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Sample records for biomarker risk score

  1. A biomarker-based risk score to predict death in patients with atrial fibrillation: the ABC (age, biomarkers, clinical history) death risk score

    Science.gov (United States)

    Hijazi, Ziad; Oldgren, Jonas; Lindbäck, Johan; Alexander, John H; Connolly, Stuart J; Eikelboom, John W; Ezekowitz, Michael D; Held, Claes; Hylek, Elaine M; Lopes, Renato D; Yusuf, Salim; Granger, Christopher B; Siegbahn, Agneta; Wallentin, Lars

    2018-01-01

    Abstract Aims In atrial fibrillation (AF), mortality remains high despite effective anticoagulation. A model predicting the risk of death in these patients is currently not available. We developed and validated a risk score for death in anticoagulated patients with AF including both clinical information and biomarkers. Methods and results The new risk score was developed and internally validated in 14 611 patients with AF randomized to apixaban vs. warfarin for a median of 1.9 years. External validation was performed in 8548 patients with AF randomized to dabigatran vs. warfarin for 2.0 years. Biomarker samples were obtained at study entry. Variables significantly contributing to the prediction of all-cause mortality were assessed by Cox-regression. Each variable obtained a weight proportional to the model coefficients. There were 1047 all-cause deaths in the derivation and 594 in the validation cohort. The most important predictors of death were N-terminal pro B-type natriuretic peptide, troponin-T, growth differentiation factor-15, age, and heart failure, and these were included in the ABC (Age, Biomarkers, Clinical history)-death risk score. The score was well-calibrated and yielded higher c-indices than a model based on all clinical variables in both the derivation (0.74 vs. 0.68) and validation cohorts (0.74 vs. 0.67). The reduction in mortality with apixaban was most pronounced in patients with a high ABC-death score. Conclusion A new biomarker-based score for predicting risk of death in anticoagulated AF patients was developed, internally and externally validated, and well-calibrated in two large cohorts. The ABC-death risk score performed well and may contribute to overall risk assessment in AF. ClinicalTrials.gov identifier NCT00412984 and NCT00262600 PMID:29069359

  2. Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment

    Directory of Open Access Journals (Sweden)

    David Corcoran

    2015-09-01

    Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom, in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.

  3. CAIDE Dementia Risk Score and biomarkers of neurodegeneration in memory clinic patients without dementia.

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    Enache, Daniela; Solomon, Alina; Cavallin, Lena; Kåreholt, Ingemar; Kramberger, Milica Gregoric; Aarsland, Dag; Kivipelto, Miia; Eriksdotter, Maria; Winblad, Bengt; Jelic, Vesna

    2016-06-01

    The aim of this study was to explore cross-sectional associations between Cardiovascular Risk Factors, Aging and Dementia Study (CAIDE) Dementia Risk Score and dementia-related cerebrospinal fluid and neuroimaging biomarkers in 724 patients without dementia from the Memory Clinic at Karolinska University Hospital, Huddinge, Sweden. We additionally evaluated the score's capacity to predict dementia. Two risk score versions were calculated: one including age, gender, obesity, hyperlipidemia, and hypertension; and one additionally including apolipoprotein E (APOE) ε4 carrier status. Cerebrospinal fluid was analyzed for amyloid β (Aβ), total tau, and phosphorylated tau. Visual assessments of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale, and Fazekas scale for white matter changes (WMC) were performed. Higher CAIDE Dementia Risk Score (version without APOE) was significantly associated with higher total tau, more severe MTA, WMC, and global cortical atrophy-frontal subscale. Higher CAIDE Dementia Risk Score (version with APOE) was associated with reduced Aβ, more severe MTA, and WMC. CAIDE Dementia Risk Score version with APOE seemed to predict dementia better in this memory clinic population with short follow-up than the version without APOE. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Predictive Value of Updating te Score Cardiovascular Risk Assessment Engine with Novel Biomarkers in a Type 2 Diabetes Population

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    Popa Loredana Mӑdӑlina

    2016-12-01

    Full Text Available Background and Aims: The aim of the study was to estimate the predictive value of some new biomarkers in the assessment of cardiovascular disease (CVD risk in a type 2 diabetes (T2DM population and to perform a correlation between the SCORE risk results and the risk profile estimated by the use of these biomarkers. Finally, we aimed to establish if the CVD risk assessment can be improved by adding the biomarkers into the SCORE risk equation. Material and Methods: In the study population the CVD risk assessment was performed using the SCORE High Risk Chart. The new individual biomarkers were: estimated glomerular filtration rate (eGFR, urinary albumin excretion (UAE rate, albumin/creatinine ratio (UACR, cystatin C, plasminogen activator inhibitor-1 (PAI-1, high-sensitivity C-reactive protein (hs-CRP, high density lipoprotein cholesterol (HDL and apolipoprotein B (apo-B. Results: The SCORE risk prediction model results were significantly altered by adding in the equation apo-B and HDLc values. An increase of one standard deviation of the apo-B values caused the increase of the SCORE results with 0.19 standard deviations while an increase of one standard deviation of the HDLc values decreased the SCORE results with 0.26 standard deviations. Conclusions: Advanced lipid testing, including the measurement of apo-B, provides a more comprehensive cardiac risk assessment and should be used in the development of specifically designed risk-scores for T2DM individuals.

  5. A urinary biomarker-based risk score correlates with multiparametric MRI for prostate cancer detection.

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    Hendriks, Rianne J; van der Leest, Marloes M G; Dijkstra, Siebren; Barentsz, Jelle O; Van Criekinge, Wim; Hulsbergen-van de Kaa, Christina A; Schalken, Jack A; Mulders, Peter F A; van Oort, Inge M

    2017-10-01

    Prostate cancer (PCa) diagnostics would greatly benefit from more accurate, non-invasive techniques for the detection of clinically significant disease, leading to a reduction of over-diagnosis and over-treatment. The aim of this study was to determine the association between a novel urinary biomarker-based risk score (SelectMDx), multiparametric MRI (mpMRI) outcomes, and biopsy results for PCa detection. This retrospective observational study used data from the validation study of the SelectMDx score, in which urine was collected after digital rectal examination from men undergoing prostate biopsies. A subset of these patients also underwent a mpMRI scan of the prostate. The indications for performing mpMRI were based on persistent clinical suspicion of PCa or local staging after PCa was found upon biopsy. All mpMRI images were centrally reviewed in 2016 by an experienced radiologist blinded for the urine test results and biopsy outcome. The PI-RADS version 2 was used. In total, 172 patients were included for analysis. Hundred (58%) patients had PCa detected upon prostate biopsy, of which 52 (52%) had high-grade disease correlated with a significantly higher SelectMDx score (P < 0.01). The median SelectMDx score was significantly higher in patients with a suspicious significant lesion on mpMRI compared to no suspicion of significant PCa (P < 0.01). For the prediction of mpMRI outcome, the area-under-the-curve of SelectMDx was 0.83 compared to 0.66 for PSA and 0.65 for PCA3. There was a positive association between SelectMDx score and the final PI-RADS grade. There was a statistically significant difference in SelectMDx score between PI-RADS 3 and 4 (P < 0.01) and between PI-RADS 4 and 5 (P < 0.01). The novel urinary biomarker-based SelectMDx score is a promising tool in PCa detection. This study showed promising results regarding the correlation between the SelectMDx score and mpMRI outcomes, outperforming PCA3. Our results suggest that this risk

  6. Detection of High-grade Prostate Cancer Using a Urinary Molecular Biomarker-Based Risk Score

    NARCIS (Netherlands)

    van Neste, Leander; Hendriks, Rianne J.; Dijkstra, Siebren; Trooskens, Geert; Cornel, Erik B.; Jannink, Sander A.; de Jong, Hans; Hessels, Daphne; Smit, Frank P.; Melchers, Willem J. G.; Leyten, Gisèle H. J. M.; de Reijke, Theo M.; Vergunst, Henk; Kil, Paul; Knipscheer, Ben C.; Hulsbergen-van de Kaa, Christina A.; Mulders, Peter F. A.; van Oort, Inge M.; van Criekinge, Wim; Schalken, Jack A.

    2016-01-01

    To reduce overdiagnosis and overtreatment, a test is urgently needed to detect clinically significant prostate cancer (PCa). To develop a multimodal model, incorporating previously identified messenger RNA (mRNA) biomarkers and traditional risk factors that could be used to identify patients with

  7. A methodology review on the incremental prognostic value of computed tomography biomarkers in addition to Framingham risk score in predicting cardiovascular disease: the use of association, discrimination and reclassification.

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    Pang, Chun Lap; Pilkington, Nicola; Wei, Yinghui; Peters, Jaime; Roobottom, Carl; Hyde, Chris

    2018-02-21

    Computed tomography (CT) biomarkers claim to improve cardiovascular risk stratification. This review focuses on significant differences in incremental measures between adequate and inadequate reporting practise. Studies included were those that used Framingham Risk Score as a baseline and described the incremental value of adding calcium score or CT coronary angiogram in predicting cardiovascular risk. Searches of MEDLINE, EMBASE, Web of Science and Cochrane Central were performed with no language restriction. Thirty five studies consisting of 206,663 patients (men = 118,114, 55.1%) were included. The baseline Framingham Risk Score included the 1998, 2002 and 2008 iterations. Selective reporting, inconsistent reference groupings and thresholds were found. Twelve studies (34.3%) had major and 23 (65.7%) had minor alterations and the respective Δ AUC were significantly different (p = 0.015). When the baseline model performed well, the Δ AUC was relatively lower with the addition of a CT biomarker (Spearman coefficient = - 0.46, p analysis, calibration, validation, multivariable and AUC documentation (all p Risk Score alone. Inadequate reporting of discrimination inflates effect estimate, however, that is not necessarily the case for reclassification.

  8. Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death

    DEFF Research Database (Denmark)

    Ghasemzedah, Nima; Hayek, Salim; Ko, Yi-An

    2017-01-01

    models adjusted for traditional risk factors. A high suPAR level ≥3.5 ng/mL was associated with all-cause death and myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43-2.35) after adjustment for risk factors, C-reactive protein, fibrin degradation product, and heat shock protein-70....... Addition of suPAR to the 3-BRS significantly improved the C statistic, integrated discrimination improvement, and net reclassification index for the primary outcome. A BRS of 1, 2, 3, or 4 was associated with a 1.81-, 2.59-, 6.17-, and 8.80-fold increase, respectively, in the risk of death and myocardial...

  9. PRSice: Polygenic Risk Score software.

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    Euesden, Jack; Lewis, Cathryn M; O'Reilly, Paul F

    2015-05-01

    A polygenic risk score (PRS) is a sum of trait-associated alleles across many genetic loci, typically weighted by effect sizes estimated from a genome-wide association study. The application of PRS has grown in recent years as their utility for detecting shared genetic aetiology among traits has become appreciated; PRS can also be used to establish the presence of a genetic signal in underpowered studies, to infer the genetic architecture of a trait, for screening in clinical trials, and can act as a biomarker for a phenotype. Here we present the first dedicated PRS software, PRSice ('precise'), for calculating, applying, evaluating and plotting the results of PRS. PRSice can calculate PRS at a large number of thresholds ("high resolution") to provide the best-fit PRS, as well as provide results calculated at broad P-value thresholds, can thin Single Nucleotide Polymorphisms (SNPs) according to linkage disequilibrium and P-value or use all SNPs, handles genotyped and imputed data, can calculate and incorporate ancestry-informative variables, and can apply PRS across multiple traits in a single run. We exemplify the use of PRSice via application to data on schizophrenia, major depressive disorder and smoking, illustrate the importance of identifying the best-fit PRS and estimate a P-value significance threshold for high-resolution PRS studies. PRSice is written in R, including wrappers for bash data management scripts and PLINK-1.9 to minimize computational time. PRSice runs as a command-line program with a variety of user-options, and is freely available for download from http://PRSice.info jack.euesden@kcl.ac.uk or paul.oreilly@kcl.ac.uk Supplementary data are available at Bioinformatics online. © The Author 2014. Published by Oxford University Press.

  10. Repeated Measurements of Cardiac Biomarkers in Atrial Fibrillation and Validation of the ABC Stroke Score Over Time.

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    Hijazi, Ziad; Lindahl, Bertil; Oldgren, Jonas; Andersson, Ulrika; Lindbäck, Johan; Granger, Christopher B; Alexander, John H; Gersh, Bernard J; Hanna, Michael; Harjola, Veli-Pekka; Hylek, Elaine M; Lopes, Renato D; Siegbahn, Agneta; Wallentin, Lars

    2017-06-23

    Cardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker-based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short-term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short-term risk estimate. According to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1.8 years in the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Cardiac troponin I, cardiac troponin T, and N-terminal pro-B-type natriuretic peptide were measured with high-sensitivity immunoassays. Associations with outcomes were evaluated by Cox regression. C indices and calibration plots were used to evaluate the ABC stroke score at 2 months. The average changes in biomarker levels during 2 months were small (median change cardiac troponin T +2.8%, troponin I +2.0%, and N-terminal pro-B-type natriuretic peptide +13.5%) and within-subject correlation was high (all ≥0.82). Repeated measurement of cardiac biomarkers provided some incremental prognostic value for mortality but not for stroke when combined with clinical risk factors and baseline levels of the biomarkers. Based on 8702 person-years of follow-up and 96 stroke/systemic embolic events, the ABC stroke score at 2 months achieved a similar C index of 0.70 (95% CI, 0.65-0.76) as compared with 0.70 (95% CI, 0.65-0.75) at baseline. The ABC stroke score remained well calibrated using predefined risk classes. In patients with stable atrial fibrillation, the variability of the cardiac biomarkers and the biomarker-based ABC stroke score during 2 months are small. The prognostic information by the ABC stroke score remains consistent and well calibrated with

  11. Cardiovascular risk scores for coronary atherosclerosis.

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    Yalcin, Murat; Kardesoglu, Ejder; Aparci, Mustafa; Isilak, Zafer; Uz, Omer; Yiginer, Omer; Ozmen, Namik; Cingozbay, Bekir Yilmaz; Uzun, Mehmet; Cebeci, Bekir Sitki

    2012-10-01

    The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

  12. Framingham risk score with cardiovascular events in chronic kidney disease.

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    Szu-Chia Chen

    Full Text Available The Framingham Risk Score (FRS was developed to predict coronary heart disease in various populations, and it tended to under-estimate the risk in chronic kidney disease (CKD patients. Our objectives were to determine whether FRS was associated with cardiovascular events, and to evaluate the role of new risk markers and echocardiographic parameters when they were added to a FRS model. This study enrolled 439 CKD patients. The FRS is used to identify individuals categorically as "low" (4.7 cm, left ventricular hypertrophy or left ventricular ejection fraction<50% to the FRS model significantly improves the predictive values for cardiovascular events. In CKD patients, "high" risk categorized by FRS predicts cardiovascular events. Novel biomarkers and echocardiographic parameters provide additional predictive values for cardiovascular events. Future study is needed to assess whether risk assessment enhanced by using these biomarkers and echocardiographic parameters might contribute to more effective prediction and better care for patients.

  13. Genomic Biomarkers for Breast Cancer Risk

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    Walsh, Michael F.; Nathanson, Katherine L.; Couch, Fergus J.

    2016-01-01

    Clinical risk assessment for cancer predisposition includes a three-generation pedigree and physical examination to identify inherited syndromes. Additionally genetic and genomic biomarkers may identify individuals with a constitutional basis for their disease that may not be evident clinically. Genomic biomarker testing may detect molecular variations in single genes, panels of genes, or entire genomes. The strength of evidence for the association of a genomic biomarker with disease risk may be weak or strong. The factors contributing to clinical validity and utility of genomic biomarkers include functional laboratory analyses and genetic epidemiologic evidence. Genomic biomarkers may be further classified as low, moderate or highly penetrant based on the likelihood of disease. Genomic biomarkers for breast cancer are comprised of rare highly penetrant mutations of genes such as BRCA1 or BRCA2, moderately penetrant mutations of genes such as CHEK2, as well as more common genomic variants, including single nucleotide polymorphisms, associated with modest effect sizes. When applied in the context of appropriate counseling and interpretation, identification of genomic biomarkers of inherited risk for breast cancer may decrease morbidity and mortality, allow for definitive prevention through assisted reproduction, and serve as a guide to targeted therapy. PMID:26987529

  14. Reconsidering lactate as a sepsis risk biomarker.

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    John L Moran

    Full Text Available There has been renewed interest in lactate as a risk biomarker in sepsis and septic shock. However, the ability of the odds ratio (OR and change in the area under the receiver operator characteristic curve (AUC-ROC to assess biomarker added-value has been questioned.A sepsis cohort was identified from the ICU database of an Australian tertiary referral hospital using APACHE III diagnostic codes. Demographic information, APACHE III scores, 24-hour post-admission patient lactate levels, and hospital mortality were accessed.Hospital mortality was modelled using a base predictive logistic regression model and sequential addition of admission lactate, lactate clearance ([lactateadmission-lactatefinal]/lactateadmission, and area under the lactate-time curve (LTC. Added-value was assessed using lactate index OR; AUC-ROC difference (base-model versus lactate index addition; net (mortality reclassification index (NRI; range -2 to +2; and net benefit (NB, the number of true positives per patient adjusted for the number of false positives. The data set comprised 717 patients with mean(SD age and APACHE III score 61.1(16.5 years and 68.3(28.2 respectively; 59.2% were male. Admission lactate was 2.3(2.5 mmol/l; with lactate of ≥ 4 mmol/L (37% hospital mortality in 17% and patients with lactate < 4 mmol/L having 18% hospital mortality. The admission base-model had an AUC-ROC = 0.81 with admission lactate OR = 1.127 (95%CI: 1.038, 1.224, AUC-ROC difference of 0.0032 (-0.0037, 0.01615; P = 0.61, and NRI 0.240(0.030, 0.464. The over-time model had an AUC-ROC = 0.86 with (i clearance OR = 0.771, 95%CI: 0.578, 1.030; P = 0.08; AUC-ROC difference 0.001 (-0.003, 0.014; P = 0.78, and NRI 0.109(-0.193, 0.425 and (ii LTC OR = 0.997, 95%CI: 0.989, 1.005, P = 0.49; AUC-ROC difference 0.004 (-0.002, 0.004; P = 0.34, and NRI 0.111(-0.222, 0.403. NB was not incremented by any lactate index.Lactate added-value assessment is dependent upon the performance of the underlying

  15. Novel biomarkers for cardiovascular risk prediction.

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    Wang, Juan; Tan, Guo-Juan; Han, Li-Na; Bai, Yong-Yi; He, Miao; Liu, Hong-Bin

    2017-02-01

    Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. The primary prevention of CVD is dependent upon the ability to identify high-risk individuals long before the development of overt events. This highlights the need for accurate risk stratification. An increasing number of novel biomarkers have been identified to predict cardiovascular events. Biomarkers play a critical role in the definition, prognostication, and decision-making regarding the management of cardiovascular events. This review focuses on a variety of promising biomarkers that provide diagnostic and prognostic information. The myocardial tissue-specific biomarker cardiac troponin, high-sensitivity assays for cardiac troponin, and heart-type fatty acid binding proteinall help diagnose myocardial infarction (MI) in the early hours following symptoms. Inflammatory markers such as growth differentiation factor-15, high-sensitivity C-reactive protein, fibrinogen, and uric acid predict MI and death. Pregnancy-associated plasma protein A, myeloperoxidase, and matrix metalloproteinases predict the risk of acute coronary syndrome. Lipoprotein-associated phospholipase A2 and secretory phospholipase A2 predict incident and recurrent cardiovascular events. Finally, elevated natriuretic peptides, ST2, endothelin-1, mid-regional-pro-adrenomedullin, copeptin, and galectin-3 have all been well validated to predict death and heart failure following a MI and provide risk stratification information for heart failure. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. All the biomarkers reflect different aspects of the development of atherosclerosis.

  16. Prognostic scores and biomarkers for pediatric community-acquired pneumonia: how far have we come?

    Directory of Open Access Journals (Sweden)

    Uwaezuoke SN

    2017-02-01

    Full Text Available Samuel N Uwaezuoke,1 Adaeze C Ayuk2 1Pediatric Nephrology Firm, 2Pediatric Pulmonology Firm, Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Abstract: This article aimed to review the current prognostic and diagnostic tools used for community-acquired pneumonia (CAP and highlight those potentially applicable in children with CAP. Several scoring systems have been developed to predict CAP mortality risk and serve as guides for admission into the intensive care unit. Over the years, clinicians have adopted these tools for improving site-of-care decisions because of high mortality rates in the extremes of age. The major scoring systems designed for geriatric patients include the Pneumonia Severity Index and the confusion, uremia, respiratory rate, blood pressure, age >65 years (CURB-65 rule, as well as better predictors of intensive care unit admission, such as the systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation and arterial pH (SMART-COP score, the Infectious Diseases Society of America/American Thoracic Society guidelines, the criteria developed by España et al as well as the systolic blood pressure, oxygenation, age and respiratory rate (SOAR criteria. Only the modified predisposition, insult, response and organ dysfunction (PIRO score has so far been applied to children with CAP. Because none of the tools is without its limitations, there has been a paradigm shift to incorporate biomarkers because they are reliable diagnostic tools and good predictors of disease severity and outcome, irrespective of age group. Despite the initial preponderance of reports on their utility in geriatric CAP, much progress has now been made in demonstrating their usefulness in pediatric CAP. Keywords: community-acquired pneumonia, children, scoring systems, biomarkers 

  17. Cardiac risk scores in high-risk Hispanics and the predictive value of BNP.

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    Macabasco-O'Connell, Aurelia; Danwalder, Sara; Sinha, Karabi

    2011-11-01

    The purpose of this study was to calculate cardiac risk scores in Hispanic subjects and to determine the predictive value of adding B-type natriuretic peptide in identifying those with asymptomatic left ventricular dysfunction as a measure of cardiovascular disease. Hispanics have higher rates of cardiovascular risk factors leading to coronary heart disease, asymptomatic left ventricular dysfunction and cardiovascular events. Assessing cardiac risk in these groups is important to identify those at high risk for future cardiovascular events. The use of biomarkers such as B-type natriuretic peptide may increase the accuracy of risk prediction. This study used a descriptive, cross-sectional study design to determine the utility of the standard risk assessment tools (Adult Treatment Panel III and the Framingham Risk Scores risk calculator) and the B-type natriuretic peptide biomarker to estimate coronary heart disease risk in low-income, Hispanic participants. A sample of 71 patients (age 52 SD 11, 69% female) with multiple cardiovascular risk factors seen at an ambulatory clinic at a county facility was enrolled in the study. Sociodemographic and medical history information were obtained. Two widely used risk calculators (Adult Treatment Panel III and Framingham Risk Scores) were used to estimate 10-year coronary heart disease risk in each subject. Baseline B-type natriuretic peptide measurement and echocardiography were performed with each subject to evaluate presence of asymptomatic left ventricular dysfunction. Receiver operating curve analyses were performed to compare predictability, sensitivity and specificity of the traditional risk scores against the B-type natriuretic peptide level to detect asymptomatic left ventricular dysfunction. Overall mean risk scores were 5% (SD 5%) (Adult Treatment Panel III) and 10% (SD 7%) (Framingham Risk Scores). Mean B-type natriuretic peptide levels were 108·5 (SD 191·5) pg/ml. Echocardiogram results revealed a high

  18. MODELING CREDIT RISK THROUGH CREDIT SCORING

    OpenAIRE

    Adrian Cantemir CALIN; Oana Cristina POPOVICI

    2014-01-01

    Credit risk governs all financial transactions and it is defined as the risk of suffering a loss due to certain shifts in the credit quality of a counterpart. Credit risk literature gravitates around two main modeling approaches: the structural approach and the reduced form approach. In addition to these perspectives, credit risk assessment has been conducted through a series of techniques such as credit scoring models, which form the traditional approach. This paper examines the evolution of...

  19. Quasi-linear score for capturing heterogeneous structure in biomarkers.

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    Omae, Katsuhiro; Komori, Osamu; Eguchi, Shinto

    2017-06-19

    Linear scores are widely used to predict dichotomous outcomes in biomedical studies because of their learnability and understandability. Such approaches, however, cannot be used to elucidate biodiversity when there is heterogeneous structure in target population. Our study was focused on describing intrinsic heterogeneity in predictions. Because heterogeneity can be captured by a clustering method, integrating different information from different clusters should yield better predictions. Accordingly, we developed a quasi-linear score, which effectively combines the linear scores of clustered markers. We extended the linear score to the quasi-linear score by a generalized average form, the Kolmogorov-Nagumo average. We observed that two shrinkage methods worked well: ridge shrinkage for estimating the quasi-linear score, and lasso shrinkage for selecting markers within each cluster. Simulation studies and applications to real data show that the proposed method has good predictive performance compared with existing methods. Heterogeneous structure is captured by a clustering method. Quasi-linear scores combine such heterogeneity and have a better predictive ability compared with linear scores.

  20. Biomarkers for cardiovascular risk in children.

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    Canas, Jose A; Sweeten, Shawn; Balagopal, Prabhakaran Babu

    2013-03-01

    The magnitude of lifetime risk of cardiovascular disease (CVD) has radically increased along with the high prevalence of obesity in children. The spotlight is now on dysfunctional adiposity as a precursor for the development of premature CVD. As full-blown CVD is not present in childhood, there is a critical need for surrogate markers to best assess, predict, and treat the children who are vulnerable to developing CVD. Accumulation of excess fat mass can be conceived as a derangement in the balance between energy intake and expenditure. This appears to provoke various structural and metabolic alterations leading to adipocyte dysfunction, with important cardiovascular health consequences. Subclinical inflammation, insulin resistance, oxidative stress, and endothelial dysfunction appear to play important roles early in the clinical course of obesity. Associations between biomarkers and noninvasive measures of early atherosclerosis in children continue to emerge and several biomarkers appear to be promising. At present, there are no explicit data to recommend any of these biomarkers as a routine clinical marker of CVD in children. More work is needed to validate these biomarkers and to improve understanding of their role in CVD risk prediction in the pediatric population.

  1. Accuracy of prediction scores and novel biomarkers for predicting nonalcoholic fatty liver disease in obese children.

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    Koot, Bart G P; van der Baan-Slootweg, Olga H; Bohte, Anneloes E; Nederveen, Aart J; van Werven, Jochem R; Tamminga-Smeulders, Christine L J; Merkus, Maruschka P; Schaap, Frank G; Jansen, Peter L M; Stoker, Jaap; Benninga, Marc A

    2013-03-01

    Accurate prediction scores for liver steatosis are demanded to enable clinicians to noninvasively screen for nonalcoholic fatty liver disease (NAFLD). Several prediction scores have been developed, however external validation is lacking. The aim was to determine the diagnostic accuracy of four existing prediction scores in severely obese children, to develop a new prediction score using novel biomarkers and to compare these results to the performance of ultrasonography. Liver steatosis was measured using proton magnetic resonance spectroscopy in 119 severely obese children (mean age 14.3 ± 2.1 years, BMI z-score 3.35 ± 0.35). Prevalence of steatosis was 47%. The four existing predictions scores ("NAFLD liver fat score," "fatty liver index," "hepatic steatosis index," and the pediatric prediction score) had only moderate diagnostic accuracy in this cohort (positive predictive value (PPV): 70, 61, 61, 69% and negative predictive value (NPV) 77, 69, 68, 75%, respectively). A new prediction score was built using anthropometry, routine biochemistry and novel biomarkers (leptin, adiponectin, TNF-alpha, IL-6, CK-18, FGF-21, and adiponutrin polymorphisms). The final model included ALT, HOMA, sex, and leptin. This equation (PPV 79% and NPV 80%) did not perform substantially better than the four other equations and did not outperform ultrasonography for excluding NAFLD (NPV 82%). The conclusion is in severely obese children and adolescents existing prediction scores and the tested novel biomarkers have insufficient diagnostic accuracy for diagnosing or excluding NAFLD. Copyright © 2012 The Obesity Society.

  2. RISK FACTOR DIAGNOSTIC SCORE IN DIABETIC FOOT

    Directory of Open Access Journals (Sweden)

    Mohamed Shameem P. M

    2016-09-01

    Full Text Available INTRODUCTION Diabetic foot ulcers vary in their clinical presentation and nature of severity and therefore create a challenging problem to the treating surgeon regarding the prediction of the clinical course and the end result of the treatment. Clinical studies have shown that there are certain risk factors for the progression of foot ulcers in diabetics and it may therefore be possible to predict the course of an ulcer foot at presentation itself, thus instituting proper therapy without delay. Spoken otherwise clinical scoring may tell that this particular ulcer is having highest chance of amputation, then one may be able to take an early decision for the same and avoid the septic complications, inconvenience to the patient, long hospital stay and cost of treatments. AIM OF THE STUDY Aim of the study is to evaluate the above-mentioned scoring system in predicting the course the diabetic foot ulcers. MATERIALS AND METHODS 50 patients with Diabetic Foot attending the OPD of Department of Surgery of Government Hospital attached to Calicut Medical College are included in the present study. After thorough history taking and clinical examination, six risk factors like Age, pedal vessels, renal function, neuropathy, radiological findings and ulcers were observed in the patients by giving certain scoring points to each of them. The total number of points scored by the patients at the time of admission or OPD treatment was correlated with the final outcome in these patients, whether leading to amputation or conservative management. All the data was analysed using standard statistical methods. OBSERVATIONS AND RESULTS There were 12 females and 38 males with a female to male ratio 1:3.1. All were aged above 30 years. Twenty-four (48% of them were between 30-60 years and twenty six (52% were above 60 years. 10 patients were treated conservatively with risk score range: 10 to 35. Six had single toe loss with risk score: 25 to 35. Six had multiple toe loss

  3. Development of an interstitial cystitis risk score for bladder permeability

    Science.gov (United States)

    Lamb, Laura E.; Janicki, Joseph J.; Bartolone, Sarah N.; Peters, Kenneth M.

    2017-01-01

    Background Interstitial cystitis/bladder pain syndrome (IC) is a multifactorial syndrome of severe pelvic and genitalia pain and compromised urinary function; a subset of IC patients present with Hunner’s lesions or ulcers on their bladder walls (UIC). UIC is diagnosed by cystoscopy, which may be quite painful. The objective of this study was to determine if a calculated Bladder Permeability Defect Risk Score (BP-RS) based on non-invasive urinary cytokines could discriminate UIC patients from controls and IC patients without Hunner’s ulcers. Methods A national crowdsourcing effort targeted IC patients and age-matched controls to provide urine samples. Urinary cytokine levels for GRO, IL-6, and IL-8 were determined using a Luminex assay. Results We collected 448 urine samples from 46 states consisting of 153 IC patients (147 female, 6 male), of which 54 UIC patients (50 females, 4 male), 159 female controls, and 136 male controls. A defined BP-RS was calculated to classify UIC, or a bladder permeability defect etiology, with 89% validity. Conclusions The BP-RS Score quantifies UIC risk, indicative of a bladder permeability defect etiology in a subset of IC patients. The Bladder Permeability Defect Risk Score is the first validated urine biomarker assay for interstitial cystitis/bladder pain syndrome. PMID:29088231

  4. Development of an interstitial cystitis risk score for bladder permeability.

    Science.gov (United States)

    Lamb, Laura E; Janicki, Joseph J; Bartolone, Sarah N; Peters, Kenneth M; Chancellor, Michael B

    2017-01-01

    Interstitial cystitis/bladder pain syndrome (IC) is a multifactorial syndrome of severe pelvic and genitalia pain and compromised urinary function; a subset of IC patients present with Hunner's lesions or ulcers on their bladder walls (UIC). UIC is diagnosed by cystoscopy, which may be quite painful. The objective of this study was to determine if a calculated Bladder Permeability Defect Risk Score (BP-RS) based on non-invasive urinary cytokines could discriminate UIC patients from controls and IC patients without Hunner's ulcers. A national crowdsourcing effort targeted IC patients and age-matched controls to provide urine samples. Urinary cytokine levels for GRO, IL-6, and IL-8 were determined using a Luminex assay. We collected 448 urine samples from 46 states consisting of 153 IC patients (147 female, 6 male), of which 54 UIC patients (50 females, 4 male), 159 female controls, and 136 male controls. A defined BP-RS was calculated to classify UIC, or a bladder permeability defect etiology, with 89% validity. The BP-RS Score quantifies UIC risk, indicative of a bladder permeability defect etiology in a subset of IC patients. The Bladder Permeability Defect Risk Score is the first validated urine biomarker assay for interstitial cystitis/bladder pain syndrome.

  5. Development of an interstitial cystitis risk score for bladder permeability.

    Directory of Open Access Journals (Sweden)

    Laura E Lamb

    Full Text Available Interstitial cystitis/bladder pain syndrome (IC is a multifactorial syndrome of severe pelvic and genitalia pain and compromised urinary function; a subset of IC patients present with Hunner's lesions or ulcers on their bladder walls (UIC. UIC is diagnosed by cystoscopy, which may be quite painful. The objective of this study was to determine if a calculated Bladder Permeability Defect Risk Score (BP-RS based on non-invasive urinary cytokines could discriminate UIC patients from controls and IC patients without Hunner's ulcers.A national crowdsourcing effort targeted IC patients and age-matched controls to provide urine samples. Urinary cytokine levels for GRO, IL-6, and IL-8 were determined using a Luminex assay.We collected 448 urine samples from 46 states consisting of 153 IC patients (147 female, 6 male, of which 54 UIC patients (50 females, 4 male, 159 female controls, and 136 male controls. A defined BP-RS was calculated to classify UIC, or a bladder permeability defect etiology, with 89% validity.The BP-RS Score quantifies UIC risk, indicative of a bladder permeability defect etiology in a subset of IC patients. The Bladder Permeability Defect Risk Score is the first validated urine biomarker assay for interstitial cystitis/bladder pain syndrome.

  6. Risk Factors and Biomarkers of Ischemic Stroke in Cancer Patients

    OpenAIRE

    Kim, Kwangsoo; Lee, Ji-Hun

    2014-01-01

    Background and Purpose Stroke is common among cancer patients. However, risk factors and biomarkers of stroke in cancer patients are not well established. This study aimed to investigate risk factors and biomarkers as well as etiology of ischemic stroke in cancer patients. Methods A retrospective review was conducted in cancer patients with ischemic stroke who were admitted to a general hospital in Busan, Korea, between January 2003 and December 2012. The risk factors and biomarkers for strok...

  7. Refining Long-Term Prediction of Cardiovascular Risk in Diabetes - The VILDIA Score.

    Science.gov (United States)

    Goliasch, Georg; Silbernagel, Günther; Kleber, Marcus E; Grammer, Tanja B; Pilz, Stefan; Tomaschitz, Andreas; Bartko, Philipp E; Maurer, Gerald; Koenig, Wolfgang; Niessner, Alexander; März, Winfried

    2017-07-05

    Cardiovascular risk assessment in patients with diabetes relies on traditional risk factors. However, numerous novel biomarkers have been found to be independent predictors of cardiovascular disease, which might significantly improve risk prediction in diabetic patients. We aimed to improve prediction of cardiovascular risk in diabetic patients by investigating 135 evolving biomarkers. Based on selected biomarkers a clinically applicable prediction algorithm for long-term cardiovascular mortality was designed. We prospectively enrolled 864 diabetic patients of the LUdwigshafen RIsk and Cardiovascular health (LURIC) study with a median follow-up of 9.6 years. Independent risk factors were selected using bootstrapping based on a Cox regression analysis. The following seven variables were selected for the final multivariate model: NT-proBNP, age, male sex, renin, diabetes duration, Lp-PLA2 and 25-OH vitamin D3. The risk score based on the aforementioned variables demonstrated an excellent discriminatory power for 10-year cardiovascular survival with a C-statistic of 0.76 (P < 0.001), which was significantly better than the established UKPDS risk engine (C-statistic = 0.64, P < 0.001). Net reclassification confirmed a significant improvement of individual risk prediction by 22% (95% confidence interval: 14-30%) compared to the UKPDS risk engine (P < 0.001). The VILDIA score based on traditional cardiovascular risk factors and reinforced with novel biomarkers outperforms previous risk algorithms.

  8. State of the Art: Blood Biomarkers for Risk Stratification in Patients with Stable Ischemic Heart Disease.

    Science.gov (United States)

    Omland, Torbjørn; White, Harvey D

    2017-01-01

    Multiple circulating biomarkers have been associated with the incidence of cardiovascular events and proposed as potential tools for risk stratification in stable ischemic heart disease (IHD), yet current guidelines do not make any firm recommendations concerning the use of biomarkers for risk stratification in this setting. This state-of-the-art review provides an overview of biomarkers for risk stratification in stable IHD. Circulating biomarkers associated with the risk of cardiovascular events in patients with stable IHD reflect different pathophysiological processes, including myocardial injury, myocardial stress and remodeling, metabolic status, vascular inflammation, and oxidative stress. Compared to the primary prevention setting, biomarkers reflecting end-organ damage and future risk of heart failure development and cardiovascular death may play more important roles in the stable IHD setting. Accordingly, biomarkers that reflect chronic, low-grade myocardial injury, and stress, i.e., high-sensitivity cardiac troponins and natriuretic peptides, provide graded and incremental prognostic information to conventional risk markers. In contrast, in stable IHD patients the prognostic value of traditional metabolic biomarkers, including serum lipids, is limited. Among several novel biomarkers, growth-differentiation factor-15 may provide the most robust prognostic information, whereas most inflammatory markers provide limited incremental prognostic information to risk factor models that include conventional risk factors, natriuretic peptides, and high-sensitivity troponins. Circulating biomarkers hold promise as useful tools for risk stratification in stable IHD, but their future incorporation into clinically useful risk scores will depend on prospective, rigorously performed clinical trials that document enhanced risk prediction. © 2016 American Association for Clinical Chemistry.

  9. Lead exposure biomarkers and mini-mental status exam scores in older men

    NARCIS (Netherlands)

    Wright, RO; Tsaih, SW; Schwartz, J; Spiro, A; McDonald, K; Weiss, ST; Hu, H

    2003-01-01

    Background: Lead is neurotoxic; yet, whether cognitive decline in older persons is associated with lead exposure is unknown. We studied whether lead exposure biomarkers are associated with cognitive test scores, as well as the modifying effects of age on the lead-cognition relationship. Methods:

  10. A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease

    NARCIS (Netherlands)

    Ibrahim, N.E.; Januzzi, J.L., Jr.; Magaret, C.A.; Gaggin, H.K.; Rhyne, R.F.; Gandhi, P.U.; Kelly, N.; Simon, M.L.; Motiwala, S.R.; Belcher, A.M.; Kimmenade, R.R. van

    2017-01-01

    BACKGROUND: Noninvasive models to predict the presence of coronary artery disease (CAD) may help reduce the societal burden of CAD. OBJECTIVES: From a prospective registry of patients referred for coronary angiography, the goal of this study was to develop a clinical and biomarker score to predict

  11. Normalized emphysema scores on low dose CT: Validation as an imaging biomarker for mortality.

    Directory of Open Access Journals (Sweden)

    Leticia Gallardo-Estrella

    Full Text Available The purpose of this study is to develop a computed tomography (CT biomarker of emphysema that is robust across reconstruction settings, and evaluate its ability to predict mortality in patients at high risk for lung cancer. Data included baseline CT scans acquired between August 2002 and April 2004 from 1737 deceased subjects and 5740 surviving controls taken from the National Lung Screening Trial. Emphysema scores were computed in the original scans (origES and after applying resampling, normalization and bullae analysis (normES. We compared the prognostic value of normES versus origES for lung cancer and all-cause mortality by computing the area under the receiver operator characteristic curve (AUC and the net reclassification improvement (NRI for follow-up times of 1-7 years. normES was a better predictor of mortality than origES. The 95% confidence intervals for the differences in AUC values indicated a significant difference for all-cause mortality for 2 through 6 years of follow-up, and for lung cancer mortality for 1 through 7 years of follow-up. 95% confidence intervals in NRI values showed a statistically significant improvement in classification for all-cause mortality for 2 through 7 years of follow-up, and for lung cancer mortality for 3 through 7 years of follow-up. Contrary to conventional emphysema score, our normalized emphysema score is a good predictor of all-cause and lung cancer mortality in settings where multiple CT scanners and protocols are used.

  12. Risk Factors and Biomarkers of Age-Related Macular Degeneration

    Science.gov (United States)

    Lambert, Nathan G.; Singh, Malkit K.; ElShelmani, Hanan; Mansergh, Fiona C.; Wride, Michael A.; Padilla, Maximilian; Keegan, David; Hogg, Ruth E.; Ambati, Balamurali K.

    2016-01-01

    A biomarker can be a substance or structure measured in body parts, fluids or products that can affect or predict disease incidence. As age-related macular degeneration (AMD) is the leading cause of blindness in the developed world, much research and effort has been invested in the identification of different biomarkers to predict disease incidence, identify at risk individuals, elucidate causative pathophysiological etiologies, guide screening, monitoring and treatment parameters, and predict disease outcomes. To date, a host of genetic, environmental, proteomic, and cellular targets have been identified as both risk factors and potential biomarkers for AMD. Despite this, their use has been confined to research settings and has not yet crossed into the clinical arena. A greater understanding of these factors and their use as potential biomarkers for AMD can guide future research and clinical practice. This article will discuss known risk factors and novel, potential biomarkers of AMD in addition to their application in both academic and clinical settings. PMID:27156982

  13. Novel biomarkers with potential for cardiovascular risk reclassification.

    Science.gov (United States)

    Mallikethi-Reddy, Sagar; Briasoulis, Alexandros; Akintoye, Emmanuel; Afonso, Luis

    Precise estimation of the absolute risk for CVD events is necessary when making treatment recommendations for patients. A number of multivariate risk models have been developed for estimation of cardiovascular risk in asymptomatic individuals based upon assessment of multiple variables. Due to the inherent limitation of risk models, several novel risk markers including serum biomarkers have been studied in an attempt to improve the cardiovascular risk prediction above and beyond the established risk factors. In this review, we discuss the role of underappreciated biomarkers such as red cell distribution width (RDW), cystatin C (cysC), and homocysteine (Hcy) as well as imaging biomarkers in cardiovascular risk reclassification, and highlight their utility as additional source of information in patients with intermediate risk.

  14. Prominent deep medullary veins: a predictive biomarker for stroke risk from transient ischemic attack?

    Science.gov (United States)

    Duan, Yang; Xu, Zhihua; Li, Hongyi; Cai, Xiaonan; Chang, Cancan; Yang, Benqiang

    2018-05-01

    Background Deep medullary veins (DMVs) are a biomarker of severity and prognosis in patients with acute cerebral infarction. However, their clinical significance remains unclear in patients with transient ischemic attack (TIA). Purpose To determine whether prominent deep medullary veins (PDMVs) are a predictive biomarker for stroke risk after TIA. Material and Methods Clinical and imaging data of 49 patients with TIA and 49 sex- and age-matched controls were studied. PDMVs were defined as DMVs with a score of 3 (TDMVs) or asymmetric DMVs (ADMVs), and the relationship between PDMVs and clinical features was analyzed. The DMV score based on susceptibility weighted imaging (SWI) ranged from 0 (not visible) to 3 (very prominent) and was calculated for both hemispheres separately. A different score in each hemisphere was defined as ADMVs and an equal score was defined as symmetric DMVs. The asymmetry and score of DMVs were compared between the two groups and with respect to the time from TIA onset to imaging analysis. Results Agreement between neuroradiologists for the DMV asymmetry/score on SWI was excellent. The frequency of ADMVs and TDMVs was significantly higher in patients with TIA than controls ( P  0.05); PDMVs were not correlated with age, blood pressure, or diabetes. However, PDMVs were associated with the ABCD2 score (≥4), clinical symptoms, and duration of TIA (≥10 min). Conclusion Prominent deep medullary veins is a predictive biomarker for the risk of stroke in many patients having suffered from TIA.

  15. Computation of a cardiac severity score with left-censored biomarkers for patients with heart failure

    Directory of Open Access Journals (Sweden)

    Vasudevan A

    2017-02-01

    Full Text Available Anupama Vasudevan,1,2 Alyssa G Munkres,3 Teodoro Bottiglieri,1,4 Jane I Won,1,2 Puja Garg,1,2 Peter A McCullough 1–3,5,6 1Baylor Research Institute, 2Baylor Heart and Vascular Institute, 3Texas A&M Health Science Center, College of Medicine, 4The Institute of Metabolic Disease, 5Baylor University Medical Center, Dallas, 6The Heart Hospital Baylor, Plano, TX, USA Introduction: Biomarkers reported as being less than the limit of detection (LOD are challenging to be included in analyses without being dichotomized. Substitutions by the LOD, LOD/2, LOD/√2, or zero have been attempted for left-censored values. We calculated a novel Modified Myocardial Injury Summary Score (MMISS by incorporating four biomarkers (B-type natriuretic peptide, troponin, galectin-3, and suppression of tumorigenicity 2 to efficiently stratify heart failure (HF patients. The objective of this study is to evaluate the differences in associations between MMISS, calculated by different methods of substitution, and therapeutic intensity index (TII, a composite pharmacologic score. Methods and results: This is a cross-sectional study including 39 HF patients aged ≥18 years who were treated in the Baylor Health Care System. MMISS was calculated with the left-censored biomarkers substituted by zero, LOD, LOD/2, and LOD/√2. Patients with biomarker values more than LOD (complete cases were also considered separately. The computed TII was regressed separately on MMISS for each substitution method, while controlling for age and gender. All substitution methods yielded negative associations; however, statistical significance for the association was not achieved using substitution by zero or when considering only the complete cases. The association was quite comparable with the substitution of left-censored values by LOD, LOD/2, and LOD/√2. Conclusion: Substantial loss of information is inevitable if only the data with values above the LOD are considered for analysis or when

  16. Statistical interpretation of machine learning-based feature importance scores for biomarker discovery.

    Science.gov (United States)

    Huynh-Thu, Vân Anh; Saeys, Yvan; Wehenkel, Louis; Geurts, Pierre

    2012-07-01

    Univariate statistical tests are widely used for biomarker discovery in bioinformatics. These procedures are simple, fast and their output is easily interpretable by biologists but they can only identify variables that provide a significant amount of information in isolation from the other variables. As biological processes are expected to involve complex interactions between variables, univariate methods thus potentially miss some informative biomarkers. Variable relevance scores provided by machine learning techniques, however, are potentially able to highlight multivariate interacting effects, but unlike the p-values returned by univariate tests, these relevance scores are usually not statistically interpretable. This lack of interpretability hampers the determination of a relevance threshold for extracting a feature subset from the rankings and also prevents the wide adoption of these methods by practicians. We evaluated several, existing and novel, procedures that extract relevant features from rankings derived from machine learning approaches. These procedures replace the relevance scores with measures that can be interpreted in a statistical way, such as p-values, false discovery rates, or family wise error rates, for which it is easier to determine a significance level. Experiments were performed on several artificial problems as well as on real microarray datasets. Although the methods differ in terms of computing times and the tradeoff, they achieve in terms of false positives and false negatives, some of them greatly help in the extraction of truly relevant biomarkers and should thus be of great practical interest for biologists and physicians. As a side conclusion, our experiments also clearly highlight that using model performance as a criterion for feature selection is often counter-productive. Python source codes of all tested methods, as well as the MATLAB scripts used for data simulation, can be found in the Supplementary Material.

  17. Body Mass Index Genetic Risk Score and Endometrial Cancer Risk.

    Directory of Open Access Journals (Sweden)

    Jennifer Prescott

    Full Text Available Genome-wide association studies (GWAS have identified common variants that predispose individuals to a higher body mass index (BMI, an independent risk factor for endometrial cancer. Composite genotype risk scores (GRS based on the joint effect of published BMI risk loci were used to explore whether endometrial cancer shares a genetic background with obesity. Genotype and risk factor data were available on 3,376 endometrial cancer case and 3,867 control participants of European ancestry from the Epidemiology of Endometrial Cancer Consortium GWAS. A BMI GRS was calculated by summing the number of BMI risk alleles at 97 independent loci. For exploratory analyses, additional GRSs were based on subsets of risk loci within putative etiologic BMI pathways. The BMI GRS was statistically significantly associated with endometrial cancer risk (P = 0.002. For every 10 BMI risk alleles a woman had a 13% increased endometrial cancer risk (95% CI: 4%, 22%. However, after adjusting for BMI, the BMI GRS was no longer associated with risk (per 10 BMI risk alleles OR = 0.99, 95% CI: 0.91, 1.07; P = 0.78. Heterogeneity by BMI did not reach statistical significance (P = 0.06, and no effect modification was noted by age, GWAS Stage, study design or between studies (P≥0.58. In exploratory analyses, the GRS defined by variants at loci containing monogenic obesity syndrome genes was associated with reduced endometrial cancer risk independent of BMI (per BMI risk allele OR = 0.92, 95% CI: 0.88, 0.96; P = 2.1 x 10-5. Possessing a large number of BMI risk alleles does not increase endometrial cancer risk above that conferred by excess body weight among women of European descent. Thus, the GRS based on all current established BMI loci does not provide added value independent of BMI. Future studies are required to validate the unexpected observed relation between monogenic obesity syndrome genetic variants and endometrial cancer risk.

  18. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk.

    Science.gov (United States)

    Fung, T T; Rimm, E B; Spiegelman, D; Rifai, N; Tofler, G H; Willett, W C; Hu, F B

    2001-01-01

    Although the effects of individual foods or nutrients on the development of diseases and their risk factors have been investigated in many studies, little attention has been given to the effect of overall dietary patterns. Our objective was to examine the associations of 2 major dietary patterns, Western and prudent, with biomarkers of obesity and cardiovascular disease (CVD) risk. We used factor analysis to define major dietary patterns for a subsample of men (n = 466) from the Health Professionals Follow-up Study by using dietary information collected from food-frequency questionnaires (FFQs) in 1994. We calculated partial correlation coefficients between pattern scores and biomarker values adjusted for age, smoking status, energy and alcohol intake, physical activity, hours of television watching, and body mass index. We derived 2 major dietary patterns that were generally reproducible over time. The first pattern (prudent) was characterized by higher intakes of fruit, vegetables, whole grains, and poultry. The second pattern (Western) was characterized by higher intakes of red meats, high-fat dairy products, and refined grains. Using pattern scores from 1994 and adjusting for potential confounders, we found significant positive correlations between the Western pattern and insulin, C-peptide, leptin, and homocysteine concentrations, and an inverse correlation with plasma folate concentrations. The prudent pattern was positively correlated with plasma folate and inversely correlated with insulin and homocysteine concentrations. Major dietary patterns are predictors of plasma biomarkers of CVD and obesity risk, suggesting that the effect of overall diet on CVD risk may be mediated through these biomarkers.

  19. Modeling Linkage Disequilibrium Increases Accuracy of Polygenic Risk Scores

    NARCIS (Netherlands)

    Vilhjálmsson, Bjarni J.; Yang, Jian; Finucane, Hilary K.; Gusev, Alexander; Lindström, Sara; Ripke, Stephan; Genovese, Giulio; Loh, Po-Ru; Bhatia, Gaurav; Do, Ron; Hayeck, Tristan; Won, Hong-Hee; Kathiresan, Sekar; Pato, Michele; Pato, Carlos; Tamimi, Rulla; Stahl, Eli; Zaitlen, Noah; Pasaniuc, Bogdan; Belbin, Gillian; Kenny, Eimear E.; Schierup, Mikkel H.; de Jager, Philip; Patsopoulos, Nikolaos A.; McCarroll, Steve; Daly, Mark; Purcell, Shaun; Chasman, Daniel; Neale, Benjamin; Goddard, Michael; Visscher, Peter M.; Kraft, Peter; Patterson, Nick; Price, Alkes L.; Neale, Benjamin M.; Corvin, Aiden; Walters, James T. R.; Farh, Kai-How; Holmans, Peter A.; Lee, Phil; Bulik-Sullivan, Brendan; Collier, David A.; Huang, Hailiang; Pers, Tune H.; Agartz, Ingrid; Agerbo, Esben; Albus, Margot; Alexander, Madeline; Amin, Farooq; Bacanu, Silviu A.; Begemann, Martin; Belliveau, Richard A.; Bene, Judit; Bergen, Sarah E.; Bevilacqua, Elizabeth; Bigdeli, Tim B.; Black, Donald W.; Bruggeman, Richard; Buccola, Nancy G.; Buckner, Randy L.; Byerley, William; Cahn, Wiepke; Cai, Guiqing; Campion, Dominique; Cantor, Rita M.; Carr, Vaughan J.; Carrera, Noa; Catts, Stanley V.; Chambert, Kimberly D.; Chan, Raymond C. K.; Chen, Ronald Y. L.; Chen, Eric Y. H.; Cheng, Wei; Cheung, Eric F. C.; Chong, Siow Ann; Cloninger, C. Robert; Cohen, David; Cohen, Nadine; Cormican, Paul; Craddock, Nick; Crowley, James J.; Curtis, David; Davidson, Michael; Davis, Kenneth L.; Degenhardt, Franziska; del Favero, Jurgen; DeLisi, Lynn E.; Demontis, Ditte; Dikeos, Dimitris; Dinan, Timothy; Djurovic, Srdjan; Donohoe, Gary; Drapeau, Elodie; Duan, Jubao; Dudbridge, Frank; Durmishi, Naser; Eichhammer, Peter; Eriksson, Johan; Escott-Price, Valentina; Essioux, Laurent; Fanous, Ayman H.; Farrell, Martilias S.; Frank, Josef; Franke, Lude; Freedman, Robert; Freimer, Nelson B.; Friedl, Marion; Friedman, Joseph I.; Fromer, Menachem; Georgieva, Lyudmila; Gershon, Elliot S.; Giegling, Ina; Giusti-Rodrguez, Paola; Godard, Stephanie; Goldstein, Jacqueline I.; Golimbet, Vera; Gopal, Srihari; Gratten, Jacob; Grove, Jakob; de Haan, Lieuwe; Hammer, Christian; Hamshere, Marian L.; Hansen, Mark; Hansen, Thomas; Haroutunian, Vahram; Hartmann, Annette M.; Henskens, Frans A.; Herms, Stefan; Hirschhorn, Joel N.; Hoffmann, Per; Hofman, Andrea; Hollegaard, Mads V.; Hougaard, David M.; Ikeda, Masashi; Joa, Inge; Julia, Antonio; Kahn, Rene S.; Kalaydjieva, Luba; Karachanak-Yankova, Sena; Karjalainen, Juha; Kavanagh, David; Keller, Matthew C.; Kelly, Brian J.; Kennedy, James L.; Khrunin, Andrey; Kim, Yunjung; Klovins, Janis; Knowles, James A.; Konte, Bettina; Kucinskas, Vaidutis; Kucinskiene, Zita Ausrele; Kuzelova-Ptackova, Hana; Kahler, Anna K.; Laurent, Claudine; Keong, Jimmy Lee Chee; Lee, S. Hong; Legge, Sophie E.; Lerer, Bernard; Li, Miaoxin; Li, Tao; Liang, Kung-Yee; Lieberman, Jeffrey; Limborska, Svetlana; Loughland, Carmel M.; Lubinski, Jan; Lnnqvist, Jouko; Macek, Milan; Magnusson, Patrik K. E.; Maher, Brion S.; Maier, Wolfgang; Mallet, Jacques; Marsal, Sara; Mattheisen, Manuel; Mattingsdal, Morten; McCarley, Robert W.; McDonald, Colm; McIntosh, Andrew M.; Meier, Sandra; Meijer, Carin J.; Melegh, Bela; Melle, Ingrid; Mesholam-Gately, Raquelle I.; Metspalu, Andres; Michie, Patricia T.; Milani, Lili; Milanova, Vihra; Mokrab, Younes; Morris, Derek W.; Mors, Ole; Mortensen, Preben B.; Murphy, Kieran C.; Murray, Robin M.; Myin-Germeys, Inez; Mller-Myhsok, Bertram; Nelis, Mari; Nenadic, Igor; Nertney, Deborah A.; Nestadt, Gerald; Nicodemus, Kristin K.; Nikitina-Zake, Liene; Nisenbaum, Laura; Nordin, Annelie; O'Callaghan, Eadbhard; O'Dushlaine, Colm; O'Neill, F. Anthony; Oh, Sang-Yun; Olincy, Ann; Olsen, Line; van Os, Jim; Pantelis, Christos; Papadimitriou, George N.; Papiol, Sergi; Parkhomenko, Elena; Pato, Michele T.; Paunio, Tiina; Pejovic-Milovancevic, Milica; Perkins, Diana O.; Pietilinen, Olli; Pimm, Jonathan; Pocklington, Andrew J.; Powell, John; Price, Alkes; Pulver, Ann E.; Purcell, Shaun M.; Quested, Digby; Rasmussen, Henrik B.; Reichenberg, Abraham; Reimers, Mark A.; Richards, Alexander L.; Roffman, Joshua L.; Roussos, Panos; Ruderfer, Douglas M.; Salomaa, Veikko; Sanders, Alan R.; Schall, Ulrich; Schubert, Christian R.; Schulze, Thomas G.; Schwab, Sibylle G.; Scolnick, Edward M.; Scott, Rodney J.; Seidman, Larry J.; Shi, Jianxin; Sigurdsson, Engilbert; Silagadze, Teimuraz; Silverman, Jeremy M.; Sim, Kang; Slominsky, Petr; Smoller, Jordan W.; So, Hon-Cheong; Spencer, Chris C. A.; Stahl, Eli A.; Stefansson, Hreinn; Steinberg, Stacy; Stogmann, Elisabeth; Straub, Richard E.; Strengman, Eric; Strohmaier, Jana; Stroup, T. Scott; Subramaniam, Mythily; Suvisaari, Jaana; Svrakic, Dragan M.; Szatkiewicz, Jin P.; Sderman, Erik; Thirumalai, Srinivas; Toncheva, Draga; Tooney, Paul A.; Tosato, Sarah; Veijola, Juha; Waddington, John; Walsh, Dermot; Wang, Dai; Wang, Qiang; Webb, Bradley T.; Weiser, Mark; Wildenauer, Dieter B.; Williams, Nigel M.; Williams, Stephanie; Witt, Stephanie H.; Wolen, Aaron R.; Wong, Emily H. M.; Wormley, Brandon K.; Wu, Jing Qin; Xi, Hualin Simon; Zai, Clement C.; Zheng, Xuebin; Zimprich, Fritz; Wray, Naomi R.; Stefansson, Kari; Adolfsson, Rolf; Andreassen, Ole A.; Blackwood, Douglas H. R.; Bramon, Elvira; Buxbaum, Joseph D.; Børglum, Anders D.; Cichon, Sven; Darvasi, Ariel; Domenici, Enrico; Ehrenreich, Hannelore; Esko, Tonu; Gejman, Pablo V.; Gill, Michael; Gurling, Hugh; Hultman, Christina M.; Iwata, Nakao; Jablensky, Assen V.; Jonsson, Erik G.; Kendler, Kenneth S.; Kirov, George; Knight, Jo; Lencz, Todd; Levinson, Douglas F.; Li, Qingqin S.; Liu, Jianjun; Malhotra, Anil K.; McCarroll, Steven A.; McQuillin, Andrew; Moran, Jennifer L.; Mowry, Bryan J.; Nthen, Markus M.; Ophoff, Roel A.; Owen, Michael J.; Palotie, Aarno; Pato, Carlos N.; Petryshen, Tracey L.; Posthuma, Danielle; Rietschel, Marcella; Riley, Brien P.; Rujescu, Dan; Sham, Pak C.; Sklar, Pamela; St Clair, David; Weinberger, Daniel R.; Wendland, Jens R.; Werge, Thomas; Daly, Mark J.; Sullivan, Patrick F.; O'Donovan, Michael C.; Hunter, David J.; Adank, Muriel; Ahsan, Habibul; Aittomäki, Kristiina; Baglietto, Laura; Berndt, Sonja; Blomquist, Carl; Canzian, Federico; Chang-Claude, Jenny; Chanock, Stephen J.; Crisponi, Laura; Czene, Kamila; Dahmen, Norbert; Silva, Isabel Dos Santos; Easton, Douglas; Eliassen, A. Heather; Figueroa, Jonine; Fletcher, Olivia; Garcia-Closas, Montserrat; Gaudet, Mia M.; Gibson, Lorna; Haiman, Christopher A.; Hall, Per; Hazra, Aditi; Hein, Rebecca; Henderson, Brian E.; Hofman, Albert; Hopper, John L.; Irwanto, Astrid; Johansson, Mattias; Kaaks, Rudolf; Kibriya, Muhammad G.; Lichtner, Peter; Lund, Eiliv; Makalic, Enes; Meindl, Alfons; Meijers-Heijboer, Hanne; Müller-Myhsok, Bertram; Muranen, Taru A.; Nevanlinna, Heli; Peeters, Petra H.; Peto, Julian; Prentice, Ross L.; Rahman, Nazneen; Sánchez, María José; Schmidt, Daniel F.; Schmutzler, Rita K.; Southey, Melissa C.; Travis, Ruth; Turnbull, Clare; Uitterlinden, Andre G.; van der Luijt, Rob B.; Waisfisz, Quinten; Wang, Zhaoming; Whittemore, Alice S.; Yang, Rose; Zheng, Wei

    2015-01-01

    Polygenic risk scores have shown great promise in predicting complex disease risk and will become more accurate as training sample sizes increase. The standard approach for calculating risk scores involves linkage disequilibrium (LD)-based marker pruning and applying a p value threshold to

  20. RISKS MANAGEMENT. A PROPENSITY SCORE APPLICATION

    Directory of Open Access Journals (Sweden)

    Constangioara Alexandru

    2008-05-01

    Full Text Available Risk management is relatively unexplored in Romania. Although Romanian specialists dwell on theoretical aspects such as the risks classification and the important distinction between risks and uncertainty the practical relevance of the matter is outside existing studies. Present paper uses a dataset of consumer data to build a propensity scorecard based on relevant quantitative modeling.

  1. Apolipoprotein E genotype, cardiovascular biomarkers and risk of stroke

    DEFF Research Database (Denmark)

    Khan, Tauseef A; Shah, Tina; Prieto, David

    2013-01-01

    At the APOE gene, encoding apolipoprotein E, genotypes of the ε2/ε3/ε4 alleles associated with higher LDL-cholesterol (LDL-C) levels are also associated with higher coronary risk. However, the association of APOE genotype with other cardiovascular biomarkers and risk of ischaemic stroke is less c...

  2. Evaluation of Cardiovascular Risk Scores Applied to NASA's Astronant Corps

    Science.gov (United States)

    Jain, I.; Charvat, J. M.; VanBaalen, M.; Lee, L.; Wear, M. L.

    2014-01-01

    In an effort to improve cardiovascular disease (CVD) risk prediction, this analysis evaluates and compares the applicability of multiple CVD risk scores to the NASA Astronaut Corps which is extremely healthy at selection.

  3. Genetic Risk Score for Essential Hypertension and Risk of Preeclampsia.

    Science.gov (United States)

    Smith, Caitlin J; Saftlas, Audrey F; Spracklen, Cassandra N; Triche, Elizabeth W; Bjonnes, Andrew; Keating, Brendan; Saxena, Richa; Breheny, Patrick J; Dewan, Andrew T; Robinson, Jennifer G; Hoh, Josephine; Ryckman, Kelli K

    2016-01-01

    Preeclampsia is a hypertensive complication of pregnancy characterized by novel onset of hypertension after 20 weeks gestation, accompanied by proteinuria. Epidemiological evidence suggests that genetic susceptibility exists for preeclampsia; however, whether preeclampsia is the result of underlying genetic risk for essential hypertension has yet to be investigated. Based on the hypertensive state that is characteristic of preeclampsia, we aimed to determine if established genetic risk scores (GRSs) for hypertension and blood pressure are associated with preeclampsia. Subjects consisted of 162 preeclamptic cases and 108 normotensive pregnant controls, all of Iowa residence. Subjects' DNA was extracted from buccal swab samples and genotyped on the Affymetrix Genome-wide Human SNP Array 6.0 (Affymetrix, Santa Clara, CA). Missing genotypes were imputed using MaCH and Minimac software. GRSs were calculated for hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) using established genetic risk loci for each outcome. Regression analyses were performed to determine the association between GRS and risk of preeclampsia. These analyses were replicated in an independent US population of 516 cases and 1,097 controls of European ancestry. GRSs for hypertension, SBP, DBP, and MAP were not significantly associated with risk for preeclampsia (P > 0.189). The results of the replication analysis also yielded nonsignificant associations. GRSs for hypertension and blood pressure are not associated with preeclampsia, suggesting that an underlying predisposition to essential hypertension is not on the causal pathway of preeclampsia. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  4. Biomarkers, lactate, and clinical scores as outcome predictors in systemic poisons exposures.

    Science.gov (United States)

    Lionte, C; Sorodoc, V; Tuchilus, C; Cimpoiesu, D; Jaba, E

    2017-07-01

    Acute exposure to systemic poisons represents an important challenge in clinical toxicology. We aimed to analyze the potential role of cardiac biomarkers, routine laboratory tests, and clinical scores as morbidity and in-hospital mortality predictors in patients intoxicated with various systemic poisons. We conducted a prospective study on adults acutely exposed to systemic poisons. We determined the PSS, Glasgow Coma Scale (GCS), and we performed electrocardiogram, laboratory tests, lactate and cardiac biomarkers (which were reassessed 4 h, respectively 6 h later). Of 120 patients included, 45% developed complications, 19.2% had a poor outcome, and 5% died. Multivariate logistic regression sustained lactate (odds ratio (OR) 1.58; confidence interval (CI) 95%: 0.97-2.59; p 0.066), MB isoenzyme of creatine kinase (6h-CKMB; OR 1.08; CI 95%: 1.02-1.16; p 0.018) as predictors for a poor outcome. A GCS poisons exposure. Receiver operating characteristic analysis showed that brain natriuretic peptide (area under the curve (AUC), 0.96; CI 95%: 0.92-0.99; p poisons exposure.

  5. Credit scores, cardiovascular disease risk, and human capital.

    Science.gov (United States)

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E

    2014-12-02

    Credit scores are the most widely used instruments to assess whether or not a person is a financial risk. Credit scoring has been so successful that it has expanded beyond lending and into our everyday lives, even to inform how insurers evaluate our health. The pervasive application of credit scoring has outpaced knowledge about why credit scores are such useful indicators of individual behavior. Here we test if the same factors that lead to poor credit scores also lead to poor health. Following the Dunedin (New Zealand) Longitudinal Study cohort of 1,037 study members, we examined the association between credit scores and cardiovascular disease risk and the underlying factors that account for this association. We find that credit scores are negatively correlated with cardiovascular disease risk. Variation in household income was not sufficient to account for this association. Rather, individual differences in human capital factors—educational attainment, cognitive ability, and self-control—predicted both credit scores and cardiovascular disease risk and accounted for ∼45% of the correlation between credit scores and cardiovascular disease risk. Tracing human capital factors back to their childhood antecedents revealed that the characteristic attitudes, behaviors, and competencies children develop in their first decade of life account for a significant portion (∼22%) of the link between credit scores and cardiovascular disease risk at midlife. We discuss the implications of these findings for policy debates about data privacy, financial literacy, and early childhood interventions.

