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PubMed1985

Expired PCO2 as a prognostic indicator of successful resuscitation from cardiac arrest.

We performed a study to determine if the measurement of expired PCO2 during CPR for cardiac arrest could be used as a prognostic indicator of successful resuscitation. Twelve mongrel dogs were fibrillated electrically, and external chest massage and assisted ventilation were applied for 15 minutes. Expired PCO2 and aortic and right atrial pressures were monitored each minute of arrest. Coronary perfusion pressure (CPP) was calculated by subtracting the right atrial from the aortic diastolic pressure. Half the dogs received high-force chest compression (80 lb) and half received low-force chest compression (40 lb). The six dogs that received high-force compression were resuscitated successfully. The expired PCO2 was significantly higher in the successfully resuscitated dogs (expired PCO2 = 9.6 +/- 3.2 mm Hg) when compared to those dogs that died (expired PCO2 = 3.2 +/- 1.1 mm Hg, P less than .01). Expired PCO2 was highly correlated (r = 0.91, P less than .01) with the CPPs. The measurement of expired PCO2 during attempted CPR may be useful as a noninvasive indicator of CPP and adequate technique. Further studies on the use of this technique as an assessment criterion are warranted.

Animals↗

PubMed2004

A meta-analysis of prognostic indicators to predict seizures, arrhythmias or death after tricyclic antidepressant overdose.

OBJECTIVES: To systematically review and summarize studies on the accuracy of ECG and tricyclic antidepressant (TCA) concentration as prognostic indicators of the risk of seizures, ventricular arrhythmia (VA) or death in patients with TCA overdose. METHODS: Articles were identified with MedLine and Cochrane register of controlled clinical trials searches and review of medical toxicology textbooks. Quality of the included studies was assessed. Pooled estimates of sensitivity, specificity, likelihood ratios and Summary Receiver Operating Characteristics (SROC) curves were generated. RESULTS: A total of 18 studies were included in the analysis. The pooled sensitivity (Se) and specificity (Sp) of the QRS for predicting seizures were 0.69 [95% CI 0.57-0.78] and 0.69 [95% CI 0.58-0.78] as compared to 0.75 [95% CI 0.61-0.85] and 0.72 [95% CI 0.61-0.81] for the TCA concentration. The Se and Sp of the QRS to predict VA were 0.79 [95% CI 0.58-0.91] and 0.46 [95% CI 0.35-0.59] compared to 0.78 [95% CI 0.56-0.90] and 0.57 [95% CI 0.46-0.67] for the TCA concentration. The Se and Sp of the QRS to predict death were 0.81 [95% CI 0.54-0.94] and 0.62 [95% CI 0.55-0.68] compared to 0.76 [95% CI 0.49-0.91] and 0.60 [95% CI 0.47-0.72] for the TCA concentration. Very few studies evaluated the accuracy of QTc, T 40 ms axis and the R/S ratio. CONCLUSIONS: Overall, the studies suggested that the ECG and TCA concentration have similar but relatively poor performance for predicting complications, such as seizures, VA or death, associated with TCA overdose.

Antidepressive Agents, Tricyclic↗

PubMed1990

Prognostic indicators in invasive breast cancer.

Tumor size and axillary lymph node involvement are the primary determinants of clinical course for most patients. Receptors for estrogen and progesterone are important additional prognostic factors for disease-free survival, overall survival, survival time after initial disease recurrence, and the likelihood of response to hormonal therapy. Histologic grading has merit as a prognostic factor, although poor reproducibility limits its broad application. Promising data have been emerging from the use of flow cytometry to analyze DNA content and proliferative rate. Patients with aneuploid tumors are more likely to have a shorter survival time than patients with diploid tumors. A high S-phase fraction also identifies a subset of patients at increased risk for early relapse. A combined index of ploidy and S-phase may be a more useful guide; together, diploidy and low S-phase identify a subgroup of node-negative patients at very low risk for disease recurrence. A number of oncogenes have been identified in breast cancer; amplification of the HER-2/neu gene or overexpression of the gene product may be an important prognostic indicator for node-positive patients.

Breast Neoplasms↗

PubMed1994

Comparison of double and single parameters in DNA analysis for staging and as a prognostic indicator in patients with colon and rectal carcinoma.

