Research progress of survival predictive score in veno-arterial extracorporeal membrane oxygenation / 中华危重病急救医学

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an extracorporeal circulation technique that provides circulatory and oxygenation support, and it is currently used in the treatment of cardiogenic shock (CS), pulmonary embolism, cardiac arrest (CA), and other diseases. However, this technology is still associated with high complications and mortality. The use of predictive scores for risk stratification before VA-ECMO will be helpful to screen the optimal benefiting population, make optimal clinical decisions, and allocate medical resources reasonably. At present, there are few reports about predictive scores for VA-ECMO. This article systematically reviewed the predictive performance of various scoring tools [the survival after venoarterial ECMO (SAVE) score, prediction of cardiogenic shock outcome for acute myocardial infarction (AMI) patients salvaged by VA-ECMO (ENCOURAGE) score, model for end-stage liver disease (MELD-Ⅺ) score, post-cardiotomy extracorporeal membrane oxygenation (PC-ECMO) score, the predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting (REMEMBER) score, predictors of mortality with VA-ECMO for acute massive pulmonary embolism, extracorporeal cardiopulmonary resuscitation (ECPR) score, the hypothermia outcome prediction after extracorporeal life support (HOPE) score] for patients receiving VA-ECMO to provide reference for clinical treatment.

A predictive score for COVID-19 diagnosis using clinical, laboratory and chest image data

Abstract Objectives Differential diagnosis of COVID-19 includes a broad range of conditions. Prioritizing containment efforts, protective personal equipment and testing can be challenging. Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission. Methods This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19. Predictive models of COVID-19 diagnosis were performed based on radiology, clinical and laboratory findings; bootstrapping was performed in order to account for overfitting. Results A total of 29% of patients tested positive for SARS-CoV-2. Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count ≤7.7 × 103 mm-3, LDH >273 U/L, and chest radiographic abnormality. A predictive score was built for COVID-19 diagnosis, with an area under ROC curve of 0.847 (95% CI 0.77-0.92), 96% sensitivity and 73.5% specificity. After bootstrapping, the corrected AUC for this model was 0.827 (95% CI 0.75-0.90). Conclusions Considering unavailability of RT-PCR at some centers, as well as its questionable early sensitivity, other tools might be used in order to identify patients who should be prioritized for testing, re-testing and admission to isolated wards. We propose a predictive score that can be easily applied in clinical practice. This score is yet to be validated in larger populations.

Clinical evaluation of preoperative pancreatic fistula scoring system in prediction of postoperative pancreatic fistula of pancreaticoduodenectomy / 中华普通外科杂志

Objective To explore the value of preoperative pancreatic fistula scoring system in prediction of the postoperative pancreatic fistula (POPF) of pancreaticoduodenectomy (PD).Methods 491 patients from Jan 2012 to Jan 2017 undergoing PD were retrospectively analyzed,in reference to independent risk factors for POPF.At the same time,the sensitivity,specificity and accuracy of National Cancer Center Hospital score system (NCCH score system) for preoperative pancreatic fistula score system were evaluated prospectively from Jan 2015 to Jan 2017.Results 90 patients were diagnosed as having POPF,including 56 in grade A,26 in grade B and 8 in grade C.The multivariate logistic regression analysis showed that the gender (male),the pancreatic texture (soft),the non-pancreatic cancer and the main pancreatic duct diameter (smaller than 3 mm) were the independent risk factor for POPF.The results of ROC curve analysis showed that the sensitivity and specificity of the NCCH predictive scoring system were 93.1％ and 76.9％,respectively.The area under the curve was 0.910 (95％ CI:0.857-0.962).Conclusions The NCCH score systems can predict the POPF accurately.

Post analysis simulated correlation of the El-Ganzouri airway difficulty score with difficult airway / Correlação simulada após análise dos escores de El-Ganzouri para via aérea difícil

ABSTRACT BACKGROUND: Difficult airway (DA) occurs frequently (5-15%) in clinical practice. The El-Ganzouri Risk Index (EGRI) has a high sensitivity for predicting a difficult intubation (DI). However difficult mask ventilation (DMV) was never included in the EGRI. Since DMV was not included in the EGRI assessment, and obstructive sleep apnea (OSA) is also correlated with DMV, a study correlating the prediction of DA and OSA (identified by STOP-Bang questionnaire, SB) seemed important. METHODS: We accessed a database previously collected for a post analysis simulation of the airway difficulty predictivity of the EGRI, associated with normal and difficult airway, particularly DMV. As secondary aim, we measured the correlation between the SB prediction system and DA, compared to the EGRI. RESULTS: A total of 2747 patients were included in the study. The proportion of patients with DI was 14.7% (95% CI 13.4-16) and the proportion of patients with DMV was 3.42% (95% CI 2.7-4.1). The incidence of DMV combined with DI was (2.3%). The optimal cutoff value of EGRI was 3. EGRI registered also an higher ability to predict DMV (AUC = 0.76 (95% CI 0.71-0.81)). Adding the SB variables in the logistic model, the AUC increases with the inclusion of "observed apnea" variable (0.83 vs. 0.81, p = 0.03). The area under the ROC curve for the patients with DI and DMV was 0.77 (95% CI 0.72-0.83). CONCLUSIONS: This study confirms that the incidence of DA is not negligible and suggests the use of the EGRI as simple bedside predictive score to improve patient safety.