  6. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults.

    Science.gov (United States)

    Whalen, Kristine A; McCullough, Marjorie L; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

    2016-06-01

    Chronic inflammation and oxidative balance are associated with poor diet quality and risk of cancer and other chronic diseases. A diet-inflammation/oxidative balance association may relate to evolutionary discordance. We investigated associations between 2 diet pattern scores, the Paleolithic and the Mediterranean, and circulating concentrations of 2 related biomarkers, high-sensitivity C-reactive protein (hsCRP), an acute inflammatory protein, and F2-isoprostane, a reliable marker of in vivo lipid peroxidation. In a pooled cross-sectional study of 30- to 74-y-old men and women in an elective outpatient colonoscopy population (n = 646), we created diet scores from responses on Willett food-frequency questionnaires and measured plasma hsCRP and F2-isoprostane concentrations by ELISA and gas chromatography-mass spectrometry, respectively. Both diet scores were calculated and categorized into quintiles, and their associations with biomarker concentrations were estimated with the use of general linear models to calculate and compare adjusted geometric means, and via unconditional ordinal logistic regression. There were statistically significant trends for decreasing geometric mean plasma hsCRP and F2-isoprostane concentrations with increasing quintiles of the Paleolithic and Mediterranean diet scores. The multivariable-adjusted ORs comparing those in the highest with those in the lowest quintiles of the Paleolithic and Mediterranean diet scores were 0.61 (95% CI: 0.36, 1.05; P-trend = 0.06) and 0.71 (95% CI: 0.42, 1.20; P-trend = 0.01), respectively, for a higher hsCRP concentration, and 0.51 (95% CI: 0.27, 0.95; P-trend 0.01) and 0.39 (95% CI: 0.21, 0.73; P-trend = 0.01), respectively, for a higher F2-isoprostane concentration. These findings suggest that diets that are more Paleolithic- or Mediterranean-like may be associated with lower levels of systemic inflammation and oxidative stress in humans. © 2016 American Society for Nutrition.

  7. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults123

    Science.gov (United States)

    McCullough, Marjorie L; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

    2016-01-01

    Background: Chronic inflammation and oxidative balance are associated with poor diet quality and risk of cancer and other chronic diseases. A diet–inflammation/oxidative balance association may relate to evolutionary discordance. Objective: We investigated associations between 2 diet pattern scores, the Paleolithic and the Mediterranean, and circulating concentrations of 2 related biomarkers, high-sensitivity C-reactive protein (hsCRP), an acute inflammatory protein, and F2-isoprostane, a reliable marker of in vivo lipid peroxidation. Methods: In a pooled cross-sectional study of 30- to 74-y-old men and women in an elective outpatient colonoscopy population (n = 646), we created diet scores from responses on Willett food-frequency questionnaires and measured plasma hsCRP and F2-isoprostane concentrations by ELISA and gas chromatography–mass spectrometry, respectively. Both diet scores were calculated and categorized into quintiles, and their associations with biomarker concentrations were estimated with the use of general linear models to calculate and compare adjusted geometric means, and via unconditional ordinal logistic regression. Results: There were statistically significant trends for decreasing geometric mean plasma hsCRP and F2-isoprostane concentrations with increasing quintiles of the Paleolithic and Mediterranean diet scores. The multivariable-adjusted ORs comparing those in the highest with those in the lowest quintiles of the Paleolithic and Mediterranean diet scores were 0.61 (95% CI: 0.36, 1.05; P-trend = 0.06) and 0.71 (95% CI: 0.42, 1.20; P-trend = 0.01), respectively, for a higher hsCRP concentration, and 0.51 (95% CI: 0.27, 0.95; P-trend 0.01) and 0.39 (95% CI: 0.21, 0.73; P-trend = 0.01), respectively, for a higher F2-isoprostane concentration. Conclusion: These findings suggest that diets that are more Paleolithic- or Mediterranean-like may be associated with lower levels of systemic inflammation and oxidative stress in humans. PMID

  8. Clinical Risk Assessment in the Antiphospholipid Syndrome: Current Landscape and Emerging Biomarkers.

    Science.gov (United States)

    Chaturvedi, Shruti; McCrae, Keith R

    2017-07-01

    Laboratory criteria for the classification of antiphospholipid syndrome include the detection of a lupus anticoagulant and/or anticardiolipin and anti-β2-glycoprotein I antibodies. However, the majority of patients who test positive in these assays do not have thrombosis. Current risk-stratification tools are largely limited to the antiphospholipid antibody profile and traditional thrombotic risk factors. Novel biomarkers that correlate with disease activity and potentially provide insight into future clinical events include domain 1 specific anti-β 2 GPI antibodies, antibodies to other phospholipids or phospholipid/protein antigens (such as anti-PS/PT), and functional/biological assays such as thrombin generation, complement activation, levels of circulating microparticles, and annexin A5 resistance. Clinical risk scores may also have value in predicting clinical events. Biomarkers that predict thrombosis risk in patients with antiphospholipid antibodies have been long sought, and several biomarkers have been proposed. Ultimately, integration of biomarkers with established assays and clinical characteristics may offer the best chance of identifying patients at highest risk of APS-related complications.

  9. Clinical risk stratification optimizes value of biomarkers to predict new-onset heart failure in a community-based cohort.

    Science.gov (United States)

    Brouwers, Frank P; van Gilst, Wiek H; Damman, Kevin; van den Berg, Maarten P; Gansevoort, Ron T; Bakker, Stephan J L; Hillege, Hans L; van Veldhuisen, Dirk J; van der Harst, Pim; de Boer, Rudolf A

    2014-09-01

    We aim to identify and quantify the value of biomarkers for incident new-onset heart failure (HF) in a community-based cohort and subgroups based on cardiovascular risk and evaluate the prognostic value of 13 biomarkers for HF with reduced and preserved ejection fraction. Thirteen biomarkers reflecting diverse pathophysiologic domains were examined in 8569 HF-free participants in Prevention of Vascular and Renal Endstage Disease (mean age, 49 years; 50% men). Subjects were categorized in 2 risk groups based on cardiovascular history. Incremental value per biomarker was assessed using Harrell C-indices. One hundred sixty-eight subjects (2.4%) were diagnosed with new-onset HF in the low-risk group (n=6915; Framingham Risk Score, 5.9%) and 206 (12.2%) subjects in the high-risk group (n=1654; Framingham Risk Score, 18.6%). The association of natriuretic peptides, adrenomedullin, endothelin, and galectin-3 with new-onset HF was stronger in the high-risk group (all Prisk for new-onset HF between both risk groups. The best model for new-onset HF included the combination of N-terminal pro-B-type natriuretic peptide, troponin-T, and urinary albumin excretion, increasing model accuracy to 0.81 (9.5%, Prisk group. Except for a modest effect of cystatin-C, no biomarker was associated with increased risk for HF with preserved ejection fraction. Risk stratification increases the incremental value per biomarker to predict new-onset HF, especially HF with reduced ejection fraction. We suggest that routine biomarker testing should be limited to the use of natriuretic peptides and troponin-T in patients with increased cardiovascular risk. © 2014 American Heart Association, Inc.

  10. Thrombotic risk assessment in APS: the Global APS Score (GAPSS).

    Science.gov (United States)

    Sciascia, S; Bertolaccini, M L

    2014-10-01

    Recently, we developed a risk score for antiphospholipid syndrome (APS) (Global APS Score or GAPSS). This score derived from the combination of independent risk factors for thrombosis and pregnancy loss, taking into account the antiphospholipid antibodies (aPL) profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors, and the autoimmune antibodies profile. We demonstrate that risk profile in APS can be successfully assessed, suggesting that GAPSS can be a potential quantitative marker of APS-related clinical manifestations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. Fish bioaccumulation and biomarkers in environmental risk assessment : a review

    NARCIS (Netherlands)

    van der Oost, Ron; Beyer, Jonny; Vermeulen, Nico P E

    In this review, a wide array of bioaccumulation markers and biomarkers, used to demonstrate exposure to and effects of environmental contaminants, has been discussed in relation to their feasibility in environmental risk assessment (ERA). Fish bioaccumulation markers may be applied in order to

  12. Identification of clinically-informative biomarkers for risk stratification ...

    African Journals Online (AJOL)

    Background: Barrett's esophagus is the precursor of esophageal adenocarcinoma with a 5-year survival rate of 25-30%. Objective: To define clinically useful biomarkers for transcriptional profiling in South African patients with Barrett's esophagus in order to identify those patients with an increased cancer risk necessitating ...

  13. Placental Vascular Tree as Biomarker of Autism/ASD Risk

    Science.gov (United States)

    2011-09-01

    disk edge - differs significantly between autism /ASD cases and the University of North Carolina Pregnancy, Infection and Nutrition Study (UNC PIN... Autism /ASD Risk PRINCIPAL INVESTIGATOR: Carolyn M. Salafia, M.S., M.D. CONTRACTING...TITLE AND SUBTITLE 5a. CONTRACT NUMBER Placental Vascular Tree as Biomarker of Autism /ASD Risk 5b. GRANT NUMBER W81XWH-10-1-0626 5c. PROGRAM

  14. Predicting Prostate Biopsy Results Using a Panel of Plasma and Urine Biomarkers Combined in a Scoring System

    DEFF Research Database (Denmark)

    Albitar, Maher; Ma, Wanlong; Lund, Lars

    2016-01-01

    , and PTEN in plasma and urine. Patient age, serum prostate-specific antigen (sPSA) level, and biomarkers data were used to develop two independent algorithms, one for predicting the presence of PCa and the other for predicting high-grade PCa (Gleason score [GS] ≥7). RESULTS: Using training and validation...

  15. Hemostasis biomarkers and risk of sepsis: the REGARDS cohort.

    Science.gov (United States)

    Moore, J X; Zakai, N A; Mahalingam, M; Griffin, R L; Irvin, M R; Safford, M M; Baddley, J W; Wang, H E

    2016-11-01

    Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention. Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI

  16. Schizophrenia polygenic risk score predicts mnemonic hippocampal activity.

    Science.gov (United States)

    Chen, Qiang; Ursini, Gianluca; Romer, Adrienne L; Knodt, Annchen R; Mezeivtch, Karleigh; Xiao, Ena; Pergola, Giulio; Blasi, Giuseppe; Straub, Richard E; Callicott, Joseph H; Berman, Karen F; Hariri, Ahmad R; Bertolino, Alessandro; Mattay, Venkata S; Weinberger, Daniel R

    2018-02-03

    The use of polygenic risk scores has become a practical translational approach to investigating the complex genetic architecture of schizophrenia, but the link between polygenic risk scores and pathophysiological components of this disorder has been the subject of limited research. We investigated in healthy volunteers whether schizophrenia polygenic risk score predicts hippocampal activity during simple memory encoding, which has been proposed as a risk-associated intermediate phenotype of schizophrenia. We analysed the relationship between polygenic risk scores and hippocampal activity in a discovery sample of 191 unrelated healthy volunteers from the USA and in two independent replication samples of 76 and 137 healthy unrelated participants from Europe and the USA, respectively. Polygenic risk scores for each individual were calculated as the sum of the imputation probability of reference alleles weighted by the natural log of odds ratio from the recent schizophrenia genome-wide association study. We examined hippocampal activity during simple memory encoding of novel visual stimuli assessed using blood oxygen level-dependent functional MRI. Polygenic risk scores were significantly associated with hippocampal activity in the discovery sample [P = 0.016, family-wise error (FWE) corrected within Anatomical Automatic Labeling (AAL) bilateral hippocampal-parahippocampal mask] and in both replication samples (P = 0.033, FWE corrected within AAL right posterior hippocampal-parahippocampal mask in Bari sample, and P = 0.002 uncorrected in the Duke Neurogenetics Study sample). The relationship between polygenic risk scores and hippocampal activity was consistently negative, i.e. lower hippocampal activity in individuals with higher polygenic risk scores, consistent with previous studies reporting decreased hippocampal-parahippocampal activity during declarative memory tasks in patients with schizophrenia and in their healthy siblings. Polygenic risk scores accounted for

  17. Risk score for contrast induced nephropathy following percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Ghani, Amal Abdel; Tohamy, Khalid Y.

    2009-01-01

    Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 micron mol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score ( 1 2). The developed CIN model demonstrated good discriminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multicenter trials. (author)

  18. Cardiovascular risk assessment in Italy: the CUORE Project risk score and risk chart

    Directory of Open Access Journals (Sweden)

    Simona Giampaoli

    2007-06-01

    Full Text Available

    Aim: Risk charts and risk score, based on the global absolute risk, are key tools for CVD risk assessment. When applied to the population from which they derive, they provide the best estimate of CVD risk. That is why the CUORE Project has among its objectives the assessment of the Italian population’s cardiovascular risk, identifying the model for the prediction of coronary and cerebrovascular events in 10 years.

    Methods: Data fromdifferent cohorts enrolled in the North, Centre and South of Italy between the 1980s and the 1990s were used. From the 7,056 men and 12,574 women aged 35-69 years, free of cardiovascular disease at base-line and followed up for a mean time of 10 years for total and cause-specific mortality and non fatal cerebrovascular and coronary events, 894 major cardiovascular events (596 coronary and 298 cerebrovascular were identified and validated. To assess 10-year cardiovascular risk, the risk score and risk chart were developed for men and women separately, considering the first major coronary or cerebrovascular event as the endpoint.

    Results: The risk score is applied tomen andwomen aged 35-69 years and includes age, systolic blood pressure, total cholesterol, HDL-cholesterol, smoking habit, diabetes and hypertension treatment using continuous values when possible. The risk chart is applied to persons aged 40-69 years and includes the same risk factors as risk score, except for HDL-cholesterol and hypertension treatment, and uses categorical values for all variables.

    Conclusions: The risk score and risk chart are easy-to-use tools which enable general practitioners and specialists to achieve an objective evaluation of the absolute global cardiovascular risk of middle-aged persons in primary prevention.

  19. Genetic Predisposition to Ischemic Stroke: A Polygenic Risk Score.

    Science.gov (United States)

    Hachiya, Tsuyoshi; Kamatani, Yoichiro; Takahashi, Atsushi; Hata, Jun; Furukawa, Ryohei; Shiwa, Yuh; Yamaji, Taiki; Hara, Megumi; Tanno, Kozo; Ohmomo, Hideki; Ono, Kanako; Takashima, Naoyuki; Matsuda, Koichi; Wakai, Kenji; Sawada, Norie; Iwasaki, Motoki; Yamagishi, Kazumasa; Ago, Tetsuro; Ninomiya, Toshiharu; Fukushima, Akimune; Hozawa, Atsushi; Minegishi, Naoko; Satoh, Mamoru; Endo, Ryujin; Sasaki, Makoto; Sakata, Kiyomi; Kobayashi, Seiichiro; Ogasawara, Kuniaki; Nakamura, Motoyuki; Hitomi, Jiro; Kita, Yoshikuni; Tanaka, Keitaro; Iso, Hiroyasu; Kitazono, Takanari; Kubo, Michiaki; Tanaka, Hideo; Tsugane, Shoichiro; Kiyohara, Yutaka; Yamamoto, Masayuki; Sobue, Kenji; Shimizu, Atsushi

    2017-02-01

    The prediction of genetic predispositions to ischemic stroke (IS) may allow the identification of individuals at elevated risk and thereby prevent IS in clinical practice. Previously developed weighted multilocus genetic risk scores showed limited predictive ability for IS. Here, we investigated the predictive ability of a newer method, polygenic risk score (polyGRS), based on the idea that a few strong signals, as well as several weaker signals, can be collectively informative to determine IS risk. We genotyped 13 214 Japanese individuals with IS and 26 470 controls (derivation samples) and generated both multilocus genetic risk scores and polyGRS, using the same derivation data set. The predictive abilities of each scoring system were then assessed using 2 independent sets of Japanese samples (KyushuU and JPJM data sets). In both validation data sets, polyGRS was shown to be significantly associated with IS, but weighted multilocus genetic risk scores was not. Comparing the highest with the lowest polyGRS quintile, the odds ratios for IS were 1.75 (95% confidence interval, 1.33-2.31) and 1.99 (95% confidence interval, 1.19-3.33) in the KyushuU and JPJM samples, respectively. Using the KyushuU samples, the addition of polyGRS to a nongenetic risk model resulted in a significant improvement of the predictive ability (net reclassification improvement=0.151; P<0.001). The polyGRS was shown to be superior to weighted multilocus genetic risk scores as an IS prediction model. Thus, together with the nongenetic risk factors, polyGRS will provide valuable information for individual risk assessment and management of modifiable risk factors. © 2016 The Authors.

  20. Proteomic biomarkers of preterm birth risk in women with polycystic ovary syndrome (PCOS: a systematic review and biomarker database integration.

    Directory of Open Access Journals (Sweden)

    Nicolas Galazis

    Full Text Available BACKGROUND: Preterm Birth (PTB is a major cause of neonatal mortality and morbidity. Women with Polycystic Ovary Syndrome (PCOS are at high risk of PTB. There is a need for research studies to investigate the mechanisms linking PCOS and PTB, to facilitate screening, and develop novel preventative strategies. OBJECTIVE: To list all the proteomic biomarkers of PTB and integrate this list with the PCOS biomarker database to identify commonly expressed biomarkers of the two conditions. SEARCH STRATEGY: A systematic review of PTB biomarkers and update of PCOS biomarker database. All eligible published studies on proteomic biomarkers for PTB and PCOS identified through various databases were evaluated. SELECTION CRITERIA: For the identification of the relevant studies, the following search terms were used: "proteomics", "proteomic", "preterm birth", "preterm labour", "proteomic biomarker" and "polycystic ovary syndrome". This search was restricted to humans only DATA COLLECTION AND ANALYSIS: A database on proteomic biomarkers for PTB was created while an already existing PCOS biomarker database was updated. The two databases were integrated and biomarkers that were co-expressed in both women with PCOS and PTB were identified and investigated. RESULTS: A panel of six proteomic biomarkers was similarly differentially expressed in women with PTB and women with PCOS compared to their respective controls (normal age-matched women in the case of PCOS studies and women with term pregnancy in the case of PTB studies. These biomarkers include Pyruvate kinase M1/M2, Vimentin, Fructose bisphosphonate aldolase A, Heat shock protein beta-1, Peroxiredoxin-1 and Transferrin. CONCLUSIONS: These proteomic biomarkers (Pyruvate kinase M1/M2, Vimentin, Fructose bisphosphonate aldolase A, Heat shock protein beta-1, Peroxiredoxin-1 and Transferrin can be potentially used to better understand the pathophysiological mechanisms linking PCOS and PTB. This would help to

  1. Clinical risk stratification of acute pulmonary embolism: comparing the usefulness of CTA obstruction score and pulmonary perfusion defect score with dual-energy CT.

    Science.gov (United States)

    Kong, Wei-Fang; Wang, Yu-Ting; Yin, Long-Lin; Pu, Hong; Tao, Ke-Yan

    2017-12-01

    To compare the ability of CT angiography (CTA) obstruction score and perfusion defect score on dual energy CT perfusion imaging (DEPI) for clinical risk stratification of patients with acute pulmonary embolism (PE). 55 patients diagnosed as acute PE either by CTA or DEPI were retrospectively enrolled. Patients were grouped into high-, intermediate-, and low-risk groups in accordance to the renewed guidelines of 2014. Consistency between DEPI and CTA in diagnosis of PE were assessed. Correlations between CT parameters and right-to-left ventricular (RV/LV) diameter ratio were evaluated. Difference of CTA obstruction score and perfusion defect score across three groups with different risks were analyzed. The consistent rate of DEPI with CTA was 75.4%, and the Kappa value was 0.412 (p = 0.000). 44.3% of partially obstructive PE showed on CTA did not lead to perfusion defect on DEPI. Perfusion defect score was significantly correlated with CTA obstruction score and with RV/LV (r = 0.622 and 0.599, respectively, p Perfusion defect score could distinguish low- from intermediate-risk groups (p = 0.011). However, CTA obstruction score could not distinguish the two groups (p = 0.149). DEPI had fine consistency with CTA to diagnose acute PE and offered additional information of physiologic changes. Comparing with CTA obstruction score, perfusion defect score could better correlate with right ventricular dysfunction, and could be a more promising biomarker for clinical risk stratification.

  2. FRAX® Fracture Risks Are Associated with Coronary Artery Calcification Score

    Directory of Open Access Journals (Sweden)

    Tzyy-Ling Chuang

    2017-01-01

    Full Text Available Purpose. To examine the association between fracture risk assessment tool (FRAX scores and coronary artery calcification (CAC score in adults. Methods. The medical records of 81 adults who underwent both coronary computed tomography and bone mineral density (BMD studies in a package during their health exams were reviewed at a regional hospital in Southern Taiwan. Data collected included health history, anthropomorphic characteristics, clinical laboratory results, and BMD. Fracture risk was determined using FRAX. Univariate and multivariate linear regression analysis were used to assess the association between CAC score and 10-year probability of hip fracture (HF and major osteoporotic fracture (MOF determined by FRAX. Results. The mean age of the patients was 55.8 years, and 63.0% were male. Univariate linear regression analysis showed that increases in MOF and HF risks, as measured by FRAX, were significantly and positively associated with CAC score. Multiple linear regression analysis adjusting for potential confounders showed that CAC score remained significantly associated with four FRAX indicators, including right MOF (r=0.45, P<0.001, left MOF (r=0.31, P=0.021, right HF (r=0.38, P=0.001, and left HF (r=0.23, P=0.049. Conclusions. Increased risks of MOF and HF as determined by FRAX were significantly and independently associated with CAC score.

  3. Support Vector Hazards Machine: A Counting Process Framework for Learning Risk Scores for Censored Outcomes.

    Science.gov (United States)

    Wang, Yuanjia; Chen, Tianle; Zeng, Donglin

    2016-01-01

    Learning risk scores to predict dichotomous or continuous outcomes using machine learning approaches has been studied extensively. However, how to learn risk scores for time-to-event outcomes subject to right censoring has received little attention until recently. Existing approaches rely on inverse probability weighting or rank-based regression, which may be inefficient. In this paper, we develop a new support vector hazards machine (SVHM) approach to predict censored outcomes. Our method is based on predicting the counting process associated with the time-to-event outcomes among subjects at risk via a series of support vector machines. Introducing counting processes to represent time-to-event data leads to a connection between support vector machines in supervised learning and hazards regression in standard survival analysis. To account for different at risk populations at observed event times, a time-varying offset is used in estimating risk scores. The resulting optimization is a convex quadratic programming problem that can easily incorporate non-linearity using kernel trick. We demonstrate an interesting link from the profiled empirical risk function of SVHM to the Cox partial likelihood. We then formally show that SVHM is optimal in discriminating covariate-specific hazard function from population average hazard function, and establish the consistency and learning rate of the predicted risk using the estimated risk scores. Simulation studies show improved prediction accuracy of the event times using SVHM compared to existing machine learning methods and standard conventional approaches. Finally, we analyze two real world biomedical study data where we use clinical markers and neuroimaging biomarkers to predict age-at-onset of a disease, and demonstrate superiority of SVHM in distinguishing high risk versus low risk subjects.

  4. [Biomarkers of gentotoxic risk and metabolic polymorphism].

    Science.gov (United States)

    Pavanello, S; Clonfero, E

    2000-01-01

    This paper reviews studies published in the international scientific literature evaluating the influence of genetically based metabolic polymorphisms on biological indicators of genotoxic risk in environmental or occupational exposure. Exposures due to life style (i.e. diet or smoking) were not considered. Indicators are subdivided into internal dose indicators (concentration of the substance or its metabolites in biological fluids, urinary mutagenicity, adducts of hemoglobin, plasma proteins and DNA), and early biological effects (chromosome aberrations, sister chromatid exchanges, micronuclei, COMET assay, HPRT mutants). The metabolic genotypes (or phenotypes) examined by various authors are: ALDH2 (aldehyde dehydrogenase), CYP (P450 cytochrome) 1AI, CYP1A2, CYP2E1, CYP2D6, EPHX (epoxidohydrolase), NAT2 (N-acetyl transferase), NQO1 (NAD(P)H: kinone oxidoreductase), PON1 (paraoxonase), GST (glutathione S-transferase) M1, GSTT1 and GSTP1. In more than half the studies (52 out of 96), no influence of genotype was found in the biological indicator. This may be due either to the poor sensitivity of the indicator used, or to low exposure. In studies examining the effect of genotype on the indicator, the biological plausibility of the result was evaluated, i.e., whether the effect is consistent with the type of enzymatic activity expressed. Four studies reported not very reliable results and suggest either the unfavourable influence of genotype GSTM1 with high detoxifying activity, or enzymatic activity poorly involved in the metabolism of the xenobiotics in question (NAT2 in the case of PAH). As regards urinary metabolites of genotoxic agents, eight studies reported the modulating effect of genotype. The urinary excretion of mercapturic acids was greater in subjects with high GST activity. In exposure to PAH, urinary 1-pyrenol and PAH metabolites turn out to be significantly influenced by genotypes CYP1A1 or GSTM1 null; in exposure to aromatic amines, the influence of

  5. Validation of a new prognostic staging system for hepatocellular carcinoma: a comparison of the biomarker-combined Japan Integrated Staging Score, the conventional Japan Integrated Staging Score and the BALAD Score.

    Science.gov (United States)

    Kitai, Satoshi; Kudo, Masatoshi; Minami, Yasunori; Haji, Seiji; Osaki, Yukio; Oka, Hiroko; Seki, Toshihito; Kasugai, Hiroshi; Sasaki, Yo; Matsunaga, Takashi

    2008-01-01

    The conventional Japan Integrated Staging (c-JIS) score has been reported to effectively stratify patients with hepatocellular carcinoma (HCC). Recently, two new staging systems, the biomarker-combined JIS (bm-JIS) score and the BALAD score, have been proposed. Both staging systems include three tumor markers: alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP and des-gamma-carboxy prothrombin specific for HCC. The aim of this study is to evaluate the performance of these three staging systems. A total of 1,173 HCC patients were included in this study. The stratification ability and prognostic predictive power were compared between these three staging systems. These three staging systems effectively predicted the patient survival. When accounting for the best prognostic subgroup of each staging systems (i.e. score of 0), there were significant differences between the bm-JIS score and the BALAD score and, likewise, between the c-JIS score and the BALAD score. The likelihood ratio chi(2) test showed the highest value and the Akaike information criterion value was lowest in the bm-JIS score. The bm-JIS score showed good stratification ability and was thus demonstrated to be a better predictor of the prognosis than the c-JIS score and the BALAD score, especially for the patients with a good prognosis. Copyright 2008 S. Karger AG, Basel.

  6. A Soft Intelligent Risk Evaluation Model for Credit Scoring Classification

    Directory of Open Access Journals (Sweden)

    Mehdi Khashei

    2015-09-01

    Full Text Available Risk management is one of the most important branches of business and finance. Classification models are the most popular and widely used analytical group of data mining approaches that can greatly help financial decision makers and managers to tackle credit risk problems. However, the literature clearly indicates that, despite proposing numerous classification models, credit scoring is often a difficult task. On the other hand, there is no universal credit-scoring model in the literature that can be accurately and explanatorily used in all circumstances. Therefore, the research for improving the efficiency of credit-scoring models has never stopped. In this paper, a hybrid soft intelligent classification model is proposed for credit-scoring problems. In the proposed model, the unique advantages of the soft computing techniques are used in order to modify the performance of the traditional artificial neural networks in credit scoring. Empirical results of Australian credit card data classifications indicate that the proposed hybrid model outperforms its components, and also other classification models presented for credit scoring. Therefore, the proposed model can be considered as an appropriate alternative tool for binary decision making in business and finance, especially in high uncertainty conditions.

  7. High Framingham risk score decreases quality of life in adults

    Directory of Open Access Journals (Sweden)

    Christian Yosaputra

    2010-04-01

    Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.

  8. The fracture risk assessment tool (FRAX® score in subclinical hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Polovina Snežana

    2015-01-01

    Full Text Available Background/Aim. The Fracture Risk Assessment Tool (FRAX® score is the 10-year estimated risk calculation tool for bone fracture that includes clinical data and hip bone mineral density measured by dual-energy x-ray absorptiometry (DXA. The aim of this cross-sectional study was to elucidate the ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and post-menopausal women with subclinical hyperthyroidism. Methods. The bone mineral density (by DXA, thyroid stimulating hormone (TSH level, free thyroxine (fT4 level, thyroid peroxidase antibodies (TPOAb titre, osteocalcin and beta-cross-laps were measured in 27 pre- and post-menopausal women with newly discovered subclinical hyperthyroidism [age 58.85 ± 7.83 years, body mass index (BMI 27.89 ± 3.46 kg/m2, menopause onset in 46.88 ± 10.21 years] and 51 matched euthyroid controls (age 59.69 ± 5.72 years, BMI 27.68 ± 4.66 kg/m2, menopause onset in 48.53 ± 4.58 years. The etiology of subclinical hyperthyroisims was autoimmune thyroid disease or toxic goiter. FRAX® score calculation was performed in both groups. Results. In the group with subclinical hyperthyroidism the main FRAX® score was significantly higher than in the controls (6.50 ± 1.58 vs 4.35 ± 1.56 respectively; p = 0.015. The FRAX® score for hip was also higher in the evaluated group than in the controls (1.33 ± 3.92 vs 0.50 ± 0.46 respectively; p = 0.022. There was no correlations between low TSH and fracture risk (p > 0.05. The ability of the FRAX® score in discriminating between bone fracture positive and negative pre- and postmenopausal female subjects (p < 0.001 is presented by the area under the curve (AUC plotted via ROC analysis. The determined FRAX score cut-off value by this analysis was 6%, with estimated sensitivity and specificity of 95% and 75.9%, respectively. Conclusion. Pre- and postmenopausal women with subclinical hyperthyroidism have higher FRAX® scores and thus

  9. Omentin as a novel biomarker of metabolic risk factors

    Directory of Open Access Journals (Sweden)

    Shibata Rei

    2012-07-01

    Full Text Available Abstract Background Omentin is an adipocytokine that is abundantly expressed in visceral fat tissue. We investigated the association of omentin with the number of metabolic risk factors. Finding The study population comprised 201 Japanese men who underwent annual health checkups. Plasma omentin levels were determined by enzyme-linked immunosorbent assay. We divided the subjects into 4 groups according to omentin levels. A reduction of plasma omentin levels significantly correlated with an increase in the mean number of metabolic risk factors such as increased waist circumference, dyslipidemia, high blood pressure and glucose intolerance. Conclusions Circulating omentin levels negatively correlated with the multiplicity of metabolic risk factors, suggesting that omentin acts as a biomarker of metabolic disorders.

  10. Assessment of cardiovascular risk in patients with rheumatoid arthritis using the SCORE risk index.

    Science.gov (United States)

    de Campos, Otávio Augusto Martins; Nazário, Nazaré Otília; de Magalhães Souza Fialho, Sônia Cristina; Fialho, Guilherme Loureiro; de Oliveira, Fernando José Savóia; de Castro, Gláucio Ricardo Werner; Pereira, Ivânio Alves

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease that causes systemic involvement and is associated with increased risk of cardiovascular disease. To analyze the prediction index of 10-year risk of a fatal cardiovascular disease event in female RA patients versus controls. Case-control study with analysis of 100 female patients matched for age and gender versus 100 patients in the control group. For the prediction of 10-year risk of a fatal cardiovascular disease event, the SCORE and modified SCORE (mSCORE) risk indexes were used, as suggested by EULAR, in the subgroup with two or more of the following: duration of disease ≥10 years, RF and/or anti-CCP positivity, and extra-articular manifestations. The prevalence of analyzed comorbidities was similar in RA patients compared with the control group (p>0.05). The means of the SCORE risk index in RA patients and in the control group were 1.99 (SD: 1.89) and 1.56 (SD: 1.87) (p=0.06), respectively. The means of mSCORE index in RA patients and in the control group were 2.84 (SD=2.86) and 1.56 (SD=1.87) (p=0.001), respectively. By using the SCORE risk index, 11% of RA patients were classified as of high risk, and with the use of mSCORE risk index, 36% were at high risk (p<0.001). The SCORE risk index is similar in both groups, but with the application of the mSCORE index, we recognized that RA patients have a higher 10-year risk of a fatal cardiovascular disease event, and this reinforces the importance of factors inherent to the disease not measured in the SCORE risk index, but considered in mSCORE risk index. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  11. A Novel Risk Scoring System Reliably Predicts Readmission Following Pancreatectomy

    Science.gov (United States)

    Valero, Vicente; Grimm, Joshua C.; Kilic, Arman; Lewis, Russell L.; Tosoian, Jeffrey J.; He, Jin; Griffin, James; Cameron, John L.; Weiss, Matthew J.; Vollmer, Charles M.; Wolfgang, Christopher L.

    2015-01-01

    Background Postoperative readmissions have been proposed by Medicare as a quality metric and may impact provider reimbursement. Since readmission following pancreatectomy is common, we sought to identify factors associated with readmission in order to establish a predictive risk scoring system (RSS). Study Design A retrospective analysis of 2,360 pancreatectomies performed at nine, high-volume pancreatic centers between 2005 and 2011 was performed. Forty-five factors strongly associated with readmission were identified. To derive and validate a RSS, the population was randomly divided into two cohorts in a 4:1 fashion. A multivariable logistic regression model was constructed and scores were assigned based on the relative odds ratio of each independent predictor. A composite Readmission After Pancreatectomy (RAP) score was generated and then stratified to create risk groups. Results Overall, 464 (19.7%) patients were readmitted within 90-days. Eight pre- and postoperative factors, including prior myocardial infarction (OR 2.03), ASA Class ≥ 3 (OR 1.34), dementia (OR 6.22), hemorrhage (OR 1.81), delayed gastric emptying (OR 1.78), surgical site infection (OR 3.31), sepsis (OR 3.10) and short length of stay (OR 1.51), were independently predictive of readmission. The 32-point RAP score generated from the derivation cohort was highly predictive of readmission in the validation cohort (AUC 0.72). The low (0-3), intermediate (4-7) and high risk (>7) groups correlated to 11.7%, 17.5% and 45.4% observed readmission rates, respectively (ppancreatectomy. Identification of patients with increased risk of readmission using the RAP score will allow efficient resource allocation aimed to attenuate readmission rates. It also has potential to serve as a new metric for comparative research and quality assessment. PMID:25797757

  12. Relation Between a Simple Lifestyle Risk Score and Established Biological Risk Factors for Cardiovascular Disease.

    Science.gov (United States)

    Lévesque, Valérie; Poirier, Paul; Després, Jean-Pierre; Alméras, Natalie

    2017-12-01

    Although cardiovascular disease (CVD) and diabetes mellitus are largely lifestyle driven, lifestyle metrics are not used in clinical practice. This study examined the relevance of using a simple lifestyle risk score designed for primary care medicine by testing its ability to predict biological CVD risk factors in a cohort of 3,712 individuals involved in a workplace health evaluation or management program ("Grand Défi Entreprise" project). Using a lifestyle risk score based on waist circumference, fitness, nutritional quality, and physical activity level, employees were categorized into 3 distinct estimated lifestyle risk levels (low, intermediate, and high). A biological CVD risk score was also calculated, which included high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), cholesterol-to-HDL-C ratio, blood pressure, hemoglobin glycated levels, and medication use. Diastolic blood pressure, TG levels, and the cholesterol-to-HDL-C ratio increased across categories of lifestyle risk score, whereas HDL-C decreased (p <0.05). Calculated Framingham and diabetes risk scores as well as the prevalence of hypertriglyceridemic waist phenotype also increased across categories of lifestyle risk score (p <0.05). Finally, 1-way analysis of variance revealed that the biological risk score significantly increased across the lifestyle risk score categories (p <0.0001). Our study provides evidence that lifestyle variables can be measured and targeted in clinical practice. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. A robust gene expression-based prognostic risk score predicts overall survival of lung adenocarcinoma patients.

    Science.gov (United States)

    Chen, En-Guo; Wang, Pin; Lou, Haizhou; Wang, Yunshan; Yan, Hong; Bi, Lei; Liu, Liang; Li, Bin; Snijders, Antoine M; Mao, Jian-Hua; Hang, Bo

    2018-01-23

    Identification of reliable predictive biomarkers and new therapeutic targets is a critical step for significant improvement in patient outcomes. Here, we developed a multi-step bioinformatics analytic strategy to mine large omics and clinical data to build a prognostic scoring system for predicting the overall survival (OS) of lung adenocarcinoma (LuADC) patients. In latter we first identified 1327 significantly and robustly deregulated genes, 600 of which were significantly associated with the OS of LuADC patients. Gene co-expression network analysis revealed the biological functions of these 600 genes in normal lung and LuADCs, which were found to be enriched for cell cycle-related processes, blood vessel development, cell-matrix adhesion and metabolic processes. Finally, we implemented a multiple resampling method combined with Cox regression analysis to identify a 27-gene signature associated with OS, and then created a prognostic scoring system based on this signature. This scoring system robustly predicted OS of LuADC patients in 100 sampling test sets and was further validated in four independent LuADC cohorts. In addition, in comparison to other existing prognostic gene signatures published in the literature, our signature was significantly superior in predicting OS of LuADC patients. In summary, our multi-omics and clinical data integration study created a 27-gene prognostic risk score that can predict OS of LuADC patients independent of age, gender and clinical stage. This score could guide therapeutic selection and allow stratification in clinical trials.

  14. Development of a Traumatic Brain Injury Assessment Score using Novel Biomarkers Discovered Through Autoimmune Profiling

    Science.gov (United States)

    2014-08-15

    invention disclosure document. Table 1. Candidate TBI Biomarker Proteins Identified by Autoimmune Profiling. 1 Alpha internexin – 66kDa A class IV...Neurodisease Indications. Molecular Neurobiology. 2011;43(3):180-191. 84. Lopes JP, Agostinho P. Cdk5: multitasking between physiological and

  15. Relationship between framingham risk score and coronary artery calcium score in asymptomatic Korean individuals

    Energy Technology Data Exchange (ETDEWEB)

    Heo, So Young; Park, Noh Hyuck; Park, Chan Sub; Seong, Su Ok [Dept. of Radiology, Myongji Hospital, Seonam University College of Medicine, Goyang (Korea, Republic of)

    2016-02-15

    We explored the association between Framingham risk score (FRS) and coronary artery calcium score (CACS) in asymptomatic Korean individuals. We retrospectively analyzed 2216 participants who underwent routine health screening and CACS using the 64-slice multidetector computed tomography between January 2010 and June 2014. Relationship between CACS and FRS, and factors associated with discrepancy between CACS and FRS were analyzed. CACS and FRS were positively correlated (p < 0.0001). However, in 3.7% of participants with low coronary event risk and high CACS, age, male gender, smoker, hypertension, total cholesterol, diabetes mellitus, and body mass index (BMI; ≥ 35) were associated with the discrepancy. In the diagnostic prediction model for discrepancy, the receiver operating characteristic curve including factors associated with FRS, diastolic blood pressure (≥ 75 mm Hg), diabetes mellitus, and BMI (≥ 35) showed that the area under the curve was 0.854 (95% confidence interval, 0.819–0.890), indicating good sensitivity. Diabetes mellitus or obesity (BMI ≥ 35) compensate for the weakness of FRS and may be potential indicators for application of CACS in asymptomatic Koreans with low coronary event risk.

  16. Role of biomarkers in predicting CVD risk in the setting of HIV infection?

    DEFF Research Database (Denmark)

    Worm, Signe W; Hsue, Priscilla

    2010-01-01

    with risk of CVD. Biomarkers associated with inflammation such as C-reactive protein and interleukin-6 have been suggested to improve risk stratification among intermediate-risk persons; however, their routine use is not recommended in the general population. Both biomarkers have recently been reported......-infected population and will increase as this population continues to age. Identification of intermediate-risk individuals using biomarkers will be an important tool for clinicians in the future to be able to treat HIV-infected individuals aggressively. Future studies of biomarkers among individuals with HIV...

  17. Comparison of Accuracy of Diabetes Risk Score and Components of the Metabolic Syndrome in Assessing Risk of Incident Type 2 Diabetes in Inter99 Cohort

    DEFF Research Database (Denmark)

    Shafizadeh, Tracy B; Moler, Edward J; Kolberg, Janice A

    2011-01-01

    Background: Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM); factors of metabolic syndrome (MetS) and a previously...... developed diabetes risk score, PreDxH Diabetes Risk Score (DRS). DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. Methodology/Principal Findings: DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged...... 30–60) for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity...

  18. The potential utility of urinary biomarkers for risk prediction in combat casualties: a prospective observational cohort study

    OpenAIRE

    Stewart, Ian J.; Glass, Kristen R.; Howard, Jeffrey T.; Morrow, Benjamin D.; Sosnov, Jonathan A.; Siew, Edward D.; Wickersham, Nancy; Latack, Wayne; Kwan, Hana K.; Heegard, Kelly D.; Diaz, Christina; Henderson, Aaron T.; Saenz, Kristin K.; Ikizler, T. Alp; Chung, Kevin K.

    2015-01-01

    Introduction Traditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy. Methods We conducted a prospective, observational study in United States Military personnel with tr...

  19. Accuracy of prediction scores and novel biomarkers for predicting nonalcoholic fatty liver disease in obese children

    NARCIS (Netherlands)

    Koot, Bart G. P.; van der Baan-Slootweg, Olga H.; Bohte, Anneloes E.; Nederveen, Aart J.; van Werven, Jochem R.; Tamminga-Smeulders, Christine L. J.; Merkus, Maruschka P.; Schaap, Frank G.; Jansen, Peter L. M.; Stoker, Jaap; Benninga, Marc A.

    2013-01-01

    Accurate prediction scores for liver steatosis are demanded to enable clinicians to noninvasively screen for nonalcoholic fatty liver disease (NAFLD). Several prediction scores have been developed, however external validation is lacking. The aim was to determine the diagnostic accuracy of four

  20. Scope Complexity Options Risks Excursions (SCORE) Factor Mathematical Description.

    Energy Technology Data Exchange (ETDEWEB)

    Gearhart, Jared Lee [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Samberson, Jonell Nicole [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Shettigar, Subhasini [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jungels, John [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Welch, Kimberly M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Dean A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options, resulting in scores. SCORE factors extend this capability by providing estimates of complexity relative to a base system (i.e., all design options are normalized to one weapon system). First, a clearly defined set of scope elements for a warhead option is established. The complexity of each scope element is estimated by Subject Matter Experts (SMEs), including a level of uncertainty, relative to a specific reference system. When determining factors, complexity estimates for a scope element can be directly tied to the base system or chained together via comparable scope elements in a string of reference systems that ends with the base system. The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA-12 led Enterprise Modeling and Analysis Consortium (EMAC). Historically, it has provided the data elicitation, integration, and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).

  1. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients.

    Science.gov (United States)

    Blaha, Michael J; Silverman, Michael G; Budoff, Matthew J

    2014-03-01

    Although risk factors have proven to be useful therapeutic targets, they are poor predictors of risk. Traditional risk scores are moderately successful in predicting future CHD events and can be a starting place for general risk categorization. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden, with event rates predominantly driven by burden of atherosclerosis. Serum biomarkers have yet to show any clinically significant incremental value to the FRS and even when combined cannot match the predictive value of atherosclerosis imaging. As clinicians, are we willing to base therapy decisions on risk models that lack optimum-achievable accuracy and limit personalization? The decision to treat a patient in primary prevention must be a careful one because the benefit of therapy in an asymptomatic patient must clearly outweigh the potential risk. CAC, in particular, provides a personalized assessment of risk and may identify patients who will be expected to derive the most, and the least, net absolute benefit from treatment. Emerging evidence hints that CAC may also promote long-term adherence to aspirin, exercise, diet, and statin therapy. When potentially lifelong treatment decisions are on the line, clinicians must arm their patients with the most accurate risk prediction tools, and subclinical atherosclerosis testing with CAC is, at the present time, superior to any combination of risk factors and serum biomarkers.

  2. Integrating Genetics and Social Science: Genetic Risk Scores

    Science.gov (United States)

    Belsky, Daniel W.; Israel, Salomon

    2014-01-01

    The sequencing of the human genome and the advent of low-cost genome-wide assays that generate millions of observations of individual genomes in a matter of hours constitute a disruptive innovation for social science. Many public-use social science datasets have or will soon add genome-wide genetic data. With these new data come technical challenges, but also new possibilities. Among these, the lowest hanging fruit and the most potentially disruptive to existing research programs is the ability to measure previously invisible contours of health and disease risk within populations. In this article, we outline why now is the time for social scientists to bring genetics into their research programs. We discuss how to select genetic variants to study. We explain how the polygenic architecture of complex traits and the low penetrance of individual genetic loci pose challenges to research integrating genetics and social science. We introduce genetic risk scores as a method of addressing these challenges and provide guidance on how genetic risk scores can be constructed. We conclude by outlining research questions that are ripe for social science inquiry. PMID:25343363

  3. Statistical evaluation of adding multiple risk factors improves Framingham stroke risk score.

    Science.gov (United States)

    Zhou, Xiao-Hua; Wang, Xiaonan; Duncan, Ashlee; Hu, Guizhou; Zheng, Jiayin

    2017-04-14

    Framingham Stroke Risk Score (FSRS) is the most well-regarded risk appraisal tools for evaluating an individual's absolute risk on stroke onset. However, several widely accepted risk factors for stroke were not included in the original Framingham model. This study proposed a new model which combines an existing risk models with new risk factors using synthesis analysis, and applied it to the longitudinal Atherosclerosis Risk in Communities (ARIC) data set. Risk factors in original prediction models and new risk factors in proposed model had been discussed. Three measures, like discrimination, calibration and reclassification, were used to evaluate the performance of the original Framingham model and new risk prediction model. Modified C-statistics, Hosmer-Lemeshow Test and classless NRI, class NRI were the statistical indices which, respectively, denoted the performance of discrimination, calibration and reclassification for evaluating the newly developed risk prediction model on stroke onset. It showed that the NEW-STROKE (new stroke risk score prediction model) model had higher modified C-statistics, smaller Hosmer-Lemeshow chi-square values after recalibration than original FSRS model, and the classless NRI and class NRI of the NEW-STROKE model over the original FSRS model were all significantly positive in overall group. The NEW-STROKE integrated with seven literature-derived risk factors outperformed the original FSRS model in predicting the risk score of stroke. It illustrated that seven literature-derived risk factors contributed significantly to stroke risk prediction.

  4. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses

    Directory of Open Access Journals (Sweden)

    Naveen Garg

    2017-07-01

    Conclusion: FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate.

  5. Coronary age as a risk factor in the modified Framingham risk score

    International Nuclear Information System (INIS)

    Schisterman, Enrique F; Whitcomb, Brian W

    2004-01-01

    Clinical guidelines emphasize risk assessment as vital to patient selection for medical primary intervention. However, risk assessment methods are restricted in their ability to predict further coronary events. The most widely accepted tool in the United States is the Framingham risk score. In these equations age is a powerful risk factor. Although the extent of coronary atherosclerosis increases with age, there is large inter-individual variability in the rate of development and progression of this disease. This fact limits the utility of Framingham scoring when applied to individuals. Electron beam tomography (EBT), which measures coronary calcium, provides a non-invasive method for assessing coronary plaque burden, thus offering the possibility of providing a more accurate estimate of an individual's 'arterial age' than from chronological age alone. In this paper we discuss a new and simple method for incorporating the coronary calcium score (CCS) to modify the Framingham Risk Assessment (FRA). Using this method, a coronary artery calcium (CAC) age equivalent is generated that replaces chronological age in Framingham scoring. Using a percentile table of CCS scores by age group and sex, individuals are matched to the age group whose calcium score most closely approximates their own individual score. The original 10-year absolute risk score of a 65-year old man with a CCS of 6 based on chronological age is 10%, whereas the modified absolute risk score based on CAC age equivalents is 2%. Our approach of replacing chronological age with CAC age equivalents in the Framingham equations possesses simplicity of application combined with precision. Physicians can easily derive adjusted Framingham risk scores and prescribe intervention methods based on patients' ten-year risks. The adjusted ten-year risks are likely to be more accurate than unadjusted risks since they are based on coronary calcium score information. The modified FRA approach not only

  6. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2012-04-01

    The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.

  7. Graz Critical Limb Ischemia Score: A Risk Score for Critical Limb Ischemia in Peripheral Arterial Occlusive Disease.

    Science.gov (United States)

    Gary, Thomas; Belaj, Klara; Hafner, Franz; Eller, Philipp; Rief, Peter; Hackl, Gerald; Brodmann, Marianne

    2015-07-01

    Critical limb ischemia (CLI), a frequently encountered disorder, is associated with a high rate of limb amputation and mortality. To identify patients at high risk for CLI, we developed a simple risk score for peripheral arterial occlusive disease (PAOD).In our cross-sectional study, we first evaluated 1000 consecutive PAOD patients treated at our institution from 2005 to 2007, documenting clinical symptoms, comorbidities, and concomitant medication. We calculated odds ratios (OR) in a binary logistic regression model to find possible risk factors for CLI. We then verified the score in a second step that included the 1124 PAOD patients we treated between 2007 and 2011.In the first patient group, the greatest risk factors for CLI were age ≥75 years (OR 2.0), type 2 diabetes (OR 3.1), prior myocardial infarction (OR 2.5), and therapy with low molecular weight heparins (2.8). We scored 1 point for each of those conditions. One point was given for age between 65 and 75 years (OR 1.6) as well as for therapy with cardiac glycosides (OR 1.9) or loop diuretic therapy (OR 1.5). As statin therapy was protective for CLI with an OR of 0.5, we subtracted 1 point for those patients.In the second group, we could prove that frequency of CLI was significantly higher in patients with a high CLI score. The score correlated well with inflammatory parameters (c-reactive protein and fibrinogen). We were also able to define 3 different risk groups for low (score -1 to 1), intermediate (score 2-4), and high CLI risk (score >4).We developed a simple risk stratification scheme that is based on conditions that can be easily assessed from the medical history, without any laboratory parameters. This score should help to identify PAOD patients at high risk for CLI.

  8. Weighing of risk factors for penetrating keratoplasty graft failure: application of Risk Score System

    Directory of Open Access Journals (Sweden)

    Abdo Karim Tourkmani

    2017-03-01

    Full Text Available AIM: To analyze the relationship between the score obtained in the Risk Score System (RSS proposed by Hicks et al with penetrating keratoplasty (PKP graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. METHODS: The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases, incomplete medical notes (5 cases and follow-up less than 1y (3 cases. We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. RESULTS: Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure (P0.05 between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant (P<0.05, although the results for previous grafts and graft failure was unreliable. None of our patients had previous blood transfusion, thus, it had no impact. CONCLUSION: After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y.

  9. SCORING ASSESSMENT AND FORECASTING MODELS BANKRUPTCY RISK OF COMPANIES

    Directory of Open Access Journals (Sweden)

    SUSU Stefanita

    2014-07-01

    Full Text Available Bankruptcy risk made the subject of many research studies that aim at identifying the time of the bankruptcy, the factors that compete to achieve this state, the indicators that best express this orientation (the bankruptcy. The threats to enterprises require the managers knowledge of continually economic and financial situations, and vulnerable areas with development potential. Managers need to identify and properly manage the threats that would prevent achieving the targets. In terms of methods known in the literature of assessment and evaluation of bankruptcy risk they are static, functional, strategic, and scoring nonfinancial models. This article addresses Altman and Conan-Holder-known internationally as the model developed at national level by two teachers from prestigious universities in our country-the Robu-Mironiuc model. Those models are applied to data released by the profit and loss account and balance sheet Turism Covasna company over which bankruptcy risk analysis is performed. The results of the analysis are interpreted while trying to formulate solutions to the economic and financial viability of the entity.

  10. Genomic biomarkers and genetic risk factors in amyotrophic lateral sclerosis

    NARCIS (Netherlands)

    Saris, C.G.J.

    2013-01-01

    In this thesis, we focus our biomarker discovery on gene expression in blood of an ALS mouse model and ALS patients to find ALS specific gene activity. 1. To explore the potential of blood or muscle transcriptome changes as a diagnostic biomarker. We hypothesized that blood gene expression reflects

  11. Metabolic syndrome and Framingham risk score in obese young adults

    Directory of Open Access Journals (Sweden)

    Felix F. Widjaja

    2013-05-01

    Full Text Available Background: The increase number of the metabolic syndrome (MetS among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD which can be estimated by Framingham risk score (FRS. The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ≥ 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001, followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001, low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003, and impaired fasting glucose (p = 0.03. Four subjects had FRS ≥ 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154. There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately. (Med J Indones. 2013;22:100-6Keywords: Abdominal obesity, Framingham risk score, metabolic syndrome, young adults

  12. 1,3-BUTADIENE: BIOMARKERS AND APPLICATION TO RISK ASSESSMENT

    Science.gov (United States)

    Swenberg, James A.; Bordeerat, Narisa K.; Boysen, Gunnar; Carro, Sujey; Georgieva, Nadia I.; Nakamura, Jun; Troutman, John M.; Upton, Patricia B.; Albertini, Richard J.; Vacek, Pamela M.; Walker, Vernon E.; Sram, Radim J.; Goggin, Melissa; Tretyakova, Natalia

    2012-01-01

    1,3-Butadiene (BD) is a known rodent and human carcinogen that is metabolized mainly by P450 2E1 to three epoxides, 1,2-epoxy-3-butene (EB), 1,2:3,4-diepoxybutane (DEB) and 1,2-epoxy-3,4-butanediol (EB-diol). The individual epoxides vary up to 200-fold in their mutagenic potency, with DEB being the most mutagenic metabolite. It is important to understand the internal formation of the individual epoxides to assign the relative risk for each metabolite and to understand the molecular mechanisms responsible for major species differences in carcinogenicity. We have conducted extensive exposure-biomarker studies on mice, rats and humans. Using low exposures that range from current occupational levels to human exposures from tobacco smoke has provided evidence that mice are very different from humans, with mice forming ~200 times more DEB than humans at exposures of 0.1–1.5 ppm BD. While no gender differences have been noted in mice and rats for globin adducts or N-7 guanine adducts, female rats and mice had 2–3-fold higher Hprt mutations and DNA-DNA cross-links, suggesting a gender difference in DNA repair. Numerous molecular epidemiology studies have evaluated globin adducts and Hprt mutations, SCEs and chromosomal abnormalities. None of the blinded studies have shown evidence of human genotoxicity at current occupational exposures and studies of globin adducts have shown similar or lower formation of adducts in females than males. If one calculates the EB dose-equivalents for the three species, mice clearly differ from rats and humans, being ~44 and 174 times greater than rats and humans, respectively. These data provide a scientific basis for improved risk assessment of BD. PMID:20974116

  13. Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score*.

    Science.gov (United States)

    Allou, Nicolas; Bronchard, Regis; Guglielminotti, Jean; Dilly, Marie Pierre; Provenchere, Sophie; Lucet, Jean Christophe; Laouénan, Cédric; Montravers, Philippe

    2014-05-01

    The aims of this study were, first, to identify risk factors for microbiology-proven postoperative pneumonia after cardiac surgery and, second, to develop and validate a preoperative scoring system for the risk of postoperative pneumonia. A single-center cohort study. All consecutive patients undergoing cardiac surgery between January 2006 and July 2011. None. Multivariate analysis of risk factors for postoperative pneumonia was performed on data from patients operated between January 2006 and December 2008 (training set). External temporal validation was performed on data from patients operated between January 2009 and July 2011 (validation set). Preoperative variables identified in multivariate analysis of the training set were then used to develop a preoperative scoring system that was validated on the validation set. Postoperative pneumonia occurred in 174 of the 5,582 patients (3.1%; 95% CI, 2.7-3.6). Multivariate analysis identified four risk factors for postoperative pneumonia: age (odds ratio, 1.02; 95% CI, 1.01-1.03), chronic obstructive pulmonary disease (odds ratio, 2.97; 95% CI, 1.8-4.71), preoperative left ventricular ejection fraction (odds ratio, 0.98; 95% CI, 0.96-0.99), and the interaction between RBC transfusion during surgery and duration of cardiopulmonary bypass (odds ratio, 2.98; 95% CI, 1.96-4.54). A 6-point score including the three preoperative variables then defined two risk groups corresponding to postoperative pneumonia rates of 1.8% (score risk factors for postoperative pneumonia with the proposed scoring system could help to implement a preventive policy in high-risk patients with a risk of postoperative pneumonia greater than 4% (i.e., patients with a score ≥ 3).

  14. Common clinical practice versus new PRIM score in predicting coronary heart disease risk

    DEFF Research Database (Denmark)

    Frikke-Schmidt, Ruth; Tybjærg-Hansen, Anne; Schnohr, Peter

    2010-01-01

    To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk.......To compare the new Patient Rule Induction Method (PRIM) Score and common clinical practice with the Framingham Point Score for classification of individuals with respect to coronary heart disease (CHD) risk....

  15. Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding

    DEFF Research Database (Denmark)

    Ngu, Jing H.; Laursen, Stig Borbjerg; Chin, YK

    2017-01-01

    Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study.......Performance of upper gastrointestinal bleeding risk assessment scores in variceal bleeding: a prospective international multicenter study....

  16. COPART Risk Score, Endothelial Dysfunction, and Arterial Hypertension are Independent Risk Factors for Mortality in Claudicants.

    Science.gov (United States)

    Hackl, G; Jud, P; Avian, A; Gary, T; Deutschmann, H; Seinost, G; Brodmann, M; Hafner, F

    2016-08-01

    The COPART risk score consists of six variables to assess the prognosis of PAOD patients. The flow mediated dilation (FMD) quantifies endothelial function. The aim of this study was to evaluate the mortality prediction of these two variables in a long-term observation of claudicants. 184 consecutive claudicants were included in a prospective observational study over a median observation period of 7.9 (IQR 7.2-8.7) years. The endothelial function was assessed on the day of study inclusion using brachial FMD. Three groups were assigned according to the COPART risk score: low risk (LR), n = 72 (39%); medium risk (MR), n = 59 (32%); and high risk (HR), n = 53 (29%). Overall survival rates differed among COPART risk score groups (p 2.5, HR 2.6, 95% CI 1.4-4.9), and arterial hypertension (p = .039; HR 3.5, 95% CI 1.1-11.3). COPART risk score, FMD, and arterial hypertension are independent long-term mortality predictors in this group of claudicants. The best mortality assessment is provided by including all three predictors. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Comparison of different cardiovascular risk score calculators for cardiovascular risk prediction and guideline recommended statin uses.

    Science.gov (United States)

    Garg, Naveen; Muduli, Subrat K; Kapoor, Aditya; Tewari, Satyendra; Kumar, Sudeep; Khanna, Roopali; Goel, Pravin Kumar

    The accuracy of various 10-year cardiovascular disease (CVD) risk calculators in Indians may not be the same as in other populations. Present study was conducted to compare the various calculators for CVD risk assessment and statin eligibility according to different guidelines. Consecutive 1110 patients who presented after their first myocardial infarction were included. Their CVD risk was calculated using Framingham Risk score- Coronary heart disease (FRS-CHD), Framingham Risk Score- Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD) and WHO risk charts, assuming that they had presented one day before cardiac event for risk assessment. Eligibility for statin uses was also looked into using ACC/AHA, NICE and Canadian guidelines. FRS-CVD risk assessment model has performed the best as it could identify the highest number of patients (51.9%) to be at high CVD risk while WHO and ASCVD calculators have performed the worst (only 16.2% and 28.3% patients respectively were stratified into high CVD risk) considering 20% as cut off for high risk definition. QRISK2, JBS3 and FRS-CHD have performed intermediately. Using NICE, ACC/AHA and Canadian guidelines; 76%, 69% and 44.6% patients respectively were found to be eligible for statin use. FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate. Copyright © 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  18. Cardiovascular risk assessment scores for people with diabetes: a systematic review

    OpenAIRE

    Chamnan, P.; Simmons, R. K.; Sharp, S. J.; Griffin, S. J.; Wareham, N. J.

    2009-01-01

    People with type 2 diabetes have an increased risk of cardiovascular disease (CVD). Multivariate cardiovascular risk scores have been used in many countries to identify individuals who are at high risk of CVD. These risk scores include those originally developed in individuals with diabetes and those developed in a general population. This article reviews the published evidence for the performance of CVD risk scores in diabetic patients by: (1) examining the overall rationale for using risk s...

  19. Modified Framingham Risk Factor Score for Systemic Lupus Erythematosus.

    Science.gov (United States)

    Urowitz, Murray B; Ibañez, Dominique; Su, Jiandong; Gladman, Dafna D

    2016-05-01

    The traditional Framingham Risk Factor Score (FRS) underestimates the risk for coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE). We aimed to determine whether an adjustment to the FRS would more accurately reflect the higher prevalence of CAD among patients with SLE. Patients with SLE without a previous history of CAD or diabetes followed regularly at the University of Toronto Lupus Clinic were included. A modified FRS (mFRS) was calculated by multiplying the items by 1.5, 2, 3, or 4. In the first part of the study, using one-third of all eligible patients, we evaluated the sensitivity and specificity of the FRS and the different multipliers for the mFRS. In the second part of the study, using the remaining 2/3 of the eligible patients, we compared the predictive ability of the FRS to the mFRS. In the third part of the study, we assessed the prediction for CAD in a time-dependent analysis of the FRS and mFRS. There were 905 women (89.3%) with a total of 95 CAD events included. In part 1, we determined that a multiplier of 2 provided the best combination of sensitivity and specificity. In part 2, 2.4% of the patients were classified as moderate/high risk based on the classic FRS and 17.3% using the 2FRS (the FRS with a multiplier of 2). In part 3, a time-dependent covariate analysis for the prediction of the first CAD event revealed an HR of 3.22 (p = 0.07) for the classic FRS and 4.37 (p mFRS in which each item is multiplied by 2 more accurately predicts CAD in patients with SLE.

  20. Incorporating biomarkers in ecological risk assessment of chemical contaminants of soils

    Directory of Open Access Journals (Sweden)

    A. J. Reinecke

    2007-09-01

    Full Text Available Soil is an important but complex natural resource which is increasingly used as sink for chemicals. The monitoring of soil quality and the assessment of risks posed by contaminants have become crucial. This study deals with the potential use of biomarkers in the monitoring of soils and the assessment of risk resulting from contamination. Apart from an overview of the existing literature on biomarkers, the results of various of our field experiments in South African soils are discussed. Biomarkers may have potential in the assessment of risk because they can indicate at an early stage that exposure has taken place and that a toxic response has been initiated. It is therefore expected that early biomarkers will play an increasing role as diagnostic tools for determining exposure to chemicals and the resulting effects. They may have predictive value that can assist in the prevention or minimising of risks. The aim of this study was to investigate the possibilities of using our results on biomarker responses of soil dwelling organisms to predict changes at higher organisational levels (which may have ecological implications. Our recent experimental results on the evaluation of various biomarkers in both the laboratory and the field are interpreted and placed in perspective within the broader framework of response biology. The aim was further to contribute to the development and application of biomarkers in regulatory risk assessment schemes of soils. This critical review of our own and recent literature on biomarkers in ecotoxicology leads to the conclusion that biomarkers can, under certain conditions, be useful tools in risk assessment. Clear relationships between contamination loads in soil organisms and certain biomarker responses were determined in woodlice, earthworms and terrestrial snails. Clear correlations were also established in field experiments between biomarker responses and changes at the population level. This indicated that, in

  1. Use of novel biomarkers to explore cardiovascular risk and drug effects

    NARCIS (Netherlands)

    Kofink, Daniel

    2017-01-01

    Cardiovascular disease causes immense health care costs and production losses, underscoring the need to identify individuals at risk requiring preventive treatment. This thesis aims to identify novel cardiovascular biomarkers and to advance understanding of the pathophysiological mechanisms

  2. Improving Blood Monitoring of Enzymes as Biomarkers of Risk from Anticholinergic Pesticides and Chemical Warfare Agents

    National Research Council Canada - National Science Library

    Wilson, Barry W

    2005-01-01

    Blood biomarkers are an important way to monitor exposure to anticholinergic pesticides and chemical warfare agents and to establish whether some personnel are at greater risk than others from exposure...

  3. Improving Blood Monitoring of Enzymes as Biomarkers of Risk from Anticholinergic Pesticides and Chemical Warfare Agents

    National Research Council Canada - National Science Library

    Wilson, Barry W

    2006-01-01

    Blood biomarkers are an important way to monitor exposure to anticholinergic pesticides and chemical warfare agents and to establish whether some personnel are at greater risk than others from exposure...

  4. Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence.

    Science.gov (United States)

    Sallinen, Ville; Mali, Juha; Leppäniemi, Ari; Mentula, Panu

    2015-02-01

    Recurrence of acute diverticulitis is common, and--especially complicated recurrence--causes significant morbidity. To prevent recurrence, selected patients have been offered prophylactic sigmoid resection. However, as there is no tool to predict whose diverticulitis will recur and, in particular, who will have complicated recurrence, the indications for sigmoid resections have been variable. The objective of this study was to identify risk factors predicting recurrence of acute diverticulitis. This is a retrospective cohort study of patients presenting with computed tomography-confirmed acute diverticulitis and treated nonresectionally during 2006 to 2010. Risk factors for recurrence were identified using uni- and multivariate Cox regression. A total of 512 patients were included. History of diverticulitis was an independent risk factor predicting uncomplicated recurrence of diverticulitis (1-2 earlier diverticulitis HR 1.6, 3 or more--HR 3.2). History of diverticulitis (HR 3.3), abscess (HR 6.2), and corticosteroid medication (HR 16.1) were independent risk factors for complicated recurrence. Based on regression coefficients, risk scoring was created: 1 point for history of diverticulitis, 2 points for abscess, and 3 points for corticosteroid medication. The risk score was unable to predict uncomplicated recurrence (AUC 0.48), but was able to predict complicated recurrence (AUC 0.80). Patients were further divided into low-risk (0-2 points) and high-risk (>2 points) groups. Low-risk and high-risk groups had 3% and 43% 5-year complicated recurrence rates, respectively. Risk for complicated recurrence of acute diverticulitis can be assessed using risk scoring. The risk for uncomplicated recurrence increases along with increasing number of previous diverticulitis.