PURPOSE: This study was designed to determine the reliability of DNA analysis in predicting outcome of patients with colorectal carcinoma and compare the prognostic efficacy of DNA analysis using two parameters vs. a single parameter. METHODS: Two hundred forty-eight patients with colon and rectal carcinoma were entered in the study over a period of 84 months. Thirty-one percent of carcinomas were found in the rectum. A total of 23.6 percent of cancers were found in the sigmoid colon. Majority of the patients were 60 years or older. Male to female ratio was equal. The colon bearing carcinoma was sent in a fresh state after resection for flow cytometry and DNA analysis. In this study, analysis was made, comparing two parameters (aneuploidy and S-phase fraction over 20 percent) with single parameters (aneuploidy) for staging and as a prognostic indicator in patients with colon and rectal carcinoma. RESULTS: The combined presence of aneuploidy and S-phase fraction over 20 indicated a poorer prognosis in patients with colon and rectal carcinoma. The prediction of patient outcome was more accurate with DNA analysis using two parameters than using a single parameter alone (P value = 0.00003). CONCLUSION: In our analysis, the odds of survival are over 3.7 times greater for aneuploidy than aneuploidy plus S-phase fraction over 20 percent.

Aged↗

PubMed1976

Age as a prognostic indicator in carcinoma of the lung.

Selected elderly patients with squamous cell carcinoma localized to the lung should be considered for radical irradiation. Age should not be used as a negative prognostic indicator. This group of patients has a lower incidence of distant metastasis and local control may produce long-term survival. Radical irradiation is well tolerated, particularly as a split course, and serious complications are few.

Age Factors↗

PubMedDate not supplied

Survival of ruptured abdominal aortic aneurysms in the west of Ireland: do prognostic indicators of outcome exist?

Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause of significant morbidity and mortality. The aim of this study was to identify prognostic factors that influence outcome. Over 6 years, 42 ruptured abdominal aortic aneurysms were operated on with a mean diameter of 7.2 cm. RAAA was defined as free intraperitoneal rupture. Data were collected retrospectively from hospital medical records. The male: female ratio was 8:1 and the mean age was 74 years (range 55-89). Fifteen were in hypovolemic shock and 27 patients were clinically stable. The perioperative mortality rate for the 15 shocked patients was 60% (9 patients) and the 1-year cumulative survival rate was 33%. The perioperative mortality rate for the 27 clinically stable patients was 40% (11 patients) and the 1-year cumulative survival rate was 56%. Survival curves were constructed for these groups to compare male versus female, age >/= 70 versus age < 70, shocked versus stable, and preoperative hemoglobin (Hb) </= 10 vs > 10. No patient with preoperative cardiac arrest survived more than 24 hours. With VassarStats, the confidence interval for age, gender, hemodynamic status, and preoperative Hb were calculated. The standard weighted mean analysis by ANOVA gave a p value of < 0.001. The overall 30-day mortality rate was 47% (20 of 42) and the 1-year mortality rate was 52% (22 of 42). Male patients over 70 years with RAAA in hypovolemic shock with low Hb have a higher 30-day mortality rate and few survive more than 1 year. The study suggests that each of these 4 parameters separately was not a strong prognostic indicator. Collectively, however, they strongly influence the prognosis of patients with RAAA. These findings strengthen the case for selective treatment for RAAA.

Age Factors↗

PubMed1989

Serum osteocalcin and total alkaline phosphatase levels as prognostic indicators in tibial shaft fractures.

Serum samples were obtained periodically from 50 adult patients with closed tibial shaft fractures. Total alkaline phosphatase activity was measured in all cases and osteocalcin activity was measured in 14 patients. Fractures produced by high-energy violence generally had lower values of osteocalcin activity. This could be due to depressed circulating vitamin K levels throughout the healing period in the former fractures. In addition, normally uniting fractures had generally higher values of osteocalcin activity compared with fractures exhibiting delayed union. This indicates depressed osteoblastic activity in slowly healing fractures. The results suggest that measurement of osteocalcin activity after fracture could provide a useful prognostic indicator. By contrast, total serum alkaline phosphatase activity was not significantly different between the injury groups and between the healing groups.

