ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Objective To explore independent risk factors for 30-day mortality in critical patients with pulmonary infection and sepsis, and build a prediction model. Methods Patients diagnosed with pulmonary infection and sepsis in the MIMIC-Ⅲ database were analyzed. The CareVue database was the training cohort (n=934), and the Metavision database was the external validation cohort (n=687). A COX proportional hazards regression model was established to screen independent risk factors and draw a nomogram. We conducted internal cross-validation and external validation of the model. Using the receiver operator characteristic (ROC) curve, Calibration chart, and decision curve analysis, we detected the discrimination, calibration, and benefit of the model respectively, comparing with the SOFA scoring model. Results Age, SOFA score, white blood cell count≤4×109/L, neutrophilic granulocyte percentage (NEU%)>85%, platelet count (PLT)≤100×109/L, PLT>300×109/L, red cell distribution width >15%, blood urea nitrogen, and lactate dehydrogenase were independent risk factors. The areas under the ROC curve of the model were 0.747 (training cohort) and 0.708 (external validation cohort), respectively, which was superior to the SOFA scoring model in terms of discrimination, calibration, and benefit. Conclusion The model established in this study can accurately and effectively predict the risk of the disease mortality, and provide a visual assessment method for early identification of high-risk patients.
Objective To scoping review the risk prediction models for sarcopenia in China was conducted, and provide reference for scientific prevention and treatment of the disease and related research. Methods We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China Knowledge Network, China Biomedical Literature Database, Wanfang Database, and Weipu Database for literature related to myasthenia gravis prediction models in China, with a time frame from the construction of the database to April 30, 2024 for the search. The risk of bias and applicability of the included literature were assessed, and information on the construction of myasthenia gravis risk prediction models, model predictors, model presentation form and performance were extracted. Results A total of 25 literatures were included, the prevalence of sarcopenia ranged from 12.16% to 54.17%, and the study population mainly included the elderly, the model construction methods were categorized into two types: logistic regression model and machine learning, and age, body mass index, and nutritional status were the three predictors that appeared most frequently. Conclusion Clinical caregivers should pay attention to the high-risk factors for the occurrence of sarcopenia, construct models with accurate predictive performance and high clinical utility with the help of visual model presentation, and design prospective, multicenter internal and external validation methods to continuously improve and optimize the models to achieve the best predictive effect.
Risk stratifications are valuable aids for stratifying patients by disease severity, driving informed clinical decisions, because they allow the selection of the most appropriate strategy of treatment based on the patient's individual characteristics. The clinical algorithms help patients and their families to get a better understanding of issues relevant to treatment strategies and subsequent risks as part of the process to obtain informed consent. The current risk stratifications of coronary artery bypass grafting included the Society of Thoracic Surgeons Score, the European System for Cardiac Operative Risk Evaluation, SinoSystem for Coronary Operative Risk Evaluation. This review focuses on the progress of risk stratifications of coronary artery bypass grafting for patients undergoing cardiac surgery.
ObjectiveTo analyze the risk factors relevant retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection and provide a reference for its prevention and management. MethodsA retrospective analysis was conducted on patients with Stanford type B aortic dissection who underwent TEVAR at the First Affiliated Hospital of Chongqing Medical University from January 2017 to June 2023. The patients met the inclusion and exclusion criteria were included in the study. The multivariate logistic regression was used to analyze the risk factors for RTAD, with a test level of α=0.05. ResultsA total of 176 patients were included, among whom 7 developed RTAD, with an occurrence rate of 3.98%. The multivariate logistic regression analysis revealed that the larger τ angle between the centerline of the aorta [OR (95%CI)=1.195 (1.032, 1.384)] and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) [OR (95%CI)=0.756 (0.572, 0.999)], the higher probability of RTAD after TEVAR (P＜0.05). ConclusionsFrom the results of this study, it can be seen that for patients with Stanford B-type aortic dissection underwent TEVAR treatment, careful preoperative evaluation of morphological characteristics of the aortic arch (particularly the τ angle of the aorta centerline and the degree of curvature of the aortic arch (the curve distance from the proximal brachiocephalic trunk to the distal left subclavian artery) is crucial for reducing the occurrence of RTAD after TEVAR in patients with Stanford type B aortic dissection.
ObjectiveTo explore the value of geriatric nutritional risk index (GNRI) and sarcopenia on predicting postoperative complications in elderly patients with gastric cancer. MethodsAccording to the inclusion and exclusion criteria, the elderly (aged ≥60 years) patients with gastric cancer underwent radical gastrectomy in the Department of Gastrointestinal Surgery of Xuzhou Central Hospital from January 1, 2017 to December 31, 2021 were retrospectively gathered. The occurrence of postoperative complications (grade 2 or beyond by the Clavien-Dindo classification) was analyzed. The risk factors affecting postoperative complications were analyzed by univariate and multivariate logistic regression analyses to construct the prediction model, then was visualized by drawing a nomogram. The differentiation of the nomogram between the patients with postoperative complications and without postoperative complications was evaluated by the receiver operating characteristic (ROC) curve. The accuracy of the nomogram was evaluated by the calibration curve. Further, the clinical net benefit rate was analyzed by the decision curve analysis (DCA) to evaluate the clinical practicability. ResultsA total of 236 patients were gathered, 97 (41.1%) of whom had postoperative complications during hospitalization. The results of multivariate logistic regression analysis showed that the age, gender, GNRI, sarcopenia, surgical mode, and American Society of Aneshesiologists classification were the factors influencing the postoperative complications (P<0.05). The differentiation of nomogram based on the influencing factors was well, the area under the ROC curve was 0.732. The calibration curve showed that the model prediction curve was close to the ideal curve. The clinical net benefit rate by the DCA was higher when the probability of postoperative complications was 0.18 to 0.72. ConclusionsThe efficiency of nomogram based on GNRI and sarcopenia is well for predicting the occurrence of postoperative complications in elderly patients with gastric cancer. However, the nomogram needs to be further validated by prospective studies and external data.
Objective To investigate the clinical features, treatment methods, and prognostic influence factors of patients with malignant peripheral nerve sheath tumor (MPNST). MethodsA retrospective analysis was conducted on 96 MPNST patients treated between January 1, 2015 and December 31, 2021. There were 46 males and 50 females, aged between 15 and 87 years (mean, 48.2 years). The tumors were located in the trunk in 50 cases, extremities in 39 cases, and head and neck in 7 cases. The maximum tumor diameter was <5 cm in 49 cases, ≥5 cm in 32 cases, with 15 cases missing data. Tumor depth was deep in 77 cases and superficial in 19 cases. The Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) histological grading was G1 in 9 cases, G2 in 12 cases, and G3 in 34 cases, with 41 cases missing data. There were 37 recurrent MPNST cases, 32 cases with neurofibromatosis type 1 (NF1), and 26 cases in stage Ⅳ. Postoperative adjuvant radiotherapy was administered to 25 patients, perioperative chemotherapy to 45 patients, and anlotinib-targeted therapy to 30 patients. R0 resection was achieved in 73 cases. Patients were divided into groups based on the presence or absence of NF1, and baseline data between the two groups were compared. Kaplan-Meier curves were generated to assess disease-free survival (DFS) and overall survival (OS) based on various factors (age, gender, presence of NF1, recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, tumor location, tumor size, tumor depth, perioperative chemotherapy, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy), and differences between survival curves were analyzed using the Log-Rank test. Multivariate COX proportional hazards regression was used to identify independent prognostic factors for MPNST. Results Patients with NF1 had a significantly higher proportion of superficial tumors and lower FNCLCC grade compared to those without NF1 (P<0.05); no significant difference was found for other variables (P<0.05). Kaplan-Meier analysis showed that recurrent MPNST, stage Ⅳ MPNST, FNCLCC grade, R0 resection, perioperative chemotherapy, and anlotinib-targeted therapy were factors influencing 1-year DFS (P<0.05), while stage Ⅳ MPNST, FNCLCC grade, and perioperative chemotherapy were factors affecting 3-year OS (P<0.05). Multivariate COX proportional hazards regression analysis revealed that recurrent MPNST and high-grade FNCLCC (G3) were independent prognostic factors for 1-year DFS (P<0.05), while stage Ⅳ MPNST, superficial tumor depth, age over 60 years, postoperative adjuvant radiotherapy, and anlotinib-targeted therapy were independent prognostic factors for 3-year OS (P<0.05). Conclusion MPNST patients with NF1 tend to have more superficial tumors and lower FNCLCC grades. FNCLCC grade, R0 resection, and adjuvant therapies, including radiotherapy and anlotinib-targeted therapy, are closely associated with MPNST prognosis. Complete surgical resection should be prioritized in clinical management, along with adjuvant treatments such as radiotherapy and targeted therapy of anlotinib to improve patient outcomes.