  5. A score of low-grade inflammation and risk of mortality: prospective findings from the Moli-sani study.

    Science.gov (United States)

    Bonaccio, Marialaura; Di Castelnuovo, Augusto; Pounis, George; De Curtis, Amalia; Costanzo, Simona; Persichillo, Mariarosaria; Cerletti, Chiara; Donati, Maria Benedetta; de Gaetano, Giovanni; Iacoviello, Licia

    2016-11-01

    Low-grade inflammation is associated with an increased risk of chronic degenerative disease, but its relationship with mortality is less well explored. We aimed at evaluating, at a large epidemiological level, the possible association of low-grade inflammation, as measured by a composite score, with overall mortality risk. We conducted a population-based prospective investigation on 20,337 adult subjects free from major hematological disease and acute inflammatory status, randomly recruited from the general population of the Moli-sani study. A low-grade inflammation score was obtained from the sum of 10-tiles of plasmatic (C-reactive protein) and cellular (leukocyte and platelet counts, granulocyte/lymphocyte ratio) biomarkers of low-grade inflammation; higher levels indicated increased low-grade inflammation. Hazard ratios were calculated using multivariable Cox proportional hazard models with 95% confidence intervals. At the end of follow-up (median 7.6 years), 837 all-cause deaths were recorded. As compared to subjects in the lowest quartile of the low-grade inflammation score, those in the highest category had a significantly increased risk in overall mortality (HR=1.44; 1.17-1.77), independently of possible confounders, including the presence of chronic diseases and a number of health-related behaviors. The magnitude of the association of low-grade inflammation with mortality was relatively higher in type 2 diabetic patients (HR=2.90; 1.74-4.84) and in individuals with a history of cardiovascular disease (HR=2.48; 1.50-4.11) as compared to their counterparts who were free from the disease. In conclusion, an elevated degree of low-grade inflammation, as measured by a composite score of inflammatory biomarkers, is an independent risk factor for total mortality in an apparently healthy adult general population. Copyright© Ferrata Storti Foundation.

  6. Developing risk prediction models for kidney injury and assessing incremental value for novel biomarkers.

    Science.gov (United States)

    Kerr, Kathleen F; Meisner, Allison; Thiessen-Philbrook, Heather; Coca, Steven G; Parikh, Chirag R

    2014-08-07

    The field of nephrology is actively involved in developing biomarkers and improving models for predicting patients' risks of AKI and CKD and their outcomes. However, some important aspects of evaluating biomarkers and risk models are not widely appreciated, and statistical methods are still evolving. This review describes some of the most important statistical concepts for this area of research and identifies common pitfalls. Particular attention is paid to metrics proposed within the last 5 years for quantifying the incremental predictive value of a new biomarker. Copyright © 2014 by the American Society of Nephrology.

  7. Coronary risk assessment among intermediate risk patients using a clinical and biomarker based algorithm developed and validated in two population cohorts.

    Science.gov (United States)

    Cross, D S; McCarty, C A; Hytopoulos, E; Beggs, M; Nolan, N; Harrington, D S; Hastie, T; Tibshirani, R; Tracy, R P; Psaty, B M; McClelland, R; Tsao, P S; Quertermous, T

    2012-11-01

    Many coronary heart disease (CHD) events occur in individuals classified as intermediate risk by commonly used assessment tools. Over half the individuals presenting with a severe cardiac event, such as myocardial infarction (MI), have at most one risk factor as included in the widely used Framingham risk assessment. Individuals classified as intermediate risk, who are actually at high risk, may not receive guideline recommended treatments. A clinically useful method for accurately predicting 5-year CHD risk among intermediate risk patients remains an unmet medical need. This study sought to develop a CHD Risk Assessment (CHDRA) model that improves 5-year risk stratification among intermediate risk individuals. Assay panels for biomarkers associated with atherosclerosis biology (inflammation, angiogenesis, apoptosis, chemotaxis, etc.) were optimized for measuring baseline serum samples from 1084 initially CHD-free Marshfield Clinic Personalized Medicine Research Project (PMRP) individuals. A multivariable Cox regression model was fit using the most powerful risk predictors within the clinical and protein variables identified by repeated cross-validation. The resulting CHDRA algorithm was validated in a Multiple-Ethnic Study of Atherosclerosis (MESA) case-cohort sample. A CHDRA algorithm of age, sex, diabetes, and family history of MI, combined with serum levels of seven biomarkers (CTACK, Eotaxin, Fas Ligand, HGF, IL-16, MCP-3, and sFas) yielded a clinical net reclassification index of 42.7% (p risk level. Across all patients, the model predicted acute coronary events (hazard ratio = 2.17, p risk factor adjustments. These include the slightly different event definition with the MESA samples and inability to include PMRP fatal CHD events. A novel risk score of serum protein levels plus clinical risk factors, developed and validated in independent cohorts, demonstrated clinical utility for assessing the true risk of CHD events in intermediate risk patients

  8. REVEAL risk scores applied to riociguat-treated patients in PATENT-2: Impact of changes in risk score on survival.

    Science.gov (United States)

    Benza, Raymond L; Farber, Harrison W; Frost, Adaani; Ghofrani, Hossein-Ardeschir; Gómez-Sánchez, Miguel A; Langleben, David; Rosenkranz, Stephan; Busse, Dennis; Meier, Christian; Nikkho, Sylvia; Hoeper, Marius M

    2018-04-01

    The Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) risk score (RRS) calculator was developed using data derived from the REVEAL registry, and predicts survival in patients with pulmonary arterial hypertension (PAH) based on multiple patient characteristics. Herein we applied the RRS to a pivotal PAH trial database, the 12-week PATENT-1 and open-label PATENT-2 extension studies of riociguat. We examined the effect of riociguat vs placebo on RRS in PATENT-1, and investigated the prognostic implications of change in RRS during PATENT-1 on long-term outcomes in PATENT-2. RRS was calculated post hoc for baseline and Week 12 of PATENT-1, and Week 12 of PATENT-2. Patients were grouped into risk strata by RRS. Kaplan-Meier estimates were made for survival and clinical worsening-free survival in PATENT-2 to evaluate the relationship between RRS in PATENT-1 and long-term outcomes in PATENT-2. A total of 396 patients completed PATENT-1 and participated in PATENT-2. In PATENT-1, riociguat significantly improved RRS (p = 0.031) and risk stratum (p = 0.018) between baseline and Week 12 compared with placebo. RRS at baseline, and at PATENT-1 Week 12, and change in RRS during PATENT-1 were significantly associated with survival (hazard ratios for a 1-point reduction in RRS: 0.675, 0.705 and 0.804, respectively) and clinical worsening-free survival (hazard ratios of 0.736, 0.716 and 0.753, respectively) over 2 years in PATENT-2. RRS at baseline and Week 12, and change in RRS, were significant predictors of both survival and clinical worsening-free survival. These data support the long-term predictive value of the RRS in a controlled study population. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Effects of Supplemental Vitamin D and Calcium on Normal Colon Tissue and Circulating Biomarkers of Risk for Colorectal Neoplasms

    Science.gov (United States)

    Bostick, Roberd M.

    2015-01-01

    This brief review, based on an invited presentation at the 17th Workshop on Vitamin D, is to summarize a line of the author’s research that has been directed at the intertwined missions of clarifying and/or developing vitamin D and calcium and as preventive agents against colorectal cancer in humans, understanding the mechanisms by which these agents may reduce risk for the disease, and developing ‘treatable’ biomarkers of risk for colorectal cancer. The biological plausibility and observational and clinical trial evidence for vitamin D and calcium in reducing risk for colorectal neoplasms, the development of pre-neoplastic biomarkers of risk for colorectal neoplasms, and the clinical trial findings from the author’s research group on the efficacy of vitamin D and calcium in modulating these biomarkers are summarized. Regarding the latter, we tested the efficacy of 800 IU (20 µg) of vitamin D3 and 2.0g of calcium daily, alone and combined vs. placebo over 6 months on modulating normal colon tissue and circulating hypothesis-based biomarkers of risk for colorectal neoplasms in a randomized, double-blind, placebo-controlled, 2×2 factorial design clinical trial (n = 92). The tissue-based biomarkers were measured in biopsies of normal-appearing rectal mucosa using immunohistochemistry with quantitative image analysis, and a panel of circulating inflammation markers was measured using enzyme-linked immunoassays (ELISA). Statistically significant proportional tissue increases in the vitamin D group relative to the placebo group were found in bax (51%), p21 (141%), APC (48%), E-cadherin (78%), MSH2 (179%), the CaSR (39%), and CYP27B1 (159%). In blood, there was a 77% statistically significant decrease in a summary inflammation z-score. The findings for calcium were similar to those for vitamin D. These findings indicate that supplemental vitamin D3 or calcium can favorably modulate multiple normal colon tissue and circulating hypothesis-based biomarkers of risk

  10. The high-density lipoprotein-adjusted SCORE model worsens SCORE-based risk classification in a contemporary population of 30 824 Europeans

    DEFF Research Database (Denmark)

    Mortensen, Martin B; Afzal, Shoaib; Nordestgaard, Børge G

    2015-01-01

    AIMS: Recent European guidelines recommend to include high-density lipoprotein (HDL) cholesterol in risk assessment for primary prevention of cardiovascular disease (CVD), using a SCORE-based risk model (SCORE-HDL). We compared the predictive performance of SCORE-HDL with SCORE in an independent.......8 years of follow-up, 339 individuals died of CVD. In the SCORE target population (age 40-65; n = 30,824), fewer individuals were at baseline categorized as high risk (≥5% 10-year risk of fatal CVD) using SCORE-HDL compared with SCORE (10 vs. 17% in men, 1 vs. 3% in women). SCORE-HDL did not improve...... discrimination of future fatal CVD, compared with SCORE, but decreased the detection rate (sensitivity) of the 5% high-risk threshold from 42 to 26%, yielding a negative net reclassification index (NRI) of -12%. Importantly, using SCORE-HDL, the sensitivity was zero among women. Both SCORE and SCORE...

  11. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk)

    DEFF Research Database (Denmark)

    Hajifathalian, Kaveh; Ueda, Peter; Lu, Yuan

    2015-01-01

    data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world...... regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). FINDINGS: The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal....... Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women...

  12. Predicting risk of atrial fibrillation after heart valve surgery: evaluation of a Brazilian risk score.

    Science.gov (United States)

    Sá, Michel Pompeu Barros de Oliveira; Sá, Marcus Villander Barros de Oliveira; Albuquerque, Ana Carla Lopes de; Silva, Belisa Barreto Gomes da; Siqueira, José Williams Muniz de; Brito, Phabllo Rodrigo Santos de; Ferraz, Paulo Ernando; Lima, Ricardo de Carvalho

    2012-01-01

    The aim of this study is to evaluate the applicability of a Brazilian score for predicting atrial fibrillation (AF) in patients undergoing heart valve surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE (Recife, PE, Brazil). Retrospective study involving 491 consecutive patients operated between May/2007 and December/2010. The registers contained all the information used to calculate the score. The outcome of interest was AF. We calculated association of model factors with AF (univariate analysis and multivariate logistic regression analysis), and association of risk score classes with AF. The incidence of AF was 31.2%. In multivariate analysis, the four variables of the score were predictors of postoperative AF: age >70 years (OR 6.82; 95%CI 3.34-14.10; P 1500 ml at first 24 hours (OR 1.92; 95%CI 1.28-2.88; P=0.002). We observed that the higher the risk class of the patient (low, medium, high, very high), the greater is the incidence of postoperative AF (4.2%; 18.1%; 30.8%; 49.2%), showing that the model seems to be a good predictor of risk of postoperative AF, in a statistically significant association (P<0.001). The Brazilian score proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative AF in patients undergoing heart valve surgery at our institution.

  13. Immune function biomarker QuantiFERON-monitor is associated with infection risk in cirrhotic patients

    Science.gov (United States)

    Sood, Siddharth; Yu, Lijia; Visvanathan, Kumar; Angus, Peter William; Gow, Paul John; Testro, Adam Gareth

    2016-01-01

    AIM To investigate whether a novel immune function biomarker QuantiFERON-Monitor (QFM) can identify cirrhotic patients at greatest risk of infection. METHODS Adult cirrhotic patients on the liver transplant waiting list were recruited for this observational cohort study from a tertiary liver transplant referral unit. The immune function biomarker, QFM was performed using the same method as the widely available Quantiferon-gold assay, and measures output in interferon gamma in IU/mL after dual stimulation of the innate and adaptive immune systems. Ninety-one cirrhotic patients were recruited, with 47 (52%) transplanted on the day of their QFM. The remaining 44 (48%) were monitored for infections until transplant, death, or census date of 1st February 2014. RESULTS Cirrhotic patients express a median QFM significantly lower than healthy controls (94.5 IU/mL vs 423 IU/mL), demonstrating that they are severely immunosuppressed. Several factors including model for end stage liver disease, presence of hepatocellular carcinoma, bilirubin, international normalized ratio and haemoglobin were associated with QFM on univariate analysis. Disease aetiology did not appear to impact QFM. On multivariate analysis, only Child-Pugh score and urea were significantly associated with a patient’s immune function as objectively measured by QFM. In the 44 patients who were not transplanted immediately after their blood test and could be monitored for subsequent infection risk, 13 (29.5%) experienced a pre-transplant infection a median 20 d (range 2-182) post-test. QFM < 214 IU/mL was associated with HR = 4.1 (P = 0.01) for infection. A very low QFM < 30 IU/mL was significantly associated (P = 0.003) with death in three patients who died while awaiting transplantation (HR = 56.6). CONCLUSION QFM is lower in cirrhotics, allowing objective determinations of an individual’s unique level of immune dysfunction. Low QFM was associated with increased susceptibility to infection. PMID:28050238

  14. Recalibration and validation of the SCORE risk chart in the Australian population: the AusSCORE chart.

    Science.gov (United States)

    Chen, Lei; Tonkin, Andrew M; Moon, Lynelle; Mitchell, Paul; Dobson, Annette; Giles, Graham; Hobbs, Michael; Phillips, Patrick J; Shaw, Jonathan E; Simmons, David; Simons, Leon A; Fitzgerald, Anthony P; De Backer, Guy; De Bacquer, Dirk

    2009-10-01

    Development of a validated risk prediction model for future cardiovascular disease (CVD) in Australians is a high priority for cardiovascular health strategies. Recalibration of the SCORE (Systematic COronary Risk Evaluation) risk chart based on Australian national mortality data and average major CVD risk factor levels. Australian national mortality data (2003-2005) were used to estimate 10-year cumulative CVD mortality rates for people aged 40-74 years. Average age-specific and sex-specific levels of systolic blood pressure, total cholesterol and prevalence of current smoking were generated from data obtained in eight Australian large-scale population-based surveys undertaken from the late 1980s. The SCORE risk chart was then recalibrated by applying hazard ratios for 10-year CVD mortality obtained in the SCORE project. Discrimination and calibration of the recalibrated model was evaluated and compared with that of the original SCORE and Framingham equations in the Blue Mountains Eye Study in Australia using Harrell's c and Hosmer-Lemeshow chi statistics, respectively. An Australian risk prediction chart for CVD mortality was derived. Among 1998 Blue Mountains Eye Study participants aged 49-74 years with neither CVD nor diabetes at baseline, the Harrell's c statistics for the Australian risk prediction chart for CVD mortality were 0.76 (95% confidence interval: 0.69-0.84) and 0.71 (confidence interval: 0.62-0.80) in men and women, respectively. The corresponding Hosmer-Lemeshow chi statistics, the measure of calibration, were 2.32 (P = 0.68) and 7.43 (P = 0.11), which were superior to both the SCORE and Framingham equations. This new tool provides a valid and reliable method to predict risk of CVD mortality in the general Australian population.

  15. A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort.

    Science.gov (United States)

    Jacobs, Simone; Boushey, Carol J; Franke, Adrian A; Shvetsov, Yurii B; Monroe, Kristine R; Haiman, Christopher A; Kolonel, Laurence N; Le Marchand, Loic; Maskarinec, Gertraud

    2017-08-01

    Dietary indices have been related to risk for type 2 diabetes (T2D) predominantly in white populations. The present study evaluated this association in the ethnically diverse Multiethnic Cohort and examined four diet quality indices in relation to T2D risk, homoeostatic model assessment-estimated insulin resistance (HOMA-IR) and biomarkers of dyslipidaemia, inflammation and adipokines. The T2D analysis included 166 550 white, African American, Native Hawaiian, Japanese American and Latino participants (9200 incident T2D cases). Dietary intake was assessed at baseline using a quantitative FFQ and T2D status was based on three self-reports and confirmed by administrative data. Biomarkers were assessed about 10 years later in a biomarker subcohort (n 10 060). Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). Multivariable-adjusted means of biomarkers were compared across dietary index tertiles in the biomarker subcohort. The AHEI-2010, aMED (in men only) and DASH scores were related to a 10-20 % lower T2D risk, with the strongest associations in whites and the direction of the relationships mostly consistent across ethnic groups. Higher scores on the four indices were related to lower HOMA-IR, TAG and C-reactive protein concentrations, not related to leptin, and the DASH score was directly associated with adiponectin. The AHEI-2010 and DASH were directly related to HDL-cholesterol in women. Potential underlying biological mechanisms linking diet quality and T2D risk are an improved lipid profile and reduced systemic inflammation and, with regards to DASH alone, an improved adiponectin profile.

  16. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy

    OpenAIRE

    Damkondwar, Deepali R; Raman, Rajiv; Suganeswari, G; Kulothungan, Vaitheeswaran; Sharma, Tarun

    2012-01-01

    Aim: To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. Materials and Methods: In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ≥40 years). The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%), and low risk (

  17. Biomarkers of Risk for Post-Traumatic Stress Disorder (PTSD)

    National Research Council Canada - National Science Library

    Tyrka, Audrey R

    2008-01-01

    .... Cortisol samples have been obtained from 96 of these subjects. Hormone and genetic data will be used to predict the development of PTSD and chronic PTSD. In addition, interactions of these biomarkers with trauma severity and other stressors as well as social supports will be examined.

  18. Chromosomal aberrations and SCEs as biomarkers of cancer risk

    Czech Academy of Sciences Publication Activity Database

    Norppa, H.; Bonassi, S.; Hansteen, I. L.; Hagmar, L.; Strömberg, U.; Rössner st., Pavel; Boffetta, P.; Lindholm, C.; Gundy, S.; Lazutka, J.; Cebulska-Wasilewska, A.; Fabiánová, E.; Šrám, Radim; Knudsen, L. E.; Barale, R.; Fucic, A.

    2006-01-01

    Roč. 600, - (2006), s. 37-45 ISSN 0027-5107 Institutional research plan: CEZ:AV0Z50390512 Keywords : biomarkers * chromosomal aberration * sister chromatid exchange Subject RIV: DN - Health Impact of the Environment Quality Impact factor: 4.111, year: 2006

  19. Introduction of a prognostic biomarker to strengthen risk stratification of acutely admitted patients

    DEFF Research Database (Denmark)

    Sandø, Andreas; Schultz, Martin; Eugen-Olsen, Jesper

    2016-01-01

    BACKGROUND: Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious complicat......BACKGROUND: Several biomarkers have shown to carry prognostic value beyond current triage algorithms and may aid in initial risk stratification of patients in the emergency department (ED). It has yet to be established if information provided by biomarkers can be used to prevent serious......) 2016 and ends June 6(th) 2016. The study aims to include 10.000 patients in both the interventional and control arm. The results will be presented in 2017. DISCUSSION: The present article aims to describe the design and rationale of the TRIAGE III study that will investigate whether the availability...

  20. Biomarkers in lone atrial fibrillation - an additional 'fine tuning' of risk?

    Science.gov (United States)

    Ko, Darae; Magnani, Jared W; Hylek, Elaine M

    2015-01-01

    Lone atrial fibrillation (LAF) is generally regarded as a benign disorder that does not significantly increase the risk of thromboembolism and mortality. However, there is growing evidence that "lone" atrial fibrillation (AF) is a "heterogeneous" disorder with varying risk for thromboembolism based on the patient's underlying cardiovascular risk factors. Blood biomarkers, including markers of myocardial strain, inflammation, endothelial injury, platelet activation, and hypercoagulability, have potential to improve our risk stratification and management of LAF. Currently, there is a paucity of data on biomarkers in strictly defined LAF. The majority of studies that aimed to study lone atrial fibrillation excluded patients with structural heart disease, but did not exclude patients with co-existing cardiovascular risk factors such as hypertension or diabetes mellitus. Moreover, many of the studies did not exclude patients based on age, thereby increasing the likelihood of including patients with cardiovascular co-morbidities. There are currently a limited number of studies aimed to investigate the role of biomarkers in true LAF. The results are conflicting as to whether these biomarkers are associated with LAF or stroke risk. Future studies enrolling patients with true LAF using strict definition are needed. Herein, we review our current knowledge of biomarkers in association with atrial fibrillation and LAF and discuss their potential clinical utility.

  1. Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review.

    Science.gov (United States)

    Deardorff, Katrina V; McCollum, Eric D; Ginsburg, Amy Sarah

    2017-12-22

    Pneumonia is the leading infectious cause of death among children less than five years of age. Predictive tools, commonly referred to as risk scores, can be employed to identify high-risk children early for targeted management to prevent adverse outcomes. This systematic review was conducted to identify pediatric pneumonia risk scores developed, validated, and implemented in low-resource settings. We searched CAB Direct, Cochrane Reviews, Embase, PubMed, Scopus, and Web of Science for studies that developed formal risk scores to predict treatment failure or mortality among children less than five years of age diagnosed with a respiratory infection or pneumonia in low-resource settings. Data abstracted from articles included location and study design, sample size, age, diagnosis, score features and model discrimination. Three pediatric pneumonia risk scores predicted mortality specifically, and two treatment failure. Scores developed using World Health Organization recommended variables for pneumonia assessment demonstrated better predictive fit than scores developed using alternative features. Scores developed using routinely collected healthcare data performed similarly well as those developed using clinical trial data. No score has been implemented in low-resource settings. While pediatric pneumonia-specific risk scores have been developed and validated, it is yet unclear if implementation is feasible, what impact, if any, implemented scores may have on child outcomes, or how broadly scores may be generalized. To increase the feasibility of implementation, future research should focus on developing scores based on routinely collected data.

  2. Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population

    Science.gov (United States)

    Yang, Justin; Farioli, Andrea; Korre, Maria; Kales, Stefanos N.

    2014-01-01

    Introduction Greater adherence to a Mediterranean diet is linked to lower risk for cardiovascular morbidity/mortality in studies of Mediterranean cohorts, older subjects, and/or those with existing health conditions. No studies have examined the effects of this dietary pattern in younger working populations in the United States. We investigated the effects of Mediterranean diet adherence on cardiovascular disease (CVD) biomarkers, metabolic syndrome and body composition in an occupationally active, non-Mediterranean cohort. Methods A cross-sectional study in a cohort of 780 career male firefighters, ages 18 years or older, from the United States Midwest. No dietary intervention was performed. A modified Mediterranean diet score (mMDS) was developed for assessment of adherence to a Mediterranean dietary pattern from a previously administered life-style questionnaire that examined pre-existing dietary habits. Clinical data from fire department medical examinations were extracted and analyzed. Results Obese subjects had significantly lower mMDS, and they reported greater fast/take-out food consumption (pMediterranean-style dietary pattern had significant inverse associations with metabolic syndrome, LDL-cholesterol and reported weight gain, and was significantly and independently associated with higher HDL-cholesterol. Our results support the potential effectiveness of this diet in young, non-Mediterranean working cohorts, and justify future intervention studies. PMID:24503596

  3. Aerobic exercise reduces biomarkers related to cardiovascular risk among cleaners

    DEFF Research Database (Denmark)

    Korshøj, Mette; Ravn, Marie Højbjerg; Holtermann, Andreas

    2016-01-01

    an aerobic exercise worksite intervention changes the level of inflammation biomarkers among cleaners. METHODS: The design was a cluster-randomized controlled trial with 4-month worksite intervention. Before the 116 cleaners aged 18-65 years were randomized, they signed an informed consent form....... The reference group (n = 59) received lectures, and the aerobic exercise group (n = 57) performed worksite aerobic exercise (30 min twice a week). Levels of biomarkers (high-sensitive C-reactive protein, fibrinogen, cholesterol, low- and high-density lipoprotein cholesterol and triglyceride) were collected...... that an aerobic exercise intervention among cleaners leads to reduced levels of high-sensitive C-reactive protein and low-density lipoprotein cholesterol, and an unaltered level of fibrinogen. The aerobic exercise seems to improve inflammatory levels and lipoprotein profile among cleaners, with no signs...

  4. Risk scores for diabetes and impaired glycaemia in the Middle East and North Africa

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Witte, Daniel Rinse; Almdal, Thomas Peter

    2013-01-01

    AIMS: To develop risk scores for diabetes and diabetes or impaired glycaemia for individuals living in the Middle East and North Africa region. In addition, to derive national risk scores for Algeria, Saudi Arabia and the United Arab Emirates and to compare the performance of the regional risk...

  5. Coffee consumption and coronary heart disease risk using the Framingham risk score.

    Science.gov (United States)

    Noh, Hye-Mi; Park, Yong Soon; Kim, Jeong-Hyeon

    2017-01-01

    Although concerns regarding the influence of coffee consumption on human health have accompanied the massive increase in coffee consumption, the effects of coffee intake on the risk for coronary heart disease (CHD) remain controversial. Therefore, we evaluated the association between coffee consumption and CHD risk as estimated using the Framingham risk model in Korean adults. This cross-sectional study involved 3,987 participants aged 30-74 years who participated in the fifth Korea National Health and Nutrition Examination Survey conducted in 2010. The frequency of coffee consumption was self-reported and classified into 4 categories (non-drinker, 1, 2, and >=3 cups/day). The 10-year risk for CHD was determined from the Framingham risk score. Across the levels of coffee consumption, there were significant differences in the frequency of smoking among men and advanced age, low high-density lipoprotein cholesterol level, diabetes, and smoking among women. In the multiple logistic regression analyses, the adjusted odds ratios (95% CI) for >=20% 10-year CHD risk was 0.211 (0.060-0.745) for women who consumed >=3 cups of coffee per day compared with women who consumed coffee consumption and 10-year CHD risk persisted even after adjusting for multiple confounding factors. For the men, however, there was no significant association between coffee consumption and 10-year CHD risk. Coffee consumption is associated with a lower risk for CHD in Korean women.

  6. Quest for biomarkers of treatment-resistant depression: shifting the paradigm toward risk

    DEFF Research Database (Denmark)

    Smith, Donald F.

    2013-01-01

    have, however, used a post hoc experimental design that failed to determine the association between biomarkers and the initial risk ofTRD. Particular ttention in future studies should be on shifting the experimental paradigm oward procedures that can determine the risk for developing treatment...

  7. Significant relationships between a simple marker of redox balance and lifestyle behaviours; Relevance to the Framingham risk score

    Science.gov (United States)

    Seyedsadjadi, Neda; Berg, Jade; Bilgin, Ayse A.; Tung, Chin

    2017-01-01

    Oxidative stress has been closely linked to the progressive cell damage associated with emerging non-communicable disease (NCDs). Early detection of these biochemical abnormalities before irreversible cell damage occurs may therefore be useful in identifying disease risk at an individual level. In order to test this hypothesis, this study assessed the relationship between a simple measure of redox status and lifestyle risk factors for NCDs, and the population-based risk score of Framingham. In a cross-sectional study design, 100 apparently healthy middle-aged males (n = 48) and females (n = 52) were asked to complete a comprehensive lifestyle assessment questionnaire, followed by body fat percentage and blood pressure measurements, and blood collection. The ratio of plasma total antioxidant capacity to hydroperoxide (TAC/HPX) was used as an index of redox balance. One-way ANOVA and multiple linear regression analysis were performed to analyse the association between TAC/HPX, lifestyle components and other plasma biomarkers. The TAC/HPX ratio was higher in males compared to females (t96 = 2.34, P = 0.021). TAC/HPX was also lower in participants with poor sleep quality (t93 = 2.39, P = 0.019), with high sleep apnoea risk (t62.2 = 3.32, P = 0.002), with high caffeine (F(2, 93) = 3.97, P = 0.022) and red meat intake (F(2, 93) = 5.55, P = 0.005). These associations were independent of gender. Furthermore, the TAC/HPX ratio decreased with increasing body fat percentage (F(2, 95) = 4.74, P = 0.011) and depression score (t94 = 2.38, P = 0.019), though these associations were dependent on gender. Importantly, a negative association was observed between TAC/HPX levels and the Framingham risk score in both males (r(45) = -0.39, P = 0.008) and females (r(50) = -0.33, P = 0.019) that was independent of other Framingham risk score components. Findings from this study suggests that a relatively simple measure of redox balance such as the TAC/HPX ratio may be a sensitive indicator

  8. Significant relationships between a simple marker of redox balance and lifestyle behaviours; Relevance to the Framingham risk score.

    Directory of Open Access Journals (Sweden)

    Neda Seyedsadjadi

    Full Text Available Oxidative stress has been closely linked to the progressive cell damage associated with emerging non-communicable disease (NCDs. Early detection of these biochemical abnormalities before irreversible cell damage occurs may therefore be useful in identifying disease risk at an individual level. In order to test this hypothesis, this study assessed the relationship between a simple measure of redox status and lifestyle risk factors for NCDs, and the population-based risk score of Framingham. In a cross-sectional study design, 100 apparently healthy middle-aged males (n = 48 and females (n = 52 were asked to complete a comprehensive lifestyle assessment questionnaire, followed by body fat percentage and blood pressure measurements, and blood collection. The ratio of plasma total antioxidant capacity to hydroperoxide (TAC/HPX was used as an index of redox balance. One-way ANOVA and multiple linear regression analysis were performed to analyse the association between TAC/HPX, lifestyle components and other plasma biomarkers. The TAC/HPX ratio was higher in males compared to females (t96 = 2.34, P = 0.021. TAC/HPX was also lower in participants with poor sleep quality (t93 = 2.39, P = 0.019, with high sleep apnoea risk (t62.2 = 3.32, P = 0.002, with high caffeine (F(2, 93 = 3.97, P = 0.022 and red meat intake (F(2, 93 = 5.55, P = 0.005. These associations were independent of gender. Furthermore, the TAC/HPX ratio decreased with increasing body fat percentage (F(2, 95 = 4.74, P = 0.011 and depression score (t94 = 2.38, P = 0.019, though these associations were dependent on gender. Importantly, a negative association was observed between TAC/HPX levels and the Framingham risk score in both males (r(45 = -0.39, P = 0.008 and females (r(50 = -0.33, P = 0.019 that was independent of other Framingham risk score components. Findings from this study suggests that a relatively simple measure of redox balance such as the TAC/HPX ratio may be a sensitive

  9. Self-perceived quality of life predicts mortality risk better than a multi-biomarker panel, but the combination of both does best

    Directory of Open Access Journals (Sweden)

    Nauck Matthias

    2011-07-01

    Full Text Available Abstract Background Associations between measures of subjective health and mortality risk have previously been shown. We assessed the impact and comparative predictive performance of a multi-biomarker panel on this association. Methods Data from 4,261 individuals aged 20-79 years recruited for the population-based Study of Health in Pomerania was used. During an average 9.7 year follow-up, 456 deaths (10.7% occurred. Subjective health was assessed by SF-12 derived physical (PCS-12 and mental component summaries (MCS-12, and a single-item self-rated health (SRH question. We implemented Cox proportional-hazards regression models to investigate the association of subjective health with mortality and to assess the impact of a combination of 10 biomarkers on this association. Variable selection procedures were used to identify a parsimonious set of subjective health measures and biomarkers, whose predictive ability was compared using receiver operating characteristic (ROC curves, C-statistics, and reclassification methods. Results In age- and gender-adjusted Cox models, poor SRH (hazard ratio (HR, 2.07; 95% CI, 1.34-3.20 and low PCS-12 scores (lowest vs. highest quartile: HR, 1.75; 95% CI, 1.31-2.33 were significantly associated with increased risk of all-cause mortality; an association independent of various covariates and biomarkers. Furthermore, selected subjective health measures yielded a significantly higher C-statistic (0.883 compared to the selected biomarker panel (0.872, whereas a combined assessment showed the highest C-statistic (0.887 with a highly significant integrated discrimination improvement of 1.5% (p Conclusion Adding biomarker information did not affect the association of subjective health measures with mortality, but significantly improved risk stratification. Thus, a combined assessment of self-reported subjective health and measured biomarkers may be useful to identify high-risk individuals for intensified monitoring.

  10. Mortality risk prediction by application of pediatric risk of mortality scoring system in pediatric intensive care unit.

    Science.gov (United States)

    Khajeh, Ali; Noori, Noor Mohammad; Reisi, Mohsen; Fayyazi, Afshin; Mohammadi, Mahdi; Miri-Aliabad, Ghasem

    2013-10-01

    The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU. In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15. Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%. PRISM score is a good predictor for evaluation of mortality risk in PICU.

  11. CLINICAL RISK INDEX FOR BABIES (CRIB) II SCORE AS A ...

    African Journals Online (AJOL)

    2011-01-01

    Jan 1, 2011 ... specificity of 75.3%, and a predictive value of 77.7% compared to 72.5, 71.2, and 71.8% respectively for birthweight. Gestational age was found to have even lower figures;. 56, 75 and 66% for sensitivity, specificity and predictive values respectively. Conclusion: CRIB II score of > 4 was found to have better ...

  12. Uses of NHANES Biomarker Data for Chemical Risk Assessment: Trends, Challenges, and Opportunities.

    Science.gov (United States)

    Sobus, Jon R; DeWoskin, Robert S; Tan, Yu-Mei; Pleil, Joachim D; Phillips, Martin Blake; George, Barbara Jane; Christensen, Krista; Schreinemachers, Dina M; Williams, Marc A; Hubal, Elaine A Cohen; Edwards, Stephen W

    2015-10-01

    Each year, the U.S. NHANES measures hundreds of chemical biomarkers in samples from thousands of study participants. These biomarker measurements are used to establish population reference ranges, track exposure trends, identify population subsets with elevated exposures, and prioritize research needs. There is now interest in further utilizing the NHANES data to inform chemical risk assessments. This article highlights a) the extent to which U.S. NHANES chemical biomarker data have been evaluated, b) groups of chemicals that have been studied, c) data analysis approaches and challenges, and d) opportunities for using these data to inform risk assessments. A literature search (1999-2013) was performed to identify publications in which U.S. NHANES data were reported. Manual curation identified only the subset of publications that clearly utilized chemical biomarker data. This subset was evaluated for chemical groupings, data analysis approaches, and overall trends. A small percentage of the sampled NHANES-related publications reported on chemical biomarkers (8% yearly average). Of 11 chemical groups, metals/metalloids were most frequently evaluated (49%), followed by pesticides (9%) and environmental phenols (7%). Studies of multiple chemical groups were also common (8%). Publications linking chemical biomarkers to health metrics have increased dramatically in recent years. New studies are addressing challenges related to NHANES data interpretation in health risk contexts. This article demonstrates growing use of NHANES chemical biomarker data in studies that can impact risk assessments. Best practices for analysis and interpretation must be defined and adopted to allow the full potential of NHANES to be realized.

  13. Revised Framingham Stroke Risk Score, Nontraditional Risk Markers, and Incident Stroke in a Multiethnic Cohort.

    Science.gov (United States)

    Flueckiger, Peter; Longstreth, Will; Herrington, David; Yeboah, Joseph

    2018-02-01

    Limited data exist on the performance of the revised Framingham Stroke Risk Score (R-FSRS) and the R-FSRS in conjunction with nontraditional risk markers. We compared the R-FSRS, original FSRS, and the Pooled Cohort Equation for stroke prediction and assessed the improvement in discrimination by nontraditional risk markers. Six thousand seven hundred twelve of 6814 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) were included. Cox proportional hazard, area under the curve, net reclassification improvement, and integrated discrimination increment analysis were used to assess and compare each stroke prediction risk score. Stroke was defined as fatal/nonfatal strokes (hemorrhagic or ischemic). After mean follow-up of 10.7 years, 231 of 6712 (3.4%) strokes were adjudicated (2.7% ischemic strokes). Mean stroke risks using the R-FSRS, original FSRS, and Pooled Cohort Equation were 4.7%, 5.9%, and 13.5%. The R-FSRS had the best calibration (Hosmer-Lemeshow goodness-of-fit, χ 2 =6.55; P =0.59). All risk scores were predictive of incident stroke. C statistics of R-FSRS (0.716) was similar to Pooled Cohort Equation (0.716), but significantly higher than the original FSRS (0.653; P =0.01 for comparison with R-FSRS). Adding nontraditional risk markers individually to the R-FSRS did not improve discrimination of the R-FSRS in the area under the curve analysis, but did improve category-less net reclassification improvement and integrated discrimination increment for incident stroke. The addition of coronary artery calcium to R-FSRS produced the highest category-less net reclassification improvement (0.36) and integrated discrimination increment (0.0027). Similar results were obtained when ischemic strokes were used as the outcome. The R-FSRS downgraded stroke risk but had better calibration and discriminative ability for incident stroke compared with the original FSRS. Nontraditional risk markers modestly improved the discriminative ability of the R-FSRS, with

  14. A genetic risk score predicts cardiovascular events in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Nyegaard, Mette; Larsen, Sanne Bøjet

    2017-01-01

    BACKGROUND: Genetic risk scores (GRSs) may predict cardiovascular risk in community-based populations. However, studies investigating the association with recurrent cardiovascular events in patients with established coronary artery disease (CAD) are conflicting. METHODS: We genotyped 879 patients...

  15. Attributable fractions, modifiable risk factors and risk stratification using a risk score for peri-implant pathology.

    Science.gov (United States)

    de Araújo Nobre, Miguel; Mano Azul, António; Rocha, Evangelista; Maló, Paulo; Salvado, Francisco

    2017-01-01

    This study aimed to estimate the impact of risk factors for peri-implant pathology, to identify potentially modifiable factors, and to evaluate the accuracy of the risk algorithm, risk scores and risk stratification. This retrospective case-control study with 1275 patients (255 cases; 1020 controls) retrieved a model according to the predictors: history of Periodontitis, bacterial plaque, bleeding, bone level, lack of passive fit or non-optimal screw joint, metal-ceramic restoration, proximity to other implants/teeth, and smoking habits. Outcome measures were the attributable fraction; the positive and negative likelihood ratios at different disease cut-off points illustrated by the area under the curve statistic. Six predictors may be modified or controlled directly by either the patient or the clinician, accounting for a reduction in up to 95% of the peri-implant pathology cases. The positive and negative likelihood ratios were 9.69 and 0.13, respectively; the area under the curve was 0.96; a risk score was developed, making the complex statistical model useful to clinicians. Based on the results, six predictors for the incidence of peri-implant pathology can be modified to significantly improve the outcome. It was possible to stratify patients per risk category according to the risk score, providing a tool for clinicians to support their decision-making process. Copyright © 2016 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  16. A risk score to predict type 2 diabetes mellitus in an elderly Spanish Mediterranean population at high cardiovascular risk.

    Science.gov (United States)

    Guasch-Ferré, Marta; Bulló, Mònica; Costa, Bernardo; Martínez-Gonzalez, Miguel Ángel; Ibarrola-Jurado, Núria; Estruch, Ramon; Barrio, Francisco; Salas-Salvadó, Jordi

    2012-01-01

    To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample). Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample). The discrimination of Finnish Diabetes Risk Score (FINDRISC), German Diabetes Risk Score (GDRS) and our scores was assessed with the area under curve (AUC). The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%), and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

  17. A risk score to predict type 2 diabetes mellitus in an elderly Spanish Mediterranean population at high cardiovascular risk.

    Directory of Open Access Journals (Sweden)

    Marta Guasch-Ferré

    Full Text Available INTRODUCTION: To develop and test a diabetes risk score to predict incident diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. MATERIALS AND METHODS: A diabetes risk score was derived from a subset of 1381 nondiabetic individuals from three centres of the PREDIMED study (derivation sample. Multivariate Cox regression model ß-coefficients were used to weigh each risk factor. PREDIMED-personal Score included body-mass-index, smoking status, family history of type 2 diabetes, alcohol consumption and hypertension as categorical variables; PREDIMED-clinical Score included also high blood glucose. We tested the predictive capability of these scores in the DE-PLAN-CAT cohort (validation sample. The discrimination of Finnish Diabetes Risk Score (FINDRISC, German Diabetes Risk Score (GDRS and our scores was assessed with the area under curve (AUC. RESULTS: The PREDIMED-clinical Score varied from 0 to 14 points. In the subset of the PREDIMED study, 155 individuals developed diabetes during the 4.75-years follow-up. The PREDIMED-clinical score at a cutoff of ≥6 had sensitivity of 72.2%, and specificity of 72.5%, whereas AUC was 0.78. The AUC of the PREDIMED-clinical Score was 0.66 in the validation sample (sensitivity = 85.4%; specificity = 26.6%, and was significantly higher than the FINDRISC and the GDRS in both the derivation and validation samples. DISCUSSION: We identified classical risk factors for diabetes and developed the PREDIMED-clinical Score to determine those individuals at high risk of developing diabetes in elderly individuals at high cardiovascular risk. The predictive capability of the PREDIMED-clinical Score was significantly higher than the FINDRISC and GDRS, and also used fewer items in the questionnaire.

  18. Impact of a Genetic Risk Score on Myocardial Infarction Risk Across Different Ethnic Populations.

    Science.gov (United States)

    Joseph, Philip G; Pare, Guillaume; Asma, Senay; Engert, James C; Yusuf, Salim; Anand, Sonia S

    2016-12-01

    Myocardial infarction (MI) risk varies by ethnicity, although the influence of genetic factors remains unclear. Using a genetic risk score (GRS), we examined the association between 25 coronary artery disease (CAD)-related single nucleotide polymorphisms and MI across 6 ethnic groups. We studied 8556 participants in the INTERHEART case-control study from 6 ethnic groups: Europeans, South Asians, Southeast Asians, Arabs, Latin Americans, and Africans. Associations between the GRS and MI were tested in each group by logistic regression and overall by meta-analysis. Overall, the GRS increased the odds of MI by 1.07 (95% confidence interval [CI], 1.04-1.09) per risk allele in the unadjusted model, with little change (odds ratio, 1.06; 95% CI, 1.04-1.09) after adjusting for demographic and modifiable factors. In Europeans, South Asians, Southeast Asians, and Arabs, the GRS was significantly associated with MI, with minimal heterogeneity observed. In these groups, a score > 23 risk alleles (highest 4 quintiles) was associated with only a 5% difference in population attributable risk (PAR) (36% to 41%) for MI. The GRS was not significant in Latin Americans or Africans. In the overall cohort, modest changes, beyond clinical factors, in PAR (88% to 91%), concordance statistic (0.73 to 0.74), and continuous net reclassification improvement (12%) were observed with the GRS. A CAD GRS is associated with MI across a multiethnic cohort, with significant and consistent effects across 4 distinct ethnicities. However, it only modestly improves MI risk prediction beyond clinical factors. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Torp-Pedersen, Christian; Hansen, Morten Lock

    2012-01-01

    associated with increasing CHA2DS2-VASc score was estimated in Cox regression models adjusted for year of inclusion and antiplatelet therapy. The value of adding the extra CHA2DS2-VASc risk factors to the CHADS2 score was evaluated by c-statistics, Net Reclassification Improvement (NRI) and Integrated......DS2-VASc score significantly improved the predictive value of the CHADS2 score alone and a CHA2DS2-VASc score=0 could clearly identify 'truly low risk' subjects. Use of the CHA2DS2-VASc score would significantly improve classification of AF patients at low and intermediate risk of stroke, compared......North American and European guidelines on atrial fibrillation (AF) are conflicting regarding the classification of patients at low/intermediate risk of stroke. We aimed to investigate if the CHA2DS2-VASc score improved risk stratification of AF patients with a CHADS2 score of 0-1. Using individual...

  20. Proposal for a new categorization of aseptic processing facilities based on risk assessment scores.

    Science.gov (United States)

    Katayama, Hirohito; Toda, Atsushi; Tokunaga, Yuji; Katoh, Shigeo

    2008-01-01

    Risk assessment of aseptic processing facilities was performed using two published risk assessment tools. Calculated risk scores were compared with experimental test results, including environmental monitoring and media fill run results, in three different types of facilities. The two risk assessment tools used gave a generally similar outcome. However, depending on the tool used, variations were observed in the relative scores between the facilities. For the facility yielding the lowest risk scores, the corresponding experimental test results showed no contamination, indicating that these ordinal testing methods are insufficient to evaluate this kind of facility. A conventional facility having acceptable aseptic processing lines gave relatively high risk scores. The facility showing a rather high risk score demonstrated the usefulness of conventional microbiological test methods. Considering the significant gaps observed in calculated risk scores and in the ordinal microbiological test results between advanced and conventional facilities, we propose a facility categorization based on risk assessment. The most important risk factor in aseptic processing is human intervention. When human intervention is eliminated from the process by advanced hardware design, the aseptic processing facility can be classified into a new risk category that is better suited for assuring sterility based on a new set of criteria rather than on currently used microbiological analysis. To fully benefit from advanced technologies, we propose three risk categories for these aseptic facilities.

  1. A Healthy Lifestyle Score Is Associated with Cardiometabolic and Neuroendocrine Risk Factors among Puerto Rican Adults.

    Science.gov (United States)

    Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N; Falcón, Luis M; Gao, Xiang; Tucker, Katherine L; Mattei, Josiemer

    2015-07-01

    Although individual healthy lifestyle behaviors may reduce cardiovascular disease risk, few studies have analyzed the combined effect of multiple lifestyle components as one all-inclusive measure on such outcomes, much less in minority populations. We aimed to develop a Healthy Lifestyle Score (HLS) that included several lifestyle recommendations and to test its association with metabolic syndrome (MetS) and allostatic load (AL) and their cardiometabolic and neuroendocrine factors in Puerto Ricans. In a cross-sectional study in 787 Puerto Ricans living in Boston (aged 45-75 y), we developed an HLS that ranged from 0 to 190 (higher score indicative of healthier lifestyle) and included 5 components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep). Multivariable-adjusted models were used to test associations between the HLS and biomarkers of dysregulation and odds of MetS and high AL (≥4 out of 10 components). The HLS showed adequate internal consistency (ρ = 0.31-0.69) and was inversely associated with urinary cortisol (β ± SE = -0.22 ± 0.11; P = 0.042), epinephrine (-0.20 ± 0.09; P = 0.017), and norepinephrine (-0.26 ± 0.11; P = 0.016); waist circumference (-0.014 ± 0.004; P = 0.003); and serum insulin (-0.30 ± 0.13; P = 0.028) and positively associated with plasma HDL cholesterol (0.007 ± 0.003; P = 0.021) after adjustment for potential confounders. For each 20-unit increase in HLS, participants had 19% (95% CI: 2%, 33%) and 25% (11%, 36%) lower odds of MetS or AL, respectively. Healthier scores for social support and network and smoking components were associated with lower odds of high AL (P lifestyle components. Following an overall healthy lifestyle that comprises a combination of multiple behaviors may provide stronger protection against MetS and AL in Puerto Rican adults than individual components. The HLS may be a useful tool for examining health-related outcomes. This trial was registered at

  2. Recurrence risk of low Apgar score among term singletons: a population-based cohort study

    NARCIS (Netherlands)

    Ensing, Sabine; Schaaf, Jelle M.; Abu-Hanna, Ameen; Mol, Ben W. J.; Ravelli, Anita C. J.

    2014-01-01

    To examine the risk of recurrence of low Apgar score in a subsequent term singleton pregnancy. Population-based cohort study. The Netherlands. A total of 190,725 women with two subsequent singleton term live births between 1999 and 2007. We calculated the recurrence risk of low Apgar score after

  3. Vertebral fracture risk (VFR) score for fracture prediction in postmenopausal Women

    DEFF Research Database (Denmark)

    Lillholm, Martin; Ghosh, A.; Pettersen, P. C.

    2011-01-01

    Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by...

  4. [Risk scores for community acquired pneumonia in elderly and geriatric patients].

    Science.gov (United States)

    Pflug, M A; Wesemann, T; Heppner, H J; Thiem, U

    2015-10-01

    Community-acquired pneumonia (CAP) is still an important and serious disease for elderly and geriatric patients. For epidemiological and clinical reasons it is important to collate the frequencies of the various degrees of severity of CAP and to obtain information on the spread and degree of the threat to the various risk groups by CAP. In outpatient treatment a simple to execute prognosis score can be used to objectify the assessment of the clinical status of a patient and to support therapeutic decision-making. For this purpose knowledge of the appropriate instruments should be available to potential users. Since the 1990s a variety of risk scores for stratification of CAP have been developed and evaluated. This article presents the content and value of the available risk scores whereby the advantages and disadvantages of the individual scores are critically compared. Special emphasis is placed on the importance of the risk scores for geriatric patients. At present the decision about outpatient or inpatient treatment is primarily based on the risk score CRB-65. Criteria for intensive care unit admissions are provided by the modified American Thoracic Society (ATS) set of criteria. Overall, risk scores are less reliable for elderly patients than for younger adults. For treatment decisions for the elderly, functional aspects should also be considered in addition to the aspects of risk scores discussed here. In particular, the decision about inpatient admission for elderly, geriatric CAP patients should be made on an individual basis taking the benefit-risk relationship into consideration.

  5. Polygenic risk scores for smoking: predictors for alcohol and cannabis use?

    NARCIS (Netherlands)

    Vink, J.M.; de Geus, E.J.C.; Willemsen, G.; Neale, M.C.; Furberg, H.; Boomsma, D.I.

    2014-01-01

    Background and Aims: A strong correlation exists between smoking and the use of alcohol and cannabis. This paper uses polygenic risk scores to explore the possibility of overlapping genetic factors. Those scores reflect a combined effect of selected risk alleles for smoking. Methods: Summary-level

  6. The "polyenviromic risk score": Aggregating environmental risk factors predicts conversion to psychosis in familial high-risk subjects.

    Science.gov (United States)

    Padmanabhan, Jaya L; Shah, Jai L; Tandon, Neeraj; Keshavan, Matcheri S

    2017-03-01

    Young relatives of individuals with schizophrenia (i.e. youth at familial high-risk, FHR) are at increased risk of developing psychotic disorders, and show higher rates of psychiatric symptoms, cognitive and neurobiological abnormalities than non-relatives. It is not known whether overall exposure to environmental risk factors increases risk of conversion to psychosis in FHR subjects. Subjects consisted of a pilot longitudinal sample of 83 young FHR subjects. As a proof of principle, we examined whether an aggregate score of exposure to environmental risk factors, which we term a 'polyenviromic risk score' (PERS), could predict conversion to psychosis. The PERS combines known environmental risk factors including cannabis use, urbanicity, season of birth, paternal age, obstetric and perinatal complications, and various types of childhood adversity, each weighted by its odds ratio for association with psychosis in the literature. A higher PERS was significantly associated with conversion to psychosis in young, familial high-risk subjects (OR=1.97, p=0.009). A model combining the PERS and clinical predictors had a sensitivity of 27% and specificity of 96%. An aggregate index of environmental risk may help predict conversion to psychosis in FHR subjects. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Predicting 10-Year Risk of Fatal Cardiovascular Disease in Germany: An Update Based on the SCORE-Deutschland Risk Charts.

    Science.gov (United States)

    Rücker, Viktoria; Keil, Ulrich; Fitzgerald, Anthony P; Malzahn, Uwe; Prugger, Christof; Ertl, Georg; Heuschmann, Peter U; Neuhauser, Hannelore

    2016-01-01

    Estimation of absolute risk of cardiovascular disease (CVD), preferably with population-specific risk charts, has become a cornerstone of CVD primary prevention. Regular recalibration of risk charts may be necessary due to decreasing CVD rates and CVD risk factor levels. The SCORE risk charts for fatal CVD risk assessment were first calibrated for Germany with 1998 risk factor level data and 1999 mortality statistics. We present an update of these risk charts based on the SCORE methodology including estimates of relative risks from SCORE, risk factor levels from the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) and official mortality statistics from 2012. Competing risks methods were applied and estimates were independently validated. Updated risk charts were calculated based on cholesterol, smoking, systolic blood pressure risk factor levels, sex and 5-year age-groups. The absolute 10-year risk estimates of fatal CVD were lower according to the updated risk charts compared to the first calibration for Germany. In a nationwide sample of 3062 adults aged 40-65 years free of major CVD from DEGS1, the mean 10-year risk of fatal CVD estimated by the updated charts was lower by 29% and the estimated proportion of high risk people (10-year risk > = 5%) by 50% compared to the older risk charts. This recalibration shows a need for regular updates of risk charts according to changes in mortality and risk factor levels in order to sustain the identification of people with a high CVD risk.

  8. Development of a metabolites risk score for one-year mortality risk prediction in pancreatic adenocarcinoma patients.

    Science.gov (United States)

    Fontana, Andrea; Copetti, Massimiliano; Di Gangi, Iole Maria; Mazza, Tommaso; Tavano, Francesca; Gioffreda, Domenica; Mattivi, Fulvio; Andriulli, Angelo; Vrhovsek, Urska; Pazienza, Valerio

    2016-02-23

    Survival among patients with adenocarcinoma pancreatic cancer (PDCA) is highly variable, which ranges from 0% to 20% at 5 years. Such a wide range is due to tumor size and stage, as well other patients' characteristics. We analyzed alterations in the metabolomic profile, of PDCA patients, which are potentially predictive of patient's one-year mortality. A targeted metabolomic assay was conducted on serum samples of patients diagnosed with pancreatic cancer. Statistical analyses were performed only for those 27 patients with information on vital status at follow-up and baseline clinical features. Random Forest analysis was performed to identify all metabolites and clinical variables with the best capability to predict patient's mortality risk at one year. Regression coefficients were estimated from multivariable Weibull survival model, which included the most associated metabolites. Such coefficients were used as weights to build a metabolite risk score (MRS) which ranged from 0 (lowest mortality risk) to 1 (highest mortality risk). The stability of these weights were evaluated performing 10,000 bootstrap resamplings. MRS was built as a weighted linear combination of the following five metabolites: Valine (HR = 0.62, 95%CI: 0.11-1.71 for each standard deviation (SD) of 98.57), Sphingomyeline C24:1 (HR = 2.66, 95%CI: 1.30-21.09, for each SD of 20.67), Lysine (HR = 0.36, 95%CI: 0.03-0.77, for each SD of 51.73), Tripentadecanoate TG15 (HR = 0.25, 95%CI: 0.01-0.82, for each SD of 2.88) and Symmetric dimethylarginine (HR = 2.24, 95%CI: 1.28-103.08, for each SD of 0.62), achieving a very high discrimination ability (survival c-statistic of 0.855, 95%CI: 0.816-0.894). Such association was still present even after adjusting for the most associated clinical variables (confounders). The mass spectrometry-based metabolomic profiling of serum represents a valid tool for discovering novel candidate biomarkers with prognostic ability to predict one-year mortality risk in patients

  9. The Management of Cardiovascular Risk through Epigenetic Biomarkers

    Directory of Open Access Journals (Sweden)

    Laurent Metzinger

    2017-01-01

    Full Text Available Epigenetic sciences study heritable changes in gene expression not related to changes in the genomic DNA sequence. The most important epigenetic mechanisms are DNA methylation, posttranslational histone modification, and gene regulation by noncoding RNAs, such as microRNAs (miRNAs and long noncoding RNAs (lncRNAs. Cardiovascular diseases (CVD are responsible for at least one-third of premature deaths worldwide and represent a heavy burden of healthcare expenditure. We will discuss in this review the most recent findings dealing with epigenetic alterations linked to cardiovascular physiopathology in patients. A particular focus will be put on the way these changes can be translated in the clinic, to develop innovative and groundbreaking biomarkers in CVD field.

  10. A genetic risk score combining ten psoriasis risk loci improves disease prediction.

    Directory of Open Access Journals (Sweden)

    Haoyan Chen

    2011-04-01

    Full Text Available Psoriasis is a chronic, immune-mediated skin disease affecting 2-3% of Caucasians. Recent genetic association studies have identified multiple psoriasis risk loci; however, most of these loci contribute only modestly to disease risk. In this study, we investigated whether a genetic risk score (GRS combining multiple loci could improve psoriasis prediction. Two approaches were used: a simple risk alleles count (cGRS and a weighted (wGRS approach. Ten psoriasis risk SNPs were genotyped in 2815 case-control samples and 858 family samples. We found that the total number of risk alleles in the cases was significantly higher than in controls, mean 13.16 (SD 1.7 versus 12.09 (SD 1.8, p = 4.577×10(-40. The wGRS captured considerably more risk than any SNP considered alone, with a psoriasis OR for high-low wGRS quartiles of 10.55 (95% CI 7.63-14.57, p = 2.010×10(-65. To compare the discriminatory ability of the GRS models, receiver operating characteristic curves were used to calculate the area under the curve (AUC. The AUC for wGRS was significantly greater than for cGRS (72.0% versus 66.5%, p = 2.13×10(-8. Additionally, the AUC for HLA-C alone (rs10484554 was equivalent to the AUC for all nine other risk loci combined (66.2% versus 63.8%, p = 0.18, highlighting the dominance of HLA-C as a risk locus. Logistic regression revealed that the wGRS was significantly associated with two subphenotypes of psoriasis, age of onset (p = 4.91×10(-6 and family history (p = 0.020. Using a liability threshold model, we estimated that the 10 risk loci account for only 11.6% of the genetic variance in psoriasis. In summary, we found that a GRS combining 10 psoriasis risk loci captured significantly more risk than any individual SNP and was associated with early onset of disease and a positive family history. Notably, only a small fraction of psoriasis heritability is captured by the common risk variants identified to date.

  11. Antithrombotic drugs and non-variceal bleeding outcomes and risk scoring systems: comparison of Glasgow Blatchford, Rockall and Charlson scores

    Science.gov (United States)

    Taha, Ali S; McCloskey, Caroline; Craigen, Theresa; Angerson, Wilson J

    2016-01-01

    Objectives Antithrombotic drugs (ATDs) cause non-variceal upper gastrointestinal bleeding (NVUGIB). Risk scoring systems have not been validated in ATD users. We compared Blatchford, Rockall and Charlson scores in predicting outcomes of NVUGIB in ATD users and controls. Methods A total of 2071 patients with NVUGIB were grouped into ATD users (n=851) and controls (n=1220) in a single-centre retrospective analysis. Outcomes included duration of hospital admission, the need for blood transfusion, rebleeding requiring surgery and 30-day mortality. Results Duration of admission correlated with all scores in controls, but correlations were significantly weaker in ATD users. Rank correlation coefficients in control versus ATD: 0.45 vs 0.20 for Blatchford; 0.48 vs 0.32 for Rockall and 0.42 vs 0.26 for Charlson (all p<0.001). The need for transfusion was best predicted by Blatchford (p<0.001 vs Rockall and Charlson in both ATD users and controls), but all scores performed less well in ATD users. Area under the receiver operation characteristic curve (AUC) in control versus ATD: 0.90 vs 0.85 for Blatchford; 0.77 vs 0.61 for Rockall and 0.69 vs 0.56 for Charlson (all p<0.005). In predicting surgery, Rockall performed best; while mortality was best predicted by Charlson with lower AUCs in ATD patients than controls (p<0.05). Stratification showed the scores' performance to be age-dependent. Conclusions Blatchford score was the strongest predictor of transfusion, Rockall's had the strongest correlation with duration of admission and with rebleeding requiring surgery and Charlson was best in predicting 30-day mortality. Modifications of these systems should be explored to improve their efficiency in ATD users. PMID:28839866

  12. A risk prediction score for invasive mold disease in patients with hematological malignancies.

    Directory of Open Access Journals (Sweden)

    Marta Stanzani

    Full Text Available BACKGROUND: A risk score for invasive mold disease (IMD in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis. METHODS: We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008 to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012. RESULTS: Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of 5% of IMD, with a negative predictive value (NPV of 0.99, (95% CI 0.98-0.99. During 2009-2012, patients with a calculated risk score at admission of 6 (0.9% vs. 10.6%, P <0.001. CONCLUSION: An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.

  13. A Risk Score for Fluconazole Failure among Patients with Candidemia.

    Science.gov (United States)

    Ostrosky-Zeichner, Luis; Harrington, Rachel; Azie, Nkechi; Yang, Hongbo; Li, Nanxin; Zhao, Jing; Koo, Valerie; Wu, Eric Q

    2017-05-01

    This study aimed to develop a prediction model to identify patients with candidemia who were at high risk of failing fluconazole treatment. Adult patients in the United States with candidemia who received fluconazole during hospitalization were selected from the Cerner Health Facts Hospital Database (04/2004 to 03/2013). Fluconazole failure was defined as switching/adding another antifungal, positive Candida culture ≥10 days after fluconazole initiation, or death during hospitalization. Patients were randomized into modeling and validation samples. Using the modeling sample, a regression analysis of least absolute shrinkage and selection operator was used to select risk predictors of fluconazole failure (demographics, Candida species, initiation of fluconazole before positive culture and after admission, and comorbidities, procedures, and treatments during the 6 months before admission and fluconazole initiation). The prediction model was evaluated using the validation sample. We found that of 987 identified patients (average age of 61 years, 51% male, 72% Caucasian), 49% failed and 51% did not fail fluconazole treatment. Of those who failed, 70% switched or added another antifungal, 21% had a second positive Candida test, and 42% died during hospitalization. Nine risk factors were included in the prediction model: days to start fluconazole after admission, Candida glabrata or Candida krusei infection, hematological malignancy, venous thromboembolism (VTE), enteral nutrition, use of nonoperative intubation/irrigation, and other antifungal use. All but VTE were associated with a higher risk of failure. The model's c-statistic was 0.65, with a Hosmer-Lemeshow test P value of 0.23. In summary, this prediction model identified patients with a high risk of fluconazole failure, illustrating the potential value and feasibility of personalizing candidemia treatment. Copyright © 2017 American Society for Microbiology.

  14. INTEGRATIVE CLINICAL NUTRITION DIALYSIS SCORE (ICNDS FOR PREDICTION OF NUTRITIONAL RISK IN HEMODIALYSIS PATIENTS

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    Sara Blumberg

    2012-06-01

    Full Text Available The Integrative Clinical Nutrition Dialysis Score is a new quantitative method for identifying nutritional risk in hemodialysis patients. It is based on biochemical measures and weight change taken as a part of the patient’s monthly routine care and can be accomplished within a short time following completion of laboratory results. The Scoring result is a number between 0-100 given for each patient. A higher Score indicates a good nutritional status, a lower Score represents malnutrition. The Score identifies also a monthly change in nutritional status, and patients who should receive nutritional intervention. In 59 patients, Score results were found to be significantly correlated with nutrition evaluation by the Subjective Global Assessment taken within the same month. In 165 patients, baseline score emerged as a significant inverse predictor of mortality and hospitalization: each 1-unit increase in score reduced mortality risk by 7.1%, and reduced hospitalization risk by 6.5%. A 1- unit increase of slope of monthly scores reduced mortality risk by 23.6% and reduced hospitalization risk by 20.1%. A threshold of Score greater or equal to 75 reduced mortality by 64.2%. Patients were divided into four categories based on baseline score (above/equal or below a threshold of 75 and slope of monthly scores (smaller or larger/equal to 0. Worsening nutrition status over time as indicated by both score and slope, significantly increased death hazard. Results confirm that Integrative Clinical Nutrition Dialysis Score (ICNDS is a simple, useful prognostic tool to reflect hemodialysis patients nutrition status, and nutrition deterioration at its very commencement.

  15. Adding multiple risk factors improves Framingham coronary heart disease risk scores

    Directory of Open Access Journals (Sweden)

    Hu G

    2014-09-01

    Full Text Available Guizhou Hu,1 Martin Root,2 Ashlee W Duncan1 1BioSignia, Inc., Durham, NC, USA; 2Department of Nutrition and Health Care Management, Appalachian State University, Boone, NC, USA Purpose: Since the introduction of the Framingham Risk Score (FRS, numerous versions of coronary heart disease (CHD prediction models have claimed improvement over the FRS. Tzoulaki et al challenged the validity of these claims by illustrating methodology deficiencies among the studies. However, the question remains: Is it possible to create a new CHD model that is better than FRS while overcoming the noted deficiencies? To address this, a new CHD prediction model was developed by integrating additional risk factors, using a novel modeling process. Methods: Using the National Health Nutritional Examination Survey III data set with CHD-specific mortality outcomes and the Atherosclerosis Risk in Communities data set with CHD incidence outcomes, two FRSs (FRSv1 from 1998 and FRSv2 from National Cholesterol Education Program Adult Treatment Panel III, along with an additional risk score in which the high density lipoprotein (HDL component of FRSv1 was ignored (FRSHDL, were compared with a new CHD model (NEW-CHD. This new model contains seven elements: the original Framingham equation, FRSv1, and six additional risk factors. Discrimination, calibration, and reclassification improvements all were assessed among models. Results: Discrimination was improved for NEW-CHD in both cohorts when compared with FRSv1 and FRSv2 (P<0.05 and was similar in magnitude to the improvement of FRSv1 over FRSHDL. NEW-CHD had a similar calibration to FRSv2 and was improved over FRSv1. Net reclassification for NEW-CHD was substantially improved over both FRSv1 and FRSv2, for both cohorts, and was similar in magnitude to the improvement of FRSv1 over FRSHDL. Conclusion: While overcoming several methodology deficiencies reported by earlier authors, the NEW-CHD model improved CHD risk assessment when

  16. Strongly enhanced colorectal cancer risk stratification by combining family history and genetic risk score

    Directory of Open Access Journals (Sweden)

    Weigl K

    2018-01-01

    Full Text Available Korbinian Weigl,1,2 Jenny Chang-Claude,3,4 Phillip Knebel,5 Li Hsu,6 Michael Hoffmeister,1 Hermann Brenner1,2,7 1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ, Heidelberg, 2German Cancer Consortium (DKTK, German Cancer Research Center (DKFZ, Heidelberg, 3Unit of Genetic Epidemiology, German Cancer Research Center (DKFZ, Heidelberg, 4University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, 5Department for General, Visceral and Transplantation Surgery, University Heidelberg, Heidelberg, Germany; 6Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; 7Division of Preventive Oncology, German Cancer Research Center (DKFZ and National Center for Tumor Diseases (NCT, Heidelberg, Germany Background and aim: Family history (FH and genetic risk scores (GRSs are increasingly used for risk stratification for colorectal cancer (CRC screening. However, they were mostly considered alternatively rather than jointly. The aim of this study was to assess the potential of individual and joint risk stratification for CRC by FH and GRS.Patients and methods: A GRS was built based on the number of risk alleles in 53 previously identified single-nucleotide polymorphisms among 2,363 patients with a first diagnosis of CRC and 2,198 controls in DACHS [colorectal cancer: chances for prevention through screening], a population-based case-control study in Germany. Associations between GRS and FH with CRC risk were quantified by multiple logistic regression.Results: A total of 316 cases (13.4% and 214 controls (9.7% had a first-degree relative (FDR with CRC (adjusted odds ratio [aOR] 1.86, 95% CI 1.52–2.29. A GRS in the highest decile was associated with a 3.0-fold increased risk of CRC (aOR 3.00, 95% CI 2.24–4.02 compared with the lowest decile. This association was tentatively more pronounced in older age groups. FH and GRS were essentially unrelated, and their

  17. Effect of Exercise Training on Cardiac Biomarkers in At-Risk Populations: A Systematic Review.

    Science.gov (United States)

    Glenney, Susan Sullivan; Brockemer, Derrick Paul; Ng, Andy C; Smolewski, Michael A; Smolgovskiy, Vladimir M; Lepley, Adam S

    2017-12-01

    Studies have demonstrated beneficial effects of exercise on cardiovascular disease biomarkers for healthy individuals; however, a comprehensive review regarding the effect of exercise on cardiovascular disease biomarkers in at-risk populations is lacking. A literature search was performed to identify studies meeting the following criteria: randomized controlled study, participants with pathology/activity limitations, biomarker outcome (total cholesterol, high-density lipoprotein, low-density lipoprotein, C-reactive protein, insulin, triglycerides, or glucose), and exercise intervention. Means and standard deviations from each biomarker were used to calculate standardized Cohen's d effect sizes with 95% confidence intervals. In total, 37 articles were included. The majority (44/57; 77%) of data points demonstrated moderate to strong effects for the reduction in total cholesterol, triglycerides, and low-density lipoprotein, and elevation in high-density lipoprotein following exercise. The majority of data points demonstrated strong effects for reductions in blood glucose (24/30; 80%) and insulin (23/24; 96%) levels following exercise intervention. Evidence is heterogeneous regarding the influence of exercise on cardiovascular disease biomarkers in at-risk patients, which does not allow a definitive conclusion. Favorable effects include reductions in triglycerides, total cholesterol, low-density lipoprotein, glucose, and insulin, and elevation in high-density lipoprotein following exercise intervention. The strongest evidence indicates that exercise is favorable for the reduction in glucose and cholesterol levels among obese patients, and reduction of insulin regardless of population.