Adolescent↗

PubMed2006

Sexual function before and after radical retropubic prostatectomy: A systematic review of prognostic indicators for a successful outcome.

OBJECTIVES: Erectile dysfunction is common after surgery for prostate cancer. Potency rates after radical retropubic prostatectomy (RRP) vary widely among different studies. Since the introduction of the nerve-sparing technique potency rates have increased. Erectile function recovery rates for selected groups of patients are high. However, studies from community practices have shown less favourable outcomes after RP. METHODS: We have performed a systematic review of the literature concerning sexual function after RRP and focused on prognostic indicators for a successful sexual outcome. RESULTS: Most important prognostic factors for the return of potency after RRP are preservation of the neurovascular bundles, age of the patient and sexual function before the operation. Neurogenic and vasculogenic factors seem to play an important role in the aetiology of the erectile dysfunction after surgery. The role of preserving the accessory pudendal artery is not certain, although some investigators found significant hemodynamic changes after sacrificing the accessory pudendal artery. Colour Doppler ultrasound studies in combination with intracavernous injection of vasoactive drugs or after PDE-5 inhibitors administration has shown to be a reliable test for vascular factors. CONCLUSIONS: After bilateral nerve-sparing RRP sexual potency is preserved in 31-86% of sexually active men with organ-confined disease. The aetiology of impotence following RRP is multifactorial, but neurogenic factors seem to play a major role. Vascular factors may be of importance in selective cases. Colour Doppler ultrasound appears to be the most reliable, non-invasive diagnostic test for erectile dysfunction after RRP in patients who do not respond to pharmacotherapy.

Erectile Dysfunction↗

PubMed1994

DNA content and the proliferation marker Ki-67 as prognostic indicators in renal cell carcinoma.

Patients suffering from renal cell carcinoma have a generally poor prognosis. Even cases that are clinically in comparable stages can, however, take quite different courses. The basic prognostic factors, histological grade and TNM stage do not do justice to the heterogeneous biological behavior of this tumor entity. In this study, the possible prognostic indicators, DNA content and proliferation rate, assessed with Ki-67, were compared with the histological grade and the TNM stage. Though there was no correlation between the proliferation rate (Ki-67) and the two, there was a significant correlation between DNA content and both histological grade and TNM stage.

Aneuploidy↗

PubMed2002

Risk factors, prognostic indicators, and outcome of pyothorax in cats: 80 cases (1986-1999).

OBJECTIVE: To identify risk factors associated with development of pyothorax in cats, assess survival rates for cats that are treated, determine prognostic indicators, and determine recurrence rates. DESIGN: Retrospective study. ANIMALS: 80 cats with pyothorax and 212 control cats. PROCEDURE: History; month of evaluation; physical examination findings; results of hematologic, serum biochemical, and retrovirus testing; radiographic findings; outcome; recurrence rate; and necropsy findings were recorded. For control cats, age, sex, breed, indoor versus outdoor status, vaccination history, and single- versus multi-cat household status were recorded. RESULTS: Cats from multi-cat households were 3.8 times as likely (95% confidence interval, 1.9 to 8.2) to develop pyothorax, compared with cats from single-cat households. Indoor or outdoor status was not a risk factor. Cats with pyothorax were significantly younger (mean, 3.83 +/- 3.43 years) than controls (mean, 5.62 +/- 5.27 years). Nonsurvivors had significantly lower heart rates than survivors. Hypersalivation was significantly more common in nonsurvivors (11/39; 26.8%) than survivors (1/39; 3%). Overall, 48.8% (39/80) of cats survived. When cats that were euthanatized without treatment were excluded from analyses, the survival rate was 66.1% (39/59). Pyothorax recurred in 1 of 17 cats for which follow-up information was obtained. CONCLUSIONS AND CLINICAL RELEVANCE: Cats with pyothorax that received treatment had a fair to good prognosis, with low recurrence rates in survivors. Hypersalivation and low heart rate were associated with worse clinical outcome. Cats with pyothorax were likely to come from multi-cat households.

Age Factors↗

PubMed2000

Prognostic indicators of post partum viability of kids born to Escherichia coli-vaccinated or unvaccinated does.

