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PubMed1990

Mortality rate and prognostic indices in 2615 burned patients.

Two thousand six hundred and fifteen burned patients are analysed according to mortality rate and the results are compared with other prognostic indices. Our statistical data are similar to those reported by Feller et al. (1976), but differ from those expected by Roi et al. (1983) and Bull (1971). It is suggested that other burns centres should produce their statistical figures in the same way, thereby producing a wider statistical experience and a more accurate prognostic index. The improvement in the survival rate in our centre in the past 5 years is also discussed.

Age Factors↗

PubMed2006

Sperm deoxyribonucleic acid fragmentation as a prognostic indicator of assisted reproductive technology outcome.

OBJECTIVE: To examine sperm DNA fragmentation in semen used for assisted reproduction procedures to establish this factor's prognostic role in fertilization rate, embryo development, pregnancy rate, and outcome. DESIGN: Prospective study. SETTING: Department of Medicine and Biology of Reproduction of the Edouard Herriot Hospital in Lyon, France. PATIENT(S): 322 couples, divided into 88 cycles of in vitro fertilization (IVF) or 234 cycles of intracytoplasmic sperm injection (ICSI). INTERVENTION(S): Sperm DNA fragmentation was detected in sperm obtained 2 to 5 months before the ART procedure. MAIN OUTCOME MEASURE(S): Sperm DNA fragmentation was measured with the terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) technique. RESULT(S): There was a negative statistical correlation between the rate of fragmentation and the semen characteristics. A statistically significant negative relationship was found for sperm DNA fragmentation and fertilization when ICSI and IVF were compared. With ICSI, a statistically significant negative relationship was found between fertilization rate and percentage of sperm DNA fragmentation (DNA fragmentation index, or DFI). The risk of nontransfer due to blocked embryo development increased when the DFI exceeded 15% (18.2% for ICSI vs 4.2% for IVF) with an odds ratio of 5.05. The miscarriage risk increased fourfold when the DFI exceeded 15% (37.5% for ICSI vs 8.8% for IVF). CONCLUSION(S): Sperm DNA fragmentation measured 2 to 5 months before the assisted reproduction procedure was a prognostic indicator of the fertilization, pregnancy, and miscarriage rates and the pregnancy outcome.

Adult↗

PubMed2004

Outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma: 54 cases (1988-2002).

OBJECTIVE: To determine the outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma. DESIGN: Retrospective study. ANIMALS: 43 dogs and 11 cats. PROCEDURE: Medical records of dogs and cats with radiographic evidence of pneumoperitoneum and no history of penetrating trauma were reviewed. Information collected included signalment, previous medical problems, initial complaint, duration of illness, physical examination findings, radiographic findings, laboratory abnormalities, abdominocentesis results, bacterial culture results, concurrent diseases, hospitalization time, and outcome. Abdominal radiographs were reviewed, and radiographic severity of pneumoperitoneum was classified. For those animals that underwent exploratory laparotomy, time from admission to surgery and results of histologic examination of biopsy specimens were recorded. RESULTS: 24 (44%) animals survived and were discharged from the hospital, but none of the variables examined was associated with whether animals survived. Rupture of the gastrointestinal tract was the cause of pneumoperitoneum in 40 animals. However, cause and location of gastrointestinal tract rupture was not associated with whether animals survived. Twenty-three of 40 (58%) animals that underwent exploratory laparotomy survived, compared with only 1 of 14 animals that did not undergo surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that pneumoperitoneum in dogs and cats without any history of penetrating trauma is most commonly associated with rupture of the gastrointestinal tract and requires immediate surgical intervention. Even when appropriate treatment is instituted, the shortterm prognosis is only fair.

Animals↗

PubMed2006

Capillary refill time as an independent prognostic indicator in severe and complicated malaria.

OBJECTIVES: To improve algorithms for the identification of children at risk of dying of malaria in endemic areas. STUDY DESIGN: In a prospective study of 2446 children with severe and complicated malaria admitted to a tertiary referral center in Ghana, West Africa, 12 clinical and laboratory signs were evaluated as indicators of death. RESULTS: A prolonged (> 2 seconds) capillary refill time (pCRT) was identified as an independent prognostic indicator of death along with acidosis, coma, and respiratory distress. Among the clinical signs, pCRT increased the risk of dying from 4-fold to 11-fold when present in addition to coma and respiratory distress. CONCLUSIONS: The recognition of pCRT as an independent indicator of death justifies its inclusion as a defining criterion of severe and complicated malaria and improves the use of clinical examinations in the triage of patients with malaria. As pCRT has been shown to reflect circulatory disturbances in children, it should be included in upcoming studies as a possible sign to indicate the need for intravenous fluid administration.