  18. [Biomarkers and risk factors of cardiovascular system disease in diabetes mellitus type 2].

    Science.gov (United States)

    Prystupiuk, O M

    2013-01-01

    The content of glycated hemoglobin, a biomarker of diabetes in patients with type 2 diabetes correlates with risk factors for cardiovascular disease: hypertension, BMI and ratio of total cholesterol to HDL cholesterol. Therefore, increase in glycosylated hemoglobin should be considered a predictor of cardiovascular disease in patients with type 2 diabetes.

  19. Antioxidant vitamins and cancer risk: is oxidative damage to DNA a relevant biomarker?

    DEFF Research Database (Denmark)

    Loft, Steffen; Møller, Peter; Cooke, Marcus S

    2008-01-01

    -dihydroguanine (8-oxodG) are increasingly being regarded as reliable biomarkers of oxidative stress and they may have a predictive value of cancer risk, although this needs to be established independently in several cohort studies. A survey of intervention studies of the ingestion of antioxidant-containing foods...

  20. Application of miRNAs as Biomarkers of Exposure and Effects in Risk Evaluation

    Science.gov (United States)

    Of the known epigenetic mechanisms, non-coding RNA and more specifically, microRNA (miRNA), offer the most immediate promise for risk assessment applications because these molecules can serve as excellent biomarkers of toxicity. The advantages of miRNA versus more classical prot...

  1. A prospective study of the immune system activation biomarker neopterin and colorectal cancer risk

    NARCIS (Netherlands)

    Aleksandrova, K.; Chuang, S.C.; Boeing, H.; Zuo, Huijuan; Tell, G.S.; Pischon, T.; Jenab, M.; Bueno-De-Mesquita, B.; Vollset, S.E.; Midttun, Øivind; Ueland, P.M.; Fedirko, V.; Johansson, M.; Weiderpass, E.; Severi, G.; Racine, A.; Boutron-Ruault, M.C.; Kaaks, R.; Kühn, Tilman; Tjønneland, A.; Overvad, K.; Quirós, José R.; Jakszyn, P.; Sánchez, M.-J; Dorronsoro, M.; Chirlaque, M.D.; Ardanaz, E.; Khaw, Kay T.; Wareham, Nicholas J.; Travis, Ruth C.; Trichopoulou, A.; Lagiou, P.; Trichopoulos, D.; Palli, D.; Sieri, S.; Tumino, R.; Panico, S.; May, A.M.; Palmqvist, R.; Ljuslinder, Ingrid; Kong, S.Y.J.; Freisling, H.; Gunter, Marc J.; Lu, Y.; Cross, Amanda J.; Riboli, E.; Vineis, P.

    2015-01-01

    Background: Neopterin may be relevant for colorectal cancer (CRC) development, as a biomarker of cellular immune activity exerting pleiotropic effects on cellular ageing, oxidative stress, and inflammation. So far, the association between prediagnostic neopterin and colon and rectal cancer risk has

  2. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS)

    Science.gov (United States)

    Dominguez, Ligia J.; Bes-Rastrollo, Maira; Basterra-Gortari, Francisco Javier; Gea, Alfredo; Barbagallo, Mario; Martínez-González, Miguel A.

    2015-01-01

    Background Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM). Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS), which integrates optimal food patterns, with the risk of developing T2DM in the SUN (“Seguimiento Universidad de Navarra”) longitudinal study. Methods We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points) were used to build the DDS (maximum: 60 points). Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR) of T2DM. Results We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25–39 points) vs. low (11–24) category 0.43 [95% confidence interval (CI) 0.21, 0.89]; and for high (40–60) vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019). Conclusions The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve

  3. Association of a Dietary Score with Incident Type 2 Diabetes: The Dietary-Based Diabetes-Risk Score (DDS.

    Directory of Open Access Journals (Sweden)

    Ligia J Dominguez

    Full Text Available Strong evidence supports that dietary modifications may decrease incident type 2 diabetes mellitus (T2DM. Numerous diabetes risk models/scores have been developed, but most do not rely specifically on dietary variables or do not fully capture the overall dietary pattern. We prospectively assessed the association of a dietary-based diabetes-risk score (DDS, which integrates optimal food patterns, with the risk of developing T2DM in the SUN ("Seguimiento Universidad de Navarra" longitudinal study.We assessed 17,292 participants initially free of diabetes, followed-up for a mean of 9.2 years. A validated 136-item FFQ was administered at baseline. Taking into account previous literature, the DDS positively weighted vegetables, fruit, whole cereals, nuts, coffee, low-fat dairy, fiber, PUFA, and alcohol in moderate amounts; while it negatively weighted red meat, processed meats and sugar-sweetened beverages. Energy-adjusted quintiles of each item (with exception of moderate alcohol consumption that received either 0 or 5 points were used to build the DDS (maximum: 60 points. Incident T2DM was confirmed through additional detailed questionnaires and review of medical records of participants. We used Cox proportional hazards models adjusted for socio-demographic and anthropometric parameters, health-related habits, and clinical variables to estimate hazard ratios (HR of T2DM.We observed 143 T2DM confirmed cases during follow-up. Better baseline conformity with the DDS was associated with lower incidence of T2DM (multivariable-adjusted HR for intermediate (25-39 points vs. low (11-24 category 0.43 [95% confidence interval (CI 0.21, 0.89]; and for high (40-60 vs. low category 0.32 [95% CI: 0.14, 0.69]; p for linear trend: 0.019.The DDS, a simple score exclusively based on dietary components, showed a strong inverse association with incident T2DM. This score may be applicable in clinical practice to improve dietary habits of subjects at high risk of T2DM

  4. The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records

    Directory of Open Access Journals (Sweden)

    Andrew Dalton

    2011-07-01

    Conclusions A simple method of substituting missing risk factor data can produce reliable estimates of CVD risk scores. Targeted screening for high CVD risk, using pre-existing electronic medical record data, does not require multiple imputation methods in risk estimation.

  5. Utility of the Japan arteriosclerosis longitudinal study score for identifying a high risk for vasospastic angina.

    Science.gov (United States)

    Funayama, Akira; Watanabe, Tetsu; Otaki, Yoichiro; Nishiyama, Satoshi; Arimoto, Takanori; Takahashi, Hiroki; Shishido, Tetsuro; Miyamoto, Takuya; Kubota, Isao

    2015-01-01

    The aim of this study was to investigate whether the Japan Arteriosclerosis Longitudinal Study (JALS) score, which is calculated from the traditional atherosclerotic coronary risk, is associated with the incidence of coronary vasospasms. We performed vasospasm provocation tests with acetylcholine in 109 patients referred to our hospital due to suspected vasospastic angina and subsequently calculated the atherosclerotic risk score according to the JALS score. Consequently, coronary vasospasms were evoked in 51 patients. The patients were divided into three groups according to the tertile of the JALS score: 1st, 42, n=37. The third tertile exhibited the greatest risk for vasospasms. A multivariate logistic regression analysis revealed that the JALS score (odds ratio: 1.686, pJALS score can serve as a useful tool for evaluating patients with suspected coronary vasospasms.

  6. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Csordas, Adam; Nietlispach, Fabian; Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E; Cahenzly, Martin; Binder, Ronald K; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F

    2015-01-01

    Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0-26.0, P 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8-5.6, P = 0.13). The Harrell's C-statistic was 0.58 (95% CI 0.45-0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71-0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1-31.3), P <0.01) and improved the model's net reclassification index (0.89, 95% CI (0.28-1.59). These results were confirmed in the independent validation cohort. Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.

  7. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Directory of Open Access Journals (Sweden)

    Adam Csordas

    Full Text Available Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR. Elevated levels of midregional proadrenomedullin (MR-proADM levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population.We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population.We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality.During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%. Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0-26.0, P 6.8 only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8-5.6, P = 0.13. The Harrell's C-statistic was 0.58 (95% CI 0.45-0.82 for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71-0.92, P = 0.01. In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1-31.3, P <0.01 and improved the model's net reclassification index (0.89, 95% CI (0.28-1.59. These results were confirmed in the independent validation cohort.Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.

  8. Fatal cardiovascular risk assessment with SCORE model in type 2 diabetes patients from Republic of Macedonia

    OpenAIRE

    Smokovski, Ivica; Milenkovic, Tatjana

    2013-01-01

    Aim: Assessment of 10-year fatal cardiovascular risk (%) with SCORE model in patients with type 2 diabetes mellitus (DM) from Republic of Macedonia, adjusted for diabetic population. Methods and materials: Observational, cross-sectional study of cohort of 1,404 type 2 DM aged 25 to 65 years, without cardiovascular disease or cancer. 10-year fatal cardiovascular risk (%) with SCORE model was calculated for every patient, taking in consideration the increased relative risk of DM compared to non...

  9. Salivary Biomarkers of Chronic Psychosocial Stress and CVD Risks: A Systematic Review.

    Science.gov (United States)

    An, Kyungeh; Salyer, Jeanne; Brown, Roy E; Kao, Hsueh-Fen Sabrina; Starkweather, Angela; Shim, Insop

    2016-05-01

    The use of salivary biomarkers in stress research is increasing, and the precision and accuracy with which researchers are able to measure these biomarkers have dramatically improved. Chronic psychosocial stress is often linked to the pathogenesis of cardiovascular disease (CVD). Salivary biomarkers represent a noninvasive biological method of characterizing the stress phenomenon that may help to more fully describe the mechanism by which stress contributes to the pathogenesis and outcomes of CVD. We conducted a systematic review of 40 research articles to identify the salivary biomarkers researchers have most commonly used to help describe the biological impact of chronic psychosocial stress and explore its associations with CVD risk. We address strengths and weaknesses of specimen collection and measurement. We used PubMed, CINAHL, EBSCOhost, Web of Science, BIOSIS Previews, Biological Sciences (ProQuest), and Dissertations/Theses (ProQuest) to retrieve 387 initial articles. Once we applied our inclusion/exclusion criteria to specifically target adult human studies dealing with chronic stress rather than acute/laboratory-induced stress, 40 studies remained, which we synthesized using Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Cortisol was the biomarker used most frequently. Sources of psychosocial stress included job strain, low socioeconomic status, and environmental factors. Overall, psychosocial stress was associated with CVD risks such as vascular pathology (hypertension, blood pressure fluctuation, and carotid artery plaque) as well as metabolic factors such as abnormal blood glucose, dyslipidemia, and elevated cardiac enzymes. Diverse salivary biomarkers have been useful in stress research, particularly when linked to CVD risks. © The Author(s) 2015.

  10. Exercise, weight loss and biomarkers for breast cancer risk

    NARCIS (Netherlands)

    Gemert, W.A.M. van

    2015-01-01

    Background: Postmenopausal breast cancer is the most prevalent cancer in Western women. There are several known risk factors for postmenopausal breast cancer of which few are lifestyle-related and, thereby, modifiable. These risk factors provide an opportunity for primary prevention. In this thesis,

  11. All at-risk patients are not created equal: analysis of Braden pressure ulcer risk scores to identify specific risks.

    Science.gov (United States)

    Tescher, Ann N; Branda, Megan E; Byrne, T J O; Naessens, James M

    2012-01-01

    To improve identification of risk factors for pressure ulcer development and enhance targeted interventions and prevention strategies. The records of 12,566 adult patients hospitalized in intensive or progressive care units within Mayo Clinic were analyzed. Inclusion criteria were Braden Scale of 18 or less during the hospitalization; exclusion criteria were preexisting pressure ulcer or length of stay less than 24 hours. This study is a retrospective cohort analysis of electronic medical record data from January 1, 2007, to December 31, 2007. Only iatrogenic stage 2 to 4 pressure ulcers were considered as incident events. Demographic and clinical data were extracted from the medical record, including total Braden Scale score and Braden subscale scores at hospital admission, length of stay, admission to the intensive care unit at the time of hospitalization, and presence of acute respiratory failure, acute renal failure, or diabetes. Time to event was calculated based on time from admission to pressure ulcer occurrence or to hospital discharge. Four hundred sixteen (3.3%) of patients developed a pressure ulcer during their hospitalizations. The Braden Scale score total by itself was found to be highly predictive of pressure ulcer development (P ≤ .0001, C = 0.71), as were all individual subscores. The friction/shear subscale had the greatest predictive power among Braden Scale scores (subscores and total score) (C = 0.83). The multivariate model after selection included 5 Braden Scale subscales, surgery, and acute respiratory failure (C = 0.91). The total Braden Scale score is predictive of pressure ulcer development but does not assist the clinician to develop an individualized targeted prevention plan. In contrast, the use of subscale scores can enhance prevention programs and resource utilization by focusing care on the risk factors specific to the individual patient.

  12. Correlates of cardiovascular disease risk scores in women in Riyadh, Kingdom of Saudi Arabia.

    Science.gov (United States)

    Alquaiz, AlJohara M; Kazi, Ambreen; Qureshi, Riaz; Siddiqui, Amna Rehana; Jamal, Amr; Shaik, Shaffi Ahamed

    2015-01-01

    Saudi Arabia has a high prevalence of obesity and physical inactivity. We measured cardiovascular (CVD) risk scores and determined the factors associated with them in women in Riyadh, Saudi Arabia. A cross-sectional study using a self-administered questionnaire was conducted on 291 women aged ≥ 30 years. Information was collected on socio-demographics and physical health status. Anthropometric and blood pressure measurements were taken. Physical activity was measured using Kaiser's Physical Activity Survey and Godin's Leisure Time Exercise questionnaire. CVD risk scores were calculated using the non-laboratory-based Framingham Risk (FRS) prediction model for primary care. FRS scores ranged from 0.50 to 21.9. A total of 2.7% (n = 8) of women had a high FRS score (>20), 5.5% (n = 16) had intermediate scores (11-20), and 91.8% (n = 267) of women had low scores (<10) CVD risk scores. Multiple linear regression results indicated that a one-unit change in physical activity (household/caregiver index), strenuous exercise, waist circumference, number of children, television watching, and knee pain were significantly associated with -0.20 (p < .01), -0.12 (p = .03), 0.19 (p = .001), 0.29 (p < .01), 0.13 (p = .04), and 0.11 (p = .05) unit change in CVD risk scores, respectively. Household activities and strenuous exercise had a protective role in females in relation to CVD risk. Programs recommending physical activity at all levels should be encouraged.

  13. Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort

    DEFF Research Database (Denmark)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H

    2015-01-01

    Background and Purpose—The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death...... and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. Results—42 182 patients with incident...... ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores...

  14. Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and Women.

    Science.gov (United States)

    Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N; Mattei, Josiemer; Fung, Teresa T; Li, Yanping; Pan, An; Willett, Walter C; Rimm, Eric B; Hu, Frank B

    2015-12-08

    Adherence to several diet quality scores, including the Alternative Healthy Eating Index, Alternative Mediterranean Diet score, and Dietary Approach to Stop Hypertension, has been associated with lower risk of cardiovascular disease (CVD), but little is known about how changes in these scores over time influence subsequent CVD risk. We analyzed the association between 4-year changes in the 3 diet quality scores (Alternative Healthy Eating Index, Alternative Mediterranean Diet score, and Dietary Approach to Stop Hypertension) and subsequent cardiovascular disease (CVD) risk among 29 343 men in the Health Professionals Follow-up Study and 51 195 women in the Nurses' Health Study (1986-2010). During 1 394 702 person-years of follow-up, we documented 11 793 CVD cases. Compared with participants whose diet quality remained relatively stable in each 4-year period, those with the greatest improvement in diet quality scores had a 7% to 8% lower CVD risk in the subsequent 4-year period (pooled hazard ratio, 0.92 [95% confidence interval (CI), 0.87-0.99] for the Alternative Healthy Eating Index; 0.93 [95% CI, 0.85-1.02] for the Alternative Mediterranean Diet score; and 0.93 [95% CI, 0.87-0.99] for the Dietary Approach to Stop Hypertension; all P for trend the long term, increasing the diet scores from baseline to the first 4-year follow-up was associated with lower CVD risk during the next 20 years (7% [95% CI, 1-12] for the Alternative Healthy Eating Index, and 9% [95% CI, 3-14] for the Alternative Mediterranean Diet score). A decrease in diet quality scores was associated with significantly elevated risk of CVD in subsequent time periods. Improving adherence to diet quality scores over time is associated with significantly lower CVD risk in both the short term and long term. © 2015 American Heart Association, Inc.

  15. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy.

    Science.gov (United States)

    Damkondwar, Deepali R; Raman, Rajiv; Suganeswari, G; Kulothungan, Vaitheeswaran; Sharma, Tarun

    2012-01-01

    To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ≥40 years). The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%), and low risk (diabetic retinopathy and sight-threatening retinopathy was more in the high-risk group (21% and 4.5%, respectively). The risk factors for developing diabetic retinopathy were similar in both the groups (low vs. high) - duration of diabetes (OR 1.14 vs. 1.08), higher HbA1c (OR 1.24 vs. 1.22), presence of macro- and microalbuminuria (OR 10.17 vs. 6.12 for macro-albuminuria) and use of insulin (OR 2.06 vs. 4.38). The additional risk factors in the high-risk group were presence of anemia (OR 2.65) and higher serum high density lipoprotein (HDL) cholesterol (OR 1.05). Framingham risk scoring, a global risk assessment tool to predict the 10-year risk of developing CVD, can also predict the occurrence and type of diabetic retinopathy. Those patients with high CVD scores should be followed up more frequently and treated adequately. This also warrants good interaction between the treating physician/cardiologist and the ophthalmologist.

  16. Blood-borne biomarkers of mortality risk: systematic review of cohort studies.

    Directory of Open Access Journals (Sweden)

    Evelyn Barron

    Full Text Available Lifespan and the proportion of older people in the population are increasing, with far reaching consequences for the social, political and economic landscape. Unless accompanied by an increase in health span, increases in age-related diseases will increase the burden on health care resources. Intervention studies to enhance healthy ageing need appropriate outcome measures, such as blood-borne biomarkers, which are easily obtainable, cost-effective, and widely accepted. To date there have been no systematic reviews of blood-borne biomarkers of mortality.To conduct a systematic review to identify available blood-borne biomarkers of mortality that can be used to predict healthy ageing post-retirement.Four databases (Medline, Embase, Scopus, Web of Science were searched. We included prospective cohort studies with a minimum of two years follow up and data available for participants with a mean age of 50 to 75 years at baseline.From a total of 11,555 studies identified in initial searches, 23 fulfilled the inclusion criteria. Fifty-one blood borne biomarkers potentially predictive of mortality risk were identified. In total, 20 biomarkers were associated with mortality risk. Meta-analyses of mortality risk showed significant associations with C-reactive protein (Hazard ratios for all-cause mortality 1.42, p<0.001; Cancer-mortality 1.62, p<0.009; CVD-mortality 1.31, p = 0.033, N Terminal-pro brain natriuretic peptide (Hazard ratios for all-cause mortality 1.43, p<0.001; CHD-mortality 1.58, p<0.001; CVD-mortality 1.67, p<0.001 and white blood cell count (Hazard ratios for all-cause mortality 1.36, p = 0.001. There was also evidence that brain natriuretic peptide, cholesterol fractions, erythrocyte sedimentation rate, fibrinogen, granulocytes, homocysteine, intercellular adhesion molecule-1, neutrophils, osteoprotegerin, procollagen type III aminoterminal peptide, serum uric acid, soluble urokinase plasminogen activator receptor, tissue inhibitor of

  17. Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

    Directory of Open Access Journals (Sweden)

    Marat Fudim

    2016-03-01

    Full Text Available The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD, to assess an individual׳s risk of future cardiovascular disease (CVD events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA is a population based study (n=6814 of White (38%, Black (28%, Chinese (22% and Hispanic (12% subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS performance across gender and ethnicities. Keywords: Risk stratification, Coronary calcium scoring, Gender, Ethnicity, MESA, {C}{C}

  18. A novel score to estimate the risk of pneumonia after cardiac surgery.

    Science.gov (United States)

    Kilic, Arman; Ohkuma, Rika; Grimm, Joshua C; Magruder, J Trent; Sussman, Marc; Schneider, Eric B; Whitman, Glenn J R

    2016-05-01

    The purpose of this study was to derive and validate a risk score for pneumonia (PNA) after cardiac surgery. Adults undergoing cardiac surgery between 2005 and 2012 were identified in a single-institution database. The primary outcome was postoperative PNA. Patients were randomly assigned to training and validation sets in a 3:1 ratio. A multivariable model was constructed incorporating univariate pre- and intraoperative predictors of PNA in the training set. Points were assigned to significant risk factors in the multivariable model based on their associated regression coefficients. A total of 6222 patients were included. The overall rate of postoperative PNA was 4.5% (n = 282). A 33-point score incorporating 6 risk factors (age, chronic lung disease, peripheral vascular disease, cardiopulmonary bypass time, intraoperative red blood cell transfusion, and pre- or intraoperative intra-aortic balloon pump) was generated. The model used to generate the score in the training set was robust in predicting PNA (c = 0.72, P risk score, ranging from 1.2% (score = 0) to 59% (score = 33). There was significant correlation between predicted rates of PNA based on the training cohort and actual rates of pneumonia in the validation cohort in weighted regression analysis (r = 0.74, P risk score is strongly predictive of postoperative PNA after cardiac surgery. The composite score has utility in tailoring perioperative management and in targeting diagnostic and preventative interventions. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. Integration and relative value of biomarkers for prediction of MCI to AD progression: Spatial patterns of brain atrophy, cognitive scores, APOE genotype and CSF biomarkers

    Directory of Open Access Journals (Sweden)

    Xiao Da

    2014-01-01

    Full Text Available This study evaluates the individual, as well as relative and joint value of indices obtained from magnetic resonance imaging (MRI patterns of brain atrophy (quantified by the SPARE-AD index, cerebrospinal fluid (CSF biomarkers, APOE genotype, and cognitive performance (ADAS-Cog in progression from mild cognitive impairment (MCI to Alzheimer's disease (AD within a variable follow-up period up to 6 years, using data from the Alzheimer's Disease Neuroimaging Initiative-1 (ADNI-1. SPARE-AD was first established as a highly sensitive and specific MRI-marker of AD vs. cognitively normal (CN subjects (AUC = 0.98. Baseline predictive values of all aforementioned indices were then compared using survival analysis on 381 MCI subjects. SPARE-AD and ADAS-Cog were found to have similar predictive value, and their combination was significantly better than their individual performance. APOE genotype did not significantly improve prediction, although the combination of SPARE-AD, ADAS-Cog and APOE ε4 provided the highest hazard ratio estimates of 17.8 (last vs. first quartile. In a subset of 192 MCI patients who also had CSF biomarkers, the addition of Aβ1–42, t-tau, and p-tau181p to the previous model did not improve predictive value significantly over SPARE-AD and ADAS-Cog combined. Importantly, in amyloid-negative patients with MCI, SPARE-AD had high predictive power of clinical progression. Our findings suggest that SPARE-AD and ADAS-Cog in combination offer the highest predictive power of conversion from MCI to AD, which is improved, albeit not significantly, by APOE genotype. The finding that SPARE-AD in amyloid-negative MCI patients was predictive of clinical progression is not expected under the amyloid hypothesis and merits further investigation.

  20. Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy.

    Science.gov (United States)

    Ahmadpour-Kacho, Mousa; Asnafi, Nesa; Javadian, Maryam; Hajiahmadi, Mahmood; Taleghani, Nazila

    2010-12-01

    The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad Hospital, which is affiliated to Babol University of Medical Sciences. Apgar score at 1 and 5 minutes after birth was taken and an umbilical cord blood gas analysis was done immediately after birth in both groups. Mothers came with a labor pain and were divided into high-risk and low risk if they have had any perinatal risk factors. Other data like gestational age, birth weight, need for resuscitation and admission to the newborn ward or Neonatal Intensive Care Unit was gathered by a questionnaire for comparison between the two groups. P-value less than 0.05 was considered being significant. The gestational age and birth weight were the same in high-risk and low risk mothers. Mean umbilical artery blood pH in high-risk mothers was significantly lower than in low risk mothers (P=0.004). Mean Apgar scores at 1 and 5 minutes were significantly lower in high-risk mothers than in low risk mothers (Pumbilical cord pH in low risk group (r=0.212, P=0.1). But in high-risk group there was significant correlation between Apgar score at 1(st) and 5(th) minute and the umbilical cord pH (r=0.01, P=0.036 and r=0.176, P=0.146, respectively). Combination of Apgar score and umbilical cord pH measurement in high-risk pregnant mother could better detect jeopardized baby.

  1. Validation of the Ectasia Risk Score System for Preoperative Laser in Situ Keratomileusis Screening

    Science.gov (United States)

    Randleman, J. Bradley; Trattler, William B.; Stulting, R. Doyle

    2013-01-01

    Purpose To validate the Ectasia Risk Score System for identifying patients at high risk for developing ectasia after laser in situ keratomileusis (LASIK).. Design Retrospective case-control study Methods Fifty eyes that developed ectasia and 50 control eyes with normal postoperative courses after LASIK were analyzed and compared using the previously described Ectasia Risk Score System, which assigns points in a weighted fashion to the following variables: topographic patter, predicted residual stromal bed thickness (RSB), age, preoperative corneal thickness (CT), and manifest refraction spherical equivalent (MRSE). Results In this series 92% of eyes with ectasia were correctly classified as being at high risk for the development of ectasia, while 6% of controls were incorrectly classified as being at high risk for ectasia. (pectasia risk score than by traditional screening parameters relying on abnormal topography or residual stromal bed thickness less than 250 μ (92% vs. 50%, p Ectasia Risk Score System in the population from which it was derived and this independent population of ectasia cases and controls. Conclusion The Ectasia Risk Score System is a valid and effective method for detecting eyes at risk for ectasia after LASIK and represents a significant improvement over previously utilized screening strategies. PMID:18328998

  2. Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Xing, Xue-Zhong; Wang, Hai-Jun; Huang, Chu-Lin; Yang, Quan-Hui; Qu, Shi-Ning; Zhang, Hao; Wang, Hao; Gao, Yong; Xiao, Qing-Ling; Sun, Ke-Lin

    2012-01-01

    Several risk scoures have been used in predicting acute kidney injury (AKI) of patients undergoing general or specific operations such as cardiac surgery. This study aimed to evaluate the use of two AKI risk scores in patients who underwent non-cardiac surgery but required intensive care. The clinical data of patients who had been admitted to ICU during the first 24 hours of ICU stay between September 2009 and August 2010 at the Cancer Institute, Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively collected and analyzed. AKI was diagnosed based on the acute kidney injury network (AKIN) criteria. Two AKI risk scores were calculated: Kheterpal and Abelha factors. The incidence of AKI was 10.3%. Patients who developed AKI had a increased ICU mortality of 10.9% vs. 1.0% and an in-hospital mortality of 13.0 vs. 1.5%, compared with those without AKI. There was a significant difference between the classification of Kheterpal's AKI risk scores and the occurrence of AKI (PAbelha's AKI risk scores and the occurrence of AKI (P=0.499). Receiver operating characteristic curves demonstrated an area under the curve of 0.655±0.043 (P=0.001, 95% confidence interval: 0.571-0.739) for Kheterpal's AKI risk score and 0.507±0.044 (P=0.879, 95% confidence interval: 0.422-0.592) for Abelha's AKI risk score. Kheterpal's AKI risk scores are more accurate than Abelha's AKI risk scores in predicting the occurrence of AKI in patients undergoing non-cardiac surgery with moderate predictive capability.

  3. Joint modelling of longitudinal 3MS scores and the risk of mortality among cognitively impaired individuals.

    Directory of Open Access Journals (Sweden)

    Chris B Guure

    Full Text Available Modified Mini-Mental State Examination (3MS is an instrument administered by trained personnel to examine levels of participants' cognitive function. However, the association between changes in scores over time and the risk of death (mortality is not known. The aims of this study are to examine the association between 3MS scores and mortality via cognitive impairment among older women and to determine individuals' risk of changes in scores to better predict their survival and mortality rates.We propose a Bayesian joint modelling approach to determine mortality due to cognitive impairment via repeated measures of 3MS scores trajectories over a 21-year follow-up period. Data for this study are taken from the Osteoporotic Fracture longitudinal study among women aged 65+ which started in 1986-88.The standard relative risk model from the analyses with a baseline 3MS score after adjusting for all the significant covariates demonstrates that, every unit decrease in a 3MS score corresponds to a non-significant 1.059 increase risk of mortality with a 95% CI of (0.981, 1.143, while the extended model results in a significant 0.09% increased risk in mortality. The joint modelling approach found a strong association between the 3MS scores and the risk of mortality, such that, every unit decrease in 3MS scores results in a 1.135 (13% increased risk of death via cognitive impairment with a 95% CI of (1.056, 1.215.It has been demonstrated that a decrease in 3MS results has a significant increase risk of mortality due to cognitive impairment via joint modelling, but insignificant when considered under the standard relative risk approach.

  4. Developing a Conceptually Equivalent Type 2 Diabetes Risk Score for Indian Gujaratis in the UK

    Directory of Open Access Journals (Sweden)

    Naina Patel

    2016-01-01

    Full Text Available Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers’ ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions.

  5. 1,3-Butadiene: Biomarkers and application to risk assessment

    Czech Academy of Sciences Publication Activity Database

    Swenberg, J. A.; Bordeerat, N. K.; Boysen, G.; Carro, S.; Georgieva, N. I.; Troutman, J. M.; Upton, P. B.; Albertini, R. J.; Vacek, P. M.; Walker, V. E.; Šrám, Radim; Goggin, M.; Tretyakova, N.

    2011-01-01

    Roč. 192, 1-2 (2011), s. 150-154 ISSN 0009-2797 Institutional research plan: CEZ:AV0Z50390512 Keywords : risk assessment * 1,3-butadiene * occupational exposure Subject RIV: DN - Health Impact of the Environment Quality Impact factor: 2.865, year: 2011

  6. Improving Risk Assessment in Acquired Heart Disease: Biomarkers and Beyond

    NARCIS (Netherlands)

    N. van Boven (Nick)

    2017-01-01

    markdownabstractThe aim of this thesis was to identify characteristics associated with adverse clinical outcome, and to present novel prediction models that may aid in risk stratification of patients at different stages of cardiovascular disease. First, we focused on patients with coronary artery

  7. Urinary metalloproteinases: noninvasive biomarkers for breast cancer risk assessment

    DEFF Research Database (Denmark)

    Pories, Susan E; Zurakowski, David; Roy, Roopali

    2008-01-01

    , urine samples from women with known risk marker lesions, atypical hyperplasia and lobular carcinoma in situ (LCIS), were analyzed. Urine samples were obtained from 148 women: 44 women with atypical hyperplasia, 24 women with LCIS, and 80 healthy controls. MMP analysis was done using gelatin zymography...

  8. Poor predictive ability of the risk chart SCORE in a Danish population

    DEFF Research Database (Denmark)

    Saidj, Madina; Jørgensen, Torben; Prescott, Eva

    2013-01-01

    In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was there......In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study...... was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population....

  9. Poor predictive ability of the risk chart SCORE in a Danish population

    DEFF Research Database (Denmark)

    Saidj, Madina; Jørgensen, Torben; Prescott, Eva

    2013-01-01

    In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study was there...... was therefore to assess the predictive ability of the SCORE risk chart with regard to fatal cardiovascular risk according to the socio-demographic factors of age, sex, income and education in a Danish population.......In Denmark, the European risk chart Systematic COronary Risk Evaluation (SCORE) from the European Society of Cardiology is recommended for use in cardiovascular prevention. Nevertheless, its predictive ability in a Danish population has never been investigated. The purpose of this study...

  10. A Simple Risk Score for Identifying Individuals with Impaired Fasting Glucose in the Southern Chinese Population

    Directory of Open Access Journals (Sweden)

    Hui Wang

    2015-01-01

    Full Text Available This study aimed to develop and validate a simple risk score for detecting individuals with impaired fasting glucose (IFG among the Southern Chinese population. A sample of participants aged ≥20 years and without known diabetes from the 2006–2007 Guangzhou diabetes cross-sectional survey was used to develop separate risk scores for men and women. The participants completed a self-administered structured questionnaire and underwent simple clinical measurements. The risk scores were developed by multiple logistic regression analysis. External validation was performed based on three other studies: the 2007 Zhuhai rural population-based study, the 2008–2010 Guangzhou diabetes cross-sectional study and the 2007 Tibet population-based study. Performance of the scores was measured with the Hosmer-Lemeshow goodness-of-fit test and ROC c-statistic. Age, waist circumference, body mass index and family history of diabetes were included in the risk score for both men and women, with the additional factor of hypertension for men. The ROC c-statistic was 0.70 for both men and women in the derivation samples. Risk scores of ≥28 for men and ≥18 for women showed respective sensitivity, specificity, positive predictive value and negative predictive value of 56.6%, 71.7%, 13.0% and 96.0% for men and 68.7%, 60.2%, 11% and 96.0% for women in the derivation population. The scores performed comparably with the Zhuhai rural sample and the 2008–2010 Guangzhou urban samples but poorly in the Tibet sample. The performance of pre-existing USA, Shanghai, and Chengdu risk scores was poorer in our population than in their original study populations. The results suggest that the developed simple IFG risk scores can be generalized in Guangzhou city and nearby rural regions and may help primary health care workers to identify individuals with IFG in their practice.

  11. Evaluation of excess statistical significance in meta-analyses of 98 biomarker associations with cancer risk.

    Science.gov (United States)

    Tsilidis, Konstantinos K; Papatheodorou, Stefania I; Evangelou, Evangelos; Ioannidis, John P A

    2012-12-19

    Numerous biomarkers have been associated with cancer risk. We assessed whether there is evidence for excess statistical significance in results of cancer biomarker studies, suggesting biases. We systematically searched PubMed for meta-analyses of nongenetic biomarkers and cancer risk. The number of observed studies with statistically significant results was compared with the expected number, based on the statistical power of each study under different assumptions for the plausible effect size. We also evaluated small-study effects using asymmetry tests. All statistical tests were two-sided. We included 98 meta-analyses with 847 studies. Forty-three meta-analyses (44%) found nominally statistically significant summary effects (random effects). The proportion of meta-analyses with statistically significant effects was highest for infectious agents (86%), inflammatory (67%), and insulin-like growth factor (IGF)/insulin system (52%) biomarkers. Overall, 269 (32%) individual studies observed nominally statistically significant results. A statistically significant excess of the observed over the expected number of studies with statistically significant results was seen in 20 meta-analyses. An excess of observed vs expected was observed in studies of IGF/insulin (P ≤ .04) and inflammation systems (P ≤ .02). Only 12 meta-analyses (12%) had a statistically significant summary effect size, more than 1000 case patients, and no hints of small-study effects or excess statistical significance; only four of them had large effect sizes, three of which pertained to infectious agents (Helicobacter pylori, hepatitis and human papilloma viruses). Most well-documented biomarkers of cancer risk without evidence of bias pertain to infectious agents. Conversely, an excess of statistically significant findings was observed in studies of IGF/insulin and inflammation systems, suggesting reporting biases.

  12. Assessing Framingham cardiovascular risk scores in subjects with diabetes and their correlation with diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Deepali R Damkondwar

    2012-01-01

    Full Text Available Aim: To study the Framingham cardiovascular risk assessment scores in subjects with diabetes and their association with diabetic retinopathy in subjects with diabetes. Materials and Methods: In this population-based prospective study, subjects with diabetes were recruited (n=1248; age ≥40 years. The Framingham cardiovascular risk scores were calculated for 1248 subjects with type 2 diabetes. The scores were classified as high risk (>10%, and low risk (<10%. Results: Out of the 1248 subjects, 830 (66.5% patients had a low risk of developing cardiovascular disease (CVD in 10 years and 418 (33.5% had a high risk of developing CVD in 10 years. The risk of developing CVD was more in males than females (56.8% vs. 7% The prevalence of both diabetic retinopathy and sight-threatening retinopathy was more in the high-risk group (21% and 4.5%, respectively. The risk factors for developing diabetic retinopathy were similar in both the groups (low vs. high - duration of diabetes (OR 1.14 vs. 1.08, higher HbA1c (OR 1.24 vs. 1.22, presence of macro- and microalbuminuria (OR 10.17 vs. 6.12 for macro-albuminuria and use of insulin (OR 2.06 vs. 4.38. The additional risk factors in the high-risk group were presence of anemia (OR 2.65 and higher serum high density lipoprotein (HDL cholesterol (OR 1.05. Conclusion: Framingham risk scoring, a global risk assessment tool to predict the 10-year risk of developing CVD, can also predict the occurrence and type of diabetic retinopathy. Those patients with high CVD scores should be followed up more frequently and treated adequately. This also warrants good interaction between the treating physician/cardiologist and the ophthalmologist.

  13. Utility of combinations of biomarkers, cognitive markers, and risk factors to predict conversion from mild cognitive impairment to Alzheimer disease in patients in the Alzheimer's disease neuroimaging initiative.

    Science.gov (United States)

    Gomar, Jesus J; Bobes-Bascaran, Maria T; Conejero-Goldberg, Concepcion; Davies, Peter; Goldberg, Terry E

    2011-09-01

    Biomarkers have become increasingly important in understanding neurodegenerative processes associated with Alzheimer disease. Markers include regional brain volumes, cerebrospinal fluid measures of pathological Aβ1-42 and total tau, cognitive measures, and individual risk factors. To determine the discriminative utility of different classes of biomarkers and cognitive markers by examining their ability to predict a change in diagnostic status from mild cognitive impairment to Alzheimer disease. Longitudinal study. We analyzed the Alzheimer's Disease Neuroimaging Initiative database to study patients with mild cognitive impairment who converted to Alzheimer disease (n = 116) and those who did not convert (n = 204) within a 2-year period. We determined the predictive utility of 25 variables from all classes of markers, biomarkers, and risk factors in a series of logistic regression models and effect size analyses. The Alzheimer's Disease Neuroimaging Initiative public database. Primary outcome measures were odds ratios, pseudo- R(2)s, and effect sizes. In comprehensive stepwise logistic regression models that thus included variables from all classes of markers, the following baseline variables predicted conversion within a 2-year period: 2 measures of delayed verbal memory and middle temporal lobe cortical thickness. In an effect size analysis that examined rates of decline, change scores for biomarkers were modest for 2 years, but a change in an everyday functional activities measure (Functional Assessment Questionnaire) was considerably larger. Decline in scores on the Functional Assessment Questionnaire and Trail Making Test, part B, accounted for approximately 50% of the predictive variance in conversion from mild cognitive impairment to Alzheimer disease. Cognitive markers at baseline were more robust predictors of conversion than most biomarkers. Longitudinal analyses suggested that conversion appeared to be driven less by changes in the neurobiologic

  14. Comparison of accuracy of diabetes risk score and components of the metabolic syndrome in assessing risk of incident type 2 diabetes in Inter99 cohort.

    Directory of Open Access Journals (Sweden)

    Tracy B Shafizadeh

    Full Text Available BACKGROUND: Given the increasing worldwide incidence of diabetes, methods to assess diabetes risk which would identify those at highest risk are needed. We compared two risk-stratification approaches for incident type 2 diabetes mellitus (T2DM; factors of metabolic syndrome (MetS and a previously developed diabetes risk score, PreDx® Diabetes Risk Score (DRS. DRS assesses 5 yr risk of incident T2DM based on the measurement of 7 biomarkers in fasting blood. METHODOLOGY/PRINCIPAL FINDINGS: DRS was evaluated in baseline serum samples from 4,128 non-diabetic subjects in the Inter99 cohort (Danes aged 30-60 for whom diabetes outcomes at 5 years were known. Subjects were classified as having MetS based on the presence of at least 3 MetS risk factors in baseline clinical data. The sensitivity and false positive rate for predicting diabetes using MetS was compared to DRS. When the sensitivity was fixed to match MetS, DRS had a significantly lower false positive rate. Similarly, when the false positive rate was fixed to match MetS, DRS had a significantly higher specificity. In further analyses, subjects were classified by presence of 0-2, 3 or 4-5 risk factors with matching proportions of subjects distributed among three DRS groups. Comparison between the two risk stratification schemes, MetS risk factors and DRS, were evaluated using Net Reclassification Improvement (NRI. Comparing risk stratification by DRS to MetS factors in the total population, the NRI was 0.146 (p = 0.008 demonstrating DRS provides significantly improved stratification. Additionally, the relative risk of T2DM differed by 15 fold between the low and high DRS risk groups, but only 8-fold between the low and high risk MetS groups. CONCLUSIONS/SIGNIFICANCE: DRS provides a more accurate assessment of risk for diabetes than MetS. This improved performance may allow clinicians to focus preventive strategies on those most in need of urgent intervention.

  15. Risk score to stratify children with suspected serious bacterial infection: observational cohort study.

    Science.gov (United States)

    Brent, Andrew J; Lakhanpaul, Monica; Thompson, Matthew; Collier, Jacqueline; Ray, Samiran; Ninis, Nelly; Levin, Michael; MacFaul, Roddy

    2011-04-01

    To derive and validate a clinical score to risk stratify children presenting with acute infection. Observational cohort study of children presenting with suspected infection to an emergency department in England. Detailed data were collected prospectively on presenting clinical features, laboratory investigations and outcome. Clinical predictors of serious bacterial infection (SBI) were explored in multivariate logistic regression models using part of the dataset, each model was then validated in an independent part of the dataset, and the best model was chosen for derivation of a clinical risk score for SBI. The ability of this score to risk stratify children with SBI was then assessed in the entire dataset. Final diagnosis of SBI according to criteria defined by the Royal College of Paediatrics and Child Health working group on Recognising Acute Illness in Children. Data from 1951 children were analysed. 74 (3.8%) had SBI. The sensitivity of individual clinical signs was poor, although some were highly specific for SBI. A score was derived with reasonable ability to discriminate SBI (area under the receiver operator characteristics curve 0.77, 95% CI 0.71 to 0.83) and risk stratify children with suspected SBI. This study demonstrates the potential utility of a clinical score in risk stratifying children with suspected SBI. Further work should aim to validate the score and its impact on clinical decision making in different settings, and ideally incorporate it into a broader management algorithm including additional investigations to further stratify a child's risk.

  16. Clinical Risk Stratification Optimizes Value of Biomarkers to Predict New-Onset Heart Failure in a Community-Based Cohort

    NARCIS (Netherlands)

    Brouwers, Frank P.; van Gilst, Wiek H.; Damman, Kevin; van den Berg, Maarten P.; Gansevoort, Ron T.; Bakker, Stephan J. L.; Hillege, Hans L.; van Veldhuisen, Dirk J.; van der Harst, Pim; de Boer, Rudolf A.

    Background-We aim to identify and quantify the value of biomarkers for incident new-onset heart failure (HF) in a community-based cohort and subgroups based on cardiovascular risk and evaluate the prognostic value of 13 biomarkers for HF with reduced and preserved ejection fraction. Methods and

  17. BRAIN NATRIURETIC PEPTIDE (BNP: BIOMARKER FOR RISK STRATIFICATION AND FUNCTIONAL RECOVERY PREDICTION IN ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    STANESCU Ioana

    2015-02-01

    Full Text Available Functional outcome after cardiovascular and cerebrovascular events is traditionally predicted using demographic and clinical variables like age, gender, blood pressure, cholesterol levels, diabetes status, smoking habits or pre-existing morbidity. Identification of new variables will improve the risk stratification of specific categories of patients. Numerous blood-based biomarkers associated with increased cardiovascular risk have been identified; some of them even predict cardiovascular events. Investigators have tried to produce prediction models by incorporating traditional risk factors and biomarkers. (1. Widely-available, rapidly processed and less expensive biomarkers could be used in the future to guide management of complex cerebrovascular patients in order to maximize their recovery (2 Recently, studies have demonstrated that biomarkers can predict not only the risk for a specific clinical event, but also the risk of death of vascular cause and the functional outcome after cardiovascular or cerebrovascular events. Early prediction of fatal outcome after stroke may improve therapeutic strategies (such as the use of more aggressive treatments or inclusion of patients in clinical trials and guide decision-making processes in order to maximize patient’s chances for survival and recovery. (3 Long term functional outcome after stroke is one of the most difficult variables to predict. Elevated serum levels of brain natriuretic peptide (BNP are powerful predictor of outcomes in patients with cardiovascular disease (heart failure, atrial fibrillation. Potential role of BNP in predicting atrial fibrillation occurrence, cardio-embolic stroke and post-stroke mortality have been proved in many studies. However, data concerning the potential role of BNP in predicting short term and long term functional outcomes after stroke remain controversial.

  18. How much does HDL cholesterol add to risk estimation? A report from the SCORE Investigators.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2009-06-01

    Systematic COronary Risk Evaluation (SCORE), the risk estimation system recommended by the European guidelines on cardiovascular disease prevention, estimates 10-year risk of cardiovascular disease mortality based on age, sex, country of origin, systolic blood pressure, smoking status and either total cholesterol (TC) or TC\\/high-density lipoprotein cholesterol (HDL-C) ratio. As, counterintuitively, these two systems perform very similarly, we have investigated whether incorporating HDL-C and TC as separate variables improves risk estimation.

  19. Chromosomal aberrations and SCEs as biomarkers of cancer risk

    DEFF Research Database (Denmark)

    Norppa, H; Bonassi, S; Hansteen, I-L

    2006-01-01

    Previous studies have suggested that the frequency of chromosomal aberrations (CAs), but not of sister chromatid exchanges (SCEs), predicts cancer risk. We have further examined this relationship in European cohorts comprising altogether almost 22,000 subjects, in the framework of a European...... of xenobiotic metabolism, DNA repair, and folate metabolism affect the level of CAs and might collectively contribute to the cancer predictivity of CAs. Other factors that may influence the association between CAs and cancer include, e.g., exposure to genotoxic carcinogens and internal generation of genotoxic...

  20. A Posterior Circulation Ischemia Risk Score System to Assist the Diagnosis of Dizziness.

    Science.gov (United States)

    Chen, Ru; Su, Rui; Deng, Mingzhu; Liu, Jia; Hu, Qing; Song, Zhi

    2018-02-01

    We aimed to establish a risk score system without radio-image examination, which could help clinicians to differentiate patients with vertigo and posterior circulation ischemia (PCI) rapidly from the other dizzy patients. We analyzed 304 patients with vertigo (50% PCI). The attributes with more significant contributions were selected as the risk factors for the PCI risk score system, and every one of them was assigned a value according to their respective odds ratio values. We also compared the respective receiver operating characteristic curves of the 3 diagnostic methods (PCI score system, ABCD 2 , and Essen score systems) to evaluate their prediction effectiveness. Nine risk factors were ultimately selected for PCI score system, including high blood pressure (1'), diabetes mellitus (1'), ischemic stroke (1'), rotating and rocking (-1'), difficulty in speech (5'), tinnitus (-5'), limb and sensory deficit (5'), gait ataxia (1'), and limb ataxia (5'). According to their respective PCI risk scores, the patients were divided into 3 subgroups: low risk (≤0', risk 95.0%). When 0' was selected as a cutoff point for differentiating the patients with PCI from patients without PCI, the sensitivity was 94.1%, with a specificity of 41.4%. The areas under the receiver operator curve value of PCI score system was .82 (P = .000), much higher than the areas under the receiver operator curve value of ABCD 2 (.69, P = .000) and that of the Essen system (.67, P = .000) CONCLUSION: The PCI score system could help clinicians to differentiate patients with vertigo and PCI rapidly from the other dizzy patients. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Myocardium at risk assessed by electrocardiographic scores and cardiovascular magnetic resonance

    DEFF Research Database (Denmark)

    Sejersten, Maria; Fakhri, Yama; Pape, Marianne

    2017-01-01

    Introduction The myocardium at risk (MaR) represents the quantitative ischemic area destined to myocardial infarction (MI) if no reperfusion therapy is initiated. Different ECG scores for MaR have been developed, but there is no consensus as to which should be preferred. Objective Comparisons...... of ECG scores and Cardiac Magnetic Resonance (CMR) for determining MaR. Methods MaR was determined by 3 different ECG scores, and by CMR in ST-segment elevation MI (STEMI) patients from the MITOCARE cardioprotection trial. The Aldrich score (AL) is based on the number of leads with ST...

  2. A Bayesian framework for automated cardiovascular risk scoring on standard lumbar radiographs

    DEFF Research Database (Denmark)

    Petersen, Peter Kersten; Ganz, Melanie; Mysling, Peter

    2012-01-01

    We present a fully automated framework for scoring a patients risk of cardiovascular disease (CVD) and mortality from a standard lateral radiograph of the lumbar aorta. The framework segments abdominal aortic calcifications for computing a CVD risk score and performs a survival analysis to validate...... the score. Since the aorta is invisible on X-ray images, its position is reasoned from (1) the shape and location of the lumbar vertebrae and (2) the location, shape, and orientation of potential calcifications. The proposed framework follows the principle of Bayesian inference, which has several advantages...

  3. Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

    Science.gov (United States)

    Fudim, Marat; Zalawadiya, Sandip; Patel, Devin K.; Egolum, Ugochukwu O.; Afonso, Luis

    2016-01-01

    The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD), to assess an individual׳s risk of future cardiovascular disease (CVD) events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS) across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA) is a population based study (n=6814) of White (38%), Black (28%), Chinese (22%) and Hispanic (12%) subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female) from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS) performance across gender and ethnicities. PMID:26909370

  4. Unsupervised Deep Learning Applied to Breast Density Segmentation and Mammographic Risk Scoring.

    Science.gov (United States)

    Kallenberg, Michiel; Petersen, Kersten; Nielsen, Mads; Ng, Andrew Y; Pengfei Diao; Igel, Christian; Vachon, Celine M; Holland, Katharina; Winkel, Rikke Rass; Karssemeijer, Nico; Lillholm, Martin

    2016-05-01

    Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy to apply and generalizes to many other segmentation and scoring problems.

  5. COPART Risk Score Predicts Long-term Mortality in Peripheral Arterial Occlusive Disease.

    Science.gov (United States)

    Hackl, G; Belaj, K; Gary, T; Rief, P; Deutschmann, H; Seinost, G; Brodmann, M; Hafner, F

    2015-07-01

    The COhorte de Patients ARTériopathes (COPART) Risk Score is a risk score assessing the 1 year outcome of patients who received inpatient treatment because of their peripheral arterial occlusive disease (PAOD). The COPART Risk Score consists of six variables each of which is allocated a different number of points (age, history of myocardial infarction, C-reactive protein, ankle-brachial index, estimated glomerular filtration rate, medication with antiplatelet agents, statins and renin-angiotensin system inhibitors). 129 consecutive claudicants were included in a prospective trial with an average follow up of 8.8 (± 0.7) years. All patients were hospitalized for their first endovascular procedure to the pelvic and/or femoropopliteal arteries. The endpoints were all cause mortality and cardiovascular (CV) death. The COPART Risk Score was calculated for the three patient cohorts (low risk: 52 patients [40.3%]; medium risk: 41 patients [31.8%]; high risk: 36 patients [27.9%]). During the follow up period 23.1% (n = 12) of patients in the low risk group, 34.1% (n = 14) of patients in the medium risk group, and 63.9% (n = 23) of patients in the high risk group died. CV death occurred in 11.5% in the low, 22.0% in the medium, and 41.7% in the high risk groups. The three groups differed significantly with regard to all cause and CV mortality (p < .0001 and p = .001). The COPART Risk Score is a suitable instrument to predict long-term all cause and CV mortality in claudicants preceding their first peripheral intervention. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Lipid Biomarkers for Risk Assessment in Acute Coronary Syndromes.

    Science.gov (United States)

    Meeusen, Jeffrey W; Donato, Leslie J; Jaffe, Allan S

    2017-06-01

    The objective of this review was to summarize evidence gathered for the prognostic value of routine and novel blood lipids and lipoproteins measured in patients with acute coronary syndromes (ACS). Data supports clear association with risk and actionable value for non-high-density lipoprotein (Non-HDL) cholesterol and plasma ceramides in a setting of ACS. The prognostic value and clinical actionability of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)] in ACS have not been thoroughly tested, while the data for omega-3 fatty acids and oxidized low-density lipoprotein (Ox-LDL) are either untested or more varied. Measuring basic lipids, which should include Non-HDL cholesterol, at the time of presentation for ACS is guideline mandated. Plasma ceramides also provide useful information to guide both treatment decisions and follow-up. Additional studies targeting ACS patients are necessary for apoB, Lp(a), omega-3 fatty acids, and Ox-LDL.

  7. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding

    DEFF Research Database (Denmark)

    Stanley, Adrian J; Laine, Loren; Dalton, Harry R

    2017-01-01

    OBJECTIVE: To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. DESIGN: International multicentre prospective study. SETTING: Six large hospitals in Europe, North America, Asia, and Oceania....... PARTICIPANTS: 3012 consecutive patients presenting over 12 months with upper gastrointestinal bleeding. MAIN OUTCOME MEASURES: Comparison of pre-endoscopy scores (admission Rockall, AIMS65, and Glasgow Blatchford) and post-endoscopy scores (full Rockall and PNED) for their ability to predict predefined...... clinical endpoints: a composite endpoint (transfusion, endoscopic treatment, interventional radiology, surgery, or 30 day mortality), endoscopic treatment, 30 day mortality, rebleeding, and length of hospital stay. Optimum score thresholds to identify low risk and high risk patients were determined...

  8. Association of mallampatti score as a risk factor for obstructive sleep apnea

    International Nuclear Information System (INIS)

    Naqvi, S.U.; Shahab, A.; Zia, S.; Adil, S.O.; Tariq, S.

    2017-01-01

    Objectives: To determine the association of Mallampatti Score as a risk factor for Obstructive Sleep Apnea (OSA). Methodology: This is a prospective questionnaire based survey included 103 individuals Results: Mean BMI of patients was 23.83+-6.03 kg/m2. There were 28 (27.2%) overweight and 22 (21.4%) obese patients. High risk on Berlin questionnaire was found in 12 (11.7%) patients. Both Berlin Questionnaire and Epworth questioner showed a negative association with Mallampati; the low risk group of these variables in our study with a p-value of 0.034 and 0.016 respectively i.e they are good for exclusion of OSA if found negative. Comparison of general characteristics with Mallampatti score and snoring showed significant association among patients with >25 years of age (p=0.02), low risk of Berlin score (p=0.034) and normal Epworth Sleep Score (p=0.016). Fifteen (14.5%) of overweight and obese individuals had higher Mallampatti score III and lV but the P-values were not significant (0.283 and 0.386). Conclusion: There is strong association between high Mallampatti score and O.S.A. Therefore we suggest that high mallampatti can be taken as a risk factor / screening tool limitation for O.S.A. (author)

  9. Optimizing the risk estimation after a transient ischaemic attack - the ABCDE⊕ score.

    Science.gov (United States)

    Engelter, S T; Amort, M; Jax, F; Weisskopf, F; Katan, M; Burow, A; Bonati, L H; Hatz, F; Wetzel, S G; Fluri, F; Lyrer, P A

    2012-01-01

    The risk of stroke after a transient ischaemic attack (TIA) can be predicted by scores incorporating age, blood pressure, clinical features, duration (ABCD-score), and diabetes (ABCD2-score). However, some patients have strokes despite a low predicted risk according to these scores. We designed the ABCDE+ score by adding the variables 'etiology' and ischaemic lesion visible on diffusion-weighted imaging (DWI) -'DWI-positivity'- to the ABCD-score. We hypothesized that this refinement increases the predictability of recurrent ischaemic events. We performed a prospective cohort study amongst all consecutive TIA patients in a university hospital emergency department. Area under the computed receiver-operating curves (AUCs) were used to compare the predictive values of the scores with regard to the outcome stroke or recurrent TIA within 90 days. Amongst 248 patients, 33 (13.3%, 95%-CI 9.3-18.2%) had a stroke (n = 13) or a recurrent TIA (n = 20). Patients with recurrent ischaemic events more often had large-artery atherosclerosis as the cause for TIA (46% vs. 14%, P < 0.001) and positive DWI (61% vs. 35%; P = 0.01) compared with patients without recurrent events. Patients with and those without events did not differ with regard to age, clinical symptoms, duration, blood pressure, risk factors, and stroke preventive treatment. The comparison of AUCs [95%CI] showed superiority of the ABCDE+ score (0.67[0.55-0.75]) compared to the ABCD(2) -score (0.48[0.37-0.58]; P = 0.04) and a trend toward superiority compared to the ABCD-score (0.50[0.40-0.61]; P = 0.07). In TIA patients, the addition of the variables 'etiology' and 'DWI-positivity' to the ABCD-score seems to enhance the predictability of subsequent cerebral ischaemic events. © 2011 The Author(s). European Journal of Neurology © 2011 EFNS.

  10. Cardiovascular disease risk score prediction models for women and its applicability to Asians

    Directory of Open Access Journals (Sweden)

    Goh LGH

    2014-03-01

    Full Text Available Louise GH Goh,1 Satvinder S Dhaliwal,1 Timothy A Welborn,2 Peter L Thompson,2–4 Bruce R Maycock,1 Deborah A Kerr,1 Andy H Lee,1 Dean Bertolatti,1 Karin M Clark,1 Rakhshanda Naheed,1 Ranil Coorey,1 Phillip R Della5 1School of Public Health, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia; 2Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia; 3School of Population Health, University of Western Australia, Perth, WA, Australia; 4Harry Perkins Institute for Medical Research, Perth, WA, Australia; 5School of Nursing and Midwifery, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia Purpose: Although elevated cardiovascular disease (CVD risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women. Methods: Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20–69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups. Results: Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were

  11. Increased prevalence of cardiovascular disease and risk biomarkers in patients with unknown type 2 diabetes visiting cardiology specialists: results from the DIASPORA study.

    Science.gov (United States)

    Schöndorf, Thomas; Lübben, Georg; Karagiannis, Efstrathios; Erdmann, Erland; Forst, Thomas; Pfützner, Andreas

    2010-04-01

    Patients with diabetes mellitus and IGT have a high risk for cardiovascular events. It is tempting to speculate that these patients are often first seen by cardiologists. This cross-sectional study investigates the diabetes prevalence in cardiology care units and the correlated metabolic conditions as assessed by several circulating biomarkers. Patients aged 55 or older with suspected or overt coronary heart disease were eligible for trial participation. Fasting blood samples were drawn from patients to determine HOMA score, glycaemic and lipid profile, and several risk biomarkers. An OGTT was performed in patients without known diabetes. We enrolled 530 patients (181 male, 349 female, mean age, 68+/-7 years) in this study from 22 German cardiology centres; 156 patients (29.4%) had known diabetes and OGTT revealed that 184 patients (34.7%) had no diabetes, 106 patients (20.0%) had IGT or IFG and 84 patients (15.9%) were newly diagnosed with diabetes. Increased cardiovascular risk as reflected by increased hsCRP, ICAM and MMP-9 values was observed in diabetes patients. A higher cardiovascular biomarkers risk profile was seen in the IGT/IFG cohort. This study confirms the observation that one third of patients of a cardiologic care unit suffer from impaired glucose regulation. Furthermore, the cardiology patients with previously unknown glucose homeostasis abnormalities had a higher prevalence of macrovacular disease and an impaired biomarker risk profile. This study underlines the importance of joint treatment efforts by cardiologists in concert with diabetologists for treatment of this patient group at high risk for cardiovascular events.

  12. The Role of Biomarkers in Decreasing Risk of Cardiac Toxicity after Cancer Therapy

    Directory of Open Access Journals (Sweden)

    Christine Henri

    2016-01-01

    Full Text Available With the improvement of cancer therapy, survival related to malignancy has improved, but the prevalence of long-term cardiotoxicity has also increased. Cancer therapies with known cardiac toxicity include anthracyclines, biologic agents (trastuzumab, and multikinase inhibitors (sunitinib. The most frequent presentation of cardiac toxicity is dilated cardiomyopathy associated with poorest prognosis. Monitoring of cardiac toxicity is commonly performed by assessment of left ventricular (LV ejection fraction, which requires a significant amount of myocardial damage to allow detection of cardiac toxicity. Accordingly, this creates the impetus to search for more sensitive and reproducible biomarkers of cardiac toxicity after cancer therapy. Different biomarkers have been proposed to that end, the most studied ones included troponin release resulting from cardiomyocyte damage and natriuretic peptides reflecting elevation in LV filling pressure and wall stress. Increase in the levels of troponin and natriuretic peptides have been correlated with cumulative dose of anthracycline and the degree of LV dysfunction. Troponin is recognized as a highly efficient predictor of early and chronic cardiac toxicity, but there remains some debate regarding the clinical usefulness of the measurement of natriuretic peptides because of divergent results. Preliminary data are available for other biomarkers targeting inflammation, endothelial dysfunction, myocardial ischemia, and neuregulin-1. The purpose of this article is to review the available data to determine the role of biomarkers in decreasing the risk of cardiac toxicity after cancer therapy.

  13. Impact of adalimumab treatment on cardiovascular risk biomarkers in psoriasis: Results of a pilot study.

    Science.gov (United States)

    Gkalpakiotis, Spyridon; Arenbergerova, Monika; Gkalpakioti, Petra; Potockova, Jana; Arenberger, Petr; Kraml, Pavel

    2017-04-01

    Psoriasis is a chronic systemic immune-mediated inflammatory dermatosis associated with several comorbidities. Psoriasis patients are at increased risk of developing cardiovascular diseases (CVD), namely, coronary heart disease, stroke or peripheral vascular disease, and psoriasis seems to be an independent cardiovascular risk factor. Antipsoriatic systemic therapy, especially anti-tumor necrosis factor (TNF)-α, seems to exert a beneficial effect on these comorbidities. The purpose of this study was: (i) to measure the level of cardiovascular serum markers in psoriasis patients in comparison with healthy volunteers; and (ii) to compare the serum level of the same markers in patients before and 3 months after adalimumab therapy. We investigated six biomarkers connected to CVD: C-reactive protein (measured high sensitively, hsCRP), oxidized low-density lipoproteins (oxLDL), oxLDL/β-glycoprotein I complex (oxLDL/β2GPI), vascular endothelial adhesion molecule 1 (VCAM-1), E-selectin and interleukin (IL)-22. These biomarkers were measured in 21 patients with moderate/severe psoriasis before and after treatment with adalimumab and in healthy volunteers. hsCRP (P psoriasis patients but the difference did not reach statistical significance. A decrease of E-selectin (P psoriasis but also decreases serum cardiovascular biomarkers. E-selectin and IL-22 could serve for monitoring of the efficacy of antipsoriatic systemic therapy on cardiovascular risk. © 2016 Japanese Dermatological Association.

  14. Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort.

    Science.gov (United States)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H; Bach, Flemming W; Larsen, Torben Bjerregaard

    2015-09-01

    The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application. © 2015 American Heart Association, Inc.

  15. Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

    Science.gov (United States)

    Osugi, Naohiro; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Hayashi, Mutsuharu; Yasuda, Yoshinari; Ishii, Hideki; Shimizu, Atsuya; Murohara, Toyoaki

    2017-06-01

    Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score ≥8 (high CAC group); and CAC score 10 % in the baseline serum cystatin C level at 24 h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1 mL/min/1.73 m 2 , and the mean contrast dose administered was 37.5 mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2 %, p < 0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95 % confidence interval 1.28-2.21, p < 0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p = 0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.

  16. Risk modelling of outcome after general and trauma surgery (the IRIS score)

    NARCIS (Netherlands)

    Liebman, B.; Strating, R.P.; van Wieringen, W.N.; Mulder, W.; Oomen, J.L.T.; Engel, AF

    2010-01-01

    Background: A practical, easy to use model was developed to stratify risk groups in surgical patients: the Identification of Risk In Surgical patients (IRIS) score. Methods: Over 15 years an extensive database was constructed in a general surgery unit, containing all patients who underwent general

  17. Gender, Grade Level, PEN Scores and Risk-taking Behaviour of ...

    African Journals Online (AJOL)

    Risk-taking behaviour leading to critical accidents and deaths is widespread and a social problem world-wide among adolescents. The interplay of gender, school grade levels and PEN scores on risk-taking behaviour are mixed, without a research pattern and inconclusive hence this study anchored on the hypotheses that ...

  18. Concordance of Motion Sensor and Clinician-Rated Fall Risk Scores in Older Adults.

    Science.gov (United States)

    Elledge, Julie

    2017-12-01

    As the older adult population in the United States continues to grow, developing reliable, valid, and practical methods for identifying fall risk is a high priority. Falls are prevalent in older adults and contribute significantly to morbidity and mortality rates and rising health costs. Identifying at-risk older adults and intervening in a timely manner can reduce falls. Conventional fall risk assessment tools require a health professional trained in the use of each tool for administration and interpretation. Motion sensor technology, which uses three-dimensional cameras to measure patient movements, is promising for assessing older adults' fall risk because it could eliminate or reduce the need for provider oversight. The purpose of this study was to assess the concordance of fall risk scores as measured by a motion sensor device, the OmniVR Virtual Rehabilitation System, with clinician-rated fall risk scores in older adult outpatients undergoing physical rehabilitation. Three standardized fall risk assessments were administered by the OmniVR and by a clinician. Validity of the OmniVR was assessed by measuring the concordance between the two assessment methods. Stability of the OmniVR fall risk ratings was assessed by measuring test-retest reliability. The OmniVR scores showed high concordance with the clinician-rated scores and high stability over time, demonstrating comparability with provider measurements.

  19. Cardiovascular risk stratification by means of the SCORE system in health care workers in Veracruz, Mexico.

    Science.gov (United States)

    González-Velázquez, Felipe; Mendez, Gustavo F

    2007-09-14

    To assess cardiovascular disease risk by means of the SCORE system (Systematic Coronary Risk Evaluation) in health care workers (HCW) from Veracruz, Mexico. A cross-sectional study was undertaken at the Mexican Institute of Social Security from Veracruz. Seventy six HCW without physical limitations (NYHA Functional Class I) were included. All HCW answered a standardised medical history questionnaire and were evaluated by physical examination and lab tests. The cardiovascular risk was assessed through the SCORE system. The median age of participants was 47 years (90% range 42-57 years), female HCW had higher prevalence of obesity and lower prevalence of overweight compared to male HCW (52% vs 23% for obesity and 26% vs 63% for overweight; p=0.014). The prevalence of hypertension was 22%, type 2 diabetes 8%, hypercholesterolemia 70%, hypertriglyceridemia 47% and mixed hyperlipidemia 26%. Cardiovascular risk assessed by the SCORE system showed that 14% of all patients had a cardiovascular risk higher than 2% and 51% had a risk lower than 1%. In this first study of cardiovascular risk assessment by means of the SCORE system in HCW in Mexico, we found that 14% of them have a cardiac risk higher than 2% and that it is double than expected for their age but it is lower than reported in a European population. Also, we found a higher prevalence of hypercholesterolemia and mixed hyperlipidemia showing poor education and treatment for cardiovascular prevention.

