSS than their respective counterparts. Neutrophil-to-Lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and white blood cell (WBC) count were not significantly associated with DSS. In a multivariate Cox proportional hazard model, PS and platelet count were independent prognostic factors. Based on the hazard rate (HR) calculated by the following formula: HR = exp (0.82 × PS + 1.38 × platelet count) patients were stratified into 3 risk groups. The differences in DSS rates among the 3 groups were statistically significant.

These results suggest that PS and platelet count are independent prognostic factors and that a combination of these factors can be used to stratify metastatic prostate cancer patients treated with endocrine therapy according to their DSS risk.

The advent of multi-slice computed tomography (CT) technology has provided a new promising tool for non-invasive assessment of the coronary arteries. However, as the prognostic outcome of patients with normal or non-significant finding on computed tomography coronary angiography (CTCA) is not well-known, this study was aimed to determine the prognostic value of CTCA in patients with either normal or non-significant CTCA findings.|

This retrospective cohort study was performed on patients who were referred for CTCA to the hospital. 527 patients with known or suspected coronary artery disease (CAD), who had undergone CTCA within one year were enrolled. Among them, data of 465 patients who had normal (no stenosis, n=362) or non-significant CTCA findings (stenosis <50% of luminal narrowing, n=103) were analyzed and prevalence of cardiac risk factors and major adverse cardiac events (MACE) were compared between these groups. In addition, a correlation between these factors and the number of involved coronary arteries was also determined.

After a mean follow-up duration of 13.11±4.63 months, all cases were alive except for three patients who died by non-cardiac events. Prevalence of MACE was 0% and 3% in normal CTCA group and non-significant groups, respectively. There was no correlation found between the number of involved coronary arteries and the prevalence of MACE (P = 0.57).

A normal CTCA could be associated with extremely low risk of MACE over the first year after the initial imaging, whereas non-significant obstruction in coronary arteries may be associated with a slightly higher risk of MACE.

 Malaria is the parasitic disease caused by Plasmodium infection, and is transmitted to humans through the bite of female anopheles. At present, malaria remains the most important cause of disease and death among children and adults. Approximately 214 million people are infected with malaria worldwide.

 This study aimed to analyze the distribution level and compare procalcitonin and C-reactive protein (CRP) in malaria patients before and after treatment, with focus on discussing the prognostic value of procalcitonin recovery level for recrudescence within two weeks of antimalarial treatment.

 A retrospective analysis was adopted. We measured the procalcitonin and CRP inflammatory markers of 22 imported malaria patients, who were hospitalized in our hospital from January 2014 to February 2018. The trends of procalcitonin and CRP levels in three malaria patients before and after antimalarial treatment and during recrudescence were applied.

 The procalcitonin level was significantly elevated before antimalarial treatment in 95% (21/22) of the patients, but sharply declined within two weeks after treatment. The procalcitonin levels of 59% (13/22) and 23% (5/22) of the patients were < 0.5 ng/mL and 0.5 - 0.8 ng/mL, respectively. The difference in the procalcitonin level before and after treatment was statistically significant (Z = 4.074, P < 0.05), and the difference in the CRP level before treatment (99.63 ± 51.63 mg/L) and after treatment (20.08 ± 13.45 mg/L) was statistically significant (t = 8.167, P < 0.05). Three patients suffered from recrudescence. The procalcitonin levels of two patients were > 1.0 ng/mL and failed to recover to the normal level within two weeks after antimalarial treatment while the procalcitonin level of one patient was 0.89 ng/mL. The dynamic observation showed that the procalcitonin level progressively increased and the procalcitonin level was 0.89 ng/mL when Plasmodium was found in the blood smear.

 The procalcitonin and CRP serum levels were significantly elevated among malaria patients. The majority of the patients recovered to the normal level within two weeks after effective antimalarial treatment and no longer suffered from recrudescence. However, the procalcitonin recovery level within two weeks after antimalarial treatment remained > 0.8 ng/mL. Hence, heightened alertness should be given to recrudescence.
 

Glasgow coma scale (GCS) was originally designed to be used in standardizing the assessment of conscious level in head trauma patients. However, GCS is now widely used in emergency departments as an indicator of the CNS status in patients regardless of their primary etiology. Alongside with GCS, AVPU scale (an acronym from “alert, verbal, painful and unresponsive”) is a simpler system which can be used to measure and record a patient’s level of consciousness. Therefore, the study investigated the values of admission GCS and AVPU as outcome predictor in mixed poisoned patients. A retrospective study in toxicology unit was performed on patients presented with mixed poisoning. Outcomes were recorded as patient necessity of GI decontamination, length of neurology observation and the length of hospital stay in toxicology unit. There was longer duration of hospital stay in toxicology unit and requirement of neurology observation in patients presented with lower GCS score (whether using cut-off point at 13 or 8). Similar findings were observed in AVPU scale analysis. Majority of patients did not require GI decontamination in both GCS score and AVPU analysis. However, it did not show any statistical significance (P > 0.05) in both group analyses. Admission GCS score and AVPU scale both are not good indicators to predict severity in acute mixed poisoning patients. However, the use of AVPU scale may not be inferior to the use of GCS score in assessing acute poisoning patients.

Overexpression of human leukocyte antigen G (HLA-G) in several malignant tumors has been reported. The aim of our study was to investigate HLA-G expression in colorectal cancer tumors and determine HLA-G expression relation between clinico-pathological characteristics and survival time.
HLA-G expression was evaluated by immunohistochemistry (IHC) using anti-HLA-G antibody in 100 primary tumors of colorectal cancer with different stages.
Our results showed that 25% of the colorectal cancer tissues had positive HLA-G expression and 75% no stained with anti-HLA-G antibody. The HLA-G expression in advanced stages (III and IV) was more prevalent than those in earlier clinical stages (I and II) (P = 0.0001). Results showed that HLA-G expression can serve as an independent factor for overall survival (OS). In this study, patients with HLA-G expression had significantly shorter survival time than those with negative expressions (P = 0.023).
HLA-G expression can serve as an independent factor for OS and its expression may be directly related to aggressive tumor behavior via escape from the host antitumor immune defense. Protein expression of HLA-G correlates with poor prognosis in colorectal cancer.