Acidosis↗

PubMed1985

The zona-free hamster egg penetration assay as a prognostic indicator in a human in vitro fertilization program.

The present study was designed to test the validity of the hamster egg penetration assay as a prognostic indicator of male fertility in 54 patients undergoing in vitro fertilization. Human oocyte fertilization, cleavage, and pregnancy were compared with the results of this bioassay. Good correlation was found between hamster egg penetration and oocyte fertilization. Conversely, a definite lower limit of hamster egg penetration to define absolute male infertility could not be established because human oocyte fertilization, cleavage, and even pregnancy occurred in spite of low hamster egg penetration.

Animals↗

PubMed1998

Idiopathic dilated cardiomyopathy in children: prognostic indicators and outcome.

OBJECTIVE: To determine the outcome of Finnish children and adolescents with idiopathic dilated cardiomyopathy (IDCM) and factors that might be useful as prognostic indicators. METHODOLOGY: The clinical profile and course of 62 Finnish children and adolescents (median age, 13 months; range, 1 day to 20 years) with IDCM in 1980 to 1991 were evaluated to detect factors that might predict outcome. Factors studied included age, gender, family history, previous viral illness, and symptoms and signs at presentation. Furthermore, data on serial electrocardiographic, echocardiographic, and chest x-ray examinations, histologic findings, and treatments were analyzed. RESULTS: During a mean (+/-SD) follow-up of 3.9 +/- 4.5 years (range, 1 day to 25 years), 10 patients (16%) recovered, 17 (27%) had residual disease, 4 (6.4%) underwent heart transplantation, and 31 (50%) died. Infants (<1 year of age) and adolescent (>/=15 years of age) male patients with progressing symptoms of left ventricular failure after initiation of medical therapy tended to have the poorest outcome. However, in multivariate analysis, only histologic evidence of endocardial fibroelastosis, clinical signs of right ventricular failure at presentation, and the need for anticoagulative therapy during follow-up, the last an expression of a severely impaired left ventricular systolic function, appeared to be significant predictors of long-term outcome. CONCLUSIONS: Our study confirms that the outcome of children with IDCM still remains poor. However, a group of patients, mainly infants, make a full recovery. Adolescent male patients as well as infants suffering from endocardial fibroelastosis with persisting symptoms of congestive heart failure after initiation of medical therapy tend to have the poorest outcome. These patients need a careful follow-up at short time intervals and, in the case of lacking response to medical treatment with resulting growth failure and/or poor quality of life, should be offered urgent heart transplantation.

Adolescent↗

PubMed1982

Blood vessel invasion and axillary lymph node involvement as prognostic indicators for human breast cancer.

Blood vessel invasion and axillary lymph node involvement were examined in 175 breast cancer patients. The incidence of blood vessel invasion was 35%. The presence of blood vessel invasion was highly associated with early disease recurrence. The association of poor prognosis with blood vessel invasion was independent of clinical stage, menopausal status, node status, tumor size, or postsurgical treatment. Those patients with blood vessel invasion and two or more positive nodes were at extremely high risk for early recurrence (70% recurrence by two years compared with 15% recurrence in the remainder of the patients). Thus, blood vessel invasion is a useful indicator of early recurrence in patients with primary breast cancer and, in combination with node status, is a prognostic indicator with high discriminatory power.

Axilla↗

PubMed2000

Prognostic indicators for vision and mortality in shaken baby syndrome.

OBJECTIVE: To study ocular and nonocular signs of patients diagnosed as having "shaken baby syndrome" and determine prognostic indicators for vision and mortality. METHODS: Medical records of child abuse cases involving bilateral retinal hemorrhages were reviewed. Particular attention was paid to visual function and pupillary light reaction at the time of admission as well as the location of retinal hemorrhages, neuroimaging findings, ventilatory requirement, and associated skeletal injuries. These findings were correlated with visual prognosis and mortality. RESULTS: Thirty consecutive cases met the criteria for review. At the initial visit, mean age of the children was 9.3 months (range, 1-39 months) and 12 children (40%) had at least fix-and-follow vision. Preretinal and intraretinal hemorrhages (93% [n = 28] and 100% [n = 30]) were more common than vitreous hemorrhage (10% [n = 3]). Subdural hematomas were detected in 21 patients (70%). Twenty children (67%) had seizures and 16 (53%) required ventilatory support; bruises and long bone fractures were seen in 14 (47%) and 4 (13%) children, respectively. Eight patients died. All patients with nonreactive pupils on presentation died, while all patients with a pupillary light reaction lived (P<.001). Six (86%) of 7 patients with midline shift died, whereas 21 (91%) of 23 with no midline shift lived (P<.001). At follow-up, retinal hemorrhages had resolved in nearly all children by 4 months, and 16 children (73%) had at least fix-and-follow vision. Ventilatory requirement was associated with poorer vision (P<.01). CONCLUSIONS: Nonreactive pupils and midline shift of the brain structures correlate highly with mortality. Ventilatory requirement, but not visual acuity on presentation, predicts visual outcome.