  20. Inflammatory Biomarkers and Risk of Schizophrenia: A 2-Sample Mendelian Randomization Study.

    Science.gov (United States)

    Hartwig, Fernando Pires; Borges, Maria Carolina; Horta, Bernardo Lessa; Bowden, Jack; Davey Smith, George

    2017-12-01

    Positive associations between inflammatory biomarkers and risk of psychiatric disorders, including schizophrenia, have been reported in observational studies. However, conventional observational studies are prone to bias, such as reverse causation and residual confounding, thus limiting our understanding of the effect (if any) of inflammatory biomarkers on schizophrenia risk. To evaluate whether inflammatory biomarkers have an effect on the risk of developing schizophrenia. Two-sample mendelian randomization study using genetic variants associated with inflammatory biomarkers as instrumental variables to improve inference. Summary association results from large consortia of candidate gene or genome-wide association studies, including several epidemiologic studies with different designs, were used. Gene-inflammatory biomarker associations were estimated in pooled samples ranging from 1645 to more than 80 000 individuals, while gene-schizophrenia associations were estimated in more than 30 000 cases and more than 45 000 ancestry-matched controls. In most studies included in the consortia, participants were of European ancestry, and the prevalence of men was approximately 50%. All studies were conducted in adults, with a wide age range (18 to 80 years). Genetically elevated circulating levels of C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1Ra), and soluble interleukin-6 receptor (sIL-6R). Risk of developing schizophrenia. Individuals with schizophrenia or schizoaffective disorders were included as cases. Given that many studies contributed to the analyses, different diagnostic procedures were used. The pooled odds ratio estimate using 18 CRP genetic instruments was 0.90 (random effects 95% CI, 0.84-0.97; P = .005) per 2-fold increment in CRP levels; consistent results were obtained using different mendelian randomization methods and a more conservative set of instruments. The odds ratio for sIL-6R was 1.06 (95% CI, 1.01-1.12; P = .02

  1. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda.

    Directory of Open Access Journals (Sweden)

    Arthur Mpimbaza

    Full Text Available Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP, in collaboration with the National Malaria Control Program (NMCP, set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set. One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set. Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC, both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76 and validation dataset (AUC =0.74. Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%, moderate risk (3.5% vs. 3.2%, and high risk (16.5% vs. 12

  2. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda

    Science.gov (United States)

    Mpimbaza, Arthur; Sears, David; Sserwanga, Asadu; Kigozi, Ruth; Rubahika, Denis; Nadler, Adam; Yeka, Adoke; Dorsey, Grant

    2015-01-01

    Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our

  3. A urinary biomarker-based risk score correlates with multiparametric MRI for prostate cancer detection

    NARCIS (Netherlands)

    Hendriks, R.J.; Leest, M.M.G. van der; Dijkstra, S.; Barentsz, J.O.; Criekinge, W. van; Kaa, C.A. van de; Schalken, J.A.; Mulders, P.F.A.; Oort, I.M. van

    2017-01-01

    BACKGROUND: Prostate cancer (PCa) diagnostics would greatly benefit from more accurate, non-invasive techniques for the detection of clinically significant disease, leading to a reduction of over-diagnosis and over-treatment. The aim of this study was to determine the association between a novel

  4. Low amniotic fluid index in high risk pregnancy and poor apgar score at birth

    International Nuclear Information System (INIS)

    Sultana, S.; Akhtar, K.A.K.

    2008-01-01

    To determine the accuracy of antepartum Amniotic Fluid Index (AFI) of 5 cm was labeled as predictor of good outcome at birth. The subjects in both the groups were demographically matched and fulfilled the inclusion and exclusion criteria. The Apgar score was calculated at 5 minutes of birth. The newborns, with Apgar score 6 were labeled as healthy. AFI was compared with Apgar score, using Chi-square and a p-value was calculated to determine the statistical significance. Sensitivity, specificity, efficiency and the predictive values of AFI at a cut off point of < 5 cm as a predictor of adverse outcome at birth (Apgar score of < 6 at 5 minutes of birth) in high-risk pregnancy were calculated. Only 8 neonates of 50 women with low AFI had low Apgar score. Similarly, 6 neonates of 50 women with normal AFI had poor Apgar score. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of AFI as test were 57.1%, 51.3%, 16%, 88% and 52% respectively. Low AFI is a poor predictor of adverse outcome for high-risk term patients. AFI is not a good screening test for high-risk pregnant women at term for birth of an infant with low Apgar score. (author)

  5. Failure of renal biomarkers to predict worsening renal function in high-risk patients presenting with oliguria.

    Science.gov (United States)

    Legrand, Matthieu; Jacquemod, Aurélien; Gayat, Etienne; Collet, Corinne; Giraudeaux, Veronique; Launay, Jean-Marie; Payen, Didier

    2015-01-01

    Oliguria is a common symptom in critically ill patients and puts patients in a high risk category for further worsening renal function (WRF). We performed this study to explore the predictive value of biomarkers to predict WRF in oliguric intensive care unit (ICU) patients. Single-center prospective observational study. ICU patients were included when they presented a first episode of oliguria. Plasma and urine biomarkers were measured: plasma and urine neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL), urine α1-microglobulin, urine γ-glutamyl transferase, urine indices of tubular function, cystatin C, C terminal fragment of pro-arginine vasopressin (CT-ProAVP), and proadrenomedullin (MR-ProADM). One hundred eleven patients formed the cohort, of whom 41 [corrected] had worsening renal function. Simplified Acute Physiology Score (SAPS) II was 41 (31-51). WRF was associated with increased mortality (hazard ratio 8.65 [95 % confidence interval (CI) 3.0-24.9], p = 0.0002). pNGAL, MR-ProADM, and cystatin C had the best odds ratio and area under the receiver-operating characteristic curve (AUC-ROC: 0.83 [0.75-0.9], 0.82 [0.71-0.91], and 0.83 [0.74-0.90]), but not different from serum creatinine (Screat, 0.80 [0.70-0.88]). A clinical model that included age, sepsis, SAPS II, and Screat had AUC-ROC of 0.79 [0.69-0.87]; inclusion of pNGAL increased the AUC-ROC to 0.86 (p = 0.03). The category-free net reclassification index improved with pNGAL (total net reclassification index for events to higher risk 61 % and nonevents to lower 82 %). All episodes of oliguria do not carry the same risk. No biomarker further improved prediction of WRF compared with Screat in this selected cohort of patients at increased risk defined by oliguria.

  6. Recurrent epistaxis: predicting risk of 30-day readmission, derivation and validation of RHINO-ooze score.

    Science.gov (United States)

    Addison, A; Paul, C; Kuo, R; Lamyman, A; Martinez-Devesa, P; Hettige, R

    2017-06-01

    To derive and validate a predictive scoring tool (RHINO-ooze score) with good sensitivity and specificity in identifying patients with epistaxis at high risk of 30 day readmission and to enable risk stratification for possible definitive intervention. Using medical databases, we searched for factors influencing recurrent epistaxis. The information ascertained together with our analysis of retrospective data on patients admitted with epistaxis between October 2013 and September 2014, was used as the derivation cohort to develop the predictive scoring model (RHINO-ooze score). The tool was validated by performing statistical analysis on the validation cohort of patients admitted with epistaxis between October 2014 and October 2015. Multiple linear regressions with backwards elimination was used to derive the predictive model. The area under the curve (AUC), sensitivity and specificity were calculated. 834 admissions were encountered within the study period. Using the derivative cohort (n= 302) the RHINO-ooze score with a maximum score of 8 from five variables (Recent admission, Haemorrhage point unidentified, Increasing age over 70, posterior Nasal packing, Oral anticoagulant) was developed. The RHINO-ooze score had a chi-square value of 99.72 with a significance level of smaller than 0.0001 and hence an overall good model fit. Comparison between the derivative and validation groups revealed similar rates of 30-day readmission between the cohorts. The sensitivity and specificity of predicting 30-day readmission in high risk patients with recurrent epistaxis (RHINO-ooze score equal/larger than 6) was 81% and 84%, respectively. The RHINO-ooze scoring tool demonstrates good specificity and sensitivity in predicting the risk of 30 day readmission in patients with epistaxis and can be used as an adjunct to clinical decision making with regards to timing of operative intervention in order to reduce readmission rates.

  7. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores.

    Science.gov (United States)

    Schellings, Dirk Aam; Adiyaman, Ahmet; Dambrink, Jan-Henk E; Gosselink, At Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; Van't Hof, Arnoud Wj

    2016-01-01

    The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable. To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS. Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement. A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p =0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 ( p =0.57), integrated discrimination improvement 0.04 ( p =0.003), net reclassification improvement 0.12 ( p =0.21). In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated.

  8. A risk score development for diabetic retinopathy screening in Isfahan-Iran

    Directory of Open Access Journals (Sweden)

    Sayed Mohsen Hosseini

    2009-04-01

    Full Text Available

    • BACKGROUND: The purpose of this study was to develop a simple risk score as screening tool for retinopathy in type II diabetic patients.
    • METHODS: A cross-sectional study was carried out recruiting 3734  atients with type II diabetes in an outpatient clinic in Isfahan ndocrinology and Metabolism Research Center (IEMRC, Iran. The logistic regression was used as a model to predict diabetic retinopathy. The cut-off value for the risk score was determined using the Receiver  perating Characteristic (ROC curve procedure.
    • RESULTS: According to final models, being male, having lower body mass index (BMI, being older, longer duration of diabetes and higher HbA1c were correlated with increased risk of diabetic retinopathy. Area under the Curve (ROC was 0.704 (95% CI: 0.685-0.723. A value ; 52.5 had the optimum sensitivity (60% and specificity (69% for determining diabetic retinopathy.
    • CONCLUSIONS: The results indicated that risk factors for retinopathy were sex, BMI, age, duration of diabetes and HbA1c levels. In onclusion, applying developed retinopathy risk score is a practical way to identify patients who are at high risk for developing diabetic retinopathy for an early treatment.
    • KEYWORDS: Retinopathy risk score, sensitivity, specificity, receiver operating characteristic curve.

  9. Coronary Calcium Scoring and Cardiovascular Risk in Patients with Type 2 Diabetes Mellitus

    OpenAIRE

    Belkis Mercedes Vicente Sánchez; Gisela Zerquera Trujillo; Felix R. Jorrín Román; Lázaro E. de la Cruz Avilez; Elodia M. Rivas Alpízar

    2011-01-01

    Background: Diabetes mellitus is considered as an independent cardiovascular risk factor. Coronary calcium scoring has proved to be a useful tool for stratifying cardiovascular risk. Objective: To quantify coronary calcium in patients with diabetes mellitus type 2 in order to estimate cardiovascular risk. Methods: A descriptive observational study was conducted. The sample included 33 patients with type 2 diabetes mellitus admitted in the Center for Diabetes Care and Education of Cienfuegos f...

  10. A scoring system to predict the risk of prolonged air leak after lobectomy.

    Science.gov (United States)

    Brunelli, Alessandro; Varela, Gonzalo; Refai, Majed; Jimenez, Marcelo F; Pompili, Cecilia; Sabbatini, Armando; Aranda, Jose Luis

    2010-07-01

    Prolonged air leak (PAL) remains a frequent complication after lung resection. Perioperative preventative strategies have been tested, but their efficacy is often difficult to interpret due to heterogeneous inclusion criteria. The objective of this study was to develop and validate a practical score to stratify the risk of PAL after lobectomy. Six hundred fifty-eight consecutive patients were submitted to pulmonary lobectomy (2000 to 2008) in center A and were used to develop the risk-adjusted score predicting the incidence of PAL (> 5 days). Exclusion criteria were chest wall resection and postoperative assisted mechanical ventilation. No sealants, pleural tent, or buttressing material were used. To build the aggregate score numeric variables were categorized by receiver operating curve analysis. Variables were screened by univariate analysis and then used in stepwise logistic regression analysis (validated by bootstrap). The scoring system was developed by proportional weighing of the significant predictor estimates and was validated on patients operated on in a different center (center B). The incidence of PAL in the derivation set was 13% (87 of 658 cases). Predictive variables and their scores were the following: age greater than 65 years (1 point); presence of pleural adhesions (1 point); forced expiratory volume in one second less than 80% (1.5 points); and body mass index less than 25.5 kg/m(2) (2 points). Patients were grouped into 4 risk classes according to their aggregate scores, which were significantly associated with incremental risk of PAL in the validation set of 233 patients. The developed scoring system reliably predicts incremental risk of PAL after pulmonary lobectomy. Its use may help in identifying those high-risk patients in whom to adopt intraoperative prophylactic strategies; in developing inclusion criteria for future randomized clinical trials on new technologies aimed at reducing or preventing air leak; and for patient counseling

  11. [The scoring system for the risk-stratification in patients with the antiphospholipid syndrome].

    Science.gov (United States)

    Oku, Kenji

    2017-01-01

      Antiphospholipid syndrome (APS) is a clinical disorder characterized by thrombosis and/or pregnancy morbidity in the persistence of the pathogenic autoantibodies, the antiphospholipid antibodies (aPL). Recurernt thrombosis is often observed in patients with APS which requires persistent prophylaxis. However, an uniform prophylactic treatment for APS patients is inadequate and stratification of the thrombotic risks is important as aPL are prevalently observed in other various diseases or elderly population. It is previously known that the multiple positivity or high titre of aPL correlate to the thrombotic events. To progress the stratification of the thrombotic risks and to quantitatively analyze them, antiphospholipid score (aPL-S) and the Global Anti-Phospholipid Syndrome Score (GAPSS) were defined as the scoring-systems. Both of these scoring-systems were raised from the large patient cohort data and either aPL profile classified in detail (aPL-S) or simplified aPL profile with classical thrombotic risk factors (GAPSS) were put into scoring system. They have shown a degree of accuracy in identifying high-risk APS patients, especially those at a high risk of thrombosis. However, there are several areas requiring improvement, or at least that clinicians should be aware of, before these instruments are applied in clinical practice. One such issue is standardisation of the aPL tests, including general testing of phosphatidylserine dependent antiprothrombin antibodies (aPS/PT).

  12. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Vestergaard, Peter; Rud, Bo

    2006-01-01

    was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model...... by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause....

  13. Imaging primary prostate cancer with 11C-Choline PET/CT: relation to tumour stage, Gleason score and biomarkers of biologic aggressiveness

    International Nuclear Information System (INIS)

    Chen, Ji; Zhao, Yong; Li, Xin; Sun, Peng; Wang, Muwen; Wang, Ridong; Jin, Xunbo

    2012-01-01

    As a significant overlap of 11C-Choline standardized uptake value (SUV) between prostate cancer and benign prostate hyperplasia (BPH) tissue, controversy exists regarding the clinical value of 11C-Choline PET/CT scan in primary prostate cancer. In this study, the SUVmax of the prostate lesions and the pelvic muscles were measured and their ratios (SUVmax-P/M ratio) were calculated. Then we evaluated whether the tracer 11C-Choline uptake, quantified as SUVmax-P/M ratio, correlated with tumour stage, Gleason score, and expression levels of several biomarkers of aggressiveness. Twenty-six patients with primary prostate cancer underwent 11C-Choline PET/CT. Tumour specimens from these patients were graded histopathologically, and immunnohistochemistry for Ki-67, CD31, androgen receptor (AR), Her-2/neu, Bcl-2, and PTEN were performed. Both SUVmax and SUVmax-P/M ratio showed no significant difference between patients with tumour stage II and III, but significantly elevated in patients with tumour stage IV. SUVmax-P/M ratio was also significantly higher in lesions with Gleason score of 4+3 or higher versus less than or equal to 3+4. SUVmax-P/M ratio was found significantly correlated with expression levels of Ki-67 and CD31. In addition, a higher SUVmax-P/M ratio was demonstrated in Her-2/neu positive subgroup than negative subgroup. At the same time, Gleason score and expression levels of these biomarkers showed no significant association with SUVmax. Using the parameter SUVmax-P/M ratio, 11C-Choline PET/CT may be a valuable non-invasive imaging technology in the diagnosis of primary prostate cancer

  14. Unsupervised deep learning applied to breast density segmentation and mammographic risk scoring

    DEFF Research Database (Denmark)

    Kallenberg, Michiel Gijsbertus J.; Petersen, Peter Kersten; Nielsen, Mads

    2016-01-01

    Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used...... as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime...... and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy...

  15. Severe Spontaneous Echo Contrast/Auricolar Thrombosis in "Nonvalvular" AF: Value of Thromboembolic Risk Scores.

    Science.gov (United States)

    Mascioli, Giosuè; Lucca, Elena; Michelotti, Federica; Alioto, Giusy; Santoro, Franco; Belli, Guido; Rota, Cristina; Ornago, Ombretta; Sirianni, Giovanni; Pulcini, Emanuela; Pennesi, Matteo; Savasta, Carlo; Russo, Rosario; Pitì, Antonino

    2017-01-01

    Patients with atrial fibrillation (AF) have an increased thromboembolic risk that can be estimated with risk scores and sometimes require oral anticoagulation therapy (OAT). Despite correct anticoagulation, some patients still develop left atrial spontaneous echo contrast (SEC) or thrombosis. The value of traditional risk scores (R 2 CHADS 2 , CHADS 2 , and CHA 2 DS 2 -VASc) in predicting such events remains controversial. The aim of our study was to explore variables linked to severe SEC or atrial thrombosis and evaluate the performance of traditional risk scores in identifying these patients. In order to do this, we retrospectively analyzed 568 patients with nonvalvular nonparoxysmal AF who underwent electrical cardioversion from January 2011 to December 2016 after OAT for a minimum of 4 weeks. A transesophageal echocardiogram was performed in 265 patients for various indications, and 24 exhibited left atrial SEC or thrombosis. Female gender, history of heart failure or left ventricular ejection fraction 1 mg/dL) of C-reactive protein (CRP) were independently associated with left atrial SEC/thrombosis. A score composed by these factors (denominated HIS [Heart Failure, Inflammation, and female Sex]) showed a sensitivity of 79% and a specificity of 60% (area under receiver operating characteristic curve 0.695, P = 0.002) in identifying patients with a positive transesophageal echo; traditional risk scores did not perform as well. In patients with persistent AF and suboptimal anticoagulation, a risk score composed by history of heart failure, high CRP, and female gender identifies patients at high risk of left atrial SEC/thrombosis when its value is >1. © 2016 Wiley Periodicals, Inc.

  16. Soy Food Intake and Biomarkers of Breast Cancer Risk: Possible Difference in Asian Women?

    Science.gov (United States)

    Maskarinec, Gertraud; Ju, Dan; Morimoto, Yukiko; Franke, Adrian A; Stanczyk, Frank Z

    2017-01-01

    Soy foods may protect against breast cancer in Asian but not in Western populations. We examined if the levels of various markers of breast cancer risk and inflammation, as well as the effects of soy food consumption on these markers, differ between Asian and non-Asian premenopausal women in two soy intervention trials. One study randomized 220 women to a 2-yr intervention and the other one randomized 96 women in a crossover design to examine the effects of consumption of 2 daily soy servings on nipple aspirate fluid (NAF) volume; estrogens in serum, NAF, and urine; insulin-like growth factor-1 (IGF-1), IGF-binding protein 3, and inflammatory markers in serum; and mammographic densities. Mixed linear models were applied to assess ethnic differences in biomarkers and response to the soy diet. Serum C-reactive protein, serum leptin, NAF volume, and NAF estrone sulfate were lower, while urinary isoflavones were higher in Asian than in non-Asian women. A significant interaction (p interaction = 0.05) between ethnicity and soy diet was observed for IGF-1 but not for other biomarkers. The current findings suggest possible ethnic differences in levels of biomarkers for breast cancer risk but little evidence that Asian women respond differently to soy foods than non-Asian women.

  17. Aerobic exercise reduces biomarkers related to cardiovascular risk among cleaners: effects of a worksite intervention RCT.

    Science.gov (United States)

    Korshøj, Mette; Ravn, Marie Højbjerg; Holtermann, Andreas; Hansen, Åse Marie; Krustrup, Peter

    2016-02-01

    Blue-collar workers have an increased risk of cardiovascular disease. Accordingly, elevated levels of biomarkers related to risk of cardiovascular disease, such as high-sensitive C-reactive protein, have been observed among blue-collar workers. The objective was to examine whether an aerobic exercise worksite intervention changes the level of inflammation biomarkers among cleaners. The design was a cluster-randomized controlled trial with 4-month worksite intervention. Before the 116 cleaners aged 18-65 years were randomized, they signed an informed consent form. The reference group (n = 59) received lectures, and the aerobic exercise group (n = 57) performed worksite aerobic exercise (30 min twice a week). Levels of biomarkers (high-sensitive C-reactive protein, fibrinogen, cholesterol, low- and high-density lipoprotein cholesterol and triglyceride) were collected at baseline and after 4 months. A repeated-measure, multi-adjusted, mixed-model intention-to-treat analysis was applied to compare between-group differences. The study was registered as ISRCTN86682076. Significant (p aerobic exercise intervention among cleaners leads to reduced levels of high-sensitive C-reactive protein and low-density lipoprotein cholesterol, and an unaltered level of fibrinogen. The aerobic exercise seems to improve inflammatory levels and lipoprotein profile among cleaners, with no signs of cardiovascular overload.

  18. Signatures of reproductive events on blood counts and biomarkers of inflammation: Implications for chronic disease risk.

    Directory of Open Access Journals (Sweden)

    Daniel W Cramer

    Full Text Available Whether inflammation mediates how reproductive events affect chronic-disease risk is unclear. We studied inflammatory biomarkers in the context of reproductive events using National Health and Nutrition Examination Survey (NHANES data. From 15,986 eligible women from the 1999-2011 data cycles, we accessed information on reproductive events, blood counts, C-reactive protein (CRP, and total homocysteine (tHCY. We calculated blood-count ratios including: platelet-lymphocyte (PLR, lymphocyte-monocyte (LMR, platelet-monocyte (PMR, and neutrophil-monocyte (NMR. Using sampling weights per NHANES guidelines, means for counts, ratios, or biomarkers by reproductive events were compared using linear regression. We performed trend tests and calculated p-values with partial sum of squares F-tests. Higher PLR and lower LMR were associated with nulliparity. In postmenopausal women, lower PMR was associated with early age at first birth and higher NMR with later age at and shorter interval since last birth. Lower PNR and higher neutrophils and tHCY were associated with early natural menopause. In all women, the neutrophil count correlated positively with CRP; but, in premenopausal women, correlated inversely with tHCY. Reproductive events leave residual signatures on blood counts and inflammatory biomarkers that could underlie their links to chronic disease risk.

  19. Chemicals exposure: scoring procedure and uncertainty propagation in scenario selection for risk analysis.

    Science.gov (United States)

    Ruggeri, Bernardo

    2009-10-01

    The present work aims to obtain a methodology to score dangerous chemical pollutants related to the exposure scenarios of human risk and to evaluate the uncertainty of the scoring procedure. For chronic human risk evaluation, the problem of characterizing the most dangerous situation is posed. In this paper a ranking procedure was assessed in order to score eight pollutants through a "scoring model" approach. The scoring system was organized in a matrix form in order to put in evidence the strong connection between properties of the substances and exposure scenarios. Two different modelling approaches were considered as cause-effect relationships for risk evaluation: Risk Based Corrective Action (RBCA) and a "mobility and degradation matrix". The first takes into account the exposure pathways (soil, water and air) and the exposure routes (inhalation, ingestion and dermal contact), while the second considers the capacity of the chemicals to move into the environment and the rate of degradation associated with chemical-biological processes as measure of persistence. A specific score for each chemical along its uncertainty were evaluated. The uncertainty of the scoring procedure was evaluated by using the law of propagation of uncertainty; it was used to estimate the global uncertainty related to each exposure pathway for the eight substances for both models. Results of scoring as well uncertainty put in evidence that the ordering of chemicals is strongly dependent on the model used and on the available data. The procedure is simple and easy to use and its implementation allows users to compare several and several compounds.

  20. Early Cannabis Use, Polygenic Risk Score for Schizophrenia, and Brain Maturation in Adolescence

    Science.gov (United States)

    French, Leon; Gray, Courtney; Leonard, Gabriel; Perron, Michel; Pike, G. Bruce; Richer, Louis; Séguin, Jean R.; Veillette, Suzanne; Evans, C. John; Artiges, Eric; Banaschewski, Tobias; Bokde, Arun W. L.; Bromberg, Uli; Bruehl, Ruediger; Buchel, Christian; Cattrell, Anna; Conrod, Patricia J.; Flor, Herta; Frouin, Vincent; Gallinat, Jurgen; Garavan, Hugh; Gowland, Penny; Heinz, Andreas; Lemaitre, Herve; Martinot, Jean-Luc; Nees, Frauke; Orfanos, Dimitri Papadopoulos; Pangelinan, Melissa Marie; Poustka, Luise; Rietschel, Marcella; Smolka, Michael N.; Walter, Henrik; Whelan, Robert; Timpson, Nic J.; Schumann, Gunter; Smith, George Davey; Pausova, Zdenka; Paus, Tomáš

    2016-01-01

    IMPORTANCE Cannabis use during adolescence is known to increase the risk for schizophrenia in men. Sex differences in the dynamics of brain maturation during adolescence may be of particular importance with regard to vulnerability of the male brain to cannabis exposure. OBJECTIVE To evaluate whether the association between cannabis use and cortical maturation in adolescents is moderated by a polygenic risk score for schizophrenia. DESIGN, SETTING, AND PARTICIPANTS Observation of 3 population-based samples included initial analysis in 1024 adolescents of both sexes from the Canadian Saguenay Youth Study (SYS) and follow-up in 426 adolescents of both sexes from the IMAGEN Study from 8 European cities and 504 male youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) based in England. A total of 1577 participants (aged 12–21 years; 899 [57.0%] male) had (1) information about cannabis use; (2) imaging studies of the brain; and (3) a polygenic risk score for schizophrenia across 108 genetic loci identified by the Psychiatric Genomics Consortium. Data analysis was performed from March 1 through December 31, 2014. MAIN OUTCOMES AND MEASURES Cortical thickness derived from T1-weighted magnetic resonance images. Linear regression tests were used to assess the relationships between cannabis use, cortical thickness, and risk score. RESULTS Across the 3 samples of 1574 participants, a negative association was observed between cannabis use in early adolescence and cortical thickness in male participants with a high polygenic risk score. This observation was not the case for low-risk male participants or for the low- or high-risk female participants. Thus, in SYS male participants, cannabis use interacted with risk score vis-à-vis cortical thickness (P = .009); higher scores were associated with lower thickness only in males who used cannabis. Similarly, in the IMAGEN male participants, cannabis use interacted with increased risk score vis-à-vis a change in

  1. Genetic risk scores link body fat distribution with specific cardiometabolic profiles

    DEFF Research Database (Denmark)

    Svendstrup, Mathilde; Sandholt, Camilla H; Andersson Galijatovic, Ehm Astrid

    2016-01-01

    OBJECTIVE: Forty-nine known single nucleotide polymorphisms (SNPs) associating with body mass index (BMI)-adjusted waist-hip-ratio (WHR) (WHRadjBMI) were recently suggested to cluster into three groups with different associations to cardiometabolic traits. Genetic risk scores of the clusters...... on the risk of incident diabetes and associations with detailed cardiometabolic phenotypes were tested. METHODS: In a prospective study of 6,121 Inter99 individuals, the risk of incident diabetes using Cox proportional hazards regression was evaluated. Using linear regession, the associations between genetic...... risk scores and anthropometry and blood samples at fasting and during an oral glucose tolerance test were tested. Analyses were adjusted for age, sex, and BMI. RESULTS: Cluster 1 associated with an increased risk of diabetes (HR = 1.05, P = 2.74 × 10(-) (4) ) and with a poor metabolic profile...

  2. Improvement of Risk Prediction After Transcatheter Aortic Valve Replacement by Combining Frailty With Conventional Risk Scores.

    Science.gov (United States)

    Schoenenberger, Andreas W; Moser, André; Bertschi, Dominic; Wenaweser, Peter; Windecker, Stephan; Carrel, Thierry; Stuck, Andreas E; Stortecky, Stefan

    2018-02-26

    This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores. European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR). This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]). All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction. This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement. Copyright © 2018 American College of Cardiology Foundation

  3. A Risk Score to Predict Hypertension in Primary Care Settings in Rural India.

    Science.gov (United States)

    Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman

    2016-01-01

    We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India. © 2015 APJPH.

  4. The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease.

    Directory of Open Access Journals (Sweden)

    Sophie Liabeuf

    Full Text Available Although a variety of non-invasive methods for measuring cardiovascular (CV risk (such as carotid intima media thickness, pulse wave velocity (PWV, coronary artery and aortic calcification scores (measured either by CT scan or X-ray and the ankle brachial index (ABI have been evaluated separately in chronic kidney disease (CKD cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs improves prediction of the CV risk in patients at different CKD stages.We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI and the integrated discrimination improvement.Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%.The addition of vascular calcification scores (especially the coronary artery calcification score to TRFs appears to improve CV risk assessment in a CKD population.

  5. Use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting: the role of total score and individual subscale scores in triggering preventive interventions.

    Science.gov (United States)

    Gadd, Molly M; Morris, Sarah M

    2014-01-01

    To determine whether pressure ulcer preventive interventions are implemented when a total Braden Scale score reflects that the patient is at risk. A retrospective chart review was completed for 20 patients with confirmed hospital-acquired pressure ulcers (HAPUs). A convenience sample of 20 patients with HAPUs confirmed by a certified wound nurse was systematically selected from 63 charts. The study setting was a 200-bed acute care facility in the Midwestern United States. A retrospective review of 20 patient charts was conducted. Data collected included daily Braden Scale scores and subscale scores, along with pressure ulcer preventive intervention implementation for at-risk (cumulative Braden Scale scores ≤ 18) and not-at-risk (cumulative Braden Scale scores > 18) days. Data were collected both before and after pressure ulcer occurrence. The occurrence of preventive interventions was compared between at-risk and not-at-risk patient days. Nineteen percent of not-at-risk patient days were found to have lower subscale scores, indicating a need for focused preventive interventions. The day before an HAPU occurred, the mean Braden Scale score was 13.7 ± 2.8 (mean ± SD) for those who were provided an intervention and 18.5 ± 2.3 for those not provided an intervention (t = 3.89, P = .001). Sixty-three percent of at-risk patients received some intervention the day before an HAPU occurred, while 20% of not-at-risk patients received some intervention. Routine use of a pressure ulcer risk assessment tool is considered necessary for a comprehensive pressure ulcer prevention program. Planning preventive care according to the subscale scores of the Braden Scale may be more effective for prevention of HAPUs in some cases.

  6. Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system.

    Science.gov (United States)

    Al-Radi, Osman O; Harrell, Frank E; Caldarone, Christopher A; McCrindle, Brian W; Jacobs, Jeffrey P; Williams, M Gail; Van Arsdell, Glen S; Williams, William G

    2007-04-01

    The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac surgery. We compared the predictive value of the 2 systems. Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), and 11,438 (84%) operations, respectively. Models of in-hospital mortality and length of stay were generated for Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery using an identical data set in which both Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery scores were assigned. The likelihood ratio test for nested models and paired concordance statistics were used. After adjustment for year of operation, the odds ratios for Aristotle Basic Complexity score 3 versus 6, 9 versus 6, 12 versus 6, and 15 versus 6 were 0.29, 2.22, 7.62, and 26.54 (P Aristotle Basic Complexity (likelihood ratio chi2 = 162, P Aristotle Basic Complexity contributed much less predictive value over Risk Adjustment in Congenital Heart Surgery (likelihood ratio chi2 = 13.4, P = .009). Neither system fully adjusted for the child's age. The Risk Adjustment in Congenital Heart Surgery scores were more concordant with length of stay compared with Aristotle Basic Complexity scores (P Aristotle Basic Complexity. The use of Aristotle Basic Complexity or Risk Adjustment in Congenital Heart Surgery as risk stratification and trending tools to monitor outcomes over time and to guide risk-adjusted comparisons may be valuable.

  7. Where to Sit? Type of Sitting Matters for the Framingham Cardiovascular Risk Score

    Directory of Open Access Journals (Sweden)

    Katja Borodulin

    2016-08-01

    Full Text Available Background: Current evidence on associations of type-specific sedentary behavior with cardiovascular disease (CVD is limited to mainly screen-time sedentary behavior (SB. We aimed to study the associations of type-specific and total time spent sitting with the Framingham 10-year cardiovascular disease risk score (Framingham score in Finnish adults. Methods: Data comprise the National FINRISK 2007 and 2012 health examination surveys with 10,185 participants aged 25-74 years, apparently free of CVD. Participants reported average daily time spent sitting in different locations: work-related sitting, at home in front of television (TV, at home in front of computer, in a vehicle, and elsewhere. Total SB time was calculated from these context-specific self-reports. Accelerometer-based sedentary time was assessed in 988 FINRISK 2012 participants. Framingham score was calculated using information on blood pressure and its medication, cholesterol levels, age, diabetes status, and smoking. Analyses were adjusted for age, study year, education, employment status, leisure time physical activity, and body mass index. Results: Out of several type-specific sitting behaviors, only TV sitting showed systematic associations with the Framingham score in both genders. The lowest Framingham risk was found for TV sitting from 6 minutes to less than 1 hour daily. Of other types of sitting, computer sitting was inversely associated with the Framingham risk in men only. Total self-reported sitting time did not show significant associations with the Framingham score, but instead higher objectively assessed sedentary time showed higher Framingham risk in men. Conclusions: TV sitting showed most systematic associations with CVD risk score. This suggests that of all types of SB, reducing TV sitting should be targeted for reducing CVD risk.

  8. Enhancing the Value of Population-Based Risk Scores for Institutional-Level Use.

    Science.gov (United States)

    Raza, Sajjad; Sabik, Joseph F; Rajeswaran, Jeevanantham; Idrees, Jay J; Trezzi, Matteo; Riaz, Haris; Javadikasgari, Hoda; Nowicki, Edward R; Svensson, Lars G; Blackstone, Eugene H

    2016-07-01

    We hypothesized that factors associated with an institution's residual risk unaccounted for by population-based models may be identifiable and used to enhance the value of population-based risk scores for quality improvement. From January 2000 to January 2010, 4,971 patients underwent aortic valve replacement (AVR), either isolated (n = 2,660) or with concomitant coronary artery bypass grafting (AVR+CABG; n = 2,311). Operative mortality and major morbidity and mortality predicted by The Society of Thoracic Surgeons (STS) risk models were compared with observed values. After adjusting for patients' STS score, additional and refined risk factors were sought to explain residual risk. Differences between STS model coefficients (risk-factor strength) and those specific to our institution were calculated. Observed operative mortality was less than predicted for AVR (1.6% [42 of 2,660] vs 2.8%, p risk factors, and body surface area, creatinine, glomerular filtration rate, blood urea nitrogen, and heart failure across all levels of functional class were identified as refined risk-factor variables associated with residual risk. In many instances, risk-factor strength differed substantially from that of STS models. Scores derived from population-based models can be enhanced for institutional level use by adjusting for institution-specific additional and refined risk factors. Identifying these and measuring differences in institution-specific versus population-based risk-factor strength can identify areas to target for quality improvement initiatives. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Pressure ulcer risk assessment: retrospective analysis of Braden Scale scores in Portuguese hospitalised adult patients.

    Science.gov (United States)

    Sardo, Pedro; Simões, Cláudia; Alvarelhão, José; Costa, César; Simões, Carlos J; Figueira, Jorge; Simões, João L; Amado, Francisco; Amaro, António; Melo, Elsa

    2015-11-01

    To analyse the Braden Scale scores and sub-scores assessed in Portuguese hospitalised adult patients in association with their characteristics, diagnoses and length of stay. The Braden Scale is used worldwide for pressure ulcer risk assessment and supports nurses in the implementation of preventive interventions. Retrospective cohort analysis of electronic health record database from adult patients admitted to medical and surgical areas during 2012. Braden Scale scores and sub-scores of 8147 patients were associated with age, gender, type of admission (emergency service or programmed), specialty units (medical or surgical), length of stay, patient discharge (discharge, decease or transference to other hospital) and ICD-9 diagnosis. The participants with significantly lower Braden Scale scores were women, older people, hospitalised in medical units, with emergency service admission, longer hospitalisation stays and/or with vascular, traumatisms, respiratory, infection or cardiac diseases. Mobility, friction/shear forces and activity had higher contributions to the Braden Scale score, while nutrition had the lowest contribution. Approximately one-third of all participants had high risk of pressure ulcer development at admission, which led to the application of nursing preventive care. Our study demonstrated that nurses should pay special attention to patients over 50 years of age, who had significantly lower Braden Scale scores. The Braden Scale scores significantly increased in the last assessments showing that Braden Scale is sensitive to the clinical improvement of the patient. Braden Scale correlations with length of stay reveal its importance as predictor of length of stay. Nurses should use Braden Scale assessment and consider patients' characteristics and diagnoses to plan more focused preventive interventions and improve nursing care. This study could be the first step to create a preventive protocol based on institutional reality, patients' characteristics

  10. Risk Factors and Scoring Systems for Patients with Candidemia at a Tertiary Hospital in Jakarta, Indonesia.

    Science.gov (United States)

    Mursinah, Mursinah; Ibrahim, Fera; Wahid, Mardiastuti H

    2016-07-01

    to identify the risk factors of candidemia and to develop a scoring system that could be implemented in Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia. this study was a retrospective study with case control design using the medical records of patients since 2011 to 2014. All sepsis patients hospitalized in the RSCM with a positive blood culture for Candida were included in this study as a case group. The control group was all of the sepsis patients without candidemia. The ratio for case and control groups was equal (1:1). from 234 patients who were analyzed, the risk factors that influenced the study were length of stay of 8-14 days (OR 3.464; 95% CI 1.458-7.800), length of stay of more than 14 days (OR 6.844; 95% CI 3.0-15.330), severe sepsis (OR 16.407; 95% CI 1.458-7.800), and surgery (OR 3.03; 95% CI 1.492-6.152). The predictors for candidemia in RSCM were length of stay in hospital for 8-14 days (score 1), a length of stay ≥14 days (score 2), severe sepsis (score 3), and surgery (score 1), with a cut off score of 3.5. the results of this study have indicated that a scoring system in order to guide an empirical treatment for candidemia can be developed by using the risk factors for candidemia from patients who have been identified as patients with risk at Cipto Mangunkusumo Hospital.

  11. Recalibration of the Global Registry of Acute Coronary Events risk score in a multiethnic Asian population.

    Science.gov (United States)

    Chan, Mark Y; Shah, Bimal R; Gao, Fei; Sim, Ling Ling; Chua, Terrance; Tan, Huay Cheem; Yeo, Tiong Cheng; Ong, Hean Yee; Foo, David; Goh, Ping Ping; Surrun, Soondal K; Pieper, Karen S; Granger, Christopher B; Koh, Tian Hai; Salim, Agus; Tai, E Shyong

    2011-08-01

    Acute myocardial infarction (AMI) is a leading cause of mortality in Asia. However, quantitative risk scores to predict mortality after AMI were developed without the participation of Asian countries. We evaluated the performance of the Global Registry of Acute Coronary Events (GRACE) in-hospital mortality risk score, directly and after recalibration, in a large Singaporean cohort representing 3 major Asian ethnicities. The GRACE cohort included 11,389 patients, predominantly of European descent, hospitalized for AMI or unstable angina from 2002 to 2003. The Singapore cohort included 10,100 Chinese, 3,005 Malay, and 2,046 Indian patients hospitalized for AMI from 2002 to 2005.Using the original GRACE score, predicted in-hospital mortality was 2.4% (Chinese), 2.0% (Malay), and 1.6% (Indian). However, observed in-hospital mortality was much greater at 9.8% (Chinese), 7.6% (Malay), and 6.4% (Indian). The c statistic for Chinese, Malays, and Indians was 0.86, 0.86, and 0.84, respectively, and the Hosmer-Lemeshow statistic was 250, 56, and 41, respectively. Recalibration of the GRACE score, using the mean-centered constants derived from the Singapore cohort, did not change the c statistic but substantially improved the Hosmer-Lemeshow statistic to 90, 24, and 18, respectively. The recalibrated GRACE score predicted in-hospital mortality as follows: 7.7% (Chinese), 6.0% (Malay), and 5.2% (Indian). In this large cohort of 3 major Asian ethnicities, the original GRACE score, derived from populations outside Asia, underestimated in-hospital mortality after AMI. Recalibration improved risk estimation substantially and may help adapt externally developed risk scores for local practice. Copyright © 2011 Mosby, Inc. All rights reserved.

  12. Fall Risk Score at the Time of Discharge Predicts Readmission Following Total Joint Arthroplasty.

    Science.gov (United States)

    Ravi, Bheeshma; Nan, Zhang; Schwartz, Adam J; Clarke, Henry D

    2017-07-01

    Readmission among Medicare recipients is a leading driver of healthcare expenditure. To date, most predictive tools are too coarse for direct clinical application. Our objective in this study is to determine if a pre-existing tool to identify patients at increased risk for inpatient falls, the Hendrich Fall Risk Score, could be used to accurately identify Medicare patients at increased risk for readmission following arthroplasty, regardless of whether the readmission was due to a fall. This study is a retrospective cohort study. We identified 2437 Medicare patients who underwent a primary elective total joint arthroplasty (TJA) of the hip or knee for osteoarthritis between 2011 and 2014. The Hendrich Fall Risk score was recorded for each patient preoperatively and postoperatively. Our main outcome measure was hospital readmission within 30 days of discharge. Of 2437 eligible TJA recipients, there were 226 (9.3%) patients who had a score ≥6. These patients were more likely to have an unplanned readmission (unadjusted odds ratio 2.84, 95% confidence interval 1.70-4.76, P 3 days (49.6% vs 36.6%, P = .0001), and were less likely to be sent home after discharge (20.8% vs 35.8%, P fall risk score after TJA is strongly associated with unplanned readmission. Application of this tool will allow hospitals to identify these patients and plan their discharge. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

    Directory of Open Access Journals (Sweden)

    Priscila Costa

    2015-06-01

    Full Text Available OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns.METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve.RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points, moderate (4 to 8 points, and high (≥ 9 points. Accuracy was 0.76.CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

  14. Framingham Risk Score as a Prognostic Predictor of Sudden Sensorineural Hearing Loss: A Preliminary Study.

    Science.gov (United States)

    Chang, Young-Soo; Choi, Ji Eun; Ahn, Jungmin; Ryu, Nam-Gyu; Moon, Il Joon; Hong, Sung Hwa; Cho, Yang-Sun; Chung, Won-Ho

    2017-05-01

    Predicting the prognosis of idiopathic sudden sensorineural hearing loss (ISSHL) remains challenging. This investigation aimed to apply Framingham Risk Scores (FRS) to assess the combination of prognostic factors following ISSHL and investigate the predictive role of FRS in patients with multiple comorbidities including hypertension, diabetes, and hyperlipidemia. Retrospective study. Twenty-one patients presenting with unilateral idiopathic sudden sensorineural hearing loss and multiple comorbidities were surveyed. Framingham Risk Score was calculated, and patients were assigned into high-risk (FRS ≥20%) and low-risk (FRS hearing outcomes following established criteria were investigated. All patients were treated with the same protocol of oral methylprednisolone. Overall successful recovery rate (complete + marked recovery) was 23.81%. The mean PTA threshold of the low-risk group showed significant improvement (mean PTA ± standard error, SE: pretreatment, 73.23 ± 11.80; posttreatment, 54.89 ± 10.25, P = .002), while the high-risk group did not show significant improvement in mean PTA threshold (mean PTA ± SE: pretreatment, 71.94 ± 11.77; posttreatment, 68.89 ± 12.81, P = .73). Framingham Risk Scores may be useful in predicting outcomes for ISSHL patients with multiple comorbidities.

  15. Validation of the european SCORE risk chart in the healthy middle-aged Japanese.

    Science.gov (United States)

    Sawano, Mitsuaki; Kohsaka, Shun; Okamura, Tomonori; Inohara, Taku; Sugiyama, Daisuke; Watanabe, Makoto; Nakamura, Yasuyuki; Higashiyama, Aya; Kadota, Aya; Okud, Nagako; Murakami, Yoshitaka; Ohkubo, Takayoshi; Fujiyoshi, Akira; Miura, Katsuyuki; Okayama, Akira; Ueshima, Hirotsugu

    2016-09-01

    The European Society of Cardiology developed prediction models (SCORE) for low- and high-risk populations in the European countries. However, whether or not these models are valid in different ethnicities is unknown. We aimed to evaluate the performance of the low-risk SCORE model in the general Japanese population. Healthy middle-aged Japanese participating in the NIPPON DATA80 cohort had been observed. The predicted 10-year cardiovascular death risk was calculated using the low-risk SCORE model for the overall population as well as for each gender individually. The model performance of the low-risk SCORE model was evaluated with the Harrel's c-statistics for discrimination and the Grønnesby and Borgan goodness-of-fit test for calibration. A total of 4842 participants aged 40-64 years old and 47,606 person-years were evaluated in our study. 203 (4.19%) died within the ten-years of follow-up and 44 (0.91%) CV deaths were observed. The low-risk SCORE model in the overall population had reasonable discrimination (c statistics 0.72, 95% CI 0.71-0.73) but poor calibration (R(2), 0.67, Chi-square value 6.15, p = 0.01). Discrimination was reasonable in both men (c statistics 0.71, 95% CI 0.69-0.73) and women (c statistics 0.71, 95% CI 0.70-0.73). However, calibration was poor in men (R(2), 0.22, Chi-square value 0.749, p = 0.38) compared to women (R(2), 0.96, Chi-square value 1.39, p = 0.24). Although the low-risk SCORE model performs reasonably well in women, the SCORE models generally overestimated the risk of cardiovascular death risk in the Japanese general population. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. Comparison of the Framingham and Reynolds Risk scores for global cardiovascular risk prediction in the multiethnic Women's Health Initiative.

    Science.gov (United States)

    Cook, Nancy R; Paynter, Nina P; Eaton, Charles B; Manson, JoAnn E; Martin, Lisa W; Robinson, Jennifer G; Rossouw, Jacques E; Wassertheil-Smoller, Sylvia; Ridker, Paul M

    2012-04-10

    Framingham-based and Reynolds Risk scores for cardiovascular disease (CVD) prediction have not been directly compared in an independent validation cohort. We selected a case-cohort sample of the multiethnic Women's Health Initiative Observational Cohort, comprising 1722 cases of major CVD (752 myocardial infarctions, 754 ischemic strokes, and 216 other CVD deaths) and a random subcohort of 1994 women without prior CVD. We estimated risk using the Adult Treatment Panel III (ATP-III) score, the Reynolds Risk Score, and the Framingham CVD model, reweighting to reflect cohort frequencies. Predicted 10-year risk varied widely between models, with ≥10% risk in 6%, 10%, and 41% of women with the ATP-III, Reynolds, and Framingham CVD models, respectively. Calibration was adequate for the Reynolds model, but the ATP-III and Framingham CVD models overestimated risk for coronary heart disease and major CVD, respectively. After recalibration, the Reynolds model demonstrated improved discrimination over the ATP-III model through a higher c statistic (0.765 versus 0.757; P=0.03), positive net reclassification improvement (NRI; 4.9%; P=0.02), and positive integrated discrimination improvement (4.1%; PNRI=4.2%; P=0.01), and in white (NRI=4.3%; P=0.04) and black (NRI=11.4%; P=0.13) women. The Reynolds (NRI=12.9%; PNRI=5.9%; P=0.0001) models demonstrated better discrimination than the Framingham CVD model. The Reynolds Risk Score was better calibrated than the Framingham-based models in this large external validation cohort. The Reynolds score also showed improved discrimination overall and in black and white women. Large differences in risk estimates exist between models, with clinical implications for statin therapy.

  17. Type 2 diabetes mellitus and inflammation: Prospects for biomarkers of risk and nutritional intervention

    Directory of Open Access Journals (Sweden)

    Alaa Badawi

    2010-05-01

    Full Text Available Alaa Badawi1, Amira Klip2, Pierre Haddad3, David EC Cole4, Bibiana Garcia Bailo1,5, Ahmed El-Sohemy5, Mohamed Karmali11Office for Biotechnology, Genomics and Population Health, Public Health Agency of Canada, Toronto, ON, Canada; 2Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada; 3Natural Health Products and Metabolic Diseases Laboratory, Department of Pharmacology and Montreal Diabetes Research Centre, Montreal, QC, Canada; 4Department of Laboratory Medicine and Pathobiology, 5Department of Nutritional Sciences, University of Toronto, Toronto, ON, CanadaAbstract: Obesity is a major risk factor for type 2 diabetes mellitus (T2DM, which is a significant health problem worldwide. Active disease is associated with low-grade chronic inflammation resulting in part from the activation of the innate immune system. In obesity, this activation leads to the release of pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-1β and interleukin-6 that block major anabolic cascades downstream of insulin signaling and thus disrupt insulin homeostasis and action. Cytokines also trigger the production of acute-phase reactants such as C-reactive protein, plasminogen activator inhibitor-1, serum amyloid-A, and haptoglobin. The elevated synthesis of pro-inflammatory cytokines and acute-phase proteins (inflammatory network characterizes the early (or pre-clinical stages of T2DM and exhibits a graded increase with the disease progression. Current evidence suggests that understanding inflammatory networks can point to new biomarkers that may permit capturing the interaction between genetic and environmental risk factors in the pathogenesis of T2DM. Such biomarkers have a significant public health potential in the prediction of disease occurrence beyond risk factors presently monitored, such as family history, lifestyle assessment and standard clinical chemistry profiles. Furthermore, inflammatory markers may assist in the

  18. A clinically useful risk-score for chronic kidney disease in HIV infection

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Lundgren, Jens; Ross, Michael

    2014-01-01

    INTRODUCTION: Development of a simple, widely applicable risk score for chronic kidney disease (CKD) allows comparisons of risks or benefits of starting potentially nephrotoxic antiretrovirals (ARVs) as part of a treatment regimen. MATERIALS AND METHODS: A total of 18,055 HIV-positive persons from...... baseline eGFR, female gender, lower CD4 nadir, hypertension, diabetes and cardiovascular disease predicted CKD and were included in the risk score (Figure 1). The incidence of CKD in those at low, medium and high risk was 0.8/1000 PYFU (95% CI 0.6-1.0), 5.6 (95% CI 4.5-6.7) and 37.4 (95% CI 34...

  19. Predictive value of updating Framingham risk scores with novel risk markers in the U.S. general population.

    Directory of Open Access Journals (Sweden)

    Bart S Ferket

    Full Text Available BACKGROUND: According to population-based cohort studies CT coronary calcium score (CTCS, carotid intima-media thickness (cIMT, high-sensitivity C- reactive protein (CRP, and ankle-brachial index (ABI are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population. METHODS AND FINDINGS: Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES 2003-2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male, 70% (80% were at low (<10%, 19% (14% at intermediate (≥10-<20%, and 11% (6% at high (≥20% 10-year CVD (CHD risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02-0.19. The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01-0.03 with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38% moved to low and 22% (30% to high CVD (CHD risk. Improvements with other novel risk markers were limited. CONCLUSIONS: Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies.

  20. Predictive Value of Updating Framingham Risk Scores with Novel Risk Markers in the U.S. General Population

    Science.gov (United States)

    Hunink, M. G. Myriam; Agarwal, Isha; Kavousi, Maryam; Franco, Oscar H.; Steyerberg, Ewout W.; Max, Wendy; Fleischmann, Kirsten E.

    2014-01-01

    Background According to population-based cohort studies CT coronary calcium score (CTCS), carotid intima-media thickness (cIMT), high-sensitivity C- reactive protein (CRP), and ankle-brachial index (ABI) are promising novel risk markers for improving cardiovascular risk assessment. Their impact in the U.S. general population is however uncertain. Our aim was to estimate the predictive value of four novel cardiovascular risk markers for the U.S. general population. Methods and Findings Risk profiles, CRP and ABI data of 3,736 asymptomatic subjects aged 40 or older from the National Health and Nutrition Examination Survey (NHANES) 2003–2004 exam were used along with predicted CTCS and cIMT values. For each subject, we calculated 10-year cardiovascular risks with and without each risk marker. Event rates adjusted for competing risks were obtained by microsimulation. We assessed the impact of updated 10-year risk scores by reclassification and C-statistics. In the study population (mean age 56±11 years, 48% male), 70% (80%) were at low (risk. Net reclassification improvement was highest after updating 10-year CVD risk with CTCS: 0.10 (95%CI 0.02–0.19). The C-statistic for 10-year CVD risk increased from 0.82 by 0.02 (95%CI 0.01–0.03) with CTCS. Reclassification occurred most often in those at intermediate risk: with CTCS, 36% (38%) moved to low and 22% (30%) to high CVD (CHD) risk. Improvements with other novel risk markers were limited. Conclusions Only CTCS appeared to have significant incremental predictive value in the U.S. general population, especially in those at intermediate risk. In future research, cost-effectiveness analyses should be considered for evaluating novel cardiovascular risk assessment strategies. PMID:24558385

  1. Tissue accumulation of microplastics in mice and biomarker responses suggest widespread health risks of exposure

    Science.gov (United States)

    Deng, Yongfeng; Zhang, Yan; Lemos, Bernardo; Ren, Hongqiang

    2017-04-01

    Microplastics (MPs) are a significant environmental health issue and increasingly greater source of concern. MPs have been detected in oceans, rivers, sediments, sewages, soil and even table salts. MPs exposure on marine organisms and humans has been documented, but information about the toxicity of MPs in mammal is limited. Here we used fluorescent and pristine polystyrene microplastics (PS-MPs) particles with two diameters (5 μm and 20 μm) to investigate the tissue distribution, accumulation, and tissue-specific health risk of MPs in mice. Results indicated that MPs accumulated in liver, kidney and gut, with a tissue-accumulation kinetics and distribution pattern that was strongly depended on the MPs particle size. In addition, analyses of multiple biochemical biomarkers and metabolomic profiles suggested that MPs exposure induced disturbance of energy and lipid metabolism as well as oxidative stress. Interestingly, blood biomarkers of neurotoxicity were also altered. Our results uncovered the distribution and accumulation of MPs across mice tissues and revealed significant alteration in several biomarkers that indicate potential toxicity from MPs exposure. Collectively, our data provided new evidence for the adverse consequences of MPs.

  2. An Asian validation of the TIMI risk score for ST-segment elevation myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Sharmini Selvarajah

    Full Text Available BACKGROUND: Risk stratification in ST-elevation myocardial infarction (STEMI is important, such that the most resource intensive strategy is used to achieve the greatest clinical benefit. This is essential in developing countries with wide variation in health care facilities, scarce resources and increasing burden of cardiovascular diseases. This study sought to validate the Thrombolysis In Myocardial Infarction (TIMI risk score for STEMI in a multi-ethnic developing country. METHODS: Data from a national, prospective, observational registry of acute coronary syndromes was used. The TIMI risk score was evaluated in 4701 patients who presented with STEMI. Model discrimination and calibration was tested in the overall population and in subgroups of patients that were at higher risk of mortality; i.e., diabetics and those with renal impairment. RESULTS: Compared to the TIMI population, this study population was younger, had more chronic conditions, more severe index events and received treatment later. The TIMI risk score was strongly associated with 30-day mortality. Discrimination was good for the overall study population (c statistic 0.785 and in the high risk subgroups; diabetics (c statistic 0.764 and renal impairment (c statistic 0.761. Calibration was good for the overall study population and diabetics, with χ2 goodness of fit test p value of 0.936 and 0.983 respectively, but poor for those with renal impairment, χ2 goodness of fit test p value of 0.006. CONCLUSIONS: The TIMI risk score is valid and can be used for risk stratification of STEMI patients for better targeted treatment.

  3. A modified risk assessment scoring system for post laser in situ keratomileusis ectasia in topographically normal patients

    Directory of Open Access Journals (Sweden)

    Mohammad Miraftab

    2014-01-01

    Conclusion: Our modified ectasia risk scoring system for patients with normal corneal topography can predict post LASIK ectasia risk with acceptable sensitivity and specificity. However, there are still unidentified risk factors for which further studies are required.

  4. 75 FR 54020 - Federal Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score...

    Science.gov (United States)

    2010-09-03

    ... Housing Administration Risk Management Initiatives: New Loan-to-Value and Credit Score Requirements AGENCY... credit score threshold as well as reduce the maximum loan-to-value (LTV) for borrowers with lower credit scores who represent a higher risk of default and mortgage insurance claim; and to tighten underwriting...

  5. From differences in means between cases and controls to risk stratification: a business plan for biomarker development.

    Science.gov (United States)

    Wentzensen, Nicolas; Wacholder, Sholom

    2013-02-01

    Researchers developing biomarkers for early detection can determine the potential for clinical benefit at early stages of development. We provide the theoretical background showing the quantitative connection between biomarker levels in cases and controls and clinically meaningful risk measures, as well as a spreadsheet for researchers to use in their own research. We provide researchers with tools to decide whether a test is useful, whether it needs technical improvement, whether it may work only in specific populations, or whether any further development is futile. The methods described here apply to any method that aims to estimate risk of disease based on biomarkers, clinical tests, genetics, environment, or behavior. Many efforts go into futile biomarker development and premature clinical testing. In many instances, predictions for translational success or failure can be made early, simply based on critical analysis of case–control data. Our article presents well-established theory in a form that can be appreciated by biomarker researchers. Furthermore, we provide an interactive spreadsheet that links biomarker performance with specific disease characteristics to evaluate the promise of biomarker candidates at an early stage.

  6. Transcriptional instability during evolving sepsis may limit biomarker based risk stratification.

    Directory of Open Access Journals (Sweden)

    Antonia Kwan

    Full Text Available Sepsis causes extensive morbidity and mortality in children worldwide. Prompt recognition and timely treatment of sepsis is critical in reducing morbidity and mortality. Genomic approaches are used to discover novel pathways, therapeutic targets and biomarkers. These may facilitate diagnosis and risk stratification to tailor treatment strategies.To investigate the temporal gene expression during the evolution of sepsis induced multi-organ failure in response to a single organism, Neisseria meningitidis, in previously healthy children.RNA was extracted from serial blood samples (6 time points over 48 hours from presentation from five critically ill children with meningococcal sepsis. Extracted RNA was hybridized to Affymetrix arrays. The RNA underwent strict quality control and standardized quantitation. Gene expression results were analyzed using GeneSpring software and Ingenuity Pathway Analysis.A marked variability in differential gene expression was observed between time points and between patients revealing dynamic expression changes during the evolution of sepsis. While there was evidence of time-dependent changes in expected gene networks including those involving immune responses and inflammatory pathways, temporal variation was also evident in specific "biomarkers" that have been proposed for diagnostic and risk stratification functions. The extent and nature of this variability was not readily explained by clinical phenotype.This is the first study of its kind detailing extensive expression changes in children during the evolution of sepsis. This highlights a limitation of static or single time point biomarker estimation. Serial estimations or more comprehensive network approaches may be required to optimize risk stratification in complex, time-critical conditions such as evolving sepsis.

  7. Transcriptional instability during evolving sepsis may limit biomarker based risk stratification.

    Science.gov (United States)

    Kwan, Antonia; Hubank, Mike; Rashid, Asrar; Klein, Nigel; Peters, Mark J

    2013-01-01

    Sepsis causes extensive morbidity and mortality in children worldwide. Prompt recognition and timely treatment of sepsis is critical in reducing morbidity and mortality. Genomic approaches are used to discover novel pathways, therapeutic targets and biomarkers. These may facilitate diagnosis and risk stratification to tailor treatment strategies. To investigate the temporal gene expression during the evolution of sepsis induced multi-organ failure in response to a single organism, Neisseria meningitidis, in previously healthy children. RNA was extracted from serial blood samples (6 time points over 48 hours from presentation) from five critically ill children with meningococcal sepsis. Extracted RNA was hybridized to Affymetrix arrays. The RNA underwent strict quality control and standardized quantitation. Gene expression results were analyzed using GeneSpring software and Ingenuity Pathway Analysis. A marked variability in differential gene expression was observed between time points and between patients revealing dynamic expression changes during the evolution of sepsis. While there was evidence of time-dependent changes in expected gene networks including those involving immune responses and inflammatory pathways, temporal variation was also evident in specific "biomarkers" that have been proposed for diagnostic and risk stratification functions. The extent and nature of this variability was not readily explained by clinical phenotype. This is the first study of its kind detailing extensive expression changes in children during the evolution of sepsis. This highlights a limitation of static or single time point biomarker estimation. Serial estimations or more comprehensive network approaches may be required to optimize risk stratification in complex, time-critical conditions such as evolving sepsis.

  8. Risk score prediction model for dementia in patients with type 2 diabetes.

    Science.gov (United States)

    Li, Chia-Ing; Li, Tsai-Chung; Liu, Chiu-Shong; Liao, Li-Na; Lin, Wen-Yuan; Lin, Chih-Hsueh; Yang, Sing-Yu; Chiang, Jen-Huai; Lin, Cheng-Chieh

    2018-03-30

    No study established a prediction dementia model in the Asian populations. This study aims to develop a prediction model for dementia in Chinese type 2 diabetes patients. This retrospective cohort study included 27,540 Chinese type 2 diabetes patients (aged 50-94 years) enrolled in Taiwan National Diabetes Care Management Program. Participants were randomly allocated into derivation and validation sets at 2:1 ratio. Cox proportional hazards regression models were used to identify risk factors for dementia in the derivation set. Steps proposed by Framingham Heart Study were used to establish a prediction model with a scoring system. The average follow-up was 8.09 years, with a total of 853 incident dementia cases in derivation set. Dementia risk score summed up the individual scores (from 0 to 20). The areas under curve of 3-, 5-, and 10-year dementia risks were 0.82, 0.79, and 0.76 in derivation set and 0.84, 0.80, and 0.75 in validation set, respectively. The proposed score system is the first dementia risk prediction model for Chinese type 2 diabetes patients in Taiwan. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  9. CURB-65 Score is Equal to NEWS for Identifying Mortality Risk of Pneumonia Patients

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Henriksen, Daniel Pilsgaard

    2018-01-01

    IMPORTANCE: The CURB-65 score is widely implemented as a prediction tool for identifying patients with community-acquired pneumonia (cap) at increased risk of 30-day mortality. However, since most ingredients of CURB-65 are used as general prediction tools, it is likely that other prediction tools...

  10. Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation

    NARCIS (Netherlands)

    Mungroop, Timothy H.; van Rijssen, L. Bengt; van Klaveren, David; Smits, F. Jasmijn; van Woerden, Victor; Linnemann, Ralph J.; de Pastena, Matteo; Klompmaker, Sjors; Marchegiani, Giovanni; Ecker, Brett L.; van Dieren, Susan; Bonsing, Bert; Busch, Olivier R.; van Dam, Ronald M.; Erdmann, Joris; van Eijck, Casper H.; Gerhards, Michael F.; van Goor, Harry; van der Harst, Erwin; de Hingh, Ignace H.; de Jong, Koert P.; Kazemier, Geert; Luyer, Misha; Shamali, Awad; Barbaro, Salvatore; Armstrong, Thomas; Takhar, Arjun; Hamady, Zaed; Klaase, Joost; Lips, Daan J.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Rupert, Coen; van Santvoort, Hjalmar C.; Scheepers, Joris J.; van der Schelling, George P.; Bassi, Claudio; Vollmer, Charles M.; Steyerberg, Ewout W.; Abu Hilal, Mohammed; Groot Koerkamp, Bas; Besselink, Marc G.

    2017-01-01

    The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external

  11. A genetic risk score is associated with statin-induced low-density lipoprotein cholesterol lowering

    NARCIS (Netherlands)

    Leusink, Maarten; Maitland-van der Zee, Anke H.; Ding, Bo; Drenos, Fotios; van Iperen, Erik Pa; Warren, Helen R.; Caulfield, Mark J.; Cupples, L. Adrienne; Cushman, Mary; Hingorani, Aroon D.; Hoogeveen, Ron C.; Hovingh, G. Kees; Kumari, Meena; Lange, Leslie A.; Munroe, Patricia B.; Nyberg, Fredrik; Schreiner, Pamela J.; Sivapalaratnam, Suthesh; de Bakker, Paul Iw; de Boer, Anthonius; Keating, Brendan J.; Asselbergs, Folkert W.; Onland-Moret, N. Charlotte

    2016-01-01

    To find new genetic loci associated with statin response, and to investigate the association of a genetic risk score (GRS) with this outcome. In a discovery meta-analysis (five studies, 1991 individuals), we investigated the effects of approximately 50000 single nucleotide polymorphisms on statin

  12. Score-driven exponentially weighted moving averages and Value-at-Risk forecasting

    NARCIS (Netherlands)

    Lucas, A.; Zhang, X.

