Hospital frailty risk score predicts high-value care outcomes following brain metastasis resection.
Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices, including 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI), have recently demonstrated an important role in predicting high-value care outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients.
Adult patients with BM treated surgically at a single institution were identified (2017-2019). HFRS was calculated using ICD-10 codes, and patients were subsequently separated into low (<5), intermediate (5-15), and high (>15) HFRS cohorts. Multivariate logistic regressions were utilized to identify associations between HFRS and complications, length of stay (LOS), hospital charges, and discharge disposition. Model discrimination was assessed using receiver operating characteristic (ROC) curves.
A total of 356 patients (mean age: 61.81±11.63 years; 50.6 % female) were included. The mean±SD for HFRS, mFI-11, mFI-5, ASA, and CCI were 6.46±5.73, 1.31±1.24, 0.95±0.86, 2.94±0.48, and 8.69±2.07, respectively. On multivariate analysis, higher HFRS was significantly associated with greater complication rate (OR=1.10, p<0.001), extended LOS (OR=1.13, p<0.001), high hospital charges (OR=1.14, p<0.001), and nonroutine discharge disposition (OR=1.12, p<0.001), and comparing the ROC curves of mFI-11, mFI-5, ASA,and CCI, the predictive accuracy of HFRS was the most superior for all four outcomes assessed.
The predictive ability of HFRS on BM resection outcomes may be superior than other frailty indices, offering a new avenue for routine preoperative frailty assessment and for managing postoperative expectations.
Kazemi F
，Ahmed AK
，Roy JM
，Kuo CC
，Jimenez AE
，Rincon-Torroella J
，Jackson C
，Bettegowda C
，Weingart J
，Mukherjee D
... -
《-》
Study on the prediction model of atherosclerotic cardiovascular disease in the rural Xinjiang population based on survival analysis.
With the increase in aging and cardiovascular risk factors, the morbidity and mortality of atherosclerotic cardiovascular disease (ASCVD), represented by ischemic heart disease and stroke, continue to rise in China. For better prevention and intervention, relevant guidelines recommend using predictive models for early detection of ASCVD high-risk groups. Therefore, this study aims to establish a population ASCVD prediction model in rural areas of Xinjiang using survival analysis.
Baseline cohort data were collected from September to December 2016 and followed up till June 2022. A total of 7975 residents (4054 males and 3920 females) aged 30-74 years were included in the analysis. The data set was divided according to different genders, and the training and test sets ratio was 7:3 for different genders. A Cox regression, Lasso-Cox regression, and random survival forest (RSF) model were established in the training set. The model parameters were determined by cross-validation and parameter tuning and then verified in the training set. Traditional ASCVD prediction models (Framingham and China-PAR models) were constructed in the test set. Different models' discrimination and calibration degrees were compared to find the optimal prediction model for this population according to different genders and further analyze the risk factors of ASCVD.
After 5.79 years of follow-up, 873 ASCVD events with a cumulative incidence of 10.19% were found (7.57% in men and 14.44% in women). By comparing the discrimination and calibration degrees of each model, the RSF showed the best prediction performance in males and females (male: Area Under Curve (AUC) 0.791 (95%CI 0.767,0.813), C statistic 0.780 (95%CI 0.730,0.829), Brier Score (BS):0.060, female: AUC 0.759 (95%CI 0.734,0.783) C statistic was 0.737 (95%CI 0.702,0.771), BS:0.110). Age, systolic blood pressure (SBP), apolipoprotein B (APOB), Visceral Adiposity Index (VAI), hip circumference (HC), and plasma arteriosclerosis index (AIP) are important predictors of ASCVD in the rural population of Xinjiang.
The performance of the ASCVD prediction model based on the RSF algorithm is better than that based on Cox regression, Lasso-Cox, and the traditional ASCVD prediction model in the rural population of Xinjiang.
Qian X
，Keerman M
，Zhang X
，Guo H
，He J
，Maimaitijiang R
，Wang X
，Ma J
，Li Y
，Ma R
，Guo S
... -
《-》
Ten-year atherosclerosis cardiovascular disease (ASCVD) risk score and its components among an Iranian population: a cohort-based cross-sectional study.
Atherosclerotic cardiovascular disease (ASCVD) continues to be the first cause of mortality globally. Effective preventive strategies require focused efforts to clarify ASCVD risk factors in different subgroups of a population. This study aimed to identify individuals at higher risk of ASCVD among Shiraz University employees to guide decision-making for primary prevention.
This cohort-based cross-sectional study was conducted on data of 1191 participants (25-70 years old) from Shiraz University employees selected by systematic random sampling. The 10-year ASCVD risk was calculated with an ASCVD risk score estimator developed by the American College of Cardiology/American Heart Association (ACC/AHA). To analyze the data, descriptive and chi-square tests were used. All statistical analyses were conducted using the SPSS version 16.0 software. The p-value < 0.05 was considered a significant level.
This study demonstrated that 75.3% of the participants had low risk scores, whereas 13.2% and 2.5% of them had intermediate and high risk scores, respectively. Additionally, it revealed that among women 93.7%, 2.7%, and 0.6% had low intermediate and had high risk scores, respectively, whereas among men, 61.5%, 21.1%, and 3.9% had low intermediate and high risk scores, respectively. Based on the results of the chi-square test, men were significantly more prone to ASCVD (38.5%) than women (6.3%) were. Interestingly, 40.9% of known cases of hypertension had uncontrolled blood pressure, and 62.5% of individuals without any history of hypertension, who were considered new cases of hypertension, had abnormal blood pressure. Furthermore, 38.5% of diabetic patients and 1.6% of people who did not have a history of diabetes had abnormal serum fasting blood sugar.
It was revealed that nearly 15.7% of participants were at intermediate and high risk of developing ASCVD in the next 10 years with greater risk in men. Considerably, some of hypertensive and diabetic participants had uncontrolled blood pressure and blood sugar levels, respectively. New cases of diabetes and hypertension were also recognized in our study. Therefore, to address the primary prevention of ASCVD in this population, it is necessary to have plans for targeted interventions, which can be effective in modifying their risk factors.
Zibaeenejad F
，Mohammadi SS
，Sayadi M
，Safari F
，Zibaeenezhad MJ
... -
《-》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