Battered Child Syndrome↗

PubMed1998

A prospective study of Glasgow Coma Scale (GCS), age, CSF-neutrophil count, and CSF-protein and glucose levels as prognostic indicators in 100 adult patients with meningitis.

BACKGROUND: The Glasgow coma scale (GCS) is an objective measurement of a patient's level of consciousness and has prognostic implications in traumatic head injuries. Morbidity and mortality of patients with meningitis have been related amongst others to level of consciousness, hypoglycorrhachia, extremes of age, and high CSF protein values. In this prospective study of 100 patients the correlation between the GCS, age, CSF-neutrophil count and CSF-glucose and protein levels and the eventual outcome of the patients was assessed. METHODS: In 100 consecutive patients with meningitis (bacterial, viral, tuberculous, cryptococcal and other) the GCS, age, CSF-neutrophil count and CSF-protein and glucose levels were determined at admission. After treatment the outcome of the patient was assigned to one of four categories: healthy, minor and severe neurological deficits and death. RESULTS: From a non-parametric one-way analysis of variance it was found that with respect to mean GCS-values significant differences were present among the outcome categories (P < 0.0001). The outcome categories did not differ significantly with respect to age, CSF-neutrophil count or CSF-glucose level, but did differ significantly with respect to the CSF-protein level (P < 0.0025). Additionally, 88% of patients with a GCS value of > 12 had a good neurological outcome, while 88% of those with a GCS value of < or = 8 had a poor outcome. CONCLUSION: A good correlation between both the GCS and CSF-protein level at admission and the outcome of patients with meningitis was found, with the GCS value being a better prognostic indicator than high CSF protein levels.

Adolescent↗

PubMed1991

Measuring the ability of clinical pharmacists to effect drug therapy changes in a family practice clinic using prognostic indicators.

This study was designed to analyze physicians' acceptance of pharmacists' drug therapy recommendations in a Family Practice Clinic. It also measured the relationship between specific prognostic indicators and pharmacists' recommendations regarding drug therapy in individual patients. Once the recommendations were implemented, outcome data were collected to assess the impact on patient care. Thirty-nine patients were seen by a pharmacist during 49 clinic visits. A total of 36 recommendations were made to change therapy. Recommendations to change therapy occurred most frequently when one indicator, medication regimen changed four or more times during the past year, was present. Recommendations were accepted by physicians in 32 or 89% of cases. Patient outcome improved in 95% (18 of 19) of cases and remained unchanged in 5% (1 of 19) of cases for which outcome data were available.

Attitude of Health Personnel↗

PubMedDate not supplied

Peritoneal cytology and preoperative serum CA 125 level are important prognostic indicators of overall survival in advanced endometrial cancer.

BACKGROUND: The current study aimed to evaluate flow cytometry findings, peritoneal cytology and preoperative CA 125 level as prognostic factors of endometrial carcinoma. PATIENTS AND METHODS: A retrospective study of 44 patients with FIGO stage II-IV endometrial carcinoma who underwent abdominal hysterectomy, bilateral salpingo-oophorectomy and, all except three, pelvic lymph node dissection. At operation, a peritoneal washing sample was taken for cytological examination. Flow cytometry was performed on fresh primary tumor samples. Blood samples were obtained within 2 weeks before surgery. The median follow-up time was 54 months. RESULTS: In univariate analysis, DNA ploidy, S-phase fraction, serum CA 125 level and peritoneal cytological findings correlated significantly with survival. In multivariate analysis, peritoneal cytology (benign versus malignant), grade (1 + 2 versus 3) and preoperative serum CA 125 concentration (< or = 25 U/ml versus > 25 U/ml) remained significant independent predictors of overall survival. DNA ploidy and S-phase fraction had a strong correlation with peritoneal cytology. Malignant cytological findings were more frequent in cases with DNA aneuploidy and S-phase fraction higher than 8%. CONCLUSION: In addition to histological grade, peritoneal cytology and preoperative serum CA 125 level were also important independent prognostic indicators of outcome.