    2016-01-01

    We present a simple methodology for modeling the time variation in volatilities and other higher-order moments using a recursive updating scheme that is similar to the familiar RiskMetrics approach. The parameters are updated using the score of the forecasting distribution, which allows the

  13. Autism risk assessment in siblings of affected children using sex-specific genetic scores

    Directory of Open Access Journals (Sweden)

    Carayol Jerome

    2011-10-01

    Full Text Available Abstract Background The inheritance pattern in most cases of autism is complex. The risk of autism is increased in siblings of children with autism and previous studies have indicated that the level of risk can be further identified by the accumulation of multiple susceptibility single nucleotide polymorphisms (SNPs allowing for the identification of a higher-risk subgroup among siblings. As a result of the sex difference in the prevalence of autism, we explored the potential for identifying sex-specific autism susceptibility SNPs in siblings of children with autism and the ability to develop a sex-specific risk assessment genetic scoring system. Methods SNPs were chosen from genes known to be associated with autism. These markers were evaluated using an exploratory sample of 480 families from the Autism Genetic Resource Exchange (AGRE repository. A reproducibility index (RI was proposed and calculated in all children with autism and in males and females separately. Differing genetic scoring models were then constructed to develop a sex-specific genetic score model designed to identify individuals with a higher risk of autism. The ability of the genetic scores to identify high-risk children was then evaluated and replicated in an independent sample of 351 affected and 90 unaffected siblings from families with at least 1 child with autism. Results We identified three risk SNPs that had a high RI in males, two SNPs with a high RI in females, and three SNPs with a high RI in both sexes. Using these results, genetic scoring models for males and females were developed which demonstrated a significant association with autism (P = 2.2 × 10-6 and 1.9 × 10-5, respectively. Conclusions Our results demonstrate that individual susceptibility associated SNPs for autism may have important differential sex effects. We also show that a sex-specific risk score based on the presence of multiple susceptibility associated SNPs allow for the identification of

  14. Associations of sitting accumulation patterns with cardio-metabolic risk biomarkers in Australian adults.

    Science.gov (United States)

    Bellettiere, John; Winkler, Elisabeth A H; Chastin, Sebastien F M; Kerr, Jacqueline; Owen, Neville; Dunstan, David W; Healy, Genevieve N

    2017-01-01

    High amounts of time spent sitting can increase cardiovascular disease risk and are deleteriously associated cardio-metabolic risk biomarkers. Though evidence suggests that accruing sitting time in prolonged periods may convey additional risk, verification using high-quality measures is needed. We examined this issue in adults from the Australian Diabetes, Obesity and Lifestyle Study, using accurate measures of sitting accumulation. In 2011/12, 739 adults aged 36 to 89 years (mean±SD 58±10 years) wore activPAL3™ monitors (which provide accurate objective measures of sitting); 678 provided ≥4 valid days of monitor data and complete cardio-metabolic biomarker and confounder data. Multivariable linear regression models examined associations of sitting time, sitting time accrued in ≥30 minute bouts (prolonged sitting time), and three measures of sitting accumulation patterns with cardio-metabolic risk markers: body mass index (BMI), waist circumference, blood pressure, high- and low- density lipoprotein (HDL and LDL) cholesterol, triglycerides, glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 2-hour post-load glucose (PLG). Interactions tests examined whether associations of sitting time with biomarkers varied by usual sitting bout duration. Adjusted for potential confounders, greater amounts of sitting time and prolonged sitting time were significantly (psitting time was also significantly associated with higher PLG. Sitting accumulation patterns of frequently interrupted sitting (compared to patterns with relatively more prolonged sitting) were significantly beneficially associated with BMI, waist circumference, HDL cholesterol, triglycerides, PLG, and with FPG. Effect sizes were typically larger for accumulation patterns than for sitting time. Significant interactions (psitting time with HDL, triglycerides and PLG became more deleterious the longer at a time sitting was usually accumulated. Adding to previous evidence reliant on low

  15. Role of Biomarkers in the Diagnosis, Risk Assessment, and Management of Pulmonary Hypertension.

    Science.gov (United States)

    Rameh, Vanessa; Kossaify, Antoine

    2016-01-01

    Pulmonary hypertension is a severe and debilitating disease with no definite cure, and the domain of targeted therapies is a promising field for better management of this severe condition. The disease comprises pulmonary arterial remodeling, hypoxia, endothelial dysfunction, and inflammation, with subsequent organ damage including right heart and liver dysfunction. Biomarkers have a valuable role at different levels of the disease, from diagnosis to risk assessment and management, in order to decrease the burden of the disease in terms of both morbidity and mortality.

  16. Analysis of gender difference of cardiac risk biomarkers using hGH-transgenic mice.

    Science.gov (United States)

    Naraoka, Hitoshi; Ito, Kyoko; Suzuki, Michie; Naito, Kunihiko; Tojo, Hideaki

    2006-01-01

    We investigated gender difference in the effects of chronic exposure to human growth hormone (hGH) on cardiac risk biomarkers using transgenic mice with non-pulsatile circulating hGH. Blood plasma was obtained from transgenic and control mice at 8, 12, and 16 weeks of age, and was used for the measurement of hGH and the following cardiac risk biomarkers: total cholesterol (CHO), triglyceride (TG), HDL cholesterol (HDL), LDL cholesterol (LDL), non esterified free fatty acids (NEFA), and lipid peroxides (LPO). The hearts and the livers of transgenic mice were weighed and histopathologically examined, and the results were compared with those of control mice. Transgenic males exhibited higher levels of LDL at 8 and 12 weeks of age and higher levels of LPO at every week of age examined, as compared to those of the control males, while transgenic females exhibited somewhat lower levels of LDL and LPO from 8 to 16 weeks of age, as compared to the control females. The relative heart weight in males increased with aging and was significantly higher in the 16-week-old transgenic males compared to those of the control mice. The present results demonstrate that transgenic males had cardiac risk potential caused by chronic-exposure to hGH as compared to females. The results also show that the present transgenic mouse line is a useful model for the study of gender difference in cardiac disorders caused by hGH.

  17. Risk scores for outcome in bacterial meningitis: Systematic review and external validation study.

    Science.gov (United States)

    Bijlsma, Merijn W; Brouwer, Matthijs C; Bossuyt, Patrick M; Heymans, Martijn W; van der Ende, Arie; Tanck, Michael W T; van de Beek, Diederik

    2016-11-01

    To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis. MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer-Lemeshow test, and the distribution of calculated risks. Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57-0.61) and 0.74 (0.71-0.76) in bacterial meningitis, 0.67 (0.64-0.70) in pneumococcal meningitis, and 0.81 (0.73-0.90), 0.82 (0.74-0.91), 0.84 (0.75-0.93), 0.84 (0.76-0.93), 0.85 (0.75-0.95), and 0.90 (0.83-0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores. One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  18. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men.

    Science.gov (United States)

    Ridker, Paul M; Paynter, Nina P; Rifai, Nader; Gaziano, J Michael; Cook, Nancy R

    2008-11-25

    High-sensitivity C-reactive protein and family history are independently associated with future cardiovascular events and have been incorporated into risk prediction models for women (the Reynolds Risk Score for women); however, no cardiovascular risk prediction algorithm incorporating these variables currently exists for men. Among 10 724 initially healthy American nondiabetic men who were followed up prospectively over a median period of 10.8 years, we compared the test characteristics of global model fit, discrimination, calibration, and reclassification in 2 prediction models for incident cardiovascular events, one based on age, blood pressure, smoking status, total cholesterol, and high-density lipoprotein cholesterol (traditional model) and the other based on these risk factors plus high-sensitivity C-reactive protein and parental history of myocardial infarction before age 60 years (Reynolds Risk Score for men). A total of 1294 cardiovascular events accrued during study follow-up. Compared with the traditional model, the Reynolds Risk Score had better global fit (likelihood ratio test Pmen reclassified 17.8% (1904/10 724) of the study population (and 20.2% [1392/6884] of those at 5% to 20% 10-year risk) into higher- or lower-risk categories, with markedly improved accuracy among those reclassified. For this model comparison, the net reclassification index was 5.3%, and the clinical net reclassification index was 14.2% (both Pmen not taking lipid-lowering therapy, 16.7% of the study population (and 20.1% of those at 5% to 20% 10-year risk) were reclassified to higher- or lower-risk groups, again with significantly improved global fit, larger C-index (Paccuracy among those reclassified. For this model, the net reclassification index was 8.4% and the clinical net reclassification index was 15.8% (both Pwomen, a prediction model in men that incorporates high-sensitivity C-reactive protein and parental history significantly improves global cardiovascular risk

  19. Development and validation of a postpartum depression risk score in delivered women, Iran

    Directory of Open Access Journals (Sweden)

    Mohammad R Maracy

    2012-01-01

    Full Text Available Background: Investigators describe a dramatic increase in the incidence of mood disorder after childbirth, with the largest risk in the 90 days after delivery. This study is designed to develop a relatively simple screening tool and validate it from the significant variables associated with postpartum depression (PPD to detect delivered women at high risk of having PPD. Materials and Methods: In the cross-sectional study, 6,627 from a total of 7,300 delivered women, 2-12 months after delivery were recruited and screened for PPD. Split-half validation was used to develop the risk score. The training data set was used to develop the model, and the validation data set was used to validate the developed the risk factors of postpartum depression risk score using multiple logistic regression analysis to compute the β coefficients and odds ratio (OR for the dependent variables associated with possible PPD in this study. Calibration was checked using the Hosmer and Lemeshow test. A score for independent variables contributing to PPD was calculated. Cutoff points using a trade-off between the sensitivity and specificity of risk scores derived from PPD model using the Receiver Operating Characteristic (ROC curve. Results: The predicted and observed PPD were not different (P value = 0.885. The aROC with area under the curve (S.E. of 0.611 (0.008 for predicting PPD using the suggested cut-off point of -0.702, the proportion of participants screening positive for PPD was 70.9% (sensitivity (CI 95%; 69.5, 72.3 while the proportion screening negative was 60.1% (specificity (CI 95%; 58.2, 62.1. Conclusion: Despite of the relatively low sensitivity and specificity in this study, it could be a simple, practical and useful screening tool to identify individual at high risk for PPD in the target population.

  20. How to Identify High-Risk APS Patients: Clinical Utility and Predictive Values of Validated Scores.

    Science.gov (United States)

    Oku, Kenji; Amengual, Olga; Yasuda, Shinsuke; Atsumi, Tatsuya

    2017-08-01

    Antiphospholipid syndrome (APS) is a clinical disorder characterised by thrombosis and/or pregnancy morbidity in the persistence of antiphospholipid (aPL) antibodies that are pathogenic and have pro-coagulant activities. Thrombosis in APS tends to recur and require prophylaxis; however, the stereotypical treatment for APS patients is inadequate and stratification of the thrombotic risks is important as aPL are prevalently observed in various diseases or elderly population. It is previously known that the multiple positive aPL or high titre aPL correlate to thrombotic events. To progress the stratification of thrombotic risks in APS patients and to quantitatively analyse those risks, antiphospholipid score (aPL-S) and the Global Anti-phospholipid Syndrome Score (GAPSS) were defined. These scores were raised from the large patient cohort data and either aPL profile classified in detail (aPL-S) or simplified aPL profile with classical thrombotic risk factors (GAPSS) was put into a scoring system. Both the aPL-S and GAPSS have shown a degree of accuracy in identifying high-risk APS patients, especially those at a high risk of thrombosis. However, there are several areas requiring improvement, or at least that clinicians should be aware of, before these instruments are applied in clinical practice. One such issue is standardisation of the aPL tests, including general testing of phosphatidylserine-dependent antiprothrombin antibodies (aPS/PT). Additionally, clinicians may need to be aware of the patient's medical history, particularly with respect to the incidence of SLE, which influences the cutoff value for identifying high-risk patients.

  1. Calcium scores in the risk assessment of an asymptomatic population: implications for airline pilots.

    Science.gov (United States)

    Wirawan, I Made Ady; Wu, Rodney; Abernethy, Malcolm; Aldington, Sarah; Larsen, Peter D

    2014-08-01

    This study evaluated whether coronary artery calcium score (CACS) improved cardiovascular disease risk prediction when compared to the New Zealand Cardiovascular Risk Charts (NZ-CRC), and describes the potential utilization of CACS in cardiovascular disease (CVD) risk assessment of pilots. A cross-sectional study was performed among asymptomatic patients who underwent coronary computed tomography angiography at Pacific Radiology Wellington, New Zealand, between August 2007 and July 2012 and had their CACS and CVD risk score calculated. Receiver-operating characteristics (ROC) analyses were used to measure the accuracy of the NZ-CRC and CACS. Reclassification analyses were performed to examine the net reclassification improvement (NRI) of CACS when compared to NZ-CRC. Over a 5-yr study period, 237 male asymptomatic patients with ages ranging from 30 to 69 yr with a mean (SD) of 53.24 (8.18) yr, were included. The area under the ROC curves (AUC) (95% CI) for CACS and NZ-CRC were 0.88 (0.83-0.93) and 0.66 (0.59-0.73), respectively. The NRI (95% CI) of the calcium scores was 0.39 (0.17-0.62). CACS should be assessed in pilots with 5-yr CVD risk scores of 5-10% and 10-15%. CACS has a better accuracy than the NZ-CRC and reclassified a considerable proportion of asymptomatic patients into correct cardiovascular risk categories. An approach on how the CACS should be employed in the cardiovascular risk assessment of airline pilots is noted in this paper.

  2. The East London glaucoma prediction score: web-based validation of glaucoma risk screening tool

    Science.gov (United States)

    Stephen, Cook; Benjamin, Longo-Mbenza

    2013-01-01

    AIM It is difficult for Optometrists and General Practitioners to know which patients are at risk. The East London glaucoma prediction score (ELGPS) is a web based risk calculator that has been developed to determine Glaucoma risk at the time of screening. Multiple risk factors that are available in a low tech environment are assessed to provide a risk assessment. This is extremely useful in settings where access to specialist care is difficult. Use of the calculator is educational. It is a free web based service. Data capture is user specific. METHOD The scoring system is a web based questionnaire that captures and subsequently calculates the relative risk for the presence of Glaucoma at the time of screening. Three categories of patient are described: Unlikely to have Glaucoma; Glaucoma Suspect and Glaucoma. A case review methodology of patients with known diagnosis is employed to validate the calculator risk assessment. RESULTS Data from the patient records of 400 patients with an established diagnosis has been captured and used to validate the screening tool. The website reports that the calculated diagnosis correlates with the actual diagnosis 82% of the time. Biostatistics analysis showed: Sensitivity = 88%; Positive predictive value = 97%; Specificity = 75%. CONCLUSION Analysis of the first 400 patients validates the web based screening tool as being a good method of screening for the at risk population. The validation is ongoing. The web based format will allow a more widespread recruitment for different geographic, population and personnel variables. PMID:23550097

  3. Genetic risk scores and family history as predictors of schizophrenia in Nordic registers

    DEFF Research Database (Denmark)

    Lu, Y.; Pouget, J. G.; Andreassen, O. A.

    2017-01-01

    Background: Family history is a long-standing and readily obtainable risk factor for schizophrenia (SCZ). Low-cost genotyping technologies have enabled large genetic studies of SCZ, and the results suggest the utility of genetic risk scores (GRS, direct assessments of inherited common variant risk...... through the quality control procedures used by the Psychiatric Genomics Consortium. Using external training data, GRS were estimated for SCZ, bipolar disorder (BIP), major depression, autism, educational attainment, and body mass index. Multivariable modeling was used to estimate effect sizes. Results...

  4. Fall risk assessment: retrospective analysis of Morse Fall Scale scores in Portuguese hospitalized adult patients.

    Science.gov (United States)

    Sardo, Pedro Miguel Garcez; Simões, Cláudia Sofia Oliveira; Alvarelhão, José Joaquim Marques; Simões, João Filipe Fernandes Lindo; Melo, Elsa Maria de Oliveira Pinheiro de

    2016-08-01

    The Morse Fall Scale is used in several care settings for fall risk assessment and supports the implementation of preventive nursing interventions. Our work aims to analyze the Morse Fall Scale scores of Portuguese hospitalized adult patients in association with their characteristics, diagnoses and length of stay. Retrospective cohort analysis of Morse Fall Scale scores of 8356 patients hospitalized during 2012. Data were associated to age, gender, type of admission, specialty units, length of stay, patient discharge, and ICD-9 diagnosis. Elderly patients, female, with emergency service admission, at medical units and/or with longer length of stays were more frequently included in the risk group for falls. ICD-9 diagnosis may also be an important risk factor. More than a half of hospitalized patients had "medium" to "high" risk of falling during the length of stay, which determines the implementation and maintenance of protocoled preventive nursing interventions throughout hospitalization. There are several fall risk factors not assessed by Morse Fall Scale. There were no statistical differences in Morse Fall Scale score between the first and the last assessment. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Prediction of individual genetic risk to prostate cancer using a polygenic score

    DEFF Research Database (Denmark)

    Szulkin, Robert; Whitington, Thomas; Eklund, Martin

    2015-01-01

    BACKGROUND: Polygenic risk scores comprising established susceptibility variants have shown to be informative classifiers for several complex diseases including prostate cancer. For prostate cancer it is unknown if inclusion of genetic markers that have so far not been associated with prostate...... prioritized based on their association with prostate cancer. Six-fold cross validation was performed to assess genetic risk scores and optimize the number of additional variants to be included. The final model was evaluated in an independent study population including 1,370 cases and 1,239 controls. RESULTS...... regions established as associated with prostate cancer risk. CONCLUSIONS: Inclusion of additional genetic variants from established prostate cancer susceptibility regions improves disease prediction....

  6. Risk prediction is improved by adding markers of subclinical organ damage to SCORE

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Jeppesen, Jørgen; Hansen, Tine W

    2010-01-01

    cardiovascular, anti-diabetic, or lipid-lowering treatment, aged 41, 51, 61, or 71 years, we measured traditional cardiovascular risk factors, left ventricular (LV) mass index, atherosclerotic plaques in the carotid arteries, carotid/femoral pulse wave velocity (PWV), and urine albumin/creatinine ratio (UACR......) and followed them for a median of 12.8 years. Eighty-one subjects died because of cardiovascular causes. Risk of cardiovascular death was independently of SCORE associated with LV hypertrophy [hazard ratio (HR) 2.2 (95% CI 1.2-4.0)], plaques [HR 2.5 (1.6-4.0)], UACR > or = 90th percentile [HR 3.3 (1.......07). CONCLUSION: Subclinical organ damage predicted cardiovascular death independently of SCORE and the combination may improve risk prediction....

  7. Myocardial Perfusion in Rheumatoid Arthritis Patients: Associations with Traditional Risk Factors and Novel Biomarkers

    Directory of Open Access Journals (Sweden)

    Miguel Bernardes

    2017-01-01

    Full Text Available Introduction. Cardiovascular (CV diseases are a major cause of death in rheumatoid arthritis (RA patients. Novel biomarkers [B-type natriuretic peptide (BNP; osteoprotegerin (OPG/receptor activator of nuclear factor-kappa B ligand (RANKL ratio; and dickkopf-1 (DKK-1] have been used in CV risk assessment. We analysed, in established RA patients, the presence of silent myocardial ischemia and its association with clinical variables, BNP, and bone and atheroma biomarkers. Methods. From a single-center tertiary referral hospital, RA patients asymptomatic for CV disease were submitted to myocardial perfusion scintigraphy (MPS under adenosine stress and biomarkers measurements. Logistic regression was used to estimate crude odds ratios (OR and 95% confidence intervals (CI. Results. In 189 patients, perfusion defects were frequent (25% and associated with BNP ≥ 100 pg/mL (OR = 5.68; 95% CI: 2.038–15.830, fourth log OPG/RANKL ratio quartile (OR = 2.88; 95% CI: 1.091–7.622, and DKK-1 ≥ 133 pmol/L (OR = 2.69; 95% CI: 1.058–6.840. Similar associations were confirmed in those with C-reactive protein > or ≤ 3 mg/L. No relationship was found with the majority of traditional CV factors nor with disease variables. Conclusions. Our results corroborated the hypothesis that MPS could reveal subclinical CV dysfunction, supported the utility of BNP measurements as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients.

  8. A preoperative risk score for transfusion in infrarenal endovascular aneurysm repair to avoid type and cross.

    Science.gov (United States)

    O'Donnell, Thomas F X; Shean, Katie E; Deery, Sarah E; Bodewes, Thomas C F; Wyers, Mark C; O'Brien, Kerry L; Matyal, Robina; Schermerhorn, Marc L

    2018-02-01

    Preoperative type and cross are often routinely ordered before elective endovascular aneurysm repair (EVAR), but the cost of this practice is high, and transfusion is rare. We therefore aimed to stratify patients by their risk of transfusion to identify a cohort in whom a type and screen would be sufficient. We queried the targeted vascular module of the National Surgical Quality Improvement Program (NSQIP) for all elective EVARs from 2011 to 2015. We included only infrarenal aneurysms and excluded ruptured aneurysms and patients transfused within 72 hours preoperatively. Two-thirds of the cases were randomly assigned to a model derivation cohort and one third to a validation cohort. We created and subsequently validated a risk model for transfusion within the first 24 hours of surgery (including intraoperatively), using logistic regression. Between 2011 and 2015, there were 4875 patients who underwent elective infrarenal EVAR, only 221 (4.5%) of whom received a transfusion within 24 hours of surgery. The frequency of transfusion during the study period declined monotonously from 6.5% in 2011 to 3.2% in 2015. The factors independently associated with transfusion were preoperative hematocrit risk prediction model based on these criteria produced a C statistic of 0.69 in the prediction cohort and 0.76 in the validation cohort and a Hosmer-Lemeshow goodness of fit of 0.62 and 0.14, respectively. A score of cross in 86% of patients. Of the 4203 patients (86%) with a hematocrit >36%, only 6 (0.1%) had a risk score of >3. Perioperative transfusion for EVAR is becoming increasingly uncommon and is predicted well by a transfusion risk score or simply a hematocrit of risk score would avoid unnecessary type and cross in the majority of patients, leading to significant savings in both time and cost. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  9. A multi-institutional external validation of the fistula risk score for pancreatoduodenectomy.

    Science.gov (United States)

    Miller, Benjamin C; Christein, John D; Behrman, Stephen W; Drebin, Jeffrey A; Pratt, Wande B; Callery, Mark P; Vollmer, Charles M

    2014-01-01

    The Fistula Risk Score (FRS), a ten-point scale that relies on weighted influence of four variables, has been shown to effectively predict clinically relevant postoperative pancreatic fistula (CR-POPF) development and its consequences after pancreatoduodenectomy (PD). The proposed FRS demonstrated excellent predictive capacity; however, external validation of this tool would confirm its universal applicability. From 2001 to 2012, 594 PDs with pancreatojejunostomy reconstructions were performed at three institutions. POPFs were graded by International Study Group on Pancreatic Fistula standards as grades A, B, or C. The FRS was calculated for each patient, and clinical outcomes were evaluated across four discrete risk zones as described in the original work. Receiver operator curve analysis was performed to judge model validity. One hundred forty-two patients developed any sort of POPF, of which 68 were CR-POPF (11.4 % overall; 8.9 % grade B, 2.5 % grade C). Increasing FRS scores (0-10) correlated well with CR-POPF development (p < 0.001) with a C-statistic of 0.716. When segregated by discrete FRS-risk groups, CR-POPFs occurred in low-, moderate-, and high-risk patients, 6.6, 12.9, and 28.6 % of the time, respectively (p < 0.001). Clinical outcomes including complications, length of stay, and readmission rates also increased across risk groups. This multi-institutional experience confirms the Fistula Risk Score as a valid tool for predicting the development of CR-POPF after PD. Patients devoid of any risk factors did not develop a CR-POPF, and the rate of CR-POPF approximately doubles with each subsequent risk zone. The FRS is validated as a strongly predictive tool, with widespread applicability, which can be readily incorporated into common clinical practice and research analysis.

  10. The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study.

    Science.gov (United States)

    Kutz, Alexander; Hausfater, Pierre; Amin, Devendra; Amin, Adina; Canavaggio, Pauline; Sauvin, Gabrielle; Bernard, Maguy; Conca, Antoinette; Haubitz, Sebastian; Struja, Tristan; Huber, Andreas; Mueller, Beat; Schuetz, Philipp

    2016-01-01

    The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial. We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome. Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252). Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).

  11. Prediction of Breast and Prostate Cancer Risks in Male BRCA1 and BRCA2 Mutation Carriers Using Polygenic Risk Scores

    DEFF Research Database (Denmark)

    Lecarpentier, Julie; Silvestri, Valentina; Kuchenbaecker, Karoline B

    2017-01-01

    for male carriers of BRCA1/ 2 mutations and implications for cancer risk prediction. Materials and Methods We genotyped 1,802 male carriers of BRCA1/2 mutations from the Consortium of Investigators of Modifiers of BRCA1/2 by using the custom Illumina OncoArray. We investigated the combined effects......Purpose BRCA1/2 mutations increase the risk of breast and prostate cancer in men. Common genetic variants modify cancer risks for female carriers of BRCA1/2 mutations. We investigated-for the first time to our knowledge-associations of common genetic variants with breast and prostate cancer risks...... of established breast and prostate cancer susceptibility variants on cancer risks for male carriers of BRCA1/2 mutations by constructing weighted polygenic risk scores (PRSs) using published effect estimates as weights. Results In male carriers of BRCA1/2 mutations, PRS that was based on 88 female breast cancer...

  12. The Surgical Site Infection Risk Score (SSIRS: A Model to Predict the Risk of Surgical Site Infections.

    Directory of Open Access Journals (Sweden)

    Carl van Walraven

    Full Text Available Surgical site infections (SSI are an important cause of peri-surgical morbidity with risks that vary extensively between patients and surgeries. Quantifying SSI risk would help identify candidates most likely to benefit from interventions to decrease the risk of SSI.We randomly divided all surgeries recorded in the National Surgical Quality Improvement Program from 2010 into a derivation and validation population. We used multivariate logistic regression to determine the independent association of patient and surgical covariates with the risk of any SSI (including superficial, deep, and organ space SSI within 30 days of surgery. To capture factors particular to specific surgeries, we developed a surgical risk score specific to all surgeries having a common first 3 numbers of their CPT code.Derivation (n = 181 894 and validation (n = 181 146 patients were similar for all demographics, past medical history, and surgical factors. Overall SSI risk was 3.9%. The SSI Risk Score (SSIRS found that risk increased with patient factors (smoking, increased body mass index, certain comorbidities (peripheral vascular disease, metastatic cancer, chronic steroid use, recent sepsis, and operative characteristics (surgical urgency; increased ASA class; longer operation duration; infected wounds; general anaesthesia; performance of more than one procedure; and CPT score. In the validation population, the SSIRS had good discrimination (c-statistic 0.800, 95% CI 0.795-0.805 and calibration.SSIRS can be calculated using patient and surgery information to estimate individual risk of SSI for a broad range of surgery types.

  13. Correlation between Umbilical Cord pH and Apgar Score in High-Risk Pregnancy

    OpenAIRE

    Ahmadpour-Kacho, Mousa; Asnafi, Nesa; Javadian, Maryam; Hajiahmadi, Mahmood; Taleghani, Nazila

    2010-01-01

    Objective The Apgar score as a proven useful tool for rapid assessment of the neonate is often poorly correlated with other indicators of intrapartum neonatal well-being. This study was carried out to determine the correlation between umbilical cord pH and Apgar score in high-risk pregnancies. Methods This is a prospective cross-sectional, analytic study performed on 96 mother-fetal pairs during 2004-2005 at Shahid Yahyanejad Hospital, which is affiliated to Babol University of Medical Scienc...

  14. Population-standardized genetic risk score: the SNP-based method of choice for inherited risk assessment of prostate cancer

    Directory of Open Access Journals (Sweden)

    Carly A Conran

    2016-01-01

    Full Text Available Several different approaches are available to clinicians for determining prostate cancer (PCa risk. The clinical validity of various PCa risk assessment methods utilizing single nucleotide polymorphisms (SNPs has been established; however, these SNP-based methods have not been compared. The objective of this study was to compare the three most commonly used SNP-based methods for PCa risk assessment. Participants were men (n = 1654 enrolled in a prospective study of PCa development. Genotypes of 59 PCa risk-associated SNPs were available in this cohort. Three methods of calculating SNP-based genetic risk scores (GRSs were used for the evaluation of individual disease risk such as risk allele count (GRS-RAC, weighted risk allele count (GRS-wRAC, and population-standardized genetic risk score (GRS-PS. Mean GRSs were calculated, and performances were compared using area under the receiver operating characteristic curve (AUC and positive predictive value (PPV. All SNP-based methods were found to be independently associated with PCa (all P 0.05 for comparisons between the three methods, and all three SNP-based methods had a significantly higher AUC than family history (all P < 0.05. Results from this study suggest that while the three most commonly used SNP-based methods performed similarly in discriminating PCa from non-PCa at the population level, GRS-PS is the method of choice for risk assessment at the individual level because its value (where 1.0 represents average population risk can be easily interpreted regardless of the number of risk-associated SNPs used in the calculation.

  15. Cardiovascular Risk Stratification in Patients with Metabolic Syndrome Without Diabetes or Cardiovascular Disease: Usefulness of Metabolic Syndrome Severity Score.

    Science.gov (United States)

    Masson, Walter; Epstein, Teo; Huerín, Melina; Lobo, Lorenzo Martín; Molinero, Graciela; Angel, Adriana; Masson, Gerardo; Millán, Diana; De Francesca, Salvador; Vitagliano, Laura; Cafferata, Alberto; Losada, Pablo

    2017-09-01

    The estimated cardiovascular risk determined by the different risk scores, could be heterogeneous in patients with metabolic syndrome without diabetes or vascular disease. This risk stratification could be improved by detecting subclinical carotid atheromatosis. To estimate the cardiovascular risk measured by different scores in patients with metabolic syndrome and analyze its association with the presence of carotid plaque. Non-diabetic patients with metabolic syndrome (Adult Treatment Panel III definition) without cardiovascular disease were enrolled. The Framingham score, the Reynolds score, the new score proposed by the 2013 ACC/AHA Guidelines and the Metabolic Syndrome Severity Calculator were calculated. Prevalence of carotid plaque was determined by ultrasound examination. A Receiver Operating Characteristic analysis was performed. A total of 238 patients were enrolled. Most patients were stratified as "low risk" by Framingham score (64%) and Reynolds score (70.1%). Using the 2013 ACC/AHA score, 45.3% of the population had a risk ≥7.5%. A significant correlation was found between classic scores but the agreement (concordance) was moderate. The correlation between classical scores and the Metabolic Syndrome Severity Calculator was poor. Overall, the prevalence of carotid plaque was 28.2%. The continuous metabolic syndrome score used in our study showed a good predictive power to detect carotid plaque (area under the curve 0.752). In this population, the calculated cardiovascular risk was heterogenic. The prevalence of carotid plaque was high. The Metabolic Syndrome Severity Calculator showed a good predictive power to detect carotid plaque.

  16. Development and Internal Validation of a Clinical Risk Score to Predict Pain Response After Palliative Radiation Therapy in Patients With Bone Metastases.

    Science.gov (United States)

    van der Velden, Joanne M; Peters, Max; Verlaan, Jorrit-Jan; Versteeg, Anne L; Zhang, Liying; Tsao, May; Danjoux, Cyril; Barnes, Elizabeth; van Vulpen, Marco; Chow, Edward; Verkooijen, Helena M

    2017-11-15

    To investigate the relationship between patient and tumor characteristics and pain response in patients with metastatic bone disease, and construct and internally validate a clinical prediction model for pain response to guide individualized treatment decision making. A total of 965 patients with painful bone metastases undergoing palliative radiation therapy at a tertiary referral center between 1999 and 2007 were identified. Pain scores were measured at 1, 2, and 3 months after radiation therapy. Pain response was defined as at least a 2-point decrease on a pain score scale of 0-10, without increase in analgesics, or an analgesic decrease of at least 25% without an increase in pain score. Thirteen candidate predictors were identified from the literature and expert experience. After multiple imputation, final predictors were selected using stepwise regression and collapsed into a prediction model. Model performance was evaluated by calibration and discrimination and corrected for optimism. Overall 462 patients (47.9%) showed a response. Primary tumor site, performance status, and baseline pain score were predictive for pain response, with a corrected c-statistic of 0.63. The predicted response rates after radiation therapy increased from 37.5% for patients with the highest risk score to 79.8% for patients with the lowest risk score and were in good agreement with the observed response rates. A prediction score for pain response after palliative radiation therapy was developed. The model performance was moderate, showing that prediction of pain response is difficult. New biomarkers and predictors may lead to improved identification of the large group of patients who are unlikely to respond and who may benefit from other or innovative treatment options. Copyright © 2017. Published by Elsevier Inc.

  17. Validation of prognostic biomarker scores for predicting progression of dementia in patients with amnestic mild cognitive impairment.

    Science.gov (United States)

    Moreland, Jamie; Urhemaa, Timo; van Gils, Mark; Lötjönen, Jyrki; Wolber, Jan; Buckley, Christopher J

    2018-04-01

    The objective of this study was to develop and validate a practical computerized prognostic model that uses baseline psychometric and imaging data, including results of PET imaging of amyloid deposition, to predict the progression to dementia in patients at risk for Alzheimer's disease (AD). Data from patients in a phase II trial of [F]flutemetamol for PET imaging of brain amyloid and from the Alzheimer's Disease Neuroimaging Initiative were used to train the prognostic model to yield a disease state index (DSI), a measure of the similarity of an individual patient's data to data from patients in specific diagnostic groups. Inputs to the model included amyloid PET results, MRI measurements of hippocampal volume, and the results of psychometric tests. The model was subsequently validated by using data from a prospective study of an independent cohort of patients with mild cognitive impairment. In total, data from 223 patients of the 233 enroled were suitable for analysis. The DSI predicted by the model and the risk of progression to AD dementia within 3 years were higher for patients with amyloid deposition and neurodegeneration than for patients with amyloid deposition without neurodegeneration. Rates of non-AD dementia among patients with neurodegeneration at baseline were consistent with the results of other studies. The results were consistent with the Jack model of AD progression. The DSI from the model that included psychometric, MRI, and PET amyloid data provides useful prognostic information in cases of mild cognitive impairment.

  18. Influence of Polygenic Risk Scores on the Association Between Infections and Schizophrenia

    DEFF Research Database (Denmark)

    Benros, Michael E; Trabjerg, Betina; Meier, Sandra M

    2016-01-01

    BACKGROUND: Several studies have suggested an important role of infections in the etiology of schizophrenia; however, shared genetic liability toward infections and schizophrenia could influence the association. We therefore investigated the possible effect of polygenic risk scores (PRSs) for sch......BACKGROUND: Several studies have suggested an important role of infections in the etiology of schizophrenia; however, shared genetic liability toward infections and schizophrenia could influence the association. We therefore investigated the possible effect of polygenic risk scores (PRSs...... hospital contact with infection had occurred in 41% of the individuals with schizophrenia and increased the incidence rate ratio (IRR) of schizophrenia by 1.43 (95% confidence interval [CI] = 1.22-1.67). Adding PRS, which was robustly associated with schizophrenia (by an IRR of 1.46 [95% CI = 1.......34-1.60] per standard deviation of the score), did not alter the association with infections and the increased risk of schizophrenia remained (IRR = 1.41; 95% CI = 1.20-1.66). Furthermore, there were no interactions between PRS and infections on the risk of developing schizophrenia (p = .554). Neither did PRS...

  19. Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

    Directory of Open Access Journals (Sweden)

    Satoshi Nagano

    2014-01-01

    Full Text Available Surgical site infection (SSI has not been extensively studied in musculoskeletal tumors (MST owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P=0.0002 and intraoperative blood loss (P=0.0005 was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials. The MOSI index (0–4 points score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points. The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

  20. Framingham coronary heart disease risk score can be predicted from structural brain images in elderly subjects.

    Directory of Open Access Journals (Sweden)

    Jane Maryam Rondina

    2014-12-01

    Full Text Available Recent literature has presented evidence that cardiovascular risk factors (CVRF play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer’s disease (AD and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies in a sample of healthy elderly individuals. We aim to answer the following questions: Is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: i we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease. ii When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. iii We found important gender differences, and the possible causes of that finding are discussed.

  1. Toronto HCC risk index: A validated scoring system to predict 10-year risk of HCC in patients with cirrhosis.

    Science.gov (United States)

    Sharma, Suraj A; Kowgier, Matthew; Hansen, Bettina E; Brouwer, Willem Pieter; Maan, Raoel; Wong, David; Shah, Hemant; Khalili, Korosh; Yim, Colina; Heathcote, E Jenny; Janssen, Harry L A; Sherman, Morris; Hirschfield, Gideon M; Feld, Jordan J

    2017-08-24

    Current guidelines recommend biannual surveillance for hepatocellular carcinoma (HCC) in all patients with cirrhosis, regardless of etiology. However, HCC incidence is not well established for many causes of cirrhosis. We aimed to assess the disease-specific incidence of HCC in a large cohort of patients with cirrhosis and to develop a scoring system to predict HCC risk. A derivation cohort of patients with cirrhosis diagnosed by biopsy or non-invasive measures was identified through retrospective chart review. The disease-specific incidence of HCC was calculated according to etiology of cirrhosis. Factors associated with HCC were identified through multivariable Cox regression and used to develop a scoring system to predict HCC risk. The scoring system was evaluated in an external cohort for validation. Of 2,079 patients with cirrhosis and ≥6months follow-up, 226 (10.8%) developed HCC. The 10-year cumulative incidence of HCC varied by etiologic category from 22% in patients with viral hepatitis, to 16% in those with steatohepatitis and 5% in those with autoimmune liver disease (pHCC. Points were assigned in proportion to each hazard ratio to create the Toronto HCC Risk Index (THRI). The 10-year cumulative HCC incidence was 3%, 10% and 32% in the low-risk (240) groups respectively, values that remained consistent after internal validation. External validation was performed on a cohort of patients with primary biliary cirrhosis, hepatitis B viral and hepatitis C viral cirrhosis (n=1,144), with similar predictive ability (Harrell's c statistic 0.77) in the validation and derivation cohorts. HCC incidence varies markedly by etiology of cirrhosis. The THRI, using readily available clinical and laboratory parameters, has good predictive ability for HCC in patients with cirrhosis, and has been validated in an external cohort. This risk score may help to guide recommendations regarding HCC surveillance among patients with cirrhosis. HCC incidence varies markedly

  2. Alimentary habits, physical activity, and Framingham global risk score in metabolic syndrome.

    Science.gov (United States)

    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo

    2014-04-01

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

  3. Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

    International Nuclear Information System (INIS)

    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo

    2014-01-01

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases

  4. Alimentary Habits, Physical Activity, and Framingham Global Risk Score in Metabolic Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Thays Soliman; Piovesan, Carla Haas; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Bodanese, Luiz Carlos; Feoli, Ana Maria Pandolfo, E-mail: anamariafeoli@hotmail.com [Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil)

    2014-04-15

    Metabolic syndrome is a complex disorder represented by a set of cardiovascular risk factors. A healthy lifestyle is strongly related to improve Quality of Life and interfere positively in the control of risk factors presented in this condition. To evaluate the effect of a program of lifestyle modification on the Framingham General Cardiovascular Risk Profile in subjects diagnosed with metabolic syndrome. A sub-analysis study of a randomized clinical trial controlled blind that lasted three months. Participants were randomized into four groups: dietary intervention + placebo (DIP), dietary intervention + supplementation of omega 3 (fish oil 3 g/day) (DIS3), dietary intervention + placebo + physical activity (DIPE) and dietary intervention + physical activity + supplementation of omega 3 (DIS3PE). The general cardiovascular risk profile of each individual was calculated before and after the intervention. The study included 70 subjects. Evaluating the score between the pre and post intervention yielded a significant value (p < 0.001). We obtained a reduction for intermediate risk in 25.7% of subjects. After intervention, there was a significant reduction (p < 0.01) on cardiovascular age, this being more significant in groups DIP (5.2%) and DIPE (5.3%). Proposed interventions produced beneficial effects for reducing cardiovascular risk score. This study emphasizes the importance of lifestyle modification in the prevention and treatment of cardiovascular diseases.

  5. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction

    Directory of Open Access Journals (Sweden)

    Dai Hongying

    2013-01-01

    Full Text Available Abstract Background Multifactor Dimensionality Reduction (MDR has been widely applied to detect gene-gene (GxG interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. Results We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. Conclusions The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi are proposed to detect multiple GxG interactions.

  6. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction

    Science.gov (United States)

    2013-01-01

    Background Multifactor Dimensionality Reduction (MDR) has been widely applied to detect gene-gene (GxG) interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk) from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. Results We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR) method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX) that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. Conclusions The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi) are proposed to detect multiple GxG interactions. PMID:23294634

  7. Risk score modeling of multiple gene to gene interactions using aggregated-multifactor dimensionality reduction.

    Science.gov (United States)

    Dai, Hongying; Charnigo, Richard J; Becker, Mara L; Leeder, J Steven; Motsinger-Reif, Alison A

    2013-01-08

    Multifactor Dimensionality Reduction (MDR) has been widely applied to detect gene-gene (GxG) interactions associated with complex diseases. Existing MDR methods summarize disease risk by a dichotomous predisposing model (high-risk/low-risk) from one optimal GxG interaction, which does not take the accumulated effects from multiple GxG interactions into account. We propose an Aggregated-Multifactor Dimensionality Reduction (A-MDR) method that exhaustively searches for and detects significant GxG interactions to generate an epistasis enriched gene network. An aggregated epistasis enriched risk score, which takes into account multiple GxG interactions simultaneously, replaces the dichotomous predisposing risk variable and provides higher resolution in the quantification of disease susceptibility. We evaluate this new A-MDR approach in a broad range of simulations. Also, we present the results of an application of the A-MDR method to a data set derived from Juvenile Idiopathic Arthritis patients treated with methotrexate (MTX) that revealed several GxG interactions in the folate pathway that were associated with treatment response. The epistasis enriched risk score that pooled information from 82 significant GxG interactions distinguished MTX responders from non-responders with 82% accuracy. The proposed A-MDR is innovative in the MDR framework to investigate aggregated effects among GxG interactions. New measures (pOR, pRR and pChi) are proposed to detect multiple GxG interactions.

  8. Dysautonomy in different death risk groups (Rassi score) in patients with Chagas heart disease.

    Science.gov (United States)

    Merejo Peña, Catherine Masiel; Reis, Michel Silva; Pereira, Basílio de Bragança; Nascimento, Emília Matos do; Pedrosa, Roberto Coury

    2018-01-05

    It has been difficult to prove that "catecholamine-induced cardiomyopathy" contributes to the mechanism of sudden cardiac death in Chagas heart disease. Also, it is almost impossible to rule out the possibility that it is not involved in the process. More importantly, the vagal-cholinergic pathway in the ventricle plays a direct role in the prevention of the initiation of complex ventricular arrhythmias, including nonsustained ventricular tachycardia, ventricular fibrillation responsible for sudden death. To determine frequency of parasympathetic autonomic indices among the different groups of risk of cardiovascular death when stratified by Rassi score. Patients with Chagas heart disease were selected and divided into three risk groups by Rassi score. A fourth group, non-Chagas group, was of similar age and gender. All were subjected to analysis of heart rate variability during controlled breathing (RSA) and tilt table passive test (tilt test). High frequency and low frequency/high frequency ratio were calculated and presented by box-plot. Also, t-test was used to compare the two groups. It was observed that the parasympathetic and sympathetic component were affected, when the risk group increased the response was worsened to the stimulus (RSA or Tilt). Also, the low-risk group was jeopardized, when compared to the non-Chagas group. The loss of parasympathetic modulation was present in all Rassi risk groups, including the low risk, indicating that a morphological change of the myocardium represents a detectable neurofunctional change. © 2018 Wiley Periodicals, Inc.

  9. What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

    Directory of Open Access Journals (Sweden)

    Pletcher Mark J

    2004-08-01

    Full Text Available Abstract Background The coronary artery calcium (CAC score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female, we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham to 6–9%; if her score were over 100, however (a 17% chance, her risk estimate would be markedly higher (25–51% in 10 years. In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy.

  10. What does my patient's coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk

    Science.gov (United States)

    Pletcher, Mark J; Tice, Jeffrey A; Pignone, Michael; McCulloch, Charles; Callister, Tracy Q; Browner, Warren S

    2004-01-01

    Background The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to produce post-test risk estimates, and to determine whether the score may add clinically useful information. Methods We measured the independent cross-sectional associations between conventional cardiac risk factors and the CAC score among asymptomatic persons referred for non-contrast electron beam computed tomography. Using the resulting multivariable models and published CAC score-specific relative risk estimates, we estimated post-test coronary heart disease risk in a number of different scenarios. Results Among 9341 asymptomatic study participants (age 35–88 years, 40% female), we found that conventional coronary heart disease risk factors including age, male sex, self-reported hypertension, diabetes and high cholesterol were independent predictors of the CAC score, and we used the resulting multivariable models for predicting post-test risk in a variety of scenarios. Our models predicted, for example, that a 60-year-old non-smoking non-diabetic women with hypertension and high cholesterol would have a 47% chance of having a CAC score of zero, reducing her 10-year risk estimate from 15% (per Framingham) to 6–9%; if her score were over 100, however (a 17% chance), her risk estimate would be markedly higher (25–51% in 10 years). In low risk scenarios, the CAC score is very likely to be zero or low, and unlikely to change management. Conclusion Combining information from the CAC score with information from conventional risk factors can change assessment of coronary heart disease risk to an extent that may be clinically important, especially when the pre-test 10-year risk estimate is intermediate. The attached spreadsheet makes these calculations easy. PMID:15327691

  11. Risk assessment and predicting outcomes in patients with depressive symptoms: A review of potential role of peripheral blood based biomarkers.

    Directory of Open Access Journals (Sweden)

    Bhautesh Dinesh Jani

    2015-02-01

    Full Text Available Depression is one of the major global health challenges and a leading contributor of health related disability and costs. Depression is a heterogeneous disorder and current methods for assessing its severity in clinical practice rely on symptom count, however this approach is unreliable and inconsistent. The clinical evaluation of depressive symptoms is particularly challenging in primary care, where the majority of patients with depression are managed, due to the presence of co-morbidities. Current methods for risk assessment of depression do not accurately predict treatment response or clinical outcomes. Several biological pathways have been implicated in the pathophysiology of depression; however, accurate and predictive biomarkers remain elusive. We conducted a systematic review of the published evidence supporting the use of peripheral biomarkers to predict outcomes in depression, using Medline and Embase. Peripheral biomarkers in depression were found to be statistically significant predictors of mental health outcomes such as treatment response, poor outcome and symptom remission; and physical health outcomes such as increased incidence of cardiovascular events and deaths, and all-cause mortality. However, the available evidence has multiple methodological limitations which must be overcome to make any real clinical progress. Despite extensive research on the relationship of depression with peripheral biomarkers, its translational application in practice remains uncertain. In future, peripheral biomarkers identified with novel techniques and combining multiple biomarkers may have a potential role in depression risk assessment but further research is needed in this area.

  12. A Novel Risk Scoring System to Predict Cardiovascular Death in Patients With Acute Myocardial Infarction: CHA2DS2-VASc-CF Score.

    Science.gov (United States)

    Kundi, Harun; Kiziltunc, Emrullah; Korkmaz, Ahmet; Cicek, Gokhan; Ornek, Ender; Ileri, Mehmet

    2018-03-01

    The present study aimed to determine the long-term prognostic validity of the CHA 2 DS 2 -VASc score in patients with acute myocardial infarction (AMI). In addition, we formulated a novel scoring system, the CHA 2 DS 2 -VASc-CF (which includes cigarette smoking and a family history of coronary artery disease as risk factors). This study included 4373 consecutive patients with AMI who presented to the emergency department of our hospital and underwent cardiac catheterization procedures between December 2009 and September 2016. Among these patients, 1427 were diagnosed with ST elevation myocardial infarction (STEMI) and 2946 were diagnosed with non-STEMI. The study included 4373 patients. The study population was divided into 2 groups according to the occurrence of cardiovascular death during the follow-up period. Multivariate logistic regression analysis showed that the CHA 2 DS 2 -VASc-CF score, CHA 2 DS 2 -VASc score, major adverse cardiac events, current cigarette smoking, older age, hypertension, and family history of coronary artery disease were significantly higher, and that the left ventricular ejection fraction and glomerular filtration rate were significantly lower in the cardiovascular death (+) group. Using a cutoff score of >3 for the CHA 2 DS 2 -VASc-CF score, long-term cardiovascular death was predicted with a sensitivity of 78.4% and specificity of 76.4%. The CHA 2 DS 2 -VASc-CF score is suitable for use in all patients with AMI, regardless of the type of treatment, presence of atrial fibrillation, and type of AMI. This risk score, which is easy to calculate, provides important prognostic data. In the future, we think that interventional cardiologists will be able to use this novel scoring system to identify patients with a high risk of long-term cardiovascular death.

  13. Screening applicants for risk of poor academic performance: a novel scoring system using preadmission grade point averages and graduate record examination scores.

    Science.gov (United States)

    Luce, David

    2011-01-01

    The purpose of this study was to develop an effective screening tool for identifying physician assistant (PA) program applicants at highest risk for poor academic performance. Prior to reviewing applications for the class of 2009, a retrospective analysis of preadmission data took place for the classes of 2006, 2007, and 2008. A single composite score was calculated for each student who matriculated (number of subjects, N=228) incorporating the total undergraduate grade point average (UGPA), the science GPA (SGPA), and the three component Graduate Record Examination (GRE) scores: verbal (GRE-V), quantitative (GRE-Q), analytical (GRE-A). Individual applicant scores for each of the five parameters were ranked in descending quintiles. Each applicant's five quintile scores were then added, yielding a total quintile score ranging from 25, which indicated an excellent performance, to 5, which indicated poorer performance. Thirteen of the 228 students had academic difficulty (dismissal, suspension, or one-quarter on academic warning or probation). Twelve of the 13 students having academic difficulty had a preadmission total quintile score 12 (range, 6-14). In response to this descriptive analysis, when selecting applicants for the class of 2009, the admissions committee used the total quintile score for screening applicants for interviews. Analysis of correlations in preadmission, graduate, and postgraduate performance data for the classes of 2009-2013 will continue and may help identify those applicants at risk for academic difficulty. Establishing a threshold total quintile score of applicant GPA and GRE scores may significantly decrease the number of entering PA students at risk for poor academic performance.

  14. Risk scoring systems for adults admitted to the emergency department: a systematic review

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Clausen, Nicola Groes

    2010-01-01

    . Even though most scoring systems are not meant to be used on an individual level, they can support the more inexperienced doctors and nurses in assessing the risk of deterioration of their patients. We therefore performed a systematic review on the level of evidence of literature on scoring systems...... developed or validated in the MAU. We hypothesized that existing scoring systems would have a low level of evidence and only few systems would have been externally validated. METHODS: We conducted a systematic search using Medline, EMBASE and the Cochrane Library, according to the PRISMA guidelines...... between observed and predicted outcome (calibration) along with the method of derivation and validation (application on a new cohort) were extracted. RESULTS: We identified 1,655 articles. Thirty were selected for further review and 10 were included in this review. Eight systems used vital signs...

  15. Predicting PTSD using the New York Risk Score with genotype data: potential clinical and research opportunities

    Directory of Open Access Journals (Sweden)

    Boscarino JA

    2013-04-01

    Full Text Available Joseph A Boscarino,1,2 H Lester Kirchner,3,4 Stuart N Hoffman,5 Porat M Erlich1,4 1Center for Health Research, Geisinger Clinic, Danville, 2Department of Psychiatry, Temple University School of Medicine, Philadelphia, 3Division of Medicine, Geisinger Clinic, Danville, 4Department of Medicine, Temple University School of Medicine, Philadelphia, 5Department of Neurology, Geisinger Clinic, Danville, PA, USA Background: We previously developed a post-traumatic stress disorder (PTSD screening instrument, ie, the New York PTSD Risk Score (NYPRS, that was effective in predicting PTSD. In the present study, we assessed a version of this risk score that also included genetic information. Methods: Utilizing diagnostic testing methods, we hierarchically examined different prediction variables identified in previous NYPRS research, including genetic risk-allele information, to assess lifetime and current PTSD status among a population of trauma-exposed adults. Results: We found that, in predicting lifetime PTSD, the area under the receiver operating characteristic curve (AUC for the Primary Care PTSD Screen alone was 0.865. When we added psychosocial predictors from the original NYPRS to the model, including depression, sleep disturbance, and a measure of health care access, the AUC increased to 0.902, which was a significant improvement (P = 0.0021. When genetic information was added in the form of a count of PTSD risk alleles located within FKBP, COMT, CHRNA5, and CRHR1 genetic loci (coded 0–6, the AUC increased to 0.920, which was also a significant improvement (P = 0.0178. The results for current PTSD were similar. In the final model for current PTSD with the psychosocial risk factors included, genotype resulted in a prediction weight of 17 for each risk allele present, indicating that a person with six risk alleles or more would receive a PTSD risk score of 17 × 6 = 102, the highest risk score for any of the predictors studied. Conclusion: Genetic

  16. Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries

    DEFF Research Database (Denmark)

    Ueda, Peter; Woodward, Mark; Lu, Yuan

    2017-01-01

    BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and ...

  17. A novel weighted scoring system for estimating the risk of rapid growth in untreated intracranial meningiomas.

    Science.gov (United States)

    Lee, Eun Jung; Kim, Jeong Hoon; Park, Eun Suk; Kim, Young-Hoon; Lee, Jae Koo; Hong, Seok Ho; Cho, Young Hyun; Kim, Chang Jin

    2017-11-01

    OBJECTIVE Advances in neuroimaging techniques have led to the increased detection of asymptomatic intracranial meningiomas (IMs). Despite several studies on the natural history of IMs, a comprehensive evaluation method for estimating the growth potential of these tumors, based on the relative weight of each risk factor, has not been developed. The aim of this study was to develop a weighted scoring system that estimates the risk of rapid tumor growth to aid treatment decision making. METHODS The authors performed a retrospective analysis of 232 patients with presumed IM who had been prospectively followed up in the absence of treatment from 1997 to 2013. Tumor volume was measured by imaging at each follow-up visit, and the growth rate was determined by regression analysis. Predictors of rapid tumor growth (defined as ≥ 2 cm 3 /year) were identified using a logistic regression model; each factor was awarded a score based on its own coefficient value. The probability (P) of rapid tumor growth was estimated using the following formula:[Formula: see text] RESULTS Fifty-nine tumors (25.4%) showed rapid growth. Tumor size (OR per cm 3 1.07, p = 0.000), absence of calcification (OR 3.87, p = 0.004), peritumoral edema (OR 2.74, p = 0.025), and hyperintense or isointense signal on T2-weighted MRI (OR 3.76, p = 0.049) were predictors of tumor growth rate. In the Asan Intracranial Meningioma Scoring System (AIMSS), tumor size was categorized into 3 groups of operating characteristic curve was 0.86. CONCLUSIONS The authors suggest a weighted scoring system (AIMSS) that predicts the specific probability of rapid tumor growth for patients with untreated IM. This scoring system will aid treatment decision making in clinical settings by screening out patients at high risk for rapid tumor growth.

  18. A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

    Directory of Open Access Journals (Sweden)

    Hebun Erdur

    2018-02-01

    Full Text Available BackgroundSymptomatic intracranial hemorrhage (sICH after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors—namely, pretreatment with statins and severe renal impairment.MethodsWe analyzed our local cohort (Berlin of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016. Outcome was sICH according to ECASS-III criteria. A multiple regression model identified variables associated with sICH and receiver operating characteristics were calculated for the best discriminatory model for sICH. The model was validated in an independent thrombolysis cohort (Basel.ResultssICH occurred in 53 (4.0% of 1,336 patients in the derivation cohort. Age, baseline National Institutes of Health Stroke Scale, systolic blood pressure on admission, blood glucose on admission, and prior medication with medium- or high-dose statins were associated with sICH and included into the risk of intracranial hemorrhage score. The validation cohort included 983 patients of whom 33 (3.4% had a sICH. c-Statistics for sICH was 0.72 (95% CI 0.66–0.79 in the derivation cohort and 0.69 (95% CI 0.60–0.77 in the independent validation cohort. Inclusion of severe renal impairment did not improve the score.ConclusionWe developed a simple score with fair discriminating capability to predict rt-PA-related sICH by adding prior statin use to known prognostic factors of sICH. This score may help clinicians to identify patients with higher risk of sICH requiring intensive monitoring.

  19. Can the Obesity Surgery Mortality Risk Score predict postoperative complications other than mortality?

    Directory of Open Access Journals (Sweden)

    Piotr Major

    2016-12-01

    Full Text Available Introduction : Laparoscopic sleeve gastrectomy (LSG and laparoscopic Roux-en-Y gastric bypass (LRYGB are bariatric procedures with acceptable risk of postoperative morbidities and mortalities, but identification of high-risk patients is an ongoing issue. DeMaria et al. introduced the Obesity Surgery Mortality Risk Score (OS-MRS, which was designed for mortality risk assessment but not perioperative morbidity risk. Aim : To assess the possibility to use the OS-MRS to predict the risk of perioperative complications related to LSG and LRYGB. Material and methods: Retrospective analysis of patients operated on for morbid obesity was performed. Patients were evaluated before and after surgery. We included 408 patients (233 LSG, 175 LRYGB. Perioperative complications were defined as adverse effects in the 30-day period. The Clavien-Dindo scale was used for description of complications. Patients were assigned to five grades and three classes according to the OS-MRS results, then risk of morbidity was analyzed. Results: Complications were observed in 30 (7.35% patients. Similar morbidity was related to both procedures (OR = 1.14, 95% CI: 0.53–2.44, p = 0.744. The reoperation and mortality rates were 1.23% and 0.49% respectively. There were no significant differences in median OS-MRS value between the group without and the group with perioperative complications. There were no significant differences in OS-MRS between groups (p = 0.091. Obesity Surgery Mortality Risk Score was not related to Clavien-Dindo grades (p = 0.800. Conclusions : It appears that OS-MRS is not useful in predicting risk of perioperative morbidity after bariatric procedures.

  20. Development and Validation of a Risk Score for Age-Related Macular Degeneration: The STARS Questionnaire.

    Science.gov (United States)

    Delcourt, Cécile; Souied, Eric; Sanchez, Alice; Bandello, Francesco

    2017-12-01

    To develop and validate a risk score for AMD based on a simple self-administered questionnaire. Risk factors having shown the most consistent associations with AMD were included in the STARS (Simplified Théa AMD Risk-Assessment Scale) questionnaire. Two studies were conducted, one in Italy (127 participating ophthalmologists) and one in France (80 participating ophthalmologists). During 1 week, participating ophthalmologists invited all their patients aged 55 years or older to fill in the STARS questionnaire. Based on fundus examination, early AMD was defined by the presence of soft drusen and/or pigmentary abnormalities and late AMD by the presence of geographic atrophy and/or neovascular AMD. The Italian and French samples consisted of 12,639 and 6897 patients, respectively. All 13 risk factors included in the STARS questionnaire showed significant associations with AMD in the Italian sample. The area under the receiving operating characteristic curve for the STARS risk score, derived from the multivariate logistic regression in the Italian sample, was 0.78 in the Italian sample and 0.72 in the French sample. In both samples, less than 10% of patients without AMD were classified at high risk, and less than 13% of late AMD cases were classified as low risk, with a more intermediate situation in early AMD cases. STARS is a new, simple self-assessed questionnaire showing good discrimination of risk for AMD in two large European samples. It might be used by ophthalmologists in routine clinical practice or as a self-assessment for risk of AMD in the general population.

  1. The Use of a Scoring System to Guide Thromboprophylaxis in a High-Risk Pregnant Population

    Directory of Open Access Journals (Sweden)

    D. Schoenbeck

    2011-01-01

    Full Text Available Guidelines for thromboprophylaxis in pregnancy are usually based upon clinical observations and expert opinion. For optimal impact, their use must be attended by consistency in the advice given to women. In this observational study, we evaluated the performance of a scoring system, used as a guide for clinicians administering dalteparin to pregnant women at increased risk of venous thromboembolism. The work included 47 women treated with dalteparin prior to adoption of the scoring system and 58 women treated with dalteparin after its adoption. The indication for thromboprophylaxis was recorded in each case together with details of the regimen employed, obstetric, and haematological outcomes. The main outcome measure was to determine whether consistency improved after adoption of the scoring system. We also recorded the occurrence of any new venous thromboembolism, haemorrhage, the use of regional anaesthesia during labour, evidence of allergy, and thrombocytopenia. We found that use of the scoring system improved the consistency of advice and increased the mean duration of thromboprophylaxis. None of the subjects suffered venous thromboembolism after assessment using the scoring system. There was no increase in obstetric or anaesthetic morbidity when dalteparin was given antenatally period and no evidence of heparin-induced thrombocytopenia.

  2. Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

    OpenAIRE

    de Koning, Lawrence; Chiuve, Stephanie E.; Fung, Teresa T.; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

    2011-01-01

    Objective: To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata. Research Design and Methods: Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for \\(\\leq 20\\) years. The Healthy Eating Index (HEI) 2005, the alternative HEI ...

  3. Association Between a Healthy Lifestyle Score and the Risk of Cardiovascular Disease in the SUN Cohort.

    Science.gov (United States)

    Díaz-Gutiérrez, Jesús; Ruiz-Canela, Miguel; Gea, Alfredo; Fernández-Montero, Alejandro; Martínez-González, Miguel Ángel

    2017-12-26

    A healthy lifestyle (HLS) is essential to attaining optimal cardiovascular health. Our objective was to assess the association between a HLS score and the incidence of hard cardiovascular disease (CVD) events. The SUN project is a dynamic, prospective, multipurpose cohort of Spanish university graduates with a retention proportion of 92%. In 19 336 participants, we calculated a HLS score ranging from 0 to 10 points: never smoking, physical activity (> 20 METs-h/wk), Mediterranean diet adherence (≥ 4/8 points), low body mass index (≤ 22), moderate alcohol intake (women, 0.1-5g/d; men, 0.1-10g/d), low television exposure (≤ 2h/d), no binge drinking (≤ 5 alcoholic drinks anytime), taking a short afternoon nap ( 1h/d and working> 40h/wk. After a median follow-up of 10.4 years, we identified 140 incident cases of CVD. After adjustment for potential confounders, the highest category of HLS score adherence (7-10 points) showed a significant 78% relative reduction in the risk of primary CVD compared with the lowest category (0-3 points) (adjusted HR, 0.22; 95%CI, 0.11-0.46). Each healthy habit was individually associated with a lower risk of CVD. A HLS score including several simple healthy habits was associated with a lower risk of developing primary CVD. This index may be useful to reinforce CVD prevention without the need to include traditional risk factors. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score.

    Science.gov (United States)

    Jasseron, Carine; Legeai, Camille; Jacquelinet, Christian; Leprince, Pascal; Cantrelle, Christelle; Audry, Benoît; Porcher, Raphael; Bastien, Olivier; Dorent, Richard

    2017-09-01

    The cardiac allocation system in France is currently based on urgency and geography. Medical urgency is defined by therapies without considering objective patient mortality risk factors. This study aimed to develop a waitlist mortality risk score from commonly available candidate variables. The study included all patients, aged 16 years or older, registered on the national registry CRISTAL for first single-organ heart transplantation between January 2010 and December 2014. This population was randomly divided in a 2:1 ratio into derivation and validation cohorts. The association of variables at listing with 1-year waitlist death or delisting for worsening medical condition was assessed within the derivation cohort. The predictors were used to generate a candidate risk score (CRS). Validation of the CRS was performed in the validation cohort. Concordance probability estimation (CPE) was used to evaluate the discriminative capacity of the models. During the study period, 2333 patients were newly listed. The derivation (n =1 555) and the validation cohorts (n = 778) were similar. Short-term mechanical circulatory support, natriuretic peptide decile, glomerular filtration rate, and total bilirubin level were included in a simplified model and incorporated into the score. The Concordance probability estimation of the CRS was 0.73 in the derivation cohort and 0.71 in the validation cohort. The correlation between observed and expected 1-year waitlist mortality in the validation cohort was 0.87. The candidate risk score provides an accurate objective prediction of waitlist mortality. It is currently being used to develop a modified cardiac allocation system in France.

  5. Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions.

    Science.gov (United States)

    Abdelaal, Eltigani; Brousseau-Provencher, Cynthia; Montminy, Sarah; Plourde, Guillaume; MacHaalany, Jimmy; Bataille, Yoann; Molin, Pierre; Déry, Jean-Pierre; Barbeau, Gérald; Roy, Louis; Larose, Éric; De Larochellière, Robert; Nguyen, Can M; Proulx, Guy; Costerousse, Olivier; Bertrand, Olivier F

    2013-11-01

    To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI). TRA-PCI failure has been reported in 5% to 10% of cases. TRA-PCI failure was categorized as primary (clinical reasons) or crossover failure. Multivariate analysis was performed to determine independent predictors of TRA-PCI failure, and an integer risk score was developed. From January to June 2010, TRA-PCI was attempted in 1,609 (97.3%) consecutive patients, whereas 45 (2.7%) had primary TRA-PCI failure. Crossover TRA-PCI failure occurred in 30 (1.8%) patients. Causes of primary TRA-PCI failure included chronic radial artery occlusion (11%), previous coronary artery bypass graft (27%), and cardiogenic shock (20%). Causes for crossover TRA-PCI failure included: inadequate puncture in 17 patients (57%); radial artery spasm in 5 (17%); radial loop in 4 (13%); subclavian tortuosity in 2 (7%); and inadequate guide catheter support in 2 (7%) patients. Female sex (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.95 to 5.26, p < 0.0001), previous coronary artery bypass graft (OR: 6.1; 95% CI: 3.63 to 10.05, p < 0.0001), and cardiogenic shock (OR: 11.2; 95% CI: 2.78 to 41.2, p = 0.0011) were independent predictors of TRA-PCI failure. Risk score values from 0 to 7 predicted a TRA-PCI failure rate from 2% to 80%. In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Serum free light chain ratio as a biomarker for high-risk smoldering multiple myeloma.

    Science.gov (United States)

    Larsen, J T; Kumar, S K; Dispenzieri, A; Kyle, R A; Katzmann, J A; Rajkumar, S V

    2013-04-01

    A markedly elevated serum free light chain (FLC) ratio may serve as a biomarker for malignant transformation in high-risk smoldering multiple myeloma (SMM) and identify patients who are at imminent risk of progression. We retrospectively studied the predictive value of the serum (FLC) assay in 586 patients with SMM diagnosed between 1970 to 2010. A serum involved/uninvolved FLC ratio ≥ 100 was used to define high-risk SMM, which included 15% (n=90) of the total cohort. Receiver operating characteristics analysis determined the optimal FLC ratio cut-point to predict progression to symptomatic multiple myeloma (MM) within 2 years of diagnosis, which resulted in a specificity of 97% and sensitivity of 16%. Fifty-six percent of patients developed progressive disease during median follow-up of 52 months, but this increased to 98% in the subgroup of patients with FLC ratio ≥ 100. The median time to progression in the FLC ratio ≥ 100 group was 15 months versus 55 months in the FLC <100 group (P<0.0001). The risk of progression to MM within the first 2 years in patients with an FLC ratio ≥ 100 was 72%; the risk of progression to MM or light chain amyloidosis in 2 years was 79%. We conclude that a high FLC ratio ≥ 100 is a predictor of imminent progression in SMM, and such patients may be considered candidates for early treatment intervention.

