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Mortality Prediction (mortality + prediction)

Distribution by Scientific Domains

Medical Sciences	83%

Selected Abstracts

The importance of independent risk-factors for long-term mortality prediction after cardiac surgery

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 9 2006
I. K. Toumpoulis
Abstract Background, The purpose of the present study was to determine independent predictors for long-term mortality after cardiac surgery. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) was developed to score in-hospital mortality and recent studies have shown its ability to predict long-term mortality as well. We compared forecasts based on EuroSCORE with other models based on independent predictors. Methods, Medical records of patients with cardiac surgery who were discharged alive (n = 4852) were retrospectively reviewed. Their operative surgical risks were calculated according to EuroSCORE. Patients were randomly divided into two groups: training dataset (n = 3233) and validation dataset (n = 1619). Long-term survival data (mean follow-up 5·1 years) were obtained from the National Death Index. We compared four models: standard EuroSCORE (M1); logistic EuroSCORE (M2); M2 and other preoperative, intra-operative and post-operative selected variables (M3); and selected variables only (M4). M3 and M4 were determined with multivariable Cox regression analysis using the training dataset. Results, The estimated five-year survival rates of the quartiles in compared models in the validation dataset were: 94·5%, 87·8%, 77·1%, 64·9% for M1; 95·1%, 88·0%, 80·5%, 64·4% for M2; 93·4%, 89·4%, 80·8%, 64·1% for M3; and 95·8%, 90·9%, 81·0%, 59·9% for M4. In the four models, the odds of death in the highest-risk quartile was 8·4-, 8·5-, 9·4- and 15·6-fold higher, respectively, than the odds of death in the lowest-risk quartile (P < 0·0001 for all). Conclusions, EuroSCORE is a good predictor of long-term mortality after cardiac surgery. We developed and validated a model using selected preoperative, intra-operative and post-operative variables that has better discriminatory ability. [source]

Prospective cohort study comparing sequential organ failure assessment and acute physiology, age, chronic health evaluation III scoring systems for hospital mortality prediction in critically ill cirrhotic patients

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2006
Y-C Chen
Summary The aim of the study was to evaluate the usefulness of sequential organ failure assessment (SOFA) and acute physiology, age, chronic health evaluation III (APACHE III) scoring systems obtained on the first day of intensive care unit (ICU) admission in predicting hospital mortality in critically ill cirrhotic patients. The study enrolled 102 cirrhotic patients consecutively admitted to ICU during a 1-year period. Twenty-five demographic, clinical and laboratory variables were analysed as predicators of survival. Information considered necessary to calculate the Child,Pugh, SOFA and APACHE III scores on the first day of ICU admission was also gathered. Overall hospital mortality was 68.6%. Multiple logistic regression analysis revealed that mean arterial pressure, SOFA and APACHE III scores were significantly related to prognosis. Goodness-of-fit was good for the SOFA and APACHE III models. Both predictive models displayed a similar degree of the best Youden index (0.68) and overall correctness (84%) of prediction. The SOFA and APACHE III models displayed good areas under the receiver,operating characteristic curve (0.917 ± 0.028 and 0.912 ± 0.029, respectively). Finally, a strong and significant positive correlation exists between SOFA and APACHE III scores for individual patients (r2 = 0.628, p < 0.001). This investigation confirms the grave prognosis for cirrhotic patients admitted to ICU. Both SOFA and APACHE III scores are excellent tools to predict the hospital mortality in critically ill cirrhotic patients. The overall predictive accuracy of SOFA and APACHE III is superior to that of Child,Pugh system. The role of these scoring systems in describing the dynamic aspects of clinical courses and allocating ICU resources needs to be clarified. [source]

Simple coagulation tests improve early mortality prediction for patients in intensive care units who have proven or suspected septic shock

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 5 2007
G. LISSALDE-LAVIGNE
[source]

Comparison of Different Methods of ST Segment Resolution Analysis for Prediction of 1-Year Mortality after Primary Angioplasty for Acute Myocardial Infarction

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2007
Jakub Przyluski M.D.
Background: Resolution of ST segment elevation corresponds with myocardial tissue reperfusion and correlates with clinical outcome after ST elevation myocardial infarction. Simpler method evaluating the extent of maximal deviation persisting in a single ECG lead was an even stronger mortality predictor. Our aim was to evaluate and compare prognostic accuracy of different methods of ST segment elevation resolution analysis after primary percutaneous coronary intervention (PCI) in a real-life setting. Methods: Paired 12-lead ECGs were analyzed in 324 consecutive and unselected patients treated routinely with primary PCI in a single high-volume center. ST segment resolution was quantified and categorized into complete, partial, or none, upon the (1) sum of multilead ST elevations (sumSTE) and (2) sum of ST elevations plus reciprocal depressions (sumSTE+D); or into the low-, medium-, and high-risk groups by (3) the single-lead extent of maximal postprocedural ST deviation (maxSTE). Results: Complete, partial, and nonresolution groups by sumSTE constituted 39%, 40%, and 21% of patients, respective groups by sumSTE+D comprised 40%, 39%, and 21%. The low-, medium-, and high-risk groups constituted 43%, 32%, and 25%. One-year mortality rates for rising risk groups by sumSTE were 4.7%, 10.2%, and 14.5% (P = 0.049), for sumSTE+D 3.8%, 9.6%, and 17.6% (P = 0.004) and for maxSTE 5.1%, 6.7%, and 18.5% (P = 0.001), respectively. After adjustment for multiple covariates only maxSTE (high vs low-risk, odds ratio [OR] 3.10; 95% confidence interval [CI] 1.11,8.63; P = 0.030) and age (OR 1.07; 95% CI 1.02,1.11; P = 0.002) remained independent predictors of mortality. Conclusions: In unselected population risk stratifications based on the postprocedural ST resolution analysis correlate with 1-year mortality after primary PCI. However, only the single-lead ST deviation analysis allows an independent mortality prediction. [source]

Reproduction and lifespan: Trade-offs, overall energy budgets, intergenerational costs, and costs neglected by research,

AMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2009
Grazyna Jasienska
In human females allocation of resources to support reproduction may cause their insufficient supply to other metabolic functions, resulting in compromised physiology, increased risks of diseases and, consequently, reduced lifespan. While many studies on both historical and contemporary populations show that women with high fertility indeed have shorter lifespans. This relationship is far from universal: a lack of correlation between fertility and lifespan, or even an increased lifespan of women with high fertility have also been documented. Reduced lifespan in women with high fertility may be undetectable due to methodological weaknesses of research or it may be truly absent, and its absence may be explained from biological principles. I will discuss the following reasons for a lack of the negative relationship, described in some demographic studies, between the number of children and lifespan in women: (1) Number of children is only a proxy of the total costs of reproduction and the cost of breastfeeding is often higher than the pregnancy cost but is often not taken into account. (2) Costs of reproduction can be interpreted in a meaningful way only when they are analyzed in relation to the overall energy budget of the woman. (3) Trade-offs between risks of different diseases due to reproduction yield different mortality predictions depending on the socio-economic status of the studied populations. (4) Costs of reproduction are related not only to having children but also to having grandchildren. Such intergenerational costs should be included in analysis of trade-offs between costs of reproduction and longevity. Am. J. Hum. Biol., 2009. © 2009 Wiley-Liss, Inc. [source]

Prognostication after cardiac arrest and hypothermia: A prospective study

ANNALS OF NEUROLOGY, Issue 3 2010
Andrea O. Rossetti MD
Objective Current American Academy of Neurology (AAN) guidelines for outcome prediction in comatose survivors of cardiac arrest (CA) have been validated before the therapeutic hypothermia era (TH). We undertook this study to verify the prognostic value of clinical and electrophysiological variables in the TH setting. Methods A total of 111 consecutive comatose survivors of CA treated with TH were prospectively studied over a 3-year period. Neurological examination, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) were performed immediately after TH, at normothermia and off sedation. Neurological recovery was assessed at 3 to 6 months, using Cerebral Performance Categories (CPC). Results Three clinical variables, assessed within 72 hours after CA, showed higher false-positive mortality predictions as compared with the AAN guidelines: incomplete brainstem reflexes recovery (4% vs 0%), myoclonus (7% vs 0%), and absent motor response to pain (24% vs 0%). Furthermore, unreactive EEG background was incompatible with good long-term neurological recovery (CPC 1,2) and strongly associated with in-hospital mortality (adjusted odds ratio for death, 15.4; 95% confidence interval, 3.3,71.9). The presence of at least 2 independent predictors out of 4 (incomplete brainstem reflexes, myoclonus, unreactive EEG, and absent cortical SSEP) accurately predicted poor long-term neurological recovery (positive predictive value = 1.00); EEG reactivity significantly improved the prognostication. Interpretation Our data show that TH may modify outcome prediction after CA, implying that some clinical features should be interpreted with more caution in this setting as compared with the AAN guidelines. EEG background reactivity is useful in determining the prognosis after CA treated with TH. ANN NEUROL 2010;67:301,307 [source]