This study was undertaken to determine some blood and other physiological parameters with potential for use as prognostic indicators of viability of newborn goat kids. Of the 143 kids born during the on-farm study, 97 were crosses of Galla x Small East African (SEA) and 46 were pure SEA. The SEA x Galla kids were 46 single males, with a mean body weight at birth of 2.77 +/- 0.22 kg, 43 females with a mean body weight at birth of 2.36 +/- 0.76 kg and 5 and 3 sets of female and male twins (mean body weight at birth of 1.8 +/- 0.19 kg and 2.05 +/- 0.07 kg for the female and male kids, respectively). The SEA kids comprised 36 single male and female kids (mean body weight at birth of 2.48 +/- 0.04 kg and 10 sets of twins (both male and female) (mean body weight at birth of 1.50 +/- 0.04 kg ). Pre-suckling sera obtained on-station from kids born of does vaccinated against Escherichia coli (n = 8) and unvaccinated does (n = 7) had a total protein content of <40.0 g/l and no detectable levels of IgG and A or E. coli antibodies. Sera obtained 12 hours post partum) from kids that survived in both groups contained about 19-22 g of Ig g/l, 50-80 g total protein/l, blood glucose of >5 mmol/l and had an E. coli antibody titre of between 1/160 and 1/640. On the other hand, kids that died within 48 hours of birth (parturient deaths) and had been classified in categories 3 and 4 righting reaction had low (<40 g/l) total protein, low white blood cell count (4,000/ml) and low blood glucose concentration (<4.9 mmol/l). It is concluded that kids with delayed righting reaction (>45 minutes), low rectal temperature (<36 degrees C), low birth weights (<1.5 kg for singles and <1.0 kg for twins), low white blood cells (<4,000/ml), low (<2 mmol/l) blood glucose levels, low total protein (<40.0 g/l), low (<1:160) E. coli antibody titre and IgG (< or =3,350 mg/l) in sera obtained 12 hours after birth have a poor prognosis for survival.

Animals↗

PubMed1997

Pretreatment prognostic factors for survival in small-cell lung cancer: a new prognostic index and validation of three known prognostic indices on 341 patients.

AIMS: a) To identify which pretreatment clinical or blood parameters were predictive of patients survival in small-cell lung cancer (SCLC) in a retrospective analysis. b) To validate three known prognostic indices: Royal Marsden Model (index 1), London Group (index 2) and Manchester Score (index 3). PATIENTS AND METHODS: From 1981 to 1993, 341 SCLC patients were treated with chemotherapy with or without surgery or radiotherapy. Univariate and multiple regression analyses of survival were performed and the feasibility of these models was explored, index 1: Karnofsky index, albumin, sodium and alkaline phosphatase; index 2: ECOG performance status (PS), albumin and alanine transaminase; and index 3; lactate dehydrogenase (LDH), disease extent, sodium, Karnofsky index, alkaline phosphatase and bicarbonate. RESULTS: Significant prognostic factors for survival after univariate and multiple regression analysis were: disease extent, PS, creatine kinase, neutrophilia, LDH, hypoalbuminemia, hyperglycemia and bicarbonate. A new prognostic index was performed that included LDH, hypoalbuminemia, neutrophilia, disease extent and PS. It defined three prognostic groups (PG). Median survival and two-year survival for these PG were 12.3, 8 and 3.4 months and 16.5%, 2.3% and 0%, respectively. The following PG were identified after application of the three models proposed: Index 1 identified two PG with 0% and 16.6% two-year survival (P < 0.001); index 2 detected three PG with 0%, 5% and 15.7% two-year survival (P < 0.001) and index 3 detected three PG with 0%, 2.5% and 16.2% two-year survivals, respectively (P < 0.001). CONCLUSION: A new prognostic index is proposed allowing identification of three different PG. The feasibility of three known prognostic models was validated and demonstrated. Variables other than disease extent or PS (albumin or LDH) should be taken into account in designing future clinical trials.

Aged↗

PubMed2001

Platelet angiotensin II binding may be a useful prognostic indicator for the development of pre-eclampsia in women with pregnancy-induced hypertension: preliminary communication.