RESUMO JUSTIFICATIVA: A via aérea difícil (VAD) ocorre com frequência (5-15%) na prática clínica. O Índice de Risco de El-Ganzouri (EGRI) tem uma alta sensibilidade para prever intubação difícil (ID). No entanto, a ventilação difícil via máscara (VDM) nunca foi incluída no EGRI. Como a VDM não foi incluída na avaliação EGRI e a apneia obstrutiva do sono (AOS) também está correlacionada com a VDM, um estudo que correlacionasse a previsão da VAD e AOS (identificada pelo questionário STOP-Bang, SB) pareceu importante. MÉTODOS: Acessamos um banco de dados previamente coletados para simular uma análise posterior da previsibilidade do EGRI para via aérea difícil, associado à via aérea normal e difícil, particularmente VDM. Como objetivo secundário, avaliamos a correlação entre o sistema de previsão do SB e da VAD, em comparação com o EGRI. RESULTADOS: Foram incluídos no estudo 2.747 pacientes. A proporção de pacientes com ID foi de 14,7% (IC de 95%; 13,4-16) e a proporção de pacientes com VDM foi de 3,42% (IC de 95% 2,7-4,1). A incidência da VDM combinada com a de ID foi de 2,3%. O valor de corte ideal do EGRI foi 3. EGRI também registrou uma capacidade maior de prever VDM (ASC = 0,76 (IC de 95%; 0,71-0,81)). Ao somar as variáveis do SB no modelo logístico, a ASC aumenta com a inclusão da variável "apneia observada" (0,83 vs. 0,81, p = 0,03). A área sob a curva ROC para os pacientes com ID e VDM foi de 0,77 (IC de 95%; 0,72-0,83). CONCLUSÕES: Este estudo confirma que a incidência de VAD não é desprezível e sugere o uso do EGRI como um escore de cabeceira preditivo simples para melhorar a segurança do paciente.

Clinical Analysis of Recurrent Lumbar Disc Herniation

Recurrent lumbar disc herniation after standard lumbar discectomy was the mostcommon complication among the failed back surgery syndrome. Clinical manifestations and radiologic findings were analyzed in 56 paients who were proved to have recurrent lumbar disc herniation. Comparative analysis with Lumbar Disc Surgery Predictive Score(LDSPS) between 160 patients of failed back surgery syndrome and 56 patients of recurrent disc herniation was performed. LDSPS of the recurrent disc herniation was 81.3. The interval of the reoperation after onset of symptom was considered to be one ofthe major factors in the prognosis of the recurrent disc herniation. The patient must be educated how to prevent lumbar disc herniation. When recurrency was suspected one must diagnose precisely with the help of MRI andreoperate as soon as possible.

Analysis of Operative Treatment and the Outcome of the Lumbar Disc Surgery in Lumbar Disc Herniation / 대한정형외과학회잡지

A herniated lumbar intervertebral disc has been the most common cause of low back pain and sciatica since Mixter and Barr reported it in 1934. Our methods of treatment were the conservative treatment and the excision of the herniated disc for a limited number of carefully selected cases. The results of disc surgery relate to a number of factors, unquestionably the most important being patient selectivity. We emplopyed Finneson's lumbar disc surgery predictive score card to determine the relationship between patient selection and the outcome of lumbar disc surgery in operative cases. This report is to give a clinical review of 46 cases of the herniated disc upon which surgical removal were performed at Eul-Ji General Hospital from March 1981 to July 1982. The results were obtained as follows: 1. The most common age group were 21 to 40 year old. 2. In 46 surgically treated cases, 34 cases were male (74%) and 12 cases were female (26%). 3. The bulging of disc was found in 25 cases and the ruptured disc was found in 14 cases. The most common site of the lesion was L4-5 intervertebral disc with 30 cases (65%) and the next L5-Sl intervertebral disc with 10 cases (22%). 4. The outcomes of lumbar disc surgery were evaluated at follow-up as good in 77 per cent, fair in 11 per cent, marginal in 7 per cent and poor in 5 per cent of the patients. 5. The predictive scores of each result category were averaged and were as follows; Good: 77.1, Fair: 67.3, Marginal: 58.0, Poor: 40.0 6. The average predictive scores of each result category fell within the anticipated parameters of the score card. 7. The score card may be utilized as reliable system for presurgical patient selection.