  7. Assessment of cardiovascular risk in Tunisia: applying the Framingham risk score to national survey data.

    Science.gov (United States)

    Saidi, O; Malouche, D; O'Flaherty, M; Ben Mansour, N; A Skhiri, H; Ben Romdhane, H; Bezdah, L

    2016-11-30

    This paper aims to assess the socioeconomic determinants of a high 10 year cardiovascular risk in Tunisia. We used a national population based cross sectional survey conducted in 2005 in Tunisia comprising 7780 subjects. We applied the non-laboratory version of the Framingham equation to estimate the 10 year cardiovascular risk. 8007 participants, aged 35-74 years, were included in the sample but effective exclusion of individuals with cardiovascular diseases and cancer resulted in 7780 subjects (3326 men and 4454 women) included in the analysis. Mean age was 48.7 years. Women accounted for 50.5% of participants. According to the Framingham equation, 18.1% (17.25-18.9%) of the study population had a high risk (≥20% within 10 years). The gender difference was striking and statistically significant: 27.2% (25.7-28.7%) of men had a high risk, threefold higher than women (9.7%; 8.8-10.5%). A higher 10 year global cardiovascular risk was associated with social disadvantage in men and women; thus illiterate and divorced individuals, and adults without a professional activity had a significantly higher risk of developing a cardiovascular event in 10 years. Illiterate men were at higher risk than those with secondary and higher education (OR=7.01; 5.49 to 9.14). The risk in illiterate women was more elevated (OR=13.57; 7.58 to 24.31). Those living in an urban area had a higher risk (OR=1.45 (1.19 to 1.76) in men and OR=1.71 (1.35 to 2.18) in women). The 10 year global cardiovascular risk in the Tunisian population is already substantially high, affecting almost a third of men and 1 in 10 women, and concentrated in those more socially disadvantaged. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Credit Scoring Models: Lack of Information and the Use of Data from a Credit Risk Register

    OpenAIRE

    Verónica Balzarotti; Fernando Castelpoggi

    2008-01-01

    The main purpose of this paper is to study the problem created by the lack of information about the credit history of some debtors in the databases used to develop credit scoring models and the use of information about behavior compiled by a credit risk register as a potential solution to the problem. The paper analyzes two problems: (i) the need to provide a credit risk estimation of debtors whose behavior is unknown (because they are deleted from the databases without indication of the reas...

  9. Global cardiovascular risk stratification: comparison of the Framingham method with the SCORE method in the Mexican population.

    Science.gov (United States)

    Alcocer, Luis Antonio; Lozada, Osvaldo; Fanghänel, Guillermo; Sánchez-Reyes, Leticia; Campos-Franco, Enrique

    2011-01-01

    In the Mexican population we are unaware if the Framingham model is a better system than the SCORE system for stratifying cardiovascular risk. The present study was conducted to compare risk stratification with the Framingham tables using the same procedure but using the SCORE, with the aim of recommending the use of the most appropriate method. We analyzed a database of apparently healthy workers from the Mexico City General Hospital included in the study group "PRIT" (Prevalencia de Factores de Riesgo de Infarto del Miocardio en Trabajadores del Hospital General de México) and we calculated the risk in each simultaneously with the Framingham method and the SCORE method. It was possible to perform risk calculation with both methods in 1990 subjects from a total of 5803 PRITHGM study participants. When using the SCORE method, we stratified 1853 patients into low risk, 133 into medium risk and 4 into high risk. The Framingham method qualified 1586 subjects as low risk, 268 as medium risk and 130 as high risk. Concordance between scales to classify both patients according to the same risk was 98% in those classified as low risk, 19.4% among those classified as intermediate risk and only 3% in those classified as high risk. According to our results, it seems more appropriate in our country to recommend the Framingham model for calculating cardiovascular risk due to the fact that the SCORE model underestimated risk.

  10. A risk prediction score for acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Malhotra, Rakesh; Kashani, Kianoush B; Macedo, Etienne; Kim, Jihoon; Bouchard, Josee; Wynn, Susan; Li, Guangxi; Ohno-Machado, Lucila; Mehta, Ravindra

    2017-05-01

    Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. Early identification of high-risk patients provides an opportunity to develop strategies for prevention, early diagnosis and treatment of AKI. We undertook this multicenter prospective cohort study to develop and validate a risk score for predicting AKI in patients admitted to an intensive care unit (ICU). Patients were screened for predictor variables within 48 h of ICU admission. Baseline and acute risk factors were recorded at the time of screening and serum creatinine was measured daily for up to 7 days. A risk score model for AKI was developed with multivariate regression analysis combining baseline and acute risk factors in the development cohort (573 patients) and the model was further evaluated on a test cohort (144 patients). Validation was performed on an independent prospective cohort of 1300 patients. The discriminative ability of the risk model was assessed by the area under the receiver operating characteristic curve (AUROC) and model calibration was evaluated by Hosmer-Lemeshow statistic. AKI was defined by the Kidney Disease: Improving Global Outcomes criteria (absolute change of 0.3 mg/dL or relative change of 50% from baseline serum creatinine in 48 h to 7 days, respectively). AKI developed in 754 (37.2%) patients. In the multivariate model, chronic kidney disease, chronic liver disease, congestive heart failure, hypertension, atherosclerotic coronary vascular disease, pH ≤ 7.30, nephrotoxin exposure, sepsis, mechanical ventilation and anemia were identified as independent predictors of AKI and the AUROC for the model in the test cohort was 0.79 [95% confidence interval (CI) 0.70-0.89]. On the external validation cohort, the AUROC value was 0.81 (95% CI 0.78-0.83). The risk model demonstrated good calibration in both cohorts. Positive and negative predictive values for the optimal cutoff value of ≥ 5 points in test

  11. Biomarkers and bacterial pneumonia risk in patients with treated HIV infection: a case-control study.

    Directory of Open Access Journals (Sweden)

    Sonja M Bjerk

    Full Text Available Despite advances in HIV treatment, bacterial pneumonia continues to cause considerable morbidity and mortality in patients with HIV infection. Studies of biomarker associations with bacterial pneumonia risk in treated HIV-infected patients do not currently exist.We performed a nested, matched, case-control study among participants randomized to continuous combination antiretroviral therapy (cART in the Strategies for Management of Antiretroviral Therapy trial. Patients who developed bacterial pneumonia (cases and patients without bacterial pneumonia (controls were matched 1∶1 on clinical center, smoking status, age, and baseline cART use. Baseline levels of Club Cell Secretory Protein 16 (CC16, Surfactant Protein D (SP-D, C-reactive protein (hsCRP, interleukin-6 (IL-6, and d-dimer were compared between cases and controls.Cases (n = 72 and controls (n = 72 were 25.7% female, 51.4% black, 65.3% current smokers, 9.7% diabetic, 36.1% co-infected with Hepatitis B/C, and 75.0% were on cART at baseline. Median (IQR age was 45 (41, 51 years with CD4+ count of 553 (436, 690 cells/mm(3. Baseline CC16 and SP-D were similar between cases and controls, but hsCRP was significantly higher in cases than controls (2.94 µg/mL in cases vs. 1.93 µg/mL in controls; p = 0.02. IL-6 and d-dimer levels were also higher in cases compared to controls, though differences were not statistically significant (p-value 0.06 and 0.10, respectively.In patients with cART-treated HIV infection, higher levels of systemic inflammatory markers were associated with increased bacterial pneumonia risk, while two pulmonary-specific inflammatory biomarkers, CC16 and SP-D, were not associated with bacterial pneumonia risk.

  12. In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

    International Nuclear Information System (INIS)

    Masood, A.; Naqvi, M.A.; Jafar, S.S.

    2009-01-01

    Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p=0.001). TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI. (author)

  13. Development of a novel scoring system for identifying emerging chemical risks in the food chain.

    Science.gov (United States)

    Oltmanns, J; Licht, O; Bitsch, A; Bohlen, M-L; Escher, S E; Silano, V; MacLeod, M; Serafimova, R; Kass, G E N; Merten, C

    2018-02-21

    The European Food Safety Authority (EFSA) is responsible for risk assessment of all aspects of food safety, including the establishment of procedures aimed at the identification of emerging risks to food safety. Here, a scoring system was developed for identifying chemicals registered under the European REACH Regulation that could be of potential concern in the food chain using the following parameters: (i) environmental release based on maximum aggregated tonnages and environmental release categories; (ii) biodegradation in the environment; (iii) bioaccumulation and in vivo and in vitro toxicity. The screening approach was tested on 100 data-rich chemicals registered under the REACH Regulation at aggregated volumes of at least 1000 tonnes per annum. The results show that substance-specific data generated under the REACH Regulation can be used to identify potential emerging risks in the food chain. After application of the screening procedure, priority chemicals can be identified as potentially emerging risk chemicals through the integration of exposure, environmental fate and toxicity. The default approach is to generate a single total score for each substance using a predefined weighting scenario. However, it is also possible to use a pivot table approach to combine the individual scores in different ways that reflect user-defined priorities, which enables a very flexible, iterative definition of screening criteria. Possible applications of the approaches are discussed using illustrative examples. Either approach can then be followed by in-depth evaluation of priority substances to ensure the identification of substances that present a real emerging chemical risk in the food chain.

  14. Quest for Biomarkers of Treatment-Resistant Depression: Shifting the Paradigm Toward Risk

    OpenAIRE

    Smith, Donald F.

    2013-01-01

    The search for potential biomarkers of psychiatric disorders is a central topic in biological psychiatry. This review concerns published studies on potential biomarkers of treatment-resistant depression (TRD). The search for biomarkers of TRD in the bloodstream has focused on cytokines and steroids as well as brain-derived neurotropic factor. Additional approaches to identifying biomarkers of TRD have dealt with cerebrospinal fluid analysis, magnetic resonance imaging, and positron emission t...

  15. Polygenic Risk Scores in Clinical Psychology: Bridging Genomic Risk to Individual Differences.

    Science.gov (United States)

    Bogdan, Ryan; Baranger, David A A; Agrawal, Arpana

    2018-03-26

    Genomewide association studies (GWASs) across psychiatric phenotypes have shown that common genetic variants generally confer risk with small effect sizes (odds ratio Psychology Volume 14 is May 7, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  16. Risk stratification with the risk chart from the European Society of Hypertension compared with SCORE in the general population

    DEFF Research Database (Denmark)

    Sehestedt, Thomas; Jeppesen, Jørgen; Hansen, Tine W

    2009-01-01

    or lipid-lowering medications and with higher than optimal blood pressure (> or =120/80 mmHg), we measured traditional risk factors and subclinical organ damage. The endpoints were cardiovascular death and a composite of cardiovascular death, nonfatal myocardial infarction and stroke (CEP). RESULTS: During...... SCORE is based on traditional risk factors. We wanted to compare the predictive performance of the two charts. METHODS: In a Danish population sample of 1344 individuals aged 41, 51, 61 and 71 years without known diabetes, prior stroke or myocardial infarction, not receiving cardiovascular, antidiabetic...... the following 12.8 years cardiovascular death and CEP occurred in 71 and 132 patients, respectively. Forty-two percent had unrecognized hypertension. The sizes and characteristics of the populations in the different risk categories of the charts varied considerably as ESH risk chart allocated 368 patients...

  17. Which risk score best predicts perioperative outcomes in nonvalvular atrial fibrillation patients undergoing noncardiac surgery?

    Science.gov (United States)

    van Diepen, Sean; Youngson, Erik; Ezekowitz, Justin A; McAlister, Finlay A

    2014-07-01

    Patients with nonvalvular atrial fibrillation (NVAF) are at increased risk for adverse events after noncardiac surgery. The Revised Cardiac Index (RCI) is commonly used to predict perioperative events; however, the prognostic utility of NVAF risk scores (CHADS2, CHA2DS2-VASc, and R2CHADS2) has not been evaluated in patients undergoing noncardiac surgery. Using a population-based data set of NVAF patients (n = 32,160) who underwent major or minor noncardiac surgery between April 1, 1999, and November 30, 2009, in Alberta, Canada, we examined the incremental prognostic value of the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores over the RCI using continuous net reclassification improvement (NRI). The primary composite outcome was 30-day mortality, stroke, transient ischemic attack, or systemic embolism. The median age was 73 years, 55.1% were male, 6.6% had a previous thromboembolism, 17% of patients underwent major surgery, and the median risk scores were as follows: RCI = 1, CHADS2 = 1, CHA2DS2-VASc = 3, and R2CHADS2 = 2. The incidence of our 30-day composite was 4.2% (mortality 3.3%; stroke, transient ischemic attack, or systemic embolism 1.2%); and c indices were 0.65 for the RCI, 0.67 for the CHADS2 (NRI 14.3%, P NRI 10.7%, P NRI 11.4%, P NRI 12.3%, 8.4%, and 13.3%, respectively; all Ps < .01). In NVAF patients undergoing noncardiac surgery, the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores all improved the prediction of major perioperative events including mortality compared to the RCI. Copyright © 2014 Mosby, Inc. All rights reserved.

  18. Population-based metabolic syndrome risk score and its determinants: The Isfahan Healthy Heart Program

    Directory of Open Access Journals (Sweden)

    Mohsen Hosseini

    2014-01-01

    Full Text Available Background: Metabolic syndrome (MetSy, an important predisposing factor for the most of noncommunicable diseases, has become a global pandemic. Given different definitions used for the MetSy, recently using a score termed "continuous MetSy risk score (CMetSyS" is recommended. The aim of this study was to provide a CMetSyS in a population-based sample of Iranian adults and to assess its determinants. Materials and Methods: We used the data of the baseline survey of a community trial entitled "the Isfahan health heart program." The MetSy was defined according to the Revised National Cholesterol Education Program Third Adult Treatment Panel. All probable predictive models and their predictive performance were provided using leave-one-out cross-validated logistic regression and the receiver operation characteristic curve methods. Multiple linear regression was performed to assess factors associated with the CMetSyS. Results: The study population consisted of 8313 persons (49.9% male, mean age 38.54 ± 15.86 years. The MetSy was documented in 1539 persons (21.86%. Triglycerides and waist circumference were the best predictive components, and fasting plasma glucose had the lowest area under curve (AUC. The AUC for our best model was 95.36 (94.83-95.83%. The best predictive cutoff for this risk score was −1.151 with 89% sensitivity and 87.93% specificity. Conclusion: We provided four population-based leave-one-out cross-validated risk score models, with moderate to perfect predictive performance to identify the MetSy in Iranian adults. The CMetSyS had significant associations with high sensitive C-reactive protein, body mass index, leisure time, and workplace physical activity as well as age and gender.

  19. Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Garofallo, Silvia Bueno; Machado, Daniel Pinheiro; Rodrigues, Clarissa Garcia; Bordim, Odemir Jr.; Kalil, Renato A. K.; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Post-Graduation Program in Health Sciences: Cardiology, Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-06-15

    The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe. To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP). Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP. Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus. Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

  20. Q fever pneumonia in French Guiana: prevalence, risk factors, and prognostic score.

    Science.gov (United States)

    Epelboin, Loïc; Chesnais, Cédric; Boullé, Charlotte; Drogoul, Anne-Sophie; Raoult, Didier; Djossou, Félix; Mahamat, Aba

    2012-07-01

    Community-acquired pneumonia (CAP) is the major manifestation of Q fever, an emerging disease in French Guiana. Consequently, the empirical antibiotherapy used for the treatment of CAP combines doxycycline and the recommended amoxicillin. Our objectives were to estimate the prevalence of Q fever pneumonia and to build a prediction rule to identify patients with Q fever pneumonia for empirical antibiotic guidance. A retrospective case-control study was conducted on inpatients admitted with CAP in the Department of Infectious Diseases of Cayenne Hospital from 2004 to 2007. Serodiagnosis for Coxiella burnetii was performed for all patients. Risk factor analysis was performed using multivariate logistic regression, and a prognostic score was computed using bootstrap procedures. The score performance characteristics were used to choose the best prediction rule to identify patients with Q fever pneumonia. One hundred thirty-one patients with CAP were included and the Q fever pneumonia prevalence was 24.4% (95% confidence interval [CI], 17.1-31.9). In multivariate analysis, male sex, middle age (age, 30-60 years), headache, leukocyte count 185 mg/L were independently associated with Q fever pneumonia. Patients with a predictive score ≤3 had a low risk of Q fever pneumonia with a negative predictive value of 0.97 (95% CI, .90-1) and a sensitivity of 0.97 (95% CI, .89-1). The prediction rule described here accurately identifies patients with low risk of Q fever pneumonia and may help physicians to make more rational decisions about the empirical use of antibiotherapy. Further prospective studies should be performed to validate this score.

  1. Risk Pricing in Emerging Economies: Credit Scoring and Private Banking in Iran

    Directory of Open Access Journals (Sweden)

    Yiannis Anagnostopoulos

    2016-01-01

    Full Text Available Iran’s banking industry as a developing country is comparatively very new to risk management practices. An inevitable predictive implication of this rapid growth is the growing concerns with regard to credit risk management which is the motivation of conducting this research. The paper focuses on the credit scoring aspect of credit risk management using both logit and probit regression approaches. Real data on corporate customers are available for conducting this research which is also a contribution to this area for all other developing countries. Our questions focus on how future customers can be classified in terms of credibility, which models and methods are more effective in better capturing risks. Findings suggest that probit approaches are more effective in capturing the significance of variables and goodness-of-fitness tests. Seven variables of the Ohlson O-Score model are used: CL_CA, INTWO, OENEG, TA_TL, SIZE, WCAP_TA, and ROA; two were found to be statistically significant in logit (ROA, TL_TA and three were statistically significant in probit (ROA, TL_TA, SIZE. Also, CL_CA, ROA, and WCAP_TA were the three variables with an unexpected correlation to the probability of default. The prediction power with the cut-off point is set equal to 26% and 56.91% for defaulted customers in both logit and probit models. However, logit achieved 54.85% correct estimation of defaulted assets, 0.37% more than what probit estimated.

  2. Biomarkers of folate and vitamin B12 and breast cancer risk: report from the EPIC cohort.

    Science.gov (United States)

    Matejcic, M; de Batlle, J; Ricci, C; Biessy, C; Perrier, F; Huybrechts, I; Weiderpass, E; Boutron-Ruault, M C; Cadeau, C; His, M; Cox, D G; Boeing, H; Fortner, R T; Kaaks, R; Lagiou, P; Trichopoulou, A; Benetou, V; Tumino, R; Panico, S; Sieri, S; Palli, D; Ricceri, F; Bueno-de-Mesquita, H B As; Skeie, G; Amiano, P; Sánchez, M J; Chirlaque, M D; Barricarte, A; Quirós, J R; Buckland, G; van Gils, C H; Peeters, P H; Key, T J; Riboli, E; Gylling, B; Zeleniuch-Jacquotte, A; Gunter, M J; Romieu, I; Chajès, V

    2017-03-15

    Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER2]), alcohol intake and MTHFR polymorphisms (677C > T and 1298A > C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (OR Q4-Q1  = 1.26; 95% CI 1.00-1.58; P trend  = 0.05). Vitamin B12 status was also positively associated with BC risk in women with plasma folate levels below the median value (OR Q4-Q1  = 1.29; 95% CI 1.02-1.62; P trend  = 0.03). Overall, folate and vitamin B12 status was not clearly associated with BC risk in this prospective cohort study. However, potential interactions between vitamin B12 and alcohol or folate on the risk of BC deserve further investigation. © 2016 UICC.

  3. Inflammatory Biomarkers of Cardiometabolic Risk in Obese Egyptian Type 2 Diabetics

    Directory of Open Access Journals (Sweden)

    Lamiaa A. A. Barakat

    2017-11-01

    Full Text Available Inflammatory biomarkers provide a minimally invasive means for early detection and specific treatment of metabolic syndrome and related disorders. The objective of this work was to search for inflammatory biomarkers of cardiometabolic risk in obese type 2 diabetics. The study was performed on 165 persons attending the medical outpatient clinic of Ismailia General Hospital. Their mean age was (50.69 ± 10.15 years. They were divided into three groups. The control group was composed of 55 non-obese, non-diabetic healthy volunteers, 32 males and 23 females. Two study groups were included in this study: group 2 was composed of 55 obese, non-diabetic subjects, 25 males and 30 females matched for age and gender. All patients including the control were subjected to clinical history taking, a clinical examination for the measurement of body mass index (BMI. Investigations were carried out for fasting blood glucose, fasting serum insulin, insulin resistance (IR, the lipid profile, lipoprotein band lipoprotein phospholipase A2, and non-high-density lipoprotein cholesterol (non-HDL-C. Urea, albumin and creatinine analysis and liver function tests were performed, and a complete blood count (CBC was taken. Hemoglobin A1C (HbA1C, serum high-sensitivity C-reactive protein (hs-CRP, interleukin-6 (IL-6 and tumor necrosis factor-α (TNF-α were tested. There were statistically significant differences among the studied groups in terms of total cholesterol, non-HDL-C, high-density lipoprotein cholesterol (HDL-C, triglycerides (TG, low-density lipoprotein cholesterol (LDL-C, lipoprotein-associated phospholipase A2 and apolipoprotein B. The inflammatory biomarkers hs-CRP, IL-6 and TNF-α were significantly statistically increased in the study groups by (1.62 ± 0.99, 2.32 ± 1.11, (1.73 ± 1.14, 2.53 ± 1.34, and (1.87 ± 1.09, 2.17 ± 0.89 respectively, where p < 0.01. Significant positive correlation was found between Homeostatic Model Assessment (HOMA-IR, hs

  4. Evaluation of a risk factor scoring system for corneal ectasia after LASIK in eyes with normal topography.

    Science.gov (United States)

    Binder, Perry S; Trattler, William B

    2010-04-01

    To assess a previously published risk score system for predicting postoperative LASIK ectasia in eyes with normal preoperative topography. A retrospective review of one surgeon's LASIK database was performed for eyes with Randleman ectasia risk scores based on patient age corneal thickness -8.00 diopters that had a minimum follow-up of 1 year. RESULTS Of 1702 eyes with myopic errors and normal topographies, 35 (2.0%) eyes had a combined risk score between 5 and 9 points, 92 (5.4%) eyes had a combined risk score of 4 or higher, and 208 (12.2%) eyes had a combined score of 3 or higher. None of these eyes developed ectasia, whereas 3 eyes with preoperative topographic keratoconus with no other risk factors developed ectasia. The current risk score system would have eliminated 5.4% of eyes with 4 or more points from LASIK surgery, and would have also required the surgeon to advise an additional 6.8% of eyes with a score of 3 that they were at "moderate risk" and should "proceed with caution." In eyes with normal preoperative topographies, the scoring system may not accurately predict whether patients are at increased risk for developing postoperative LASIK ectasia.

  5. Validation of a clinical risk-scoring algorithm for severe scrub typhus

    Directory of Open Access Journals (Sweden)

    Sriwongpan P

    2014-02-01

    Full Text Available Pamornsri Sriwongpan,1,2 Jayanton Patumanond,3 Pornsuda Krittigamas,4 Hutsaya Tantipong,5 Chamaiporn Tawichasri,6 Sirianong Namwongprom1,7 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, 2Department of Social Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, 4Department of General Pediatrics, Nakornping Hospital, Chiang Mai, 5Department of Medicine, Chonburi Hospital, Chonburi, 6Clinical Epidemiology Society at Chiang Mai, Chiang Mai, 7Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: The aim of the study reported here was to validate the risk-scoring algorithm for prognostication of scrub typhus severity. Methods: The risk-scoring algorithm for prognostication of scrub typhus severity developed earlier from two general hospitals in Thailand was validated using an independent dataset of scrub typhus patients in one of the hospitals from a few years later. The predictive performances of the two datasets were compared by analysis of the area under the receiver-operating characteristic curve (AuROC. Classification of patients into non-severe, severe, and fatal cases was also compared. Results: The proportions of non-severe, severe, and fatal patients by operational definition were similar between the development and validation datasets. Patient, clinical, and laboratory profiles were also similar. Scores were similar in both datasets, both in terms of discriminating non-severe from severe and fatal patients (AuROC =88.74% versus 91.48%, P=0.324, and in discriminating fatal from severe and non-severe patients (AuROC =88.66% versus 91.22%, P=0.407. Over- and under-estimations were similar and were clinically acceptable. Conclusion: The previously developed risk-scoring algorithm for prognostication of scrub typhus severity performed similarly with the validation data and

  6. A risk score to predict acute renal failure in adult patients after lung transplantation.

    Science.gov (United States)

    Grimm, Joshua C; Lui, Cecillia; Kilic, Arman; Valero, Vicente; Sciortino, Christopher M; Whitman, Glenn J R; Shah, Ashish S

    2015-01-01

    Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value renal failure to construct the risk stratification score (RSS). During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5% (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1%, 5.3%, and 15.6% in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p renal failure highly correlated with actual rates observed in the population (r = 0.86). We introduce a novel and simple RSS that is highly predictive of renal failure after LTx. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Assessment of three risk evaluation systems for patients aged ≥70 in East China: performance of SinoSCORE, EuroSCORE II and the STS risk evaluation system.

    Science.gov (United States)

    Shan, Lingtong; Ge, Wen; Pu, Yiwei; Cheng, Hong; Cang, Zhengqiang; Zhang, Xing; Li, Qifan; Xu, Anyang; Wang, Qi; Gu, Chang; Zhang, Yangyang

    2018-01-01

    To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China. Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets. The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.

  8. Subclinical cardiovascular disease in postmenopausal women with low/medium cardiovascular risk by the Framingham risk score.

    Science.gov (United States)

    Maturana, Maria Augusta; Franz, Roberta Fernandez; Metzdorf, Marcela; da Silva, Thais Rasia; Spritzer, Poli Mara

    2015-06-01

    To evaluate the prevalence of subclinical cardiovascular disease (CVD) and its association with clinical and hormone variables in postmenopausal women from Southern Brazil. Cross-sectional study. Coronary artery calcification (CAC) assessed by electron-beam computed tomography. Carotid intima-media thickness (IMT) and atheromatous plaques assessed using B-mode ultrasound. IMT was measured at three segments. Subclinical CVD was defined as the presence of plaque and/or IMT >0.9 mm. Ninety-seven postmenopausal women (mean age 55 ± 5 years, median duration of menopause 5.8 [3-10] years) were studied. A low/medium Framingham risk score (FRS) was present in 97.9% of participants; 35.1% had subclinical CVD on carotid ultrasound, and 24.7% had the presence of plaque. Seven women had a CAC score ≥ 100, and two had a score ≥ 200. CAC score (p<0.001) and FRS (p=0.013) were higher in patients with subclinical atherosclerosis. Positive correlations were found between IMT and age (rs=0.293 p=0.004), duration of menopause (rs=0.237, p=0.020), and CAC score (rs=0.468, p<0.001). Common carotid IMT (IMT-CC) was negatively associated with estradiol levels (β=-0.237, p=0.018) and positively with age (β=0.210, p=0.033), and BMI (β=0.260, p=0.010). However, correlations with estradiol and age did not remain significant when adjusted for systolic blood pressure and LDL-cholesterol levels. A high prevalence of subclinical atherosclerosis was detected in this sample of postmenopausal women with low/medium CV risk by the FRS. The association between IMT-CC and age or endogenous estrogen levels was dependent of blood pressure and LDL-cholesterol in these postmenopausal women from Southern Brazil. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Evaluation of Polygenic Risk Scores for Breast and Ovarian Cancer Risk Prediction in BRCA1 and BRCA2 Mutation Carriers.

    Science.gov (United States)

    Kuchenbaecker, Karoline B; McGuffog, Lesley; Barrowdale, Daniel; Lee, Andrew; Soucy, Penny; Dennis, Joe; Domchek, Susan M; Robson, Mark; Spurdle, Amanda B; Ramus, Susan J; Mavaddat, Nasim; Terry, Mary Beth; Neuhausen, Susan L; Schmutzler, Rita Katharina; Simard, Jacques; Pharoah, Paul D P; Offit, Kenneth; Couch, Fergus J; Chenevix-Trench, Georgia; Easton, Douglas F; Antoniou, Antonis C

    2017-07-01

    Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P =  8.2×10 -53 ). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P =  7.2×10 -20 ). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management. © The Author 2017. Published by Oxford

  10. Evaluation of Polygenic Risk Scores for Breast and Ovarian Cancer Risk Prediction in BRCA1 and BRCA2 Mutation Carriers

    Science.gov (United States)

    Kuchenbaecker, Karoline B.; McGuffog, Lesley; Barrowdale, Daniel; Lee, Andrew; Soucy, Penny; Healey, Sue; Dennis, Joe; Lush, Michael; Robson, Mark; Spurdle, Amanda B.; Ramus, Susan J.; Mavaddat, Nasim; Terry, Mary Beth; Neuhausen, Susan L.; Hamann, Ute; Southey, Melissa; John, Esther M.; Chung, Wendy K.; Daly, Mary B.; Buys, Saundra S.; Goldgar, David E.; Dorfling, Cecilia M.; van Rensburg, Elizabeth J.; Ding, Yuan Chun; Ejlertsen, Bent; Gerdes, Anne-Marie; Hansen, Thomas V. O.; Slager, Susan; Hallberg, Emily; Benitez, Javier; Osorio, Ana; Cohen, Nancy; Lawler, William; Weitzel, Jeffrey N.; Peterlongo, Paolo; Pensotti, Valeria; Dolcetti, Riccardo; Barile, Monica; Bonanni, Bernardo; Azzollini, Jacopo; Manoukian, Siranoush; Peissel, Bernard; Radice, Paolo; Savarese, Antonella; Papi, Laura; Giannini, Giuseppe; Fostira, Florentia; Konstantopoulou, Irene; Adlard, Julian; Brewer, Carole; Cook, Jackie; Davidson, Rosemarie; Eccles, Diana; Eeles, Ros; Ellis, Steve; Frost, Debra; Hodgson, Shirley; Izatt, Louise; Lalloo, Fiona; Ong, Kai-ren; Godwin, Andrew K.; Arnold, Norbert; Dworniczak, Bernd; Engel, Christoph; Gehrig, Andrea; Hahnen, Eric; Hauke, Jan; Kast, Karin; Meindl, Alfons; Niederacher, Dieter; Schmutzler, Rita Katharina; Varon-Mateeva, Raymonda; Wang-Gohrke, Shan; Wappenschmidt, Barbara; Barjhoux, Laure; Collonge-Rame, Marie-Agnès; Elan, Camille; Golmard, Lisa; Barouk-Simonet, Emmanuelle; Lesueur, Fabienne; Mazoyer, Sylvie; Sokolowska, Joanna; Stoppa-Lyonnet, Dominique; Isaacs, Claudine; Claes, Kathleen B. M.; Poppe, Bruce; de la Hoya, Miguel; Garcia-Barberan, Vanesa; Aittomäki, Kristiina; Nevanlinna, Heli; Ausems, Margreet G. E. M.; de Lange, J. L.; Gómez Garcia, Encarna B.; Hogervorst, Frans B. L.; Kets, Carolien M.; Meijers-Heijboer, Hanne E. J.; Oosterwijk, Jan C.; Rookus, Matti A.; van Asperen, Christi J.; van den Ouweland, Ans M. W.; van Doorn, Helena C.; van Os, Theo A. M.; Kwong, Ava; Olah, Edith; Diez, Orland; Brunet, Joan; Lazaro, Conxi; Teulé, Alex; Gronwald, Jacek; Jakubowska, Anna; Kaczmarek, Katarzyna; Lubinski, Jan; Sukiennicki, Grzegorz; Barkardottir, Rosa B.; Chiquette, Jocelyne; Agata, Simona; Montagna, Marco; Teixeira, Manuel R.; Park, Sue Kyung; Olswold, Curtis; Tischkowitz, Marc; Foretova, Lenka; Gaddam, Pragna; Vijai, Joseph; Pfeiler, Georg; Rappaport-Fuerhauser, Christine; Singer, Christian F.; Tea, Muy-Kheng M.; Greene, Mark H.; Loud, Jennifer T.; Rennert, Gad; Imyanitov, Evgeny N.; Hulick, Peter J.; Hays, John L.; Piedmonte, Marion; Rodriguez, Gustavo C.; Martyn, Julie; Glendon, Gord; Mulligan, Anna Marie; Andrulis, Irene L.; Toland, Amanda Ewart; Jensen, Uffe Birk; Kruse, Torben A.; Pedersen, Inge Sokilde; Thomassen, Mads; Caligo, Maria A.; Teo, Soo-Hwang; Berger, Raanan; Friedman, Eitan; Laitman, Yael; Arver, Brita; Borg, Ake; Ehrencrona, Hans; Rantala, Johanna; Olopade, Olufunmilayo I.; Ganz, Patricia A.; Nussbaum, Robert L.; Bradbury, Angela R.; Domchek, Susan M.; Nathanson, Katherine L.; Arun, Banu K.; James, Paul; Karlan, Beth Y.; Lester, Jenny; Simard, Jacques; Pharoah, Paul D. P.; Offit, Kenneth; Couch, Fergus J.; Chenevix-Trench, Georgia; Easton, Douglas F.

    2017-01-01

    Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]–positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2×10−53). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2×10−20). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management. PMID

  11. Coronary artery calcium score in high-risk asymptomatic women in Saudi Arabia.

    Science.gov (United States)

    Fathala, Ahmed; Alreshoodi, Saleh; Rujaib, Mashael Al; Shoukri, Mohamed; Sergani, Hani Al; Buriki, Jehad Al; Sugair, Abdulaziz Al

    2015-01-01

    Coronary artery calcification (CAC) is indicated by calcium deposits in the coronary artery wall. Calcification is a component of atherosclerosis and coronary artery disease. Currently, there are no data on calcification in Saudi women at high risk of coronary artery disease. The aim of this study was to investigate the prevalence and percentiles of CAC score in high-risk asymptotic women in Saudi Arabia with comparison of age-specific CAC percentiles derived from large population-based published study in the United States. Retrospective analysis of CAC scores (CACS) at a single tertiary care center. Between January 2011 and April 2015, women referred for CAC screening because of the presence of one or more CAD risk factors were enrolled in the study. CT scans were interpreted by an experienced radiographic technologist, and confirmed by a radiologist. The study sample consisted of 918 women, mean (SD) age of 55 (11) years. All patients were asymp.tomatic and referred by their primary care physician or cardiologist for CAC screening because presence of one or more CAD risks factors. CAD risk factors included diabetes, hypertension, hypercholesterolemia, family history of CAD, and obesity. Baseline CAD risk factors were remarkably higher than in the US comparator group. CACS for 25th, 50th, 75th, and 90th percentiles were calculated. The 75th and 90th CACS percentiles in Saudi women were significantly higher than the US percentiles. Age and diabetes are the most independent predictor of severity of CAC. A potential bias due to sample collection because data was from a single tertiary care center, the study was retrospective and the sample size was small. There are significantly higher CACS percentiles in Saudi women compared with international data. Application of available published percentiles to a local population is not applicable and underestimates the severity of subclinical atherosclerosis. A large local population-based study is warranted to establish local

  12. New risk markers may change the HeartScore risk classification significantly in one-fifth of the population

    DEFF Research Database (Denmark)

    Olsen, M H; Hansen, T W; Christensen, M K

    2008-01-01

    The study aim was to determine whether urine albumin/creatinine ratio (UACR), high-sensitivity C-reactive protein (hsCRP) or N-terminal pro-brain natriuretic peptide (Nt-proBNP) added to risk prediction based on HeartScore and history of diabetes or cardiovascular disease. A Danish population...... sample of 2460 individuals was divided in three groups: 472 subjects receiving cardiovascular medication or having history of diabetes, prior myocardial infarction or stroke, 559 high-risk subjects with a 10-year risk of cardiovascular death above 5% as estimated by HeartScore, and 1429 low-moderate risk......CRP> or =6.0/7.3 mg l(-1) identified a subgroup of 16% who experienced one-third of the CEPs. In the patient group, combined absence of high UACR and high Nt-proBNP> or =110/164 pg ml(-1) (men/women) identified a subgroup of 52% who experienced only 15% of the CEPs. Additional use of UACR and hs...

  13. Comparison of Plasma and Urine Biomarker Performance in Acute Kidney Injury.

    Directory of Open Access Journals (Sweden)

    Gunnar Schley

    Full Text Available New renal biomarkers measured in urine promise to increase specificity for risk stratification and early diagnosis of acute kidney injury (AKI but concomitantly may be altered by urine concentration effects and chronic renal insufficiency. This study therefore directly compared the performance of AKI biomarkers in urine and plasma.This single-center, prospective cohort study included 110 unselected adults undergoing cardiac surgery with cardiopulmonary bypass between 2009 and 2010. Plasma and/or urine concentrations of creatinine, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL, liver fatty acid-binding protein (L-FABP, kidney injury molecule 1 (KIM1, and albumin as well as 15 additional biomarkers in plasma and urine were measured during the perioperative period. The primary outcome was AKI defined by AKIN serum creatinine criteria within 72 hours after surgery.Biomarkers in plasma showed markedly better discriminative performance for preoperative risk stratification and early postoperative (within 24h after surgery detection of AKI than urine biomarkers. Discriminative power of urine biomarkers improved when concentrations were normalized to urinary creatinine, but urine biomarkers had still lower AUC values than plasma biomarkers. Best diagnostic performance 4h after surgery had plasma NGAL (AUC 0.83, cystatin C (0.76, MIG (0.74, and L-FAPB (0.73. Combinations of multiple biomarkers did not improve their diagnostic power. Preoperative clinical scoring systems (EuroSCORE and Cleveland Clinic Foundation Score predicted the risk for AKI (AUC 0.76 and 0.71 and were not inferior to biomarkers. Preexisting chronic kidney disease limited the diagnostic performance of both plasma and urine biomarkers.In our cohort plasma biomarkers had higher discriminative power for risk stratification and early diagnosis of AKI than urine biomarkers. For preoperative risk stratification of AKI clinical models showed similar discriminative performance

  14. Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project.

    Science.gov (United States)

    Esteve-Pastor, María Asunción; Rivera-Caravaca, José Miguel; Roldan, Vanessa; Vicente, Vicente; Valdés, Mariano; Marín, Francisco; Lip, Gregory Y H

    2017-10-05

    Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. The aim of this study was to analyze the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent "real-world" anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 %/year) patients had major bleeding events, of which 65 (0.89 %/year) had intracranial haemorrhage (ICH) and 85 (1.17 %/year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 % over the ABC-Bleeding score. In conclusion, in the first "real-world" validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.

  15. Physical activity, mediating factors and risk of colon cancer : Insights into adiposity and circulating biomarkers from the EPIC cohort

    NARCIS (Netherlands)

    Aleksandrova, Krasimira; Jenab, Mazda; Leitzmann, Michael F.; Bueno-de-Mesquita, Bas; Kaaks, Rudolf; Trichopoulou, Antonia; Bamia, Christina; Lagiou, Pagona; Rinaldi, Sabina; Freisling, Heinz; Carayol, Marion; Pischon, Tobias; Drogan, Dagmar; Weiderpass, Elisabete; Jakszyn, Paula; Overvad, Kim; Dahm, Christina C.; Tjønneland, Anne; Bouton-Ruault, Marie Christine; Kühn, Tilman; Peppa, Eleni; Valanou, Elissavet; La Vecchia, Carlo; Palli, Domenico; Panico, Salvatore; Sacerdote, Carlotta; Agnoli, Claudia; Tumino, Rosario; May, Anne; van Vulpen, Jonna; Borch, Kristin Benjaminsen; Oyeyemi, Sunday Oluwafemi; Quirós, José Ramón; Bonet, Catalina; Sánchez, Mariá José; Dorronsoro, Miren; Navarro, Carmen; Barricarte, Aurelio; Van Guelpen, Bethany; Wennberg, Patrik; Key, Timothy J.; Khaw, Kay Tee; Wareham, Nicholas J.; Assi, Nada; Ward, Heather A.; Aune, Dagfinn; Riboli, Elio; Boeing, Heiner

    2017-01-01

    Background: There is convincing evidence that high physical activity lowers the risk of colon cancer; however, the underlying biological mechanisms remain largely unknown. We aimed to determine the extent to which body fatness and biomarkers of various biologically plausible pathways account for the

  16. Adiposity, mediating biomarkers and risk of colon cancer in the european prospective investigation into cancer and nutrition study

    NARCIS (Netherlands)

    Aleksandrova, K.; Drogan, D.; Boeing, H.; Jenab, M.; Bueno de Mesquita, H.B.; Duijnhoven, van F.J.B.

    2014-01-01

    Adiposity is a risk factor for colon cancer, but underlying mechanisms are not well understood. We evaluated the extent to which 11 biomarkers with inflammatory and metabolic actions mediate the association of adiposity measures, waist circumference (WC) and body mass index (BMI), with colon cancer

  17. Biomarkers for insulin resistance and inflammation and the risk for all-cause dementia and Alzheimer disease

    Science.gov (United States)

    Our aim was to investigate the contribution of biomarkers of glucose homeostasis (adiponectin, glucose, glycated albumin, and insulin levels) and inflammation (high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A(2) levels) to the risk of developing Alzheimer disease (AD) a...

  18. Evaluation of Early Allograft Function Using the Liver Graft Assessment Following Transplantation Risk Score Model.

    Science.gov (United States)

    Agopian, Vatche G; Harlander-Locke, Michael P; Markovic, Daniela; Dumronggittigule, Wethit; Xia, Victor; Kaldas, Fady M; Zarrinpar, Ali; Yersiz, Hasan; Farmer, Douglas G; Hiatt, Jonathan R; Busuttil, Ronald W

    2017-12-20

    Early allograft dysfunction (EAD) following a liver transplant (LT) unequivocally portends adverse graft and patient outcomes, but a widely accepted classification or grading system is lacking. To develop a model for individualized risk estimation of graft failure after LT and then compare the model's prognostic performance with the existing binary EAD definition (bilirubin level of ≥10 mg/dL on postoperative day 7, international normalized ratio of ≥1.6 on postoperative day 7, or aspartate aminotransferase or alanine aminotransferase level of >2000 U/L within the first 7 days) and the Model for Early Allograft Function (MEAF) score. This retrospective single-center analysis used a transplant database to identify all adult patients who underwent a primary LT and had data on 10 days of post-LT laboratory variables at the Dumont-UCLA Transplant Center of the David Geffen School of Medicine at UCLA between February 1, 2002, and June 30, 2015. Data collection took place from January 4, 2016, to June 30, 2016. Data analysis was conducted from July 1, 2016, to August 30, 2017. Three-month graft failure-free survival. Of 2021 patients who underwent primary LT over the study period, 2008 (99.4%) had available perioperative data and were included in the analysis. The median (interquartile range [IQR]) age of recipients was 56 (49-62) years, and 1294 recipients (64.4%) were men. Overall survival and graft-failure-free survival rates were 83% and 81% at year 1, 74% and 71% at year 3, and 69% and 65% at year 5, with an 11.1% (222 recipients) incidence of 3-month graft failure or death. Multivariate factors associated with 3-month graft failure-free survival included post-LT aspartate aminotransferase level, international normalized ratio, bilirubin level, and platelet count, measures of which were used to calculate the Liver Graft Assessment Following Transplantation (L-GrAFT) risk score. The L-GrAFT model had an excellent C statistic of 0.85, with a significantly superior

  19. Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic-morphological discriminants.

    Science.gov (United States)

    Xiang, Jianping; Yu, Jihnhee; Choi, Hoon; Dolan Fox, Jennifer M; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H; Meng, Hui

    2015-07-01

    We have previously developed three logistic regression models for discriminating intracranial aneurysm rupture status from 119 aneurysms based on hemodynamic-morphological parameters. In this study we exploit their use as a tool for predicting the risk of rupture of aneurysms with a defined Rupture Resemblance Score (RRS). We collected three-dimensional images of 85 consecutive aneurysms, applied the three regression models and compared model performance at predicting rupture status against anecdotal metrics (aneurysm size and aspect ratio). We then reinterpreted the model-predicted probability as RRS, where the higher the score the closer the resemblance to previously known rupture components, and applied the RRS prospectively to four unruptured aneurysms with borderline treatment decisions. All three models yielded excellent sensitivity (0.78-0.83) and specificity (0.78-0.84) at a cutoff score of 50%, whereas aneurysm size and aspect ratio showed poor sensitivities (0.28 and 0.33, respectively). Lowering the cutoff score to 30% improved sensitivity to 0.90. The RRS identified most of the ruptured aneurysms and also some unruptured ones that closely resembled ruptured aneurysms hemodynamically and/or morphologically. The prospective application of the RRS to unruptured aneurysms shows that it could provide additional insights for treatment decisions. Previous regression models based on hemodynamic-morphological parameters are able to discriminate rupture in a new cohort in the same population. A higher probability of rupture is associated with larger size ratio, lower normalized wall shear stress and higher oscillatory shear index. The RRS could potentially stratify rupture risk and assist in treatment decision-making for unruptured aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Polygenic Risk Score Prediction of Alcohol Dependence Symptoms Across Population-Based and Clinically Ascertained Samples.

    Science.gov (United States)

    Savage, Jeanne E; Salvatore, Jessica E; Aliev, Fazil; Edwards, Alexis C; Hickman, Matthew; Kendler, Kenneth S; Macleod, John; Latvala, Antti; Loukola, Anu; Kaprio, Jaakko; Rose, Richard J; Chan, Grace; Hesselbrock, Victor; Webb, Bradley T; Adkins, Amy; Bigdeli, Tim B; Riley, Brien P; Dick, Danielle M

    2018-03-01

    Despite consistent evidence of the heritability of alcohol use disorders (AUDs), few specific genes with an etiological role have been identified. It is likely that AUDs are highly polygenic; however, the etiological pathways and genetic variants involved may differ between populations. The aim of this study was thus to evaluate whether aggregate genetic risk for AUDs differed between clinically ascertained and population-based epidemiological samples. Four independent samples were obtained: 2 from unselected birth cohorts (Avon Longitudinal Study of Parents and Children [ALSPAC], N = 4,304; FinnTwin12 [FT12], N = 1,135) and 2 from families densely affected with AUDs, identified from treatment-seeking patients (Collaborative Study on the Genetics of Alcoholism, N = 2,097; Irish Affected Sib Pair Study of Alcohol Dependence, N = 706). AUD symptoms were assessed with clinical interviews, and participants of European ancestry were genotyped. Genomewide association was conducted separately in each sample, and the resulting association weights were used to create polygenic risk scores in each of the other samples (12 total discovery-validation pairs), and from meta-analyses within sample type. We then tested how well these aggregate genetic scores predicted AUD outcomes within and across sample types. Polygenic scores derived from 1 population-based sample (ALSPAC) significantly predicted AUD symptoms in another population-based sample (FT12), but not in either clinically ascertained sample. Trend-level associations (uncorrected p < 0.05) were found for polygenic score predictions within sample types but no or negative predictions across sample types. Polygenic scores accounted for 0 to 1% of the variance in AUD symptoms. Though preliminary, these results provide suggestive evidence of differences in the genetic etiology of AUDs based on sample characteristics such as treatment-seeking status, which may index other important clinical or demographic factors

  1. Comparative study of the Aristotle Comprehensive Complexity and the Risk Adjustment in Congenital Heart Surgery scores.

    Science.gov (United States)

    Bojan, Mirela; Gerelli, Sébastien; Gioanni, Simone; Pouard, Philippe; Vouhé, Pascal

    2011-09-01

    The Aristotle Comprehensive Complexity (ACC) and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) scores have been proposed for complexity adjustment in the analysis of outcome after congenital heart surgery. Previous studies found RACHS-1 to be a better predictor of outcome than the Aristotle Basic Complexity score. We compared the ability to predict operative mortality and morbidity between ACC, the latest update of the Aristotle method and RACHS-1. Morbidity was assessed by length of intensive care unit stay. We retrospectively enrolled patients undergoing congenital heart surgery. We modeled each score as a continuous variable, mortality as a binary variable, and length of stay as a censored variable. We compared performance between mortality and morbidity models using likelihood ratio tests for nested models and paired concordance statistics. Among all 1,384 patients enrolled, 30-day mortality rate was 3.5% and median length of intensive care unit stay was 3 days. Both scores strongly related to mortality, but ACC made better prediction than RACHS-1; c-indexes 0.87 (0.84, 0.91) vs 0.75 (0.65, 0.82). Both scores related to overall length of stay only during the first postoperative week, but ACC made better predictions than RACHS-1; U statistic=0.22, p<0.001. No significant difference was noted after adjusting RACHS-1 models on age, prematurity, and major extracardiac abnormalities. The ACC was a better predictor of operative mortality and length of intensive care unit stay than RACHS-1. In order to achieve similar performance, regression models including RACHS-1 need to be further adjusted on age, prematurity, and major extracardiac abnormalities. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Renal insufficiency increases mortality in acute coronary syndromes regardless of TIMI risk score.

    Science.gov (United States)

    Dudek, Dariusz; Chyrchel, Bernadeta; Siudak, Zbigniew; Depukat, Rafał; Chyrchel, Michał; Dziewierz, Artur; Mielecki, Waldemar; Rakowski, Tomasz; Rzeszutko, Łukasz; Dubiel, Jacek

    2008-01-01

    Non ST-segment elevation acute coronary syndromes (NSTE ACS) are the most frequent cause of admission to intensive care units. Early risk assessment and implementation of optimal treatment are of special importance in these patients. Previous studies have demonstrated that renal insufficiency is an independent risk factor in patients with cardiovascular disease. To assess the effects of renal function on the course of treatment and prognosis in patients with NSTE ACS admitted to hospitals without on-site invasive facilities but with a possibility of immediate transfer to a reference centre with a catheterisation laboratory. Twenty-nine community hospitals without on-site invasive facilities participated in the Krakow Registry of Acute Coronary Syndromes - a prospective, multicentre, web-based, observational registry. Renal insufficiency (RI) was defined as creatinine clearance (CrCl) Renal insufficiency was diagnosed in 34% of all patients. Only 17% of them had been diagnosed with RI prior to admission. Transfer for invasive treatment was undertaken in 10% of RI patients as compared to 16% of patients with CrCl >60 ml/min (NS). In-hospital mortality among patients remaining on conservative treatment in community hospitals was significantly higher among RI patients (4.0 vs. 0.6%; p Renal insufficiency was present in one-third of NSTE ACS patients. Patients with renal insufficiency had worse clinical risk profile and received less aggressive treatment. Patients with NSTE ACS and renal insufficiency treated conservatively had higher in-hospital mortality. Renal insufficiency modifies mortality irrespective of the TIMI risk score. Creatinine clearance should be considered in modification of the TIMI risk score scale.

  3. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  4. A score to predict short-term risk of COPD exacerbations (SCOPEX

    Directory of Open Access Journals (Sweden)

    Make BJ

    2015-01-01

    Full Text Available Barry J Make,1 Göran Eriksson,2 Peter M Calverley,3 Christine R Jenkins,4 Dirkje S Postma,5 Stefan Peterson,6 Ollie Östlund,7 Antonio Anzueto8 1Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, University of Colorado Denver School of Medicine, Denver, CO, USA; 2Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden; 3Pulmonary and Rehabilitation Research Group, University Hospital Aintree, Liverpool, UK; 4George Institute for Global Health, The University of Sydney and Concord Clinical School, Woolcock Institute of Medical Research, Sydney, NSW, Australia; 5Department of Pulmonology, University of Groningen and GRIAC Research Institute, University Medical Center Groningen, Groningen, The Netherlands; 6StatMind AB, Lund, Sweden; 7Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden; 8Department of Pulmonary/Critical Care, University of Texas Health Sciences Center and South Texas Veterans Healthcare System, San Antonio, TX, USA Background: There is no clinically useful score to predict chronic obstructive pulmonary disease (COPD exacerbations. We aimed to derive this by analyzing data from three existing COPD clinical trials of budesonide/formoterol, formoterol, or placebo in patients with moderate-to-very-severe COPD and a history of exacerbations in the previous year. Methods: Predictive variables were selected using Cox regression for time to first severe COPD exacerbation. We determined absolute risk estimates for an exacerbation by identifying variables in a binomial model, adjusting for observation time, study, and treatment. The model was further reduced to clinically useful variables and the final regression coefficients scaled to obtain risk scores of 0–100 to predict an exacerbation within 6 months. Receiver operating characteristic (ROC curves and the corresponding C-index were used to investigate the discriminatory

  5. External Validation of Velazquez-Gomez Severity Score Index and ATLAS Scores and the Identification of Risk Factors Associated with Mortality inClostridium difficileInfections.

    Science.gov (United States)

    Figh, Matthew L; Zoog, Evon S L; Moore, Richard A; Dart, Benjamin W; Heath, Gregory; Butler, Reed M; Gao, Cuilan; Kong, Joseph C; Stanley, J Daniel

    2017-12-01

    Treatment guidelines for Clostridium difficile infection (CDI) are limited by a lack of widely accepted clinical prediction tools (CPTs). Two published CPTs, the Velazquez-Gomez Severity Score Index (VGSSI) and ATLAS scores, were evaluated, and variables showing the greatest correlation with mortality in patients with CDI were identified to further develop an objective, mortality-based CPT. A retrospective review of the charts of 271 hospitalized patients with CDI was performed. VGSSI and ATLAS scores were assigned. Means and correlations of these scores with mortality were evaluated. Multivariate logistic regression analysis was performed on 32 known potential mortality predictor variables. Mortality was overall strongly associated with VGSSI and ATLAS scores with poor correlation within the intermediate ranges. Mean scores for nonsurvivors indicated poor calibration. The variables most associated with mortality were Age, vasopressors, steroids, creatinine level, and albumin. Although both CPTs revealed the ability to discriminate patients at greater risk for mortality, precision and overall calibration were lacking. Five variables were identified which had the greatest correlation with mortality. Utilization of these variables to enhance or modify the existing CPTs is suggested as the next step in the development of a useful and accurate mortality-based CPT for the treatment of CDI.

  6. Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome.

    Science.gov (United States)

    Jahangiry, Leila; Farhangi, Mahdieh Abbasalizad; Rezaei, Fatemeh

    2017-11-13

    There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome. In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm. Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters. The study is not a trial; the registration number is not applicable.

  7. Genetic risk scores and family history as predictors of schizophrenia in Nordic registers.

    Science.gov (United States)

    Lu, Y; Pouget, J G; Andreassen, O A; Djurovic, S; Esko, T; Hultman, C M; Metspalu, A; Milani, L; Werge, T; Sullivan, P F

    2017-09-25

    Family history is a long-standing and readily obtainable risk factor for schizophrenia (SCZ). Low-cost genotyping technologies have enabled large genetic studies of SCZ, and the results suggest the utility of genetic risk scores (GRS, direct assessments of inherited common variant risk). Few studies have evaluated family history and GRS simultaneously to ask whether one can explain away the other. We studied 5959 SCZ cases and 8717 controls from four Nordic countries. All subjects had family history data from national registers and genome-wide genotypes that were processed through the quality control procedures used by the Psychiatric Genomics Consortium. Using external training data, GRS were estimated for SCZ, bipolar disorder (BIP), major depression, autism, educational attainment, and body mass index. Multivariable modeling was used to estimate effect sizes. Using harmonized genomic and national register data from Denmark, Estonia, Norway, and Sweden, we confirmed that family history of SCZ and GRS for SCZ and BIP were risk factors for SCZ. In a joint model, the effects of GRS for SCZ and BIP were essentially unchanged, and the effect of family history was attenuated but remained significant. The predictive capacity of a model including GRS and family history neared the minimum for clinical utility. Combining national register data with measured genetic risk factors represents an important investigative approach for psychotic disorders. Our findings suggest the potential clinical utility of combining GRS and family history for early prediction and diagnostic improvements.

  8. Genetic Risk Score Modelling for Disease Progression in New-Onset Type 1 Diabetes Patients

    DEFF Research Database (Denmark)

    Brorsson, Caroline A; Nielsen, Lotte B; Andersen, Marie-Louise

    2016-01-01

    Genome-wide association studies (GWAS) have identified over 40 type 1 diabetes risk loci. The clinical impact of these loci on β-cell function during disease progression is unknown. We aimed at testing whether a genetic risk score could predict glycemic control and residual β-cell function in type...... 1 diabetes (T1D). As gene expression may represent an intermediate phenotype between genetic variation and disease, we hypothesized that genes within T1D loci which are expressed in islets and transcriptionally regulated by proinflammatory cytokines would be the best predictors of disease...... of the 11 candidate genes have overlapping biological functions and interact in a common network. Our results may help predict disease progression in newly diagnosed children with T1D which can be exploited for optimizing treatment....

  9. Biomarkers of tobacco smoke exposure in racial/ethnic groups at high risk for lung cancer.

    Science.gov (United States)

    Fagan, Pebbles; Moolchan, Eric T; Pokhrel, Pallav; Herzog, Thaddeus; Cassel, Kevin D; Pagano, Ian; Franke, Adrian A; Kaholokula, Joseph Keawe'aimoku; Sy, Angela; Alexander, Linda A; Trinidad, Dennis R; Sakuma, Kari-Lyn; Johnson, C Anderson; Antonio, Alyssa; Jorgensen, Dorothy; Lynch, Tania; Kawamoto, Crissy; Clanton, Mark S

    2015-06-01

    We examined biomarkers of tobacco smoke exposure among Native Hawaiians, Filipinos, and Whites, groups that have different lung cancer risk. We collected survey data and height, weight, saliva, and carbon monoxide (CO) levels from a sample of daily smokers aged 18-35 (n = 179). Mean measures of nicotine, cotinine, cotinine/cigarettes per day ratio, trans 3' hydroxycotinine, the nicotine metabolite ratio (NMR), and expired CO were compared among racial/ethnic groups. The geometric means for cotinine, the cotinine/cigarettes per day ratio, and CO did not significantly differ among racial/ethnic groups in the adjusted models. After adjusting for gender, body mass index, menthol smoking, Hispanic ethnicity, and number of cigarettes smoked per day, the NMR was significantly higher among Whites than among Native Hawaiians and Filipinos (NMR = 0.33, 0.20, 0.19, P ≤ .001). The NMR increased with increasing White parental ancestry. The NMR was not significantly correlated with social-environmental stressors. Racial/ethnic groups with higher rates of lung cancer had slower nicotine metabolism than Whites. The complex relationship between lung cancer risk and nicotine metabolism among racial/ethnic groups needs further clarification.

  10. Biomarkers of Tobacco Smoke Exposure in Racial/Ethnic Groups at High Risk for Lung Cancer

    Science.gov (United States)

    Moolchan, Eric T.; Pokhrel, Pallav; Herzog, Thaddeus; Cassel, Kevin D.; Pagano, Ian; Franke, Adrian A.; Kaholokula, Joseph Keawe’aimoku; Sy, Angela; Alexander, Linda A.; Trinidad, Dennis R.; Sakuma, Kari-Lyn; Johnson, C. Anderson; Antonio, Alyssa; Jorgensen, Dorothy; Lynch, Tania; Kawamoto, Crissy; Clanton, Mark S.

    2015-01-01

    Objectives. We examined biomarkers of tobacco smoke exposure among Native Hawaiians, Filipinos, and Whites, groups that have different lung cancer risk. Methods. We collected survey data and height, weight, saliva, and carbon monoxide (CO) levels from a sample of daily smokers aged 18–35 (n = 179). Mean measures of nicotine, cotinine, cotinine/cigarettes per day ratio, trans 3′ hydroxycotinine, the nicotine metabolite ratio (NMR), and expired CO were compared among racial/ethnic groups. Results. The geometric means for cotinine, the cotinine/cigarettes per day ratio, and CO did not significantly differ among racial/ethnic groups in the adjusted models. After adjusting for gender, body mass index, menthol smoking, Hispanic ethnicity, and number of cigarettes smoked per day, the NMR was significantly higher among Whites than among Native Hawaiians and Filipinos (NMR = 0.33, 0.20, 0.19, P ≤ .001). The NMR increased with increasing White parental ancestry. The NMR was not significantly correlated with social–environmental stressors. Conclusions. Racial/ethnic groups with higher rates of lung cancer had slower nicotine metabolism than Whites. The complex relationship between lung cancer risk and nicotine metabolism among racial/ethnic groups needs further clarification. PMID:25880962

  11. Leisure-time physical activity, television watching, and plasma biomarkers of obesity and cardiovascular disease risk.

    Science.gov (United States)

    Fung, T T; Hu, F B; Yu, J; Chu, N F; Spiegelman, D; Tofler, G H; Willett, W C; Rimm, E B

    2000-12-15

    The benefits of physical activity in reducing cardiovascular disease (CVD) are thought to be mediated through changes in blood lipids, insulin sensitivity, and thrombogenic factors. Few studies have addressed the effects of both long-term physical activity and inactivity on these factors. The authors assessed associations between long-term leisure-time physical activity, television watching, and biomarkers of CVD risk among 468 healthy male health professionals. Prior to blood collection in 1993-1994, physical activity and television watching were assessed biennially from 1986 to 1994 by a questionnaire. Physical activity was expressed as metabolic equivalents-hours per week. Multivariate linear regression analyses showed that metabolic equivalents-hours in 1994 were significantly associated with high density lipoprotein cholesterol (HDL cholesterol) (positively) and with leptin and C-peptide (inversely). The average number of hours of television watching assessed in 1994 was significantly positively associated with low density lipoprotein cholesterol and significantly inversely associated with HDL cholesterol and apolipoprotein A1. Average hours of television watching per week assessed in 1988-1994 was positively associated with leptin levels (p television watching and vigorous activity with leptin and HDL cholesterol were independent of each other. In conclusion, physical activity and television watching were significantly associated with several biochemical markers of obesity and CVD risk.

  12. Image Based Biomarker of Breast Cancer Risk: Analysis of Risk Disparity Among Minority Populations

    Science.gov (United States)

    2014-03-01

    the data is multiple photographs such as the data from deferent sensors, times, depths, or viewpoints. Image registration is a very important and...variables and the estimated cancers risk. We tested several methods co- registering mammograms containing multiple images .We have considered linear... sclerosing adenosis. 2.2 Cluster insertion method A flowchart of the automatic insertion method is shown in Fig. 3. The process begins with the

  13. Biomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Ishigami, Junichi; Jaar, Bernard G; Rebholz, Casey M; Grams, Morgan E; Michos, Erin D; Wolf, Myles; Kovesdy, Csaba P; Uchida, Shinichi; Coresh, Josef; Lutsey, Pamela L; Matsushita, Kunihiro

    2017-12-01

    Mineral and bone disorders (MBDs) might be relevant in the etiology of infection. To determine whether MBD biomarkers were associated with the incidence of hospitalization with infection. We also assessed the cross-sectional association between MBD biomarker levels and kidney function. Community-based cohort study of 11,218 participants with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 in the Atherosclerosis Risk in Communities study. We assessed the cross-sectional associations of five MBD markers-fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), calcium corrected for hypoalbuminemia, and phosphorus-with eGFR from 1990 to 1992 and their longitudinal associations with incident hospitalization with infection in 1990 to 2013. Incident hospitalization with infection. In age-, sex-, and race-adjusted models, lower eGFRs were significantly associated with greater levels of FGF23, PTH, and corrected calcium but not 25(OH)D or phosphorus. During follow-up, 5078 hospitalizations with infection occurred. In fully adjusted Cox models, with the second quartile as the reference, the hazard ratio (HR) was significantly greater in the highest quartile of FGF23 [HR, 1.12; 95% confidence interval (CI), 1.03 to 1.21], PTH (HR, 1.09; 95% CI, 1.01 to 1.18), and corrected calcium (HR, 1.11; 95% CI, 1.03 to 1.20), and lowest quartile for 25(OH)D (HR, 1.11; 95% CI, 1.03 to 1.21). The association with phosphorus was significant only when the outcome was restricted to primary diagnosis of infection. These findings were consistent across subgroups of age, sex, race, and eGFR (infection, supporting MBD involvement in the etiology of infection. Copyright © 2017 Endocrine Society

  14. Estimating the mediating effect of different biomarkers on the relation of alcohol consumption with the risk of type 2 diabetes.

    Science.gov (United States)

    Beulens, Joline W J; van der Schouw, Yvonne T; Moons, Karel G M; Boshuizen, Hendriek C; van der A, Daphne L; Groenwold, Rolf H H

    2013-04-01

    Moderate alcohol consumption is associated with a reduced type 2 diabetes risk, but the biomarkers that explain this relation are unknown. The most commonly used method to estimate the proportion explained by a biomarker is the difference method. However, influence of alcohol-biomarker interaction on its results is unclear. G-estimation method is proposed to accurately assess proportion explained, but how this method compares with the difference method is unknown. In a case-cohort study of 2498 controls and 919 incident diabetes cases, we estimated the proportion explained by different biomarkers on the relation between alcohol consumption and diabetes using the difference method and sequential G-estimation method. Using the difference method, high-density lipoprotein cholesterol explained the relation between alcohol and diabetes by 78% (95% confidence interval [CI], 41-243), whereas high-sensitivity C-reactive protein (-7.5%; -36.4 to 1.8) or blood pressure (-6.9; -26.3 to -0.6) did not explain the relation. Interaction between alcohol and liver enzymes led to bias in proportion explained with different outcomes for different levels of liver enzymes. G-estimation method showed comparable results, but proportions explained were lower. The relation between alcohol consumption and diabetes may be largely explained by increased high-density lipoprotein cholesterol but not by other biomarkers. Ignoring exposure-mediator interactions may result in bias. The difference and G-estimation methods provide similar results. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Identifying coronary artery disease in men with type 2 diabetes: osteoprotegerin, pulse wave velocity, and other biomarkers of cardiovascular risk.

    LENUS (Irish Health Repository)

    Davenport, Colin

    2012-02-01

    OBJECTIVES: In patients with type 2 diabetes, high serum levels of osteoprotegerin (OPG) have been associated with a greater risk of cardiovascular events. However, it remains unclear how well OPG performs when compared with traditional biomarkers of cardiovascular risk such as high-sensitivity C-reactive protein (hsCRP). Furthermore, OPG levels are also high in the presence of diabetes-related microvascular disease, and it is unclear whether OPG can distinguish microvascular disease from large-vessel atherosclerosis. The first aim of this study was to compare OPG levels against other biomarkers of cardiovascular risk in the identification of patients with documented multivessel coronary artery disease (CAD). The second aim was to compare OPG levels in patients with microvascular complications (microalbuminuria) against those with established CAD. METHODS: Three groups of male patients with type 2 diabetes were recruited: patients without microvascular complications or large-vessel atherosclerosis (n = 24), patients with microalbuminuria only (n = 23), and patients with microalbuminuria and documented multivessel CAD (n = 25). OPG, hsCRP, interleukin 6, urate, and pulse wave velocity were measured. RESULTS: Serum OPG levels were significantly higher in patients with a combination of microalbuminuria and CAD than in those with microalbuminuria alone. There were no significant differences in any of the other biomarkers between the groups. CONCLUSION: OPG was found to be superior to the other biomarkers studied in identifying patients with documented CAD. The presence of CAD was a greater determinant of serum OPG levels than microalbuminuria in our population. These findings support the use of OPG as a biomarker of cardiovascular risk.

  16. Effects of Positive Psychology Interventions on Risk Biomarkers in Coronary Patients: A Randomized, Wait-List Controlled Pilot Trial.

    Science.gov (United States)

    Nikrahan, Gholam Reza; Laferton, Johannes A C; Asgari, Karim; Kalantari, Mehrdad; Abedi, Mohammad Reza; Etesampour, Ali; Rezaei, Abbas; Suarez, Laura; Huffman, Jeff C

    2016-01-01

    Among cardiac patients, positive psychologic factors are consistently linked with superior clinical outcomes and improvement in key markers of inflammation and hypothalamic-pituitary-adrenal axis functioning. Further, positive psychology interventions (PPI) have effectively increased psychologic well-being in a wide variety of populations. However, there has been minimal study of PPIs in cardiac patients, and no prior study has evaluated their effect on key prognostic biomarkers of cardiac outcome. Accordingly, we investigated the effect of 3 distinct PPIs on risk biomarkers in cardiac patients. In an exploratory trial, 69 patients with recent coronary artery bypass graft surgery or percutaneous intervention were randomized to (1) one of three 6-week in-person PPIs (based on the work of Seligman, Lyubomirsky, or Fordyce) or (2) a wait-list control group. Risk biomarkers were assessed at baseline, postintervention (7 weeks), and at 15-week follow-up. Between-group differences in change from baseline biomarker levels were examined via random effects models. Compared with the control group, participants randomized to the Seligman (B = -2.06; p = 0.02) and Fordyce PPI (B = -1.54; p = 0.04) had significantly lower high-sensitivity C-reactive protein levels at 7 weeks. Further, the Lyubomirsky PPI (B = -245.86; p = 0.04) was associated with a significantly lower cortisol awakening response at 7 weeks when compared with control participants. There were no other significant between-group differences. Despite being an exploratory pilot study with multiple between-group comparisons, this initial trial offers the first suggestion that PPIs might be effective in reducing risk biomarkers in high-risk cardiac patients. Copyright © 2016 The Academy of Psychosomatic Medicine. All rights reserved.