This was a preliminary investigation to assess the value of platelet angiotensin II binding as a prognostic indicator for subsequent pre-eclampsia in women admitted with non-proteinuric pregnancy-induced hypertension. Platelet angiotensin II binding was measured in 26 women at the onset of their symptoms. All were primparous, had singleton pregnancies, were normotensive at booking and had an unremarkable medical history. The blood pressure of seven women resolved and returned to normal; 11 women remained stable throughout the remainder of their pregnancy, their blood pressure remained elevated but they did not develop significant proteinuria. Eight women developed pre-eclampsia. Platelet angiotensin II binding in the pre-eclamptic group was significantly higher compared to those who remained stable (P = 0.042) or those whose condition improved (P = 0.021). We conclude that angiotensin II binding measured at the time of admission to hospital for non-proteinuric pregnancy-induced hypertension may have a role in predicting the onset of pre-eclampsia or eclampsia.

Journal Article↗

PubMed1998

Pre-operative serum level of tumour-associated trypsin inhibitor and residual tumour size as prognostic indicators in Stage III epithelial ovarian cancer.

OBJECTIVE: To evaluate the use of the pre-operative tumour-associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer. DESIGN: Retrospective cohort study. SETTING: Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland. PARTICIPANTS: Ninety-eight women with Stage III ovarian cancer. METHODS: TATI was measured by radioimmunoassay from serum samples obtained within one week before surgery. A cutoff value of 22 microg/L was used. Multivariate analysis included pre-operative TATI level, age, histologic grade and histologic type. Mantel-Cox test was used for calculating statistical significance of differences in survival between groups. MAIN OUTCOME MEASURES: Cumulative five-year survival, pre-operative serum TATI level and residual tumour size. RESULTS: Surgery was optimal (residual tumour size < or = 2 cm) in 55 patients and suboptimal (residual tumour size > 2 cm) in 43. Pre-operative TATI level < or = 22 microg/L predicted better prognosis both in patients with optimal and suboptimal surgery compared with patients with pre-operative TATI level > 22 microg/L. Patients with optimal surgery and a pre-operative TATI > 22 microg/L had a twofold relative risk of death compared with those with a pre-operative TATI < or = 22 microg/L. The cumulative survival was less than three years for patients with suboptimal surgery and pre-operative TATI > 22 microg/L. CONCLUSIONS: Pre-operative serum TATI in combination with residual tumour size may be useful in stratifying patients with Stage III ovarian cancer into different categories in randomised treatment trials.

Adult↗

PubMed1996

Extent of skin involvement as a prognostic indicator of disease free and overall survival of patients with T3 cutaneous T-cell lymphoma treated with total skin electron beam radiation therapy.

BACKGROUND: The goal of this study was to define the prognostic significance of the extent of skin involvement (ESI) with respect to disease free survival (DFS) and overall survival (OS) of patients with T3 cutaneous T-cell lymphoma (CTCL) after total skin electron beam therapy (TSEBT). METHODS: Between 1974 and 1993, TSEBT (36 Gray [Gy], 1 Gy/day for 9 weeks, 6 MeV electrons) was administered to a total of 213 patients. Forty-six of the 213 patients were classified as having T3 CTCL based on the presence of tumor nodules on the skin at diagnosis. Patient records were evaluated retrospectively, and the percentage of total skin surface involved was calculated. Patients were analyzed with respect to response to therapy, disease free and overall survival. The median follow-up was 37.5 months (range, 1.6-93 months). RESULTS: Thirty-six of 46 patients achieved complete clinical response (CCR) by the completion of TSEBT. DFS was 12% at 36 months with approximately 28% OS. When stratified by extent of skin involvement, 100% of patients with 9% or less ESI were disease free at 18 months compared with patients with 10% or greater ESI, all of whom had relapsed by 18 months (78% achieved CCR). Fifty percent of those with 9% or less ESI remained disease free at 36 months; median DFS and OS were not reached at 63 and 65 months, respectively. The median DFS and OS for the 10% or greater ESI group were 4 and 24 months, respectively. These differences were statistically significant (P < or = 0.005). Toxicity of therapy was minimal. CONCLUSIONS: The extent of skin involvement of patients with T3 CTCL is a prognostic indicator of disease free and overall survival for those who have been treated definitively with TSEBT.

