Prognostic models and factors identifying end-of-life in non-cancer chronic diseases: a systematic review.

BACKGROUND: Precise prognostic information, if available, is very helpful for guiding treatment decisions and resource allocation in patients with non-cancer non-communicable chronic diseases (NCDs). This study aimed to systematically review the existing evidence, examining prognostic models and factors for identifying end-of-life non-cancer NCD patients. METHODS: Electronic databases, including Medline, Embase, CINAHL, Cochrane Library, PsychINFO and other sources, were searched from the inception of these databases up until June 2023. Studies published in English with findings mentioning prognostic models or factors related to identifying end-of-life in non-cancer NCD patients were included. The quality of studies was assessed using the Quality in Prognosis Studies tool. RESULTS: The analysis included data from 41 studies, with 16 focusing on chronic obstructive pulmonary diseases (COPD), 10 on dementia, 6 on heart failure and 9 on mixed NCDs. Traditional statistical modelling was predominantly used for the identified prognostic models. Common predictors in COPD models included dyspnoea, forced expiratory volume in 1 s, functional status, exacerbation history and body mass index. Models for dementia and heart failure frequently included comorbidity, age, gender, blood tests and nutritional status. Similarly, mixed NCD models commonly included functional status, age, dyspnoea, the presence of skin pressure ulcers, oral intake and level of consciousness. The identified prognostic models exhibited varying predictive accuracy, with the majority demonstrating weak to moderate discriminatory performance (area under the curve: 0.5-0.8). Additionally, most of these models lacked independent external validation, and only a few underwent internal validation. CONCLUSION: Our review summarised the most relevant predictors for identifying end-of-life in non-cancer NCDs. However, the predictive accuracy of identified models was generally inconsistent and low, and lacked external validation. Although efforts to improve these prognostic models should continue, clinicians should recognise the possibility that disease heterogeneity may limit the utility of these models for individual prognostication; they may be more useful for population level health planning.

Glycaemic optimization for patients with cardiac disease-A before-and-after study.

AIM: To investigate if glycaemic profiles and outcomes of patients with diabetes admitted for cardiothoracic surgery or acute coronary syndrome improved after implementation of a structured glycaemia management guideline. METHODS: This is a retrospective before-and-after comparative analysis of outcomes for all consecutive cardiothoracic and acute coronary syndrome patients with diabetes (N = 375), who were admitted at our tertiary-care university-affiliated hospital during the preguideline period (July-December, 2013) and the postguideline period (July-December, 2014). RESULTS: A total of 55 cardiothoracic and 136 acute coronary syndrome patients were enrolled in the before period, and 36 cardiothoracic and 148 acute coronary syndrome patients were enrolled in the after period. In the cardiothoracic group, comparing the before vs after period, mean BGL improved (9 vs 8.4 mmol/L, P = .045), but there were no significant differences in the readmission rate (18% vs 14%; P = .6), number of hypoglycaemic episodes (1 vs 1, P = .5) or in-hospital mortality (0% vs 5.6%; P = .08). In the acute coronary syndrome group, there were no significant pre-post differences in the mean BGL (9.4 vs 10.2 mmol/L, P = .14), readmission rate (10% vs 11%; P = .8), number of hypoglycaemic episodes (1 vs 1, P = 1.0) or in-hospital mortality (5% vs 7%; P = .4). Endocrinology referrals increased significantly during the after period. CONCLUSIONS: Implementation of a structured guideline for glycaemia management on inpatient wards marginally improved glycaemic profiles in the cardiothoracic group but not in the acute coronary syndrome group.

Prevalence of and associations with excessive daytime sleepiness in an Australian older population.

The aim of this research is to estimate the prevalence of excessive daytime sleepiness in an older population and associations with sociodemographic, health, and lifestyle factors using a cross-sectional, population-based study. Participants were men (1560) and women (1759), aged 55 to 85 years, enrolled in the Hunter Community Study, a longitudinal study of aging. Measurements were self-reported questionnaires, biochemical measures, and clinical measures. Of the 3319 participants, 3053 participants completed the Epworth Sleepiness Scale questionnaire. The prevalence of excessive daytime sleepiness was 15.3% overall and this was higher in males. In adjusted multivariate analysis, gender, working full time, body mass index, high-density and low-density lipoprotein cholesterol, Center for Epidemiologic Studies-Depression scale score, and Kessler psychological distress score were associated with excessive daytime sleepiness. Given the high prevalence of excessive daytime sleepiness observed in this study, further investigation and/or interventions to reduce adverse health outcomes, especially in males is warranted.

Development of thyroid diseases in the treatment of chronic hepatitis C with alpha-interferon may be a good prognosticator in achieving a sustained virological response: a meta-analysis.

BACKGROUND AND AIM: Thyroid dysfunction is the most common endocrinopathy associated with hepatitis C and its interferon-based treatment. When undergoing treatment, interferon and ribavirin synergize to potently stimulate the immune system in order to eradicate the virus. One of the innocent bystanders in this accentuated response is the thyroid. The present study investigated whether thyroid dysfunction while undergoing combination treatment for hepatitis C is a favorable prognostic maker for a sustained virological response. METHODS: We carried out a prospective clinical audit in 201 patients treated with combination ribavirin and alpha-interferon and determined the prevalence of sustained virological response in patients in association with thyroid disease. A meta-analysis was also carried out pooling 741 patients from four previous studies on this topic. RESULTS: There was positive and significant association between thyroid disease and viral clearance. This was not supported by the meta-analysis, however, and some plausible explanations are proffered for this inconsistency. CONCLUSION: Despite lacking supportive evidence from the meta-analysis, it is important that this information is confirmed (or refuted) in future studies.