Pretreatment multi-biomarker disease activity #score and radiographic progression in early #RA: results from the SWEFOT trial

http://ardbeta.bmj.com/content/early/2014/05/08/annrheumdis-2013-204986

In patients with eRA, the MBDA score at baseline was a strong independent predictor of 1-year RP. These results suggest that when choosing initial treatment in eRA the MBDA test may be clinically useful to identify a subgroup of patients at low risk of RP.

Henry Ford HEART #Score Randomized Trial
Rapid Discharge of Patients Evaluated for Possible Myocardial #Infarction
http://circoutcomes.ahajournals.org/content/10/10/e003617

Hospital evaluation of patients with chest pain is common and costly. The HEART score risk stratification tool that merges troponin testing into a clinical risk model for evaluation emergency department patients with possible acute myocardial infarction (AMI) has been shown to effectively identify a substantial low-risk subset of patients possibly safe for early discharge without stress testing, a strategy that could have tremendous healthcare savings implications.

Method and Results—A total of 105 patients evaluated for AMI in the emergency departments of 2 teaching hospitals in the Henry Ford Health System (Detroit and West Bloomfield, MI), between February 2014 and May 2015, with a modified HEART score ≤3 (which includes cardiac troponin I <0.04 ng/mL at 0 and 3 hours) were randomized to immediate discharge (n=53) versus management in an observation unit with stress testing (n=52). The primary end points were 30-day total charges and length of stay. Secondary end points were all-cause death, nonfatal AMI, rehospitalization for evaluation of possible AMI, and coronary revascularization at 30 days. Patients randomized to early discharge, compared with those who were admitted for observation and cardiac testing, spent less time in the hospital (median 6.3 hours versus 25.9 hours; P<0.001) with an associated reduction in median total charges of care ($2953 versus $9616; P<0.001). There were no deaths, AMIs, or coronary revascularizations in either group. One patient in each group was lost to follow-up.

Conclusions—Among patients evaluated for possible AMI in the emergency department with a modified HEART score ≤3, early discharge without stress testing as compared with transfer to an observation unit for stress testing was associated with significant reductions in length of stay and total charges, a finding that has tremendous potential national healthcare expenditure implications

A Risk #Score to Predict the Development of Hepatic #Encephalopathy in a Population-Based Cohort of Patients with Cirrhosis
http://onlinelibrary.wiley.com/doi/10.1002/hep.29628/full

Opiates, benzodiazepines, statins, and nonselective beta-blockers were taken at baseline by 24%, 13%, 17%, and 12%. Overall, 863(43.7%) developed HE within 5 years. In multivariable models, risk factors (HR, 95%CI) for HE included higher bilirubin (1.07, 1.05-1.09) and nonselective beta-blocker use (1.34, 1.09-1.64), while higher albumin (0.54, 0.48-0.59) and statin use (0.80, 0.65-0.98) were protective. Other clinical factors, including opiate and benzodiazepine use were not predictive. The AUROC for HE using the 4 significant variables in baseline and longitudinal models were 0.68 (0.66-0.70) and 0.73 (0.71-0.75), respectively. Model effects were validated and converted into a risk score. A score ≤0 in our longitudinal model assigns a 6% 1-year probability of HE while a score >20 assigns a 38% 1-year risk.

Conclusion: Patients with cirrhosis can be stratified by a simple risk-score for HE that accounts for changing clinical data. Our data also highlight a role for statins in reducing cirrhosis complications including HE

Predicting Subclinical #Atherosclerosis in Low-Risk Individuals
Ideal Cardiovascular Health #Score and Fuster-BEWAT Score
http://www.onlinejacc.org/content/70/20/2463

The ideal cardiovascular health score (ICHS) is recommended for use in primary prevention. Simpler tools not requiring laboratory tests, such as the Fuster-BEWAT (blood pressure B, exercise E, weight W, alimentation A, and tobacco T) score (FBS), are also available

With poor ICHS and FBS as references, individuals with ideal ICHS and FBS showed lower adjusted odds of having atherosclerotic plaques (ICHS odds ratio OR: 0.41; 95% confidence interval CI: 0.31 to 0.55 vs. FBS OR: 0.49; 95% CI: 0.36 to 0.66), coronary artery calcium (CACS) ≥1 (CACS OR: 0.41; 95% CI: 0.28 to 0.60 vs. CACS OR: 0.53; 95% CI: 0.38 to 0.74), higher number of affected territories (OR: 0.32; 95% CI: 0.26 to 0.41 vs. OR: 0.39; 95% CI: 0.31 to 0.50), and higher CACS level (OR: 0.40; 95% CI: 0.28 to 0.58 vs. OR: 0.52; 95% CI: 0.38 to 0.72). Similar levels of significantly discriminating accuracy were found for ICHS and FBS with respect to the presence of plaques (C-statistic: 0.694; 95% CI: 0.678 to 0.711 vs. 0.692; 95% CI: 0.676 to 0.709, respectively) and for CACS ≥1 (C-statistic: 0.782; 95% CI: 0.765 to 0.800 vs. 0.780; 95% CI: 0.762 to 0.798, respectively).

Conclusions Both scores predict the presence and extent of subclinical atherosclerosis with similar accuracy, highlighting the value of the FBS as a simpler and more affordable score for evaluating the risk of subclinical disease

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A modified acute respiratory distress syndrome prediction #score: a multicenter cohort study in China

http://jtd.amegroups.com/article/view/24591

..A total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed #ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 95% confidence interval (CI), 0.758−0.859, P<0.001. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717−0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728−0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046).
Conclusions: The MAPS based on risk factors could help the clinician to predict patients who will develop ARDS

Computer-aided National Early Warning #score to predict the risk of #sepsis following emergency medical admission to hospital: a model development and external validation study

http://www.cmaj.ca/content/191/14/E382

In hospitals in England, patients’ vital signs are monitored and summarized into the National Early Warning Score (NEWS); this score is more accurate than the Quick Sepsis-related Organ Failure Assessment (qSOFA) score at identifying patients with sepsis. We investigated the extent to which the accuracy of the NEWS is enhanced by developing and comparing 3 computer-aided NEWS (cNEWS) models (M0 = NEWS alone, M1 = M0 + age + sex, M2 = M1 + subcomponents of NEWS + diastolic blood pressure) to predict the risk of sepsis.

From the 3 cNEWS models, model M2 is the most accurate. Given that it places no additional burden of data collection on clinicians and can be automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure.

Sepsis is a major cause of mortality in hospitals. Survival is dependent on early recognition and treatment. Although each hour of delay is associated with a 7% reduction in survival,1,2 studies have found that treatment delays are not uncommon in hospitals