Adult↗

PubMed1991

Prognostic indices for tumor relapse and tumor mortality in follicular thyroid carcinoma.

To establish an objective basis for therapeutic decisions and follow-up programs in patients with follicular thyroid cancer, the authors developed a prognostic scoring system. The prognostic impact of nine clinical, histologic, and therapeutic parameters was quantified retrospectively based on a multivariate analysis covering 149 patients. The relative relapse risk in follicular thyroid cancer (RR) was 6.8-fold increased in the presence of a moderate when compared with a high degree of histologic tumor differentiation. The RR rose with increasing age of the patient at time of tumor diagnosis by a factor of 1.8 per 20 years. The RR was reduced by a factor of 4.3 after the performance of a neck dissection and by a factor of 2.3 after percutaneous radiation therapy of the neck. The relative mortality risk in follicular thyroid cancer (RM) rose in the absence of a tumor capsule by a factor of 10, in the presence of a moderate compared with a high degree of histologic tumor differentiation by a factor of 5.9, in the presence of distant metastases by a factor of 3.2, and with increasing age of the patient at the time of tumor diagnosis by a factor of 2.2 per 20 years. From these data prognostic indices denoting the individual risk for tumor relapse (IRR index) and tumor mortality (IMR index) were calculated. The indices categorize patients into low-risk, medium-risk, or high-risk groups with regard to tumor relapse and tumor-related death. Consequently, the IRR and IMR indices contribute to select patients with follicular thyroid cancer who need an aggressive form of treatment and an intensive follow-up program. The indices may also be used for risk stratification in prospective therapy trials.

Adult↗

PubMed1989

DNA ploidy profiles as prognostic indicators in CIN lesions.

The prognostic significance of DNA ploidy measurements in cervical tissues was examined. Microphotometric measurements of 302 Feulgen-stained tissue sections (91 normal squamous epithelia, 14 condylomata, 29 cervical intraepithelial neoplasia (CIN) I, 78 CIN II, and 90 CIN III) were performed with a personal computer (PC)-based video microphotometry system. Analysis of these data shows that the DNA profile provides significant prognostic information: CINs with a polyploid DNA profile are more likely to return to normal than are those exhibiting an aneuploid pattern. Of 211 abnormal cases, 38% had polyploid DNA profiles and 62% were aneuploid. Eight-six percent of the cases that regressed were polyploid and 14% were aneuploid. Of the 130 aneuploid DNA cases, 95% remained static or progressed and only 5% regressed. Of these nonregressing aneuploid lesions, 90 remained static and 34 progressed, whereas within the nonregressing polyploid group 37 remained static and only 6 progressed. This result holds across diagnostic categories. Several other ploidy-related descriptors also showed prognostic significance (including mean ploidy, the 5N exceeding rate and 2N deviation index, and discriminant functions derived from order statistic analysis of the cumulative DNA histograms), but not to the degree or with the consistency of expression as the DNA profile categorization. These results indicate that important information about the prognosis of CIN lesions may be obtained by the DNA profile on Feulgen-stained tissue specimens. The data were acquired by a cytophotometry system of relatively modest cost consisting of readily available hardware components.

Aneuploidy↗

PubMed1991

Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation.

There are many clinical and histologic factors that are known to be valuable in predicting survival rates for patients with cutaneous malignant melanomas. Breslow thickness is considered to be the most reliable prognostic factor; however, thickness is a unidimensional measurement. A more accurate mensuration to predict biologic behavior might be one that takes into account the three-dimensional volume of the neoplasm. In a study of 35 primary malignant melanomas, the volumes of the dermal components of the tumors were calculated. Those patients with tumor volumes of 200 mm3 or less had a 91.4% 5-year disease-free survival rate, compared with survival rate of only 16.7% for those patients whose lesions had tumor volumes exceeding 200 mm3. On multivariate analysis, tumor volume exceeded thickness as a prognostic indicator. Thus, measurement of tumor volume proved to be of greater significance than thickness in predicting the outcome for patients with malignant melanomas.

Humans↗