Adult↗

PubMed2005

Duration and severity of clinical signs as prognostic indicators in 30 dogs with thoracolumbar disk disease after surgical decompression.

The objective of this study was to evaluate the duration and severity of neurological dysfunction as prognostic indicators for the final outcome in 30 dogs with thoracolumbar intervertebral disk disease, treated surgically with hemilaminectomy without concurrent prophylactic fenestration. The lesion localization was assessed comparing plain radiographic, myelographic and surgical findings and success rates were evaluated during case follow-up. Evidence of a single disk extrusion existed in 17 dogs on survey spinal radiographs, while myelography revealed definite spinal cord compression in 28 cases and was inconclusive in the remaining two cases. Case follow-up continued for a period ranging from 3 months to 2 years post-operatively, depending on the degree of neurological dysfunction on presentation and owner compliance. The severity of clinical signs and the interval elapsing prior to decompressive surgery did not correlate with the case outcome, with 12 of 20 dogs (60%) that exhibited the most pronounced neurological dysfunction (paraplegia with or without analgesia) regaining voluntary motor function during the follow-up period. Recurrences proven to be disk-related did not occur in any dog throughout the post-surgical observation period. It was concluded that the time elapsing from loss of motor function and the severity of clinical signs is not an objective method to predict the case outcome.

Animals↗

PubMed2000

High telomerase activity is an independent prognostic indicator of poor outcome in colorectal cancer.

Telomerase activity and altered telomere length have been extensively studied in many kinds of malignant tumors for clinical diagnostic and/or prognostic utilities. In the present study, we investigated telomerase activity and telomere length in colorectal cancers and noncancerous colonic mucosa specimens in 100 patients between 1991 and 1996. To determine whether the level of telomerase activity or telomere length is a prognostic indicator of patient outcome, we followed these patients more than 3 years after surgery. Among 100 primary colorectal cancer specimens, 96 specimens had telomerase activity. Because noncancerous mucosa has some detectable telomerase activity, we divided the levels of telomerase activity into three categories: high (>50-fold more than that in noncancerous mucosa); moderate (10- to 50-fold); and low (<10-fold) levels. Among 100 cancer tissues, 28 showed moderate telomerase activity and 44 showed high telomerase activity. The frequency of tumors with moderate or high telomerase activity showed no significant relationship with any clinicopathological factors. The prognosis of the patients with high telomerase activity was significantly worse than that for patients with moderate and low telomerase activity (P < 0.01). Among the 87 patients with curative surgery, disease-free survival rate of those with high telomerase activity was also significantly poorer (P < 0.01). These results indicate that a high level of telomerase activity may be an independent prognosis-predicting factor in the patients with colorectal cancer.

Adult↗

PubMed2003

Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication.

OBJECTIVES: To assess the outcome and to identify early prognostic indicators in a global population of patients with hematologic malignancy admitted to the intensive care unit for a life-threatening complication. DESIGN: Retrospective observational study. SETTING: Medical intensive care unit at a tertiary university hospital. PATIENTS: A total of 124 consecutive critically ill patients with a hematologic malignancy admitted to the intensive care unit during a 3.5-yr period. MEASUREMENTS We collected variables at admission and during admission and identified predictors of in-hospital mortality by stepwise logistic regression analysis. MAIN RESULTS: Mean Acute Physiology and Chronic Health Evaluation II score was 26 +/- 7.7. Sixty-one percent had a high-grade malignancy, and 27% had active disease. Thirty-five percent were leukopenic (leukocyte count, <1.0 x 10(9)/L) at admission. Respiratory failure (48%), sepsis (18.5%), and neurologic impairment (17%) were the major reasons for admission at the intensive care unit. Seventy-one percent of the patients required ventilatory support for a median duration of 6 (3-17) days, 46% received vasopressors at admission, and 26.6% needed renal replacement therapy during their intensive care unit stay. A recent bacteremia precipitating intensive care unit admission was found in 21.8% of the patients. Crude intensive care unit, in-hospital, and 6-month mortality rates were 42%, 54%, and 66%, respectively. Four variables were independently associated with outcome in a multivariate logistic regression analysis: leukopenia (odds ratio, 2.9; 95% confidence interval, 1.1-7.7), vasopressors (odds ratio, 3.74; 95% confidence interval, 1.4-9.8), and urea of >0.75 g/L (>12 mmol/L) (odds ratio, 9.4; 95% confidence interval, 4.2-26) at admission were associated with poor outcome, whereas recent bacteremia (odds ratio, 0.17; 95% confidence interval, 0.05-0.58) was associated with better prognosis. Using these variables, we arbitrarily categorized our population into three groups for survival analysis: a low-risk group (low urea with or without either leukopenia or vasopressors, n = 60), an intermediate-risk group (high urea or a combination of leukopenia and vasopressors, n = 34), and a high-risk group (high urea in combination with leukopenia or vasopressors, n = 27). Patients with a bacteremia prompting intensive care unit admission were allocated to a one-step-lower risk group. Survival probabilities at 30 days and 6 months were 75% and 55% in the first group, 35% and 21% in the second group, and 4% and 0%, respectively, in the third group ( <.001). CONCLUSION: The general reluctance to admit patients with a hematologic malignancy to the intensive care unit, even with severe critical illness, is unjustified. However, we identified four early predictors of outcome that may be of value in deciding in which patients advanced or prolonged support should not be continued.

Adult↗

PubMed1988

Acute phase reactant proteins as prognostic indicators in cancer.

Raised levels of APRPs in a patients with cancer at presentation are generally an unfavourable factor for the patient's survival. The APRPs can be prognostic indicators alone but are more effective when used in combination with powerful indices such as stage and clinical performance status. The pre-treatment APRPs tend to reflect shorter term survival risks up to 18 months and are often raised during the last 6 months of life in patients with disseminated cancer, as well as acute events such as sepsis.

Acute-Phase Proteins↗

PubMed1998

Significance of circulating hepatocyte growth factor level as a prognostic indicator in primary breast cancer.

The circulating hepatocyte growth factor (HGF)/scatter factor level is frequently increased in advanced cancer patients. In this study, we have assessed the prognostic value of the circulating HGF level determined by enzymatic immunoassay in primary breast cancer patients. Of 200 primary breast cancer patients, 54 (27.0%) showed the increase of serum HGF level according to the age-matched cutoff values. The prognosis of the patients with the increased HGF level was statistically worse than that of the patients with normal HGF level (P = 0.0001, log-rank test). Multivariate analysis confirmed that the increase in HGF level was an independent prognostic indicator in primary breast cancer patients. In the background analysis, the increase in serum HGF level was significantly associated with tumor size, nodal status, and histological evidence of venous invasion. The data indicate that up-regulation of the circulating HGF level may predict systemic tumor spread and early relapse in primary breast cancer patients.

Adult↗

PubMed1991

Statistical modeling of prognostic indices for evaluation of critically ill patients.

OBJECTIVE: To identify the most predictive association of variables from the usual indices of severity of illness by statistical objective analysis. DESIGN: Logistic regression analysis of the different variables of the most important indices. SETTING: A general critical care medicine group practice in a university hospital. PATIENTS: A total of 630 critical care patients age 12 to 87 yrs were evaluated. The most important indices of severity of illness and the corresponding variables were recorded and the patient's course was followed for 3 months after ICU admission. MEASUREMENTS AND MAIN RESULTS: One of our hypotheses was that the inclusion of an excessive number of variables to obtain the most common prognostic indices of mortality in critical care patients results in an underestimation of mortality and a redundancy of prognostic information. We performed a logistic regression analysis using the variables of the currently used indices of critical care prognosis: Acute Physiology Score, Simplified Acute Physiology Score, Acute Physiology Score-II, and Mortality Prediction Model. This mathematical approach resulted in a model of five variables: organ system failure, blood glucose, serum calcium, serum prothrombin activity, and serum osmolality. The score obtained from this model gave accurate prognostic criteria:sensitivity 91.2% and specificity 90%, using a cutoff point of 0.7; sensitivity 86% and, specificity 94%, using a cutoff point of 0.5. CONCLUSIONS: Our results show that suitable statistical management of the discriminant prognostic variables allows reduction of the number of variables of the severity indices currently used, obtaining five more predictive variables.

Adolescent↗

PubMed1990

Tissue polypeptide antigen in tumor cytosol: a new prognostic indicator in primary breast cancer.

The assessment of the risk of relapse is a critical need in the management strategy of breast cancer patients. To date, the most reliable prognostic factor is axillary nodal status. Several other pathological and biological parameters are currently under evaluation. Since 1982 we have been studying the prognostic role of several tumor markers in breast cancer cytosol. Elevated cytosol concentrations of tissue polypeptide antigen (TPA) have been found to have a highly significant direct correlation with both prolonged relapse-free interval (RFI) and higher survival rate. The information provided by cytosol TPA was independent of both axillary nodal status and steroid receptor content. In patients with a low risk of relapse (no axillary metastases, estrogen and progesterone receptor positive), cytosol TPA was still a significant prognostic indicator.

Adult↗