  17. Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Joshua W. Knowles

    2017-08-01

    Full Text Available PurposeWe tested whether providing a genetic risk score (GRS for coronary artery disease (CAD would serve as a motivator to improve adherence to risk-reducing strategies.MethodsWe randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49 or without (N = 45 their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C between the 3- and 6-month follow-up visits (ΔLDL-C. Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS.ResultsSixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: −13 vs. −9 mg/dl. Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry.ConclusionAdding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.

  18. Corneal ectasia after LASIK in a patient with normal scheimpflug evaluation but a high Ectasia Risk Score.

    Science.gov (United States)

    Goncalves, Fauze Abdulmassih; Goncalves, José Marcos Santos

    2013-11-01

    To present a case of ectasia after LASIK that developed in a patient with normal Scheimpflug imaging but a high Ectasia Risk Score System (ERSS) score. Case report. A 24-year-old woman with no preoperative abnormalities on Scheimpflug evaluation but a cumulative ERSS risk of 4 (high risk) in the right eye and 3 (medium risk) in the left eye developed ectasia in both eyes 27 months after LASIK. She underwent ultraviolet-A corneal collagen cross-linking, with no signs of further progression. In this case, the ERSS was effective at predicting ectasia risk despite normal Scheimpflug imaging and only mild asymmetry on Placido topography. Copyright 2013, SLACK Incorporated.

  19. A New Scoring System to Predict the Risk for High-risk Adenoma and Comparison of Existing Risk Calculators.

    Science.gov (United States)

    Murchie, Brent; Tandon, Kanwarpreet; Hakim, Seifeldin; Shah, Kinchit; O'Rourke, Colin; Castro, Fernando J

    2017-04-01

    Colorectal cancer (CRC) screening guidelines likely over-generalizes CRC risk, 35% of Americans are not up to date with screening, and there is growing incidence of CRC in younger patients. We developed a practical prediction model for high-risk colon adenomas in an average-risk population, including an expanded definition of high-risk polyps (≥3 nonadvanced adenomas), exposing higher than average-risk patients. We also compared results with previously created calculators. Patients aged 40 to 59 years, undergoing first-time average-risk screening or diagnostic colonoscopies were evaluated. Risk calculators for advanced adenomas and high-risk adenomas were created based on age, body mass index, sex, race, and smoking history. Previously established calculators with similar risk factors were selected for comparison of concordance statistic (c-statistic) and external validation. A total of 5063 patients were included. Advanced adenomas, and high-risk adenomas were seen in 5.7% and 7.4% of the patient population, respectively. The c-statistic for our calculator was 0.639 for the prediction of advanced adenomas, and 0.650 for high-risk adenomas. When applied to our population, all previous models had lower c-statistic results although one performed similarly. Our model compares favorably to previously established prediction models. Age and body mass index were used as continuous variables, likely improving the c-statistic. It also reports absolute predictive probabilities of advanced and high-risk polyps, allowing for more individualized risk assessment of CRC.

  20. Paleolithic and Mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas.

    Science.gov (United States)

    Whalen, Kristine A; McCullough, Marji; Flanders, W Dana; Hartman, Terryl J; Judd, Suzanne; Bostick, Roberd M

    2014-12-01

    The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the "Paleolithic" and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991-1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Prediction of Breast and Prostate Cancer Risks in Male BRCA1 and BRCA2 Mutation Carriers Using Polygenic Risk Scores.

    Science.gov (United States)

    Lecarpentier, Julie; Silvestri, Valentina; Kuchenbaecker, Karoline B; Barrowdale, Daniel; Dennis, Joe; McGuffog, Lesley; Soucy, Penny; Leslie, Goska; Rizzolo, Piera; Navazio, Anna Sara; Valentini, Virginia; Zelli, Veronica; Lee, Andrew; Amin Al Olama, Ali; Tyrer, Jonathan P; Southey, Melissa; John, Esther M; Conner, Thomas A; Goldgar, David E; Buys, Saundra S; Janavicius, Ramunas; Steele, Linda; Ding, Yuan Chun; Neuhausen, Susan L; Hansen, Thomas V O; Osorio, Ana; Weitzel, Jeffrey N; Toss, Angela; Medici, Veronica; Cortesi, Laura; Zanna, Ines; Palli, Domenico; Radice, Paolo; Manoukian, Siranoush; Peissel, Bernard; Azzollini, Jacopo; Viel, Alessandra; Cini, Giulia; Damante, Giuseppe; Tommasi, Stefania; Peterlongo, Paolo; Fostira, Florentia; Hamann, Ute; Evans, D Gareth; Henderson, Alex; Brewer, Carole; Eccles, Diana; Cook, Jackie; Ong, Kai-Ren; Walker, Lisa; Side, Lucy E; Porteous, Mary E; Davidson, Rosemarie; Hodgson, Shirley; Frost, Debra; Adlard, Julian; Izatt, Louise; Eeles, Ros; Ellis, Steve; Tischkowitz, Marc; Godwin, Andrew K; Meindl, Alfons; Gehrig, Andrea; Dworniczak, Bernd; Sutter, Christian; Engel, Christoph; Niederacher, Dieter; Steinemann, Doris; Hahnen, Eric; Hauke, Jan; Rhiem, Kerstin; Kast, Karin; Arnold, Norbert; Ditsch, Nina; Wang-Gohrke, Shan; Wappenschmidt, Barbara; Wand, Dorothea; Lasset, Christine; Stoppa-Lyonnet, Dominique; Belotti, Muriel; Damiola, Francesca; Barjhoux, Laure; Mazoyer, Sylvie; Van Heetvelde, Mattias; Poppe, Bruce; De Leeneer, Kim; Claes, Kathleen B M; de la Hoya, Miguel; Garcia-Barberan, Vanesa; Caldes, Trinidad; Perez Segura, Pedro; Kiiski, Johanna I; Aittomäki, Kristiina; Khan, Sofia; Nevanlinna, Heli; van Asperen, Christi J; Vaszko, Tibor; Kasler, Miklos; Olah, Edith; Balmaña, Judith; Gutiérrez-Enríquez, Sara; Diez, Orland; Teulé, Alex; Izquierdo, Angel; Darder, Esther; Brunet, Joan; Del Valle, Jesús; Feliubadalo, Lidia; Pujana, Miquel Angel; Lazaro, Conxi; Arason, Adalgeir; Agnarsson, Bjarni A; Johannsson, Oskar Th; Barkardottir, Rosa B; Alducci, Elisa; Tognazzo, Silvia; Montagna, Marco; Teixeira, Manuel R; Pinto, Pedro; Spurdle, Amanda B; Holland, Helene; Lee, Jong Won; Lee, Min Hyuk; Lee, Jihyoun; Kim, Sung-Won; Kang, Eunyoung; Kim, Zisun; Sharma, Priyanka; Rebbeck, Timothy R; Vijai, Joseph; Robson, Mark; Lincoln, Anne; Musinsky, Jacob; Gaddam, Pragna; Tan, Yen Y; Berger, Andreas; Singer, Christian F; Loud, Jennifer T; Greene, Mark H; Mulligan, Anna Marie; Glendon, Gord; Andrulis, Irene L; Toland, Amanda Ewart; Senter, Leigha; Bojesen, Anders; Nielsen, Henriette Roed; Skytte, Anne-Bine; Sunde, Lone; Jensen, Uffe Birk; Pedersen, Inge Sokilde; Krogh, Lotte; Kruse, Torben A; Caligo, Maria A; Yoon, Sook-Yee; Teo, Soo-Hwang; von Wachenfeldt, Anna; Huo, Dezheng; Nielsen, Sarah M; Olopade, Olufunmilayo I; Nathanson, Katherine L; Domchek, Susan M; Lorenchick, Christa; Jankowitz, Rachel C; Campbell, Ian; James, Paul; Mitchell, Gillian; Orr, Nick; Park, Sue Kyung; Thomassen, Mads; Offit, Kenneth; Couch, Fergus J; Simard, Jacques; Easton, Douglas F; Chenevix-Trench, Georgia; Schmutzler, Rita K; Antoniou, Antonis C; Ottini, Laura

    2017-07-10

    Purpose BRCA1/2 mutations increase the risk of breast and prostate cancer in men. Common genetic variants modify cancer risks for female carriers of BRCA1/2 mutations. We investigated-for the first time to our knowledge-associations of common genetic variants with breast and prostate cancer risks for male carriers of BRCA1/ 2 mutations and implications for cancer risk prediction. Materials and Methods We genotyped 1,802 male carriers of BRCA1/2 mutations from the Consortium of Investigators of Modifiers of BRCA1/2 by using the custom Illumina OncoArray. We investigated the combined effects of established breast and prostate cancer susceptibility variants on cancer risks for male carriers of BRCA1/2 mutations by constructing weighted polygenic risk scores (PRSs) using published effect estimates as weights. Results In male carriers of BRCA1/2 mutations, PRS that was based on 88 female breast cancer susceptibility variants was associated with breast cancer risk (odds ratio per standard deviation of PRS, 1.36; 95% CI, 1.19 to 1.56; P = 8.6 × 10 -6 ). Similarly, PRS that was based on 103 prostate cancer susceptibility variants was associated with prostate cancer risk (odds ratio per SD of PRS, 1.56; 95% CI, 1.35 to 1.81; P = 3.2 × 10 -9 ). Large differences in absolute cancer risks were observed at the extremes of the PRS distribution. For example, prostate cancer risk by age 80 years at the 5th and 95th percentiles of the PRS varies from 7% to 26% for carriers of BRCA1 mutations and from 19% to 61% for carriers of BRCA2 mutations, respectively. Conclusion PRSs may provide informative cancer risk stratification for male carriers of BRCA1/2 mutations that might enable these men and their physicians to make informed decisions on the type and timing of breast and prostate cancer risk management.

  2. Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Guo, Yutao; Zhu, Hang; Chen, Yundai

    2018-01-01

    predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P = .361). The HAS-BLED score was superior to predict bleeding events compared...

  3. Defining the Relationship between Biomarkers of Oxidative and Inflammatory Stress and the Risk for Atherosclerosis in Astronauts during and after Long-duration Spaceflight

    Science.gov (United States)

    Lee, Stuart M. C.; Westby, Christian M.; Stenger, Michael B.; Smith, Scott M.; Zwart, Sara; Ploutz-Snyder, Robert J.; Platts, Steven H.

    2014-01-01

    (in-flight) and 48-h (pre- and post-flight) urine pools. Arterial structure will be assessed from measures of carotid intima-media thickness, which have been shown to be better indicators of atherosclerotic than the Framingham Risk Score. Arterial function will be assessed using brachial flow-mediated dilation, a well-validated measure used to assess endothelium-dependent vasodilation and is a sensitive predictor of atherosclerotic risk. Arterial pulse pressure measured in the brachial artery and stroke volume measured from cardiac ultrasound will be used to assess hemodynamic status, cardiac function, and systemic vascular compliance. Three astronauts are actively participating in the preflight data collection and training activities. One astronaut has completed all preflight activities and will participate in the first in-flight data collection sessions by the end of 2013. The first post-flight data collection sessions will occur in the spring of 2014. EXPECTED RESULTS We hypothesize that biomarkers of oxidative and inflammatory stress will increased with spaceflight and will correlate with increased carotid intima-media thickness during and after flight and with decreased flow-mediated dilation after the mission. Furthermore, we hypothesize that measures of oxidative stress will return to baseline after flight, but biomarkers of inflammatory stress and vascular indices of atherosclerotic risk will remain elevated.

  4. Association of relatives of hemodialysis patients with metabolic syndrome, albuminuria and Framingham Risk Score.

    Directory of Open Access Journals (Sweden)

    Jiun-Chi Huang

    Full Text Available BACKGROUND AND AIM: Metabolic syndrome (MetS, albuminuria, and the Framingham Risk Score (FRS are significant predictors for cardiovascular disease (CVD. However, the relationship and clinical significance of these CVD predictors in individuals with a family history of end-stage renal disease (ESRD are unclear. We investigated the association of relatives of hemodialysis (HD patients with MetS, albuminuria, and the FRS. METHODS: One hundred and sixty-six relatives of HD patients and 374 age- and sex- matched community controls were enrolled. MetS was defined using the Adult Treatment Panel III for Asians. Albuminuria was defined as urine albumin-to-creatinine ratio ≥ 30 mg/g. CVD risk was evaluated by the FRS. RESULTS: A significantly higher prevalence of MetS (19.9% vs. 12.5%, P = 0.026, albuminuria (12.7% vs. 5.1%, P = 0.002 and high FRS risk ≥ 10% of 10-year risk (15.7% vs. 8.5%, P = 0.013 was found in relatives of HD patients compared to their counterpart controls. In multivariate analysis, being relatives of HD patients (vs. controls was an independent determinant for MetS (odds ratio [OR], 1.785; 95% confidence interval [CI], 1.045 to 3.050, albuminuria (OR, 2.891; 95% CI, 1.431 to 5.841, and high FRS risk (OR, 1.863; 95% CI, 1.015 to 3.418. Higher low-density lipoprotein cholesterol (OR, 1.034; 95% CI, 1.017 to 1.052 and betel nut chewing (OR, 13.994; 95% CI, 3.384 to 57.871 were independent determinants for having a high FRS risk in relatives of HD patients. CONCLUSIONS: Being relatives of HD patients was independently associated with MetS, albuminuria and high FRS risk, suggesting family members of ESRD patients may have higher CVD risks through the interactions of renal risk factors. Proactive surveillance of these CVD predictors and preventive strategies should be targeted to this high-risk population.

  5. Development of a self-assessment score for metabolic syndrome risk in non-obese Korean adults.

    Science.gov (United States)

    Je, Youjin; Kim, Youngyo; Park, Taeyoung

    2017-03-01

    There is a need for simple risk scores that identify individuals at high risk for metabolic syndrome (MetS). Therefore, this study was performed to develop and validate a self-assessment score for MetS risk in non-obese Korean adults. Data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2007-2009 were used to develop a MetS risk score. We included a total of 5,508 non-obese participants aged 19-64 years who were free of a self-reported diagnosis of diabetes, hyperlipidemia, hypertension, stroke, angina, or cancer. Multivariable logistic regression model coefficients were used to assign each variable category a score. The validity of the score was assessed in an independent population survey performed in 2010 and 2011, KNHANES V (n=3,892). Age, BMI, physical activity, smoking, alcohol consumption, dairy consumption, dietary habit of eating less salty and food insecurity were selected as categorical variables. The MetS risk score value varied from 0 to 13, and a cut-point MetS risk score of >=7 was selected based on the highest Youden index. The cut-point provided a sensitivity of 81%, specificity of 61%, positive predictive value of 14%, and negative predictive value of 98%, with an area under the curve (AUC) of 0.78. Consistent results were obtained in the validation data sets. This simple risk score may be used to identify individuals at high risk for MetS without laboratory tests among non-obese Korean adults. Further studies are needed to verify the usefulness and feasibility of this score in various settings.

  6. [External multicentric validation of two scores predicting the risk of relapse in patients with borderline ovarian tumors: The nomogram of Bendifallah and the score of Ouldamer].

    Science.gov (United States)

    Pais, Prescilla; Huchon, Cyrille; Chevrot, Audrey; Cohen, Julien; Fauconnier, Arnaud; Rouzier, Roman; Mimouni, Myriam

    2017-09-01

    Borderline ovarian tumors are rare and can occur in young women. For these patients, a fertility sparing surgery should be discussed. Two predicting borderline ovarian tumor relapse risk models were developed in 2014 (Nomogram of Bendifallah) and 2017 (Score of Ouldamer). This study aimed to valid in an external population, these two scores using a multi-institutional BOT database. In this bicentric and retrospective study, all consecutive patients comprising the variable nomogram documented treated between January 2006 and December 2012 for BOT in centre hospitalier de Poissy-Saint-Germain and hôpital René-Huguenin were included. A ROC model was established for each predicting scores. Sixty-five patients were included in the study. Twelve patients showed a recurrence (19%), three of them experienced an infiltrative cancer (5%). The median time of recurrence was 25 months (range: 8-115). The concordance index for the Nomogram of Bendifallah and the Score of Ouldamer were 0.88 (IC 95% [0.78-0.98]) and 0.87 (IC 95% [0.77-0.96]) respectively. This study from an independent population valids the Bendifallah nomogram and Ouldamer score for clinical use in predicting borderline ovarian recurrence. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  7. Joint associations of a polygenic risk score and environmental risk factors for breast cancer in the Breast Cancer Association Consortium.

    Science.gov (United States)

    Rudolph, Anja; Song, Minsun; Brook, Mark N; Milne, Roger L; Mavaddat, Nasim; Michailidou, Kyriaki; Bolla, Manjeet K; Wang, Qin; Dennis, Joe; Wilcox, Amber N; Hopper, John L; Southey, Melissa C; Keeman, Renske; Fasching, Peter A; Beckmann, Matthias W; Gago-Dominguez, Manuela; Castelao, Jose E; Guénel, Pascal; Truong, Thérèse; Bojesen, Stig E; Flyger, Henrik; Brenner, Hermann; Arndt, Volker; Brauch, Hiltrud; Brüning, Thomas; Mannermaa, Arto; Kosma, Veli-Matti; Lambrechts, Diether; Keupers, Machteld; Couch, Fergus J; Vachon, Celine; Giles, Graham G; MacInnis, Robert J; Figueroa, Jonine; Brinton, Louise; Czene, Kamila; Brand, Judith S; Gabrielson, Marike; Humphreys, Keith; Cox, Angela; Cross, Simon S; Dunning, Alison M; Orr, Nick; Swerdlow, Anthony; Hall, Per; Pharoah, Paul D P; Schmidt, Marjanka K; Easton, Douglas F; Chatterjee, Nilanjan; Chang-Claude, Jenny; García-Closas, Montserrat

    2018-01-05

    Polygenic risk scores (PRS) for breast cancer can be used to stratify the population into groups at substantially different levels of risk. Combining PRS and environmental risk factors will improve risk prediction; however, integrating PRS into risk prediction models requires evaluation of their joint association with known environmental risk factors. Analyses were based on data from 20 studies; datasets analysed ranged from 3453 to 23 104 invasive breast cancer cases and similar numbers of controls, depending on the analysed environmental risk factor. We evaluated joint associations of a 77-single nucleotide polymorphism (SNP) PRS with reproductive history, alcohol consumption, menopausal hormone therapy (MHT), height and body mass index (BMI). We tested the null hypothesis of multiplicative joint associations for PRS and each of the environmental factors, and performed global and tail-based goodness-of-fit tests in logistic regression models. The outcomes were breast cancer overall and by estrogen receptor (ER) status. The strongest evidence for a non-multiplicative joint associations with the 77-SNP PRS was for alcohol consumption (P-interaction = 0.009), adult height (P-interaction = 0.025) and current use of combined MHT (P-interaction = 0.038) in ER-positive disease. Risk associations for these factors by percentiles of PRS did not follow a clear dose-response. In addition, global and tail-based goodness of fit tests showed little evidence for departures from a multiplicative risk model, with alcohol consumption showing the strongest evidence for ER-positive disease (P = 0.013 for global and 0.18 for tail-based tests). The combined effects of the 77-SNP PRS and environmental risk factors for breast cancer are generally well described by a multiplicative model. Larger studies are required to confirm possible departures from the multiplicative model for individual risk factors, and assess models specific for ER-negative disease. Published by

  8. Differences in open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS-MRS).

    Science.gov (United States)

    Brolin, Robert E; Cody, Ronald P; Marcella, Stephen W

    2015-01-01

    The Obesity Surgery Mortality Risk Score (OS-MRS) was developed to ascertain preoperative mortality risk of patients having bariatric surgery. To date there has not been a comparison between open and laparoscopic operations using the OS-MRS. To determine whether there are differences in mortality risk between open and laparoscopic Roux-en-Y Gastric Bypass (RYGB) using the OS-MRS. Three university-affiliated hospitals. The 90-day mortality of 2467 consecutive patients who had primary open (1574) or laparoscopic (893) RYGB performed by one surgeon was determined. Univariate and multivariate analysis using 5 OS-MRS risk factors including body mass index (BMI) gender, age>45, presence of hypertension and preoperative deep vein thrombosis (DVT) risk was performed in each group. Each patient was placed in 1 of 3 OS-MRS risk classes based on the number of risks: A (0-1), B (2-3), and C (4-5). Preoperative BMI and DVT risk factors were significantly greater in the open group (OG). Preoperative age was significantly greater in the laparoscopic group (LG). There were significantly more class B and C patients in LG. Ninety-day mortality rates for OG and LG patients were 1.0% and .9%, respectively. Pulmonary embolism was the most common cause of death. All deaths in LG occurred during first 4 years of that experience. Mortality rate by class was A = .1%; B = 1.5%; C = 2.3%. The difference in mortality between class B and C patients was not significant. Univariate analysis in the OG indicated that BMI, age, gender, and DVT risk were significant predictors of mortality. In the LG only BMI and DVT were significant predictors of death. Presence of hypertension was not a significant predictor in either group. Multivariate analysis excluding hypertension found that age was predictive of mortality in the OG while BMI (P = .057) and gender (P = .065) approached statistical significance. Conversely, only BMI was predictive of mortality in the LG with age approaching significance (P

  9. Cardiovascular risk prediction: Can Systematic Coronary Risk Evaluation (SCORE) be improved by adding simple risk markers? Results from the Copenhagen City Heart Study.

    Science.gov (United States)

    Graversen, Peter; Abildstrøm, Steen Z; Jespersen, Lasse; Borglykke, Anders; Prescott, Eva

    2016-09-01

    European society of cardiology (ESC) guidelines recommend that cardiovascular disease (CVD) risk stratification in asymptomatic individuals is based on the Systematic Coronary Risk Evaluation (SCORE) algorithm, which estimates individual 10-year risk of death from CVD. We assessed the potential improvement in CVD risk stratification of 19 easily available risk markers by adding them to the SCORE algorithm. We followed 8476 individuals without prior CVD or diabetes from the Copenhagen City Heart study. The 19 risk markers were: major and minor electrocardiographic (ECG) abnormalities, heart rate, family history (of ischaemic heart disease), body mass index (BMI), waist-hip ratio, walking duration and pace, leisure time physical activity, forced expiratory volume (FEV)1%pred, household income, education, vital exhaustion, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), high-sensitive C-reactive protein (hsCRP) and fibrinogen. With the exception of family history, BMI, triglycerides and minor ECG changes, all risk markers remained significantly associated with CVD mortality after adjustment for SCORE variables. However, the addition of the remaining 15 risk markers resulted in only small changes in discrimination calculated by area under the curve (AUC) and integrated discrimination improvement (IDI) and no improvement in net reclassification improvement (NRI). HsCRP improved AUC by 0.006 (p = 0.015) and IDI by 0.012 (p = 0.002); FEV1%pred improved AUC by 0.006 (p = 0.032) and IDI by 0.006 (p = 0.029). In the intermediate risk group FEV1%pred, education, vital exhaustion and ApoA1 all improved NRI but FEV1%pred was the only risk marker to significantly improve both IDI, AUC and NRI. The SCORE algorithm predicted CVD mortality in a Danish cohort well. Despite strong association with CVD mortality, the individual addition of 19 easily available risk makers to the SCORE model resulted in small

  10. Cardiovascular risk assessment in elderly adults using SCORE OP model in a Latin American population: The experience from Ecuador.

    Science.gov (United States)

    Sisa, Ivan

    2018-02-09

    Cardiovascular disease (CVD) mortality is predicted to increase in Latin America countries due to their rapidly aging population. However, there is very little information about CVD risk assessment as a primary preventive measure in this high-risk population. We predicted the national risk of developing CVD in Ecuadorian elderly population using the Systematic COronary Risk Evaluation in Older Persons (SCORE OP) High and Low models by risk categories/CVD risk region in 2009. Data on national cardiovascular risk factors were obtained from the Encuesta sobre Salud, Bienestar y Envejecimiento. We computed the predicted 5-year risk of CVD risk and compared the extent of agreement and reclassification in stratifying high-risk individuals between SCORE OP High and Low models. Analyses were done by risk categories, CVD risk region, and sex. In 2009, based on SCORE OP Low model almost 42% of elderly adults living in Ecuador were at high risk of suffering CVD over a 5-year period. The extent of agreement between SCORE OP High and Low risk prediction models was moderate (Cohen's kappa test of 0.5), 34% of individuals approximately were reclassified into different risk categories and a third of the population would benefit from a pharmacologic intervention to reduce the CVD risk. Forty-two percent of elderly Ecuadorians were at high risk of suffering CVD over a 5-year period, indicating an urgent need to tailor primary preventive measures for this vulnerable and high-risk population. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  11. A simple score for estimating the long-term risk of fracture in patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Bazelier, M. T.; van Staa, T. P.; Uitdehaag, B. M. J.

    2012-01-01

    was converted into integer risk scores. Results: In comparison with the FRAX calculator, our risk score contains several new risk factors that have been linked with fracture, which include MS, use of antidepressants, use of anticonvulsants, history of falling, and history of fatigue. We estimated the 5- and 10......Objective: To derive a simple score for estimating the long-term risk of osteoporotic and hip fracture in individual patients with MS. Methods: Using the UK General Practice Research Database linked to the National Hospital Registry (1997-2008), we identified patients with incident MS (n = 5......,494). They were matched 1:6 by year of birth, sex, and practice with patients without MS (control subjects). Cox proportional hazards models were used to calculate the long-term risk of osteoporotic and hip fracture. We fitted the regression model with general and specific risk factors, and the final Cox model...

  12. Skin disorders in Parkinson’s disease: potential biomarkers and risk factors

    Directory of Open Access Journals (Sweden)

    Ravn A

    2017-03-01

    biomarkers in identification of risk and diagnosis of PD. Keywords: Parkinson’s disease, melanoma, rosacea, seborrheic dermatitis, bullous pemphigoid

  13. A Risk Prediction Score for Kidney Failure or Mortality in Rhabdomyolysis

    Science.gov (United States)

    McMahon, Gearoid M.; Zeng, Xiaoxi; Waikar, Sushrut S.

    2016-01-01

    IMPORTANCE Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT). OBJECTIVE To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women’s Hospital. MAIN OUTCOMES AND MEASURES The composite of RRT or in-hospital mortality. RESULTS The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80–0.85) in the derivation cohort and 0.83 (0.80–0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (10), 61.2% died or needed RRT. CONCLUSIONS AND

  14. Demographic determinants of risk, colon distribution and density scores of diverticular disease

    Science.gov (United States)

    Golder, Mark; Ster, Irina Chis; Babu, Pratusha; Sharma, Amita; Bayat, Muhammad; Farah, Abdulkadir

    2011-01-01

    AIM: To investigate associations between ethnicity, age and sex and the risk, colon distribution and density scores of diverticular disease (DD). METHODS: Barium enemas were examined in 1000 patients: 410 male, 590 female; 760 whites, 62 Asians, 44 black africans (BAs), and 134 other blacks (OBs). Risks and diverticula density of left-sided DD (LSDD) and right-sided-component DD (RSCDD = right-sided DD + right and left DD + Pan-DD) were compared using logistic regression. RESULTS: Four hundred and forty-seven patients had DD (322 LSDD and 125 RSCDD). Adjusted risks: (1) LSDD: each year increase in age increased the odds by 6% (95% CI: 5-8, SE: 0.8%, P < 0.001); Asians: odds ratio (OR): 0.23 (95% CI: 0.10-0.53, SE: 0.1, P ≤ 0.001) and OBs: OR: 0.25 (95% CI: 0.14-0.43, SE: 0.07, P ≤ 0.001) appeared protected vs Whites; (2) RSCDD: each year increase in age increased the odds by 4% (95% CI: 2-6, SE: 1%, P < 0.001); females were 0.60 times (95% CI: 0.40-0.90, SE: 0.12, P = 0.01) less likely than males to have RSCDD; BAs were 3.51 times (95% CI: 1.70-7.24, SE: 1.30, P < 0.001) more likely than Whites to have RSCDD; and (3) DD density scores: each year increase in age increased the odds of high-density scores by 4% (95% CI: 1-6, SE: 1%, P < 0.001); RSCDD was 2.77 times (95% CI: 1.39-3.32, SE: 0.67, P < 0.001) more likely to be of high density than LSDD. No further significant differences were found in the adjusted models. CONCLUSION: Right colonic DD might be more common and has higher diverticula density in the west than previously reported. BAs appear predisposed to DD, whereas other ethnic differences appear conserved following migration. PMID:21448352

  15. Prognostic Value of High-Sensitivity Cardiac Troponin T Compared with Risk Scores in Stable Cardiovascular Disease.

    Science.gov (United States)

    Biener, Moritz; Giannitsis, Evangelos; Kuhner, Manuel; Zelniker, Thomas; Mueller-Hennessen, Matthias; Vafaie, Mehrshad; Trenk, Dietmar; Neumann, Franz-Josef; Hochholzer, Willibald; Katus, Hugo A

    2017-05-01

    Risk stratification of patients with cardiovascular disease remains challenging despite consideration of risk scores. We aimed to evaluate the prognostic performance of high-sensitivity cardiac troponin T in a low-risk outpatient population presenting for nonsecondary and secondary prevention. All-cause mortality, a composite of all-cause mortality, acute myocardial infarction, and stroke (end point 2), and a composite of all-cause mortality, acute myocardial infarction, stroke and rehospitalization for acute coronary syndrome, and decompensated heart failure (end point 3) were defined. The prognostic performance of high-sensitivity cardiac troponin T on index visit was compared with the PROCAM score and 3 FRAMINGHAM subscores. In 693 patients with a median follow-up of 796 days, we observed 16 deaths, 32 patients with end point 2, and 83 patients with end point 3. All risk scores performed better in the prediction of all-cause mortality in nonsecondary prevention (area under the curve [AUC]: PROCAM: 0.922 vs 0.523, P = .001, consistent for all other scores). In secondary prevention, high-sensitivity cardiac troponin T outperformed all risk scores in the prediction of all-cause mortality (ΔAUC: PROCAM: 0.319, P risk scores. Our findings on the prediction of all-cause mortality compared with the FRAMINGHAM-Hard Coronary Heart Disease score were confirmed in an independent validation cohort on 2046 patients. High-sensitivity troponin T provides excellent risk stratification regarding all-cause mortality and all-cause mortality, acute myocardial infarction, and stroke in a secondary prevention cohort in whom risk scores perform poorly. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Evaluation of mass spectrometry of urinary proteins and peptides as biomarkers for cats at risk of developing azotemia.

    Science.gov (United States)

    Jepson, Rosanne E; Coulton, Gary R; Cowan, Matthew L; Markwell, Peter; Syme, Harriet M; Elliott, Jonathan

    2013-02-01

    To evaluate proteomic delineation of feline urine by mass spectrometry as a method for identifying biomarkers in cats at risk of developing azotemia. Urine samples from geriatric cats (> 9 years old) with chronic kidney disease and nonazotemic cats that either remained nonazotemic (n = 10) or developed azotemia (10) within 1 year. Optimization studies with pooled urine were performed to facilitate the use of surface enhanced laser desorption-ionization time-of-flight mass spectrometry (SELDI-TOF-MS) for analysis of the urinary proteome of cats. Urine samples from nonazotemic cats at entry to the study were analyzed via SELDI-TOF-MS with weak cation exchange and strong anion exchange arrays. Spectral data were compared to identify biomarkers for development of azotemia. Low protein concentration in feline urine precluded direct application to array surfaces, and a buffer exchange and concentration step was required prior to SELDI-TOF-MS analysis. Three preparation conditions by use of weak cation and strong anion exchange arrays were selected on the basis of optimization studies for detection of biomarkers. Eight potential biomarkers with an m/z of 2,822, 9,886, 10,033, 10,151, 10,234, 11,653, 4,421, and 9,505 were delineated. SELDI-TOF-MS can be used to detect urinary low-molecular weight peptides and proteins that may represent biomarkers for early detection of renal damage. Further study is required to purify and identify potential biomarkers before their use in a clinical setting.

  17. Could symptoms and risk factors diagnose COPD? Development of a Diagnosis Score for COPD

    Directory of Open Access Journals (Sweden)

    Salameh P

    2012-09-01

    Full Text Available Pascale Salameh,1 Georges Khayat,2 Mirna Waked31Faculties of Pharmacy and of Public Health, Lebanese University, Beirut, 2Faculty of Medicine, Hôtel Dieu de France Hospital, Beirut and Saint Joseph University, Beirut, 3Faculty of Medicine, Saint George Hospital, Beirut and Balamand University, Beirut, LebanonBackground: Diagnosing chronic obstructive pulmonary disease (COPD without spirometry is still a challenge. Our objective in this study was to develop a scale for diagnosis of COPD.Methods: Data were taken from a cross-sectional epidemiological study. After reducing chronic respiratory symptoms, a logistic regression was used to select risk factors for and symptoms of COPD. The rounded coefficients generated a Diagnosis Score for COPD (DS-COPD, which was dichotomized and differentiated between COPD and other individuals with respiratory symptoms.Results: We constructed a tool for COPD diagnosis with good properties, comprising 12 items. The area under the curve was 0.849; the positive predictive value was 76% if the DS-COPD was >20 and the negative predictive value was 97% if the DS-COPD was <10. A DS-COPD of 10–19 represented a zone mostly suggestive of no COPD (77%. The score was also inversely correlated with forced expiratory volume in 1 second/forced vital capacity.Conclusion: In this study, a tool for diagnosis of COPD was constructed with good properties for use in the epidemiological setting, mainly in cases of low or high scoring. It would be of particular interest in the primary care setting, where spirometry may not be available. Prospective studies and application in clinical settings would be necessary to validate this scale further.Keywords: diagnosis, scale, development, spirometry

  18. Quantifying the impact of using Coronary Artery Calcium Score for risk categorization instead of Framingham Score or European Heart SCORE in lipid lowering algorithms in a Middle Eastern population.

    Science.gov (United States)

    Isma'eel, Hussain A; Almedawar, Mohamad M; Harbieh, Bernard; Alajaji, Wissam; Al-Shaar, Laila; Hourani, Mukbil; El-Merhi, Fadi; Alam, Samir; Abchee, Antoine

    2015-10-01

    The use of the Coronary Artery Calcium Score (CACS) for risk categorization instead of the Framingham Risk Score (FRS) or European Heart SCORE (EHS) to improve classification of individuals is well documented. However, the impact of reclassifying individuals using CACS on initiating lipid lowering therapy is not well understood. We aimed to determine the percentage of individuals not requiring lipid lowering therapy as per the FRS and EHS models but are found to require it using CACS and vice versa; and to determine the level of agreement between CACS, FRS and EHS based models. Data was collected for 500 consecutive patients who had already undergone CACS. However, only 242 patients met the inclusion criteria and were included in the analysis. Risk stratification comparisons were conducted according to CACS, FRS, and EHS, and the agreement (Kappa) between them was calculated. In accordance with the models, 79.7% to 81.5% of high-risk individuals were down-classified by CACS, while 6.8% to 7.6% of individuals at intermediate risk were up-classified to high risk by CACS, with slight to moderate agreement. Moreover, CACS recommended treatment to 5.7% and 5.8% of subjects untreated according to European and Canadian guidelines, respectively; whereas 75.2% to 81.2% of those treated in line with the guidelines would not be treated based on CACS. In this simulation, using CACS for risk categorization warrants lipid lowering treatment for 5-6% and spares 70-80% from treatment in accordance with the guidelines. Current strong evidence from double randomized clinical trials is in support of guideline recommendations. Our results call for a prospective trial to explore the benefits/risks of a CACS-based approach before any recommendations can be made.

  19. Effects of liraglutide on cardiovascular risk biomarkers in patients with type 2 diabetes and albuminuria

    DEFF Research Database (Denmark)

    von Scholten, Bernt Johan; Persson, Frederik; Rosenlund, Signe

    2017-01-01

    -regional pro-atrial natriuretic peptide (MR-proANP); and 5) Copeptin, in type 2 diabetes patients with albuminuria. In a randomised, double-blind, placebo-controlled, cross-over trial we enrolled patients with type 2 diabetes and persistent albuminuria (urinary albumin-to-creatinine ratio (UACR) > 30 mg......We assessed the effects of liraglutide treatment on five cardiovascular risk biomarkers, reflecting different pathophysiology: 1) Tumour necrosis factor-alpha (TNF-alpha); 2) Soluble urokinase plasminogen activator receptor (suPAR); 3) Mid-regional pro-adrenomedullin (MR-proADM); 4) Mid....../g) and estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73m(2) . Patients received liraglutide (1.8 mg/d) and matched placebo for 12 weeks in random order. Primary endpoint was change in albuminuria; this is a prespecified sub-study. Thirty-two patients were randomised, 27 completed the study. TNF...

  20. The predictive value of CHADS₂ risk score in post myocardial infarction arrhythmias - a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine Huth; Gang, Uffe; Thomsen, Poul Erik Bloch

    2014-01-01

    BACKGROUND: Previous studies have shown substantially increased risk of cardiac arrhythmias and sudden cardiac death in post-myocardial infarction (MI) patients. However it remains difficult to identify the patients who are at highest risk of arrhythmias in the post-MI setting. The purpose...... of this study was to investigate if CHADS₂ score (congestive heart failure, hypertension, age ≥75 years, diabetes and previous stroke/TCI [doubled]) can be used as a risk tool for predicting cardiac arrhythmias after MI. METHODS: The study included 297 post-MI patients from the CARISMA study with left....... Patients were stratified according to CHADS₂ score at enrollment. Congestive heart failure was defined as LVEF ≤40% and NYHA class II, III or IV. RESULTS: We found significantly increased risk of an arrhythmic event with increasing CHADS₂ score (CHADS₂ score=1-2: HR=2.1 [1.1-3.9], p=0.021, CHADS₂ score ≥ 3...

  1. Validation of a Simple Score to Determine Risk of Early Rejection After Pediatric Heart Transplantation.

    Science.gov (United States)

    Butts, Ryan J; Savage, Andrew J; Atz, Andrew M; Heal, Elisabeth M; Burnette, Ali L; Kavarana, Minoo M; Bradley, Scott M; Chowdhury, Shahryar M

    2015-09-01

    This study aimed to develop a reliable and feasible score to assess the risk of rejection in pediatric heart transplantation recipients during the first post-transplant year. The first post-transplant year is the most likely time for rejection to occur in pediatric heart transplantation. Rejection during this period is associated with worse outcomes. The United Network for Organ Sharing database was queried for pediatric patients (age heart transplantation from January 1, 2000 to December 31, 2012. Transplantations were divided into a derivation cohort (n = 2,686) and a validation (n = 509) cohort. The validation cohort was randomly selected from 20% of transplantations from 2005 to 2012. Covariates found to be associated with rejection (p heart transplantation recipients. The score has the potential to be used in clinical practice to aid in determining the immunosuppressant regimen and the frequency of rejection surveillance in the first post-transplant year. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Genetic risk scores for body fat distribution attenuate weight loss in women during dietary intervention

    DEFF Research Database (Denmark)

    Svendstrup, M; Allin, K H; Sørensen, T I A

    2018-01-01

    suggest that genetic variants influencing body fat distribution attenuate weight loss in women independently on the effect on WHR. The stronger effect of the GRSwomen implies heterogenic effects of the WHRadjBMI variants on weight loss. A strong effect of rs1358980-T in the VEGFA locus suggests......BACKGROUND AND AIM: The well-established link between body fat distribution and metabolic health has been suggested to act through an impact on the remodeling capacity of the adipose tissue. Remodeling of the adipose tissue has been shown to affect body fat distribution and might affect the ability...... to lose weight. We aimed to study the effect of weighted genetic risk scores (GRSs) on weight loss based on single-nucleotide polymorphisms (SNPs) associated with waist-hip-ratio adjusted for body mass index (WHRadjBMI). METHOD: We included 707 participants (533 women and 174 men) from the NUGENOB multi...

  3. Interactions of Lipid Genetic Risk Scores with Estimates of Metabolic Health in a Danish Population

    DEFF Research Database (Denmark)

    Justesen, Johanne M; Allin, Kristine H; Sandholt, Camilla H

    2015-01-01

    , high-density lipoprotein-cholesterol, or triglyceride, 4 weighted GRS were constructed. In a cross-sectional design, we investigated whether the effect of these weighted GRSs on lipid levels were modulated by diet, alcohol consumption, physical activity, and smoking or the individual metabolic health...... nucleotide polymorphisms were genotyped in 2 Danish cohorts: inter99 (n=5961) for discovery analyses and Health2006 (n=2565) for replication. On the basis of published effect sizes of single nucleotide polymorphisms associated with circulating fasting levels of total cholesterol, low-density lipoprotein-cholesterol...... and these susceptibility loci has not been fully elucidated. We tested whether genetic risk scores (GRS) of lipid-associated single nucleotide polymorphisms associate with fasting serum lipid traits and whether the effects are modulated by lifestyle factors or estimates of metabolic health. Methods and Results—The single...

  4. Emerging risk factors as markers for carotid intima media thickness scores.

    Science.gov (United States)

    Masley, Steven C; Roetzheim, Richard; Masley, Lucas V; McNamara, Timothy; Schocken, Douglas D

    2015-01-01

    Cardiovascular disease (CVD) remains the number one cause of mortality in the Western world. This study aims to determine which lifestyle factors are associated with mean carotid intima media thickness (IMT), a safe and reliable predictor of future CVD risk. A prospective cross-sectional analysis of 592 subjects. Measures were made of body composition, anthropometric measures, fitness, diet (measured with a 3-day food diary), laboratory results, and mean carotid IMT. Multivariate analyses show that higher mean IMT values are associated with increasing age (p intake of zinc (p = 0.0001). Bivariate analyses controlling for age and gender, with and without statin use, showed that higher mean IMT scores were statistically associated with higher diastolic BP (p = 0.007), higher total cholesterol/high-density lipoprotein (HDL) ratio (p fasting glucose level (p = 0.028), and lower intake of magnesium (p = 0.019), fish (p = 0.007), and fiber (p = 0.02). Other factors that were not associated with mean IMT include total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein (hs-CRP); intake of saturated fat, potassium, calcium, sodium, or vitamin K; percentage of calories from protein, fat, or carbohydrate; measures of strength (assessed with push-up and sit-up testing); and reported exercise. Aerobic fitness and dietary intake of fiber, fish, magnesium, and zinc are inversely associated with carotid IMT scores. Of the traditional CVD risk factors, only systolic BP, fasting glucose, body composition, and total cholesterol/HDL ratio have a direct relationship with mean carotid IMT.

  5. Children with hypercholesterolemia of unknown cause: Value of genetic risk scores.

    Science.gov (United States)

    Sjouke, Barbara; Tanck, Michael W T; Fouchier, Sigrid W; Defesche, Joep C; Hutten, Barbara A; Wiegman, Albert; Kastelein, John J P; Hovingh, G Kees

    2016-01-01

    Familial hypercholesterolemia (FH) is caused by mutations in LDLR, APOB, or PCSK9, and in a previous study, we identified a causative mutation in these FH genes in 95% (255 of 269) of children with the FH phenotype. It has been hypothesized that a polygenic form of hypercholesterolemia is present in FH patients in whom no mutation is identified in the 3 FH genes. To address whether a polygenic form of hypercholesterolemia, defined as high-weighted effect of low-density lipoprotein cholesterol (LDL-C) raising SNPs expressed as the genetic risk score (GRS), is present in the remaining 14 children. On reassessment of the molecular diagnosis and clinical phenotype, 8 FH kindreds met the criteria for hypercholesterolemia of unknown cause and were included in this study. We calculated a weighted GRS comprising 10 established LDL-C-associated SNPs and the APOE genotype in these index cases and evaluated whether the index cases were characterized by an increased GRS compared to 26 first-degree relatives. Phenotypically affected and unaffected individuals could not be distinguished based on any of the risk scores. In this and our previous study, we show that a causal mutation in LDLR, APOB, and PCSK9 can be identified in almost all children with a definite clinical diagnosis of FH. In the small group of patients without a mutation, we did not observe a higher GRS compared with unaffected relatives, which suggests that the FH phenotype is not caused by the aggregate of LDL-C increasing SNPs. Our data imply that application of the GRS is not instrumental as a diagnostic tool to individually define clinically diagnosed FH patients with polygenic hypercholesterolemia in our study population. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  6. Usefulness of the Trabecular Bone Score for assessing the risk of osteoporotic fracture.

    Science.gov (United States)

    Redondo, L; Puigoriol, E; Rodríguez, J R; Peris, P; Kanterewicz, E

    2018-04-01

    The trabecular bone score (TBS) is an imaging technique that assesses the condition of the trabecular microarchitecture. Preliminary results suggest that TBS, along with the bone mineral density assessment, could improve the calculation of the osteoporotic fracture risk. The aim of this study was to analyse TBS values and their relationship with the clinical characteristics, bone mineral density and history of fractures of a cohort of posmenopausal women. We analysed 2,257 posmenopausal women from the FRODOS cohort, which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry. TBS was applied to the densitometry images. TBS values ≤1230 were considered indicative of degraded microarchitecture. We performed a simple and multiple linear regression to determine the factors associated with this index. The mean TBS value in L1-L4 was 1.203±0.121. Some 55.3% of the women showed values indicating degraded microarchitecture. In the multiple linear regression analysis, the factors associated with low TBS values were age, weight, height, spinal T-score, glucocorticoid treatment, presence of type 2 diabetes and a history of fractures due to frailty. TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors, low bone mineral density values, the presence of fractures, a history of type 2 diabetes mellitus and the use of glucocorticoids. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  7. Aerobic fitness is associated with low cardiovascular disease risk: the impact of lifestyle on early risk factors for atherosclerosis in young healthy Swedish individuals – the Lifestyle, Biomarker, and Atherosclerosis study

    Directory of Open Access Journals (Sweden)

    Fernström M

    2017-03-01

    Full Text Available Maria Fernström,1,* Ulrika Fernberg,2,* Gabriella Eliason,1 Anita Hurtig-Wennlöf1 1Department of Medical Diagnostics, Medical Faculty, School of Health Sciences, 2Medical Faculty, School of Medical Sciences, Örebro University, Örebro, Sweden *These authors contributed equally to this work Background: The progression of cardiovascular disease (CVD and atherosclerosis is slow and develops over decades. In the cross-sectional Swedish Lifestyle, Biomarker, and Atherosclerosis study, 834 young, self-reported healthy adults aged 18.0–25.9 years have been studied to identify early risk factors for atherosclerosis.Purpose: The aims of this study were to 1 assess selected cardiometabolic biomarkers, carotid intima–media thickness (cIMT as a marker of subclinical atherosclerosis, and lifestyle-related indicators (food habits, handgrip strength, and oxygen uptake, VO2 max; 2 analyze the assofciations between cIMT and lifestyle factors; and 3 identify subjects at risk of CVD using a risk score and to compare the characteristics of subjects with and without risk of CVD.Method: Blood samples were taken in a fasting state, and food habits were reported through a questionnaire. cIMT was measured by ultrasound, and VO2 max was measured by ergometer bike test. The risk score was calculated according to Wildman.Result: cIMT (mean ± standard deviation was 0.50±0.06 mm, and VO2 max values were 37.8±8.5 and 42.9±9.9 mL/kg/min, in women and men, respectively. No correlation was found between aerobic fitness expressed as VO2 max (mL/kg/min and cIMT. Using Wildman’s definition, 12% of the subjects were classified as being at risk of CVD, and 15% had homeostasis model assessment of insulin resistance. A total of 35% of women and 25% of men had lower high-density lipoprotein cholesterol than recommended. Food habits did not differ between those at risk and those not at risk. However, aerobic fitness measured as VO2 max (mL/kg/min differed; 47% of the

  8. Clinically Feasible Stratification of 3-Year Chronic Disease Risk in Primary Care: The Mental Health Integration Risk Score.

    Science.gov (United States)

    May, Heidi T; Reiss-Brennan, Brenda; Brunisholz, Kimberly D; Horne, Benjamin D

    Depression is a common illness that imposes a disproportionately large health burden. Depression is generally associated with a higher prevalence of chronic disease risk factors and may contribute to higher chronic disease risk. This study aimed to create and validate sex-specific Mental Health Integration Risk Scores (MHIRS) that predict 3-year chronic disease diagnosis. MHIRS was created to predict the first diagnosis of any of the 10 chronic diseases in patients completing a Patient Health Questionnaire-9 Depression Survey who were free at baseline from those 10 chronic disease diagnoses. MHIRS used sex-specific weightings of Patient Health Questionnaire 9 results, age, and components of the complete metabolic profile and complete blood count in randomly chosen derivation (70%) and validation (30%) groups. Among females (N = 10,162, age: 48 ± 16), c-statistics for the composite chronic disease end point were 0.746 (0.725, 0.767) for the derivation group and 0.717 (0.682, 0.753) for the validation group, whereas males (N = 4615, age: 48 ± 15) had 0.755 (0.727, 0.783) and 0.742 (0.702, 0.782). In the validation group, MHIRS strata of low-, moderate-, and high-risk categories had hazard ratios (HR) for any 3-year chronic disease diagnosis among females of HR = 3.42 for moderate vs low and HR = 9.75 for high vs low, whereas males had HR = 4.80 and HR = 10.68, respectively (all p chronic disease diagnosis. Designed to be calculated electronically by an electronic health record, MHIRS can be efficiently obtained by clinicians to identify patients at higher chronic disease risk who require further evaluation and more precise clinical management. Copyright © 2017 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  9. Association between Knee Osteoarthritis, Cardiovascular Risk Factors, and the Framingham Risk Score in South Koreans: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Ho Sun Kim

    Full Text Available Osteoarthritis is a significant burden on personal health and for social cost, and its prevalence is rising. Recent research has revealed an association between osteoarthritis and cardiovascular disease, and this study uses the Framingham risk score (FRS, which is widely used as a composite index of cardiovascular risk factors, to investigate the association between osteoarthritis and various cardiovascular risk factors.A total 9,514 participants aged 50 years or older who received knee X-ray diagnosis of the 5th Korean National Health and Nutrition Examination Survey (total surveyees = 24,173 released by the Korean Centers for Disease Control and Prevention was included for analysis. Knee osteoarthritis patients were defined as participants with K-L grade ≥2 on knee X-ray regardless of knee pain. The association between major cardiovascular risk factors (blood pressure, diabetes, cholesterol, and smoking habits, FRS, and knee osteoarthritis was analyzed, adjusting for various covariates.Prevalence of knee osteoarthritis in Koreans aged ≥50 years was 36.6%, and higher in women (men: 24.9%, women: 45.4%. Prevalence of knee osteoarthritis in participants with hypertension was significantly higher than those without hypertension (fully adjusted odds ratio (OR 1.26; 95% confidence interval (CI 1.08-1.48. Knee osteoarthritis prevalence was also higher in participants with impaired fasting glucose or diabetes than those without (age, sex adjusted OR 1.19; 95% CI 1.00-1.41. Also, OR values increased statistically significantly with FRS as a continuous variable (fully adjusted OR 1.007; 95% CI 1.00-1.01.Prevalence of knee osteoarthritis was associated with hypertension and diabetes, which are major cardiovascular risk factors, and the FRS. Further studies on FRS pertaining to its relationship with osteoarthritis are warranted.

  10. Prospective Biomarker Screening for Diagnosis of Invasive Aspergillosis in High-Risk Pediatric Patients

    Science.gov (United States)

    Hafner, Julia; Mengoli, Carlo; Wirth, Clemens; Heussel, Claus Peter; Löffler, Claudia; White, P. Lewis; Ullmann, Andrew J.; Michel, Denise; Wiegering, Verena; Wölfl, Matthias; Schlegel, Paul Gerhardt; Einsele, Hermann; Springer, Jan; Eyrich, Matthias

    2016-01-01

    ABSTRACT Combined biomarker screening is increasingly used to diagnose invasive aspergillosis (IA) in high-risk patients. In adults, the combination of galactomannan (GM) and fungal DNA detection has proven to be beneficial in the diagnosis of IA. Data in purely pediatric cohorts are scarce. Here, we monitored 39 children shortly before and after allogeneic stem cell transplantation twice weekly by use of a commercial GM enzyme-linked immunosorbent assay (ELISA) and a PCR assay based on amplification of the pan-Aspergillus ITS1/5.8S ribosomal operon. In addition, clinical data were recorded and classification of IA was performed according to the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Among the 39 high-risk children, we identified 4 patients (10.3%) with probable and 2 (5.1%) with possible IA. All patients with probable IA were repeatedly positive for both tests (means of 9.5 and 6.8 positive GM and PCR samples, respectively), whereas both possible IA cases were detected by PCR. The sensitivity and specificity were, respectively, 67% and 89% for GM and 100% and 63% for PCR. Positive and negative predictive values were, respectively, 50% and 100% for GM and 27% and 100% for PCR. For the combined testing approach, both values were 100%. The number of positive samples seemed to be lower in patients undergoing antifungal therapy. Sporadically positive tests occurred in 12% (GM) and 42% (PCR) of unclassified patients. In summary, our data show that combined monitoring for GM and fungal DNA also results in a high diagnostic accuracy in pediatric patients. Future studies have to determine whether combined testing is suitable for early detection of subclinical disease and how antifungal prophylaxis impacts assay performance. PMID:27795339

  11. Complete blood count risk score and its components, including RDW, are associated with mortality in the JUPITER trial.

    Science.gov (United States)

    Horne, Benjamin D; Anderson, Jeffrey L; Muhlestein, Joseph B; Ridker, Paul M; Paynter, Nina P

    2015-04-01

    Previously, we showed that sex-specific complete blood count (CBC) risk scores strongly predicted risk of all-cause mortality in multiple sets of general medical patients. This study evaluated the CBC risk score in an independent, well-studied international primary risk population of lower-risk individuals initially free from cardiovascular (CV) disease. Observational secondary analysis of a randomized trial population. The previously derived and validated CBC score was evaluated for association with all-cause mortality among CV disease-free females (n = 6568) and males (n = 10,629) enrolled for up to 5 years in the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial. Associations of the CBC score with CV mortality and with major CV disease were also tested. The CBC score predicted all-cause mortality, with univariable hazard ratio (HR) 4.83 (95% CI 3.70-6.31) for the third CBC score tertile vs. the first tertile, and HR 2.31 (CI 1.75-3.05) for the second tertile (p trend JUPITER endpoint (p trend = 0.015). c-statistics for mortality were 0.729 among all, and 0.722 and 0.750 for females and males, respectively. The CBC risk score was strongly associated with all-cause mortality among JUPITER trial participants and had good discrimination. It also predicted CV-specific outcomes. This CBC score may be useful in identifying cardiac disease-free individuals at increased risk of mortality. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Development of a type 2 diabetes risk model from a panel of serum biomarkers from the Inter99 cohort

    DEFF Research Database (Denmark)

    Kolberg, Janice A; Jørgensen, Torben; Gerwien, Robert W

    2009-01-01

    of approximately 6,600 Danes in a nested case-control design with the primary outcome of 5-year conversion to type 2 diabetes. Nondiabetic subjects, aged >or=39 years, with BMI >or=25 kg/m(2) at baseline were selected. Baseline fasting serum samples from 160 individuals who developed type 2 diabetes and from 472......OBJECTIVE: The purpose of this study was to develop a model for assessing the 5-year risk of developing type 2 diabetes from a panel of 64 circulating candidate biomarkers. RESEARCH DESIGN AND METHODS: Subjects were selected from the Inter99 cohort, a longitudinal population-based study...... model performance was estimated using a validated bootstrap bias-correction procedure. RESULTS: A model using six biomarkers (adiponectin, C-reactive protein, ferritin, interleukin-2 receptor A, glucose, and insulin) was developed for assessing an individual's 5-year risk of developing type 2 diabetes...

  13. Evaluation of the Yale New Haven Readmission Risk Score for Pneumonia in a General Hospital Population.

    Science.gov (United States)

    Schaefer, Gabrielle; El-Kareh, Robert; Quartarolo, Jennifer; Seymann, Gregory

    2017-09-01

    The Yale New Haven Readmission Risk Score (YNHRRS) for pneumonia is a clinical prediction tool developed to assess risk for 30-day readmission. This tool was validated in a cohort of Medicare patients; generalizability to a broader patient population has not been evaluated. In addition, it lacks indicators of functional status or social support, which have been shown in other studies to be predictors of readmission. The objective of this study was to evaluate the generalizability of the YNHRRS for pneumonia in a general population of hospitalized patients, and assess the impact of incorporating measures of functional status and social support on its predictive value. This retrospective chart review comprised all patients admitted to a 563-bed academic medical center with a primary diagnosis of pneumonia between March 2014 and March 2015. Abstraction of clinical variables allowed calculation of the YNHRRS and additional indicators of functional status and social support. The primary outcome was 30-day readmission rate. We created a logistic regression model to predict readmission using the YNHRRS, functional status, and social support as covariates. Among 270 discharges with pneumonia, the observed readmission rate was 23%. The YNHRRS was a significant predictor of readmission in our multivariate model, with an odds ratio of 2.20 (95% confidence interval, 1.29-3.73) for each 10% increase in calculated risk. Indicators of functional status and social support were not significant predictors of readmission. The YNHRRS can be applied to an unselected population as a tool to predict patients with pneumonia at risk for readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. A four-year cardiovascular risk score for type 2 diabetic inpatients

    Directory of Open Access Journals (Sweden)

    Dolores Ramírez-Prado

    2015-06-01

    Full Text Available As cardiovascular risk tables currently in use were constructed using data from the general population, the cardiovascular risk of patients admitted via the hospital emergency department may be underestimated. Accordingly, we constructed a predictive model for the appearance of cardiovascular diseases in patients with type 2 diabetes admitted via the emergency department. We undertook a four-year follow-up of a cohort of 112 adult patients with type 2 diabetes admitted via the emergency department for any cause except patients admitted with acute myocardial infarction, stroke, cancer, or a palliative status. The sample was selected randomly between 2010 and 2012. The primary outcome was time to cardiovascular disease. Other variables (at baseline were gender, age, heart failure, renal failure, depression, asthma/chronic obstructive pulmonary disease, hypertension, dyslipidaemia, insulin, smoking, admission for cardiovascular causes, pills per day, walking habit, fasting blood glucose and creatinine. A cardiovascular risk table was constructed based on the score to estimate the likelihood of cardiovascular disease. Risk groups were established and the c-statistic was calculated. Over a mean follow-up of 2.31 years, 39 patients had cardiovascular disease (34.8%, 95% CI [26.0–43.6%]. Predictive factors were gender, age, hypertension, renal failure, insulin, admission due to cardiovascular reasons and walking habit. The c-statistic was 0.734 (standard error: 0.049. After validation, this study will provide a tool for the primary health care services to enable the short-term prediction of cardiovascular disease after hospital discharge in patients with type 2 diabetes admitted via the emergency department.

  15. Blood lipid genetic scores, the HMGCR gene and cancer risk: a Mendelian randomization study.

    Science.gov (United States)

    Orho-Melander, Marju; Hindy, George; Borgquist, Signe; Schulz, Christina-Alexandra; Manjer, Jonas; Melander, Olle; Stocks, Tanja

    2017-11-20

    It is unclear whether there are causal associations between blood lipids, statin use and cancer risks. Under certain assumptions, Mendelian randomization analysis of a genetic marker for an exposure eliminates reverse causation and confounding. We applied Mendelian randomization analysis to genetic scores, comprising 26-41 single-nucleotide polymorphisms (SNPs), as instrumental variables (IVs) for triglycerides and low- and high-density lipoprotein cholesterol (LDLC, HDLC), using a prospective cohort of 26 904 individuals in which there were 6607 incident cancers. We also investigated cancer risk for a SNP (rs12916) in the gene encoding hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), the targeted enzyme in statin treatment. We used logistic regression and SNP pleiotropy-adjusted analyses to estimate the odds ratio per standard deviation (OR). The OR for the triglyceride IV as a predictor of any cancer was 0.91 [95% confidence interval (CI): 0.80-1.03] unadjusted, and 0.87 (95% CI: 0.78-0.95) from the pleiotropy-adjusted analysis. For the HMGCR rs12916 per LDLC-lowering T-allele, the OR was 1.09 (95% CI: 1.01-1.18) for prostate cancer and 0.89 (95% CI: 0.82-0.96) for breast cancer. The LDLC IV was not associated with prostate cancer or breast cancer. There were no associations between IVs and cancers of the lung, colon or bladder. Under the assumptions of Mendelian randomization, there is a causal and negative association between serum triglycerides and risk of any cancer. Further, the HMGCR genetic variant might be associated with risks of prostate and breast cancers but the biological mechanisms behind these findings are unclear, as the LDLC IV was not associated with these cancers. © The Author 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

  16. Repeated measurement of the intermountain risk score enhances prognostication for mortality.

    Directory of Open Access Journals (Sweden)

    Benjamin D Horne

    Full Text Available BACKGROUND: The Intermountain Risk Score (IMRS, composed of the complete blood count (CBC and basic metabolic profile (BMP, predicts mortality and morbidity in medical and general populations. Whether longitudinal repeated measurement of IMRS is useful for prognostication is an important question for its clinical applicability. METHODS: Females (N = 5,698 and males (N = 5,437 with CBC and BMP panels measured 6 months to 2.0 years apart (mean 1.0 year had baseline and follow-up IMRS computed. Survival analysis during 4.0±2.5 years (maximum 10 years evaluated mortality (females: n = 1,255 deaths; males: n = 1,164 deaths and incident major events (myocardial infarction, heart failure [HF], and stroke. RESULTS: Both baseline and follow-up IMRS (categorized as high-risk vs. low-risk were independently associated with mortality (all p<0.001 in bivariable models. For females, follow-up IMRS had hazard ratio (HR = 5.23 (95% confidence interval [CI] = 4.11, 6.64 and baseline IMRS had HR = 3.66 (CI = 2.94, 4.55. Among males, follow-up IMRS had HR = 4.28 (CI = 3.51, 5.22 and baseline IMRS had HR = 2.32 (CI = 1.91, 2.82. IMRS components such as RDW, measured at both time points, also predicted mortality. Baseline and follow-up IMRS strongly predicted incident HF in both genders. CONCLUSIONS: Repeated measurement of IMRS at baseline and at about one year of follow-up were independently prognostic for mortality and incident HF among initially hospitalized patients. RDW and other CBC and BMP values were also predictive of outcomes. Further research should evaluate the utility of IMRS as a tool for clinical risk adjustment.

  17. Systematic Review of Metabolic Syndrome Biomarkers: A Panel for Early Detection, Management, and Risk Stratification in the West Virginian Population

    Science.gov (United States)

    Srikanthan, Krithika; Feyh, Andrew; Visweshwar, Haresh; Shapiro, Joseph I.; Sodhi, Komal

    2016-01-01

    Introduction: Metabolic syndrome represents a cluster of related metabolic abnormalities, including central obesity, hypertension, dyslipidemia, hyperglycemia, and insulin resistance, with central obesity and insulin resistance in particular recognized as causative factors. These metabolic derangements present significant risk factors for cardiovascular disease, which is commonly recognized as the primary clinical outcome, although other outcomes are possible. Metabolic syndrome is a progressive condition that encompasses a wide array of disorders with specific metabolic abnormalities presenting at different times. These abnormalities can be detected and monitored via serum biomarkers. This review will compile a list of promising biomarkers that are associated with metabolic syndrome and this panel can aid in early detection and management of metabolic syndrome in high risk populations, such as in West Virginia. Methods: A literature review was conducted using PubMed, Science Direct, and Google Scholar to search for markers related to metabolic syndrome. Biomarkers searched included adipokines (leptin, adiponectin), neuropeptides (ghrelin), pro-inflammatory cytokines (IL-6, TNF-α), anti-inflammatory cytokines (IL-10), markers of antioxidant status (OxLDL, PON-1, uric acid), and prothrombic factors (PAI-1). Results: According to the literature, the concentrations of pro-inflammatory cytokines (IL-6, TNF-α), markers of pro-oxidant status (OxLDL, uric acid), and prothrombic factors (PAI-1) were elevated in metabolic syndrome. Additionally, leptin concentrations were found to be elevated in metabolic syndrome as well, likely due to leptin resistance. In contrast, concentrations of anti-inflammatory cytokines (IL-10), ghrelin, adiponectin, and antioxidant factors (PON-1) were decreased in metabolic syndrome, and these decreases also correlated with specific disorders within the cluster. Conclusion: Based on the evidence presented within the literature, the

  18. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses.

    Directory of Open Access Journals (Sweden)

    Thijs C van Holten

    Full Text Available BACKGROUND: Cardiovascular disease is one of the major causes of death worldwide. Assessing the risk for cardiovascular disease is an important aspect in clinical decision making and setting a therapeutic strategy, and the use of serological biomarkers may improve this. Despite an overwhelming number of studies and meta-analyses on biomarkers and cardiovascular disease, there are no comprehensive studies comparing the relevance of each biomarker. We performed a systematic review of meta-analyses on levels of serological biomarkers for atherothrombosis to compare the relevance of the most commonly studied biomarkers. METHODS AND FINDINGS: Medline and Embase were screened on search terms that were related to "arterial ischemic events" and "meta-analyses". The meta-analyses were sorted by patient groups without pre-existing cardiovascular disease, with cardiovascular disease and heterogeneous groups concerning general populations, groups with and without cardiovascular disease, or miscellaneous. These were subsequently sorted by end-point for cardiovascular disease or stroke and summarized in tables. We have identified 85 relevant full text articles, with 214 meta-analyses. Markers for primary cardiovascular events include, from high to low result: C-reactive protein, fibrinogen, cholesterol, apolipoprotein B, the apolipoprotein A/apolipoprotein B ratio, high density lipoprotein, and vitamin D. Markers for secondary cardiovascular events include, from high to low result: cardiac troponins I and T, C-reactive protein, serum creatinine, and cystatin C. For primary stroke, fibrinogen and serum uric acid are strong risk markers. Limitations reside in that there is no acknowledged search strategy for prognostic studies or meta-analyses. CONCLUSIONS: For primary cardiovascular events, markers with strong predictive potential are mainly associated with lipids. For secondary cardiovascular events, markers are more associated with ischemia. Fibrinogen is a

  19. Systematic Review of Metabolic Syndrome Biomarkers: A Panel for Early Detection, Management, and Risk Stratification in the West Virginian Population.

    Science.gov (United States)

    Srikanthan, Krithika; Feyh, Andrew; Visweshwar, Haresh; Shapiro, Joseph I; Sodhi, Komal