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Background: Cytoreductive surgery (CRS) is a widely acknowledged treatment approach for peritoneal metastasis, showing favorable prognosis and long-term survival. Intraoperative scoring systems quantify tumoral burden before CRS and may predict complete cytoreduction (CC). This study reviews the intraoperative scoring systems for predicting CC and optimal cytoreduction (OC) and evaluates the predictive performance of the Peritoneal Cancer Index (PCI) and Predictive Index Value (PIV). Methods: Systematic searches were conducted in Embase, MEDLINE, and Web of Science. Meta-analyses of extracted data were performed to compare the absolute predictive performances of PCI and PIV. Results: Thirty-eight studies (5834 patients) focusing on gynecological (n = 34; 89.5%), gastrointestinal (n = 2; 5.3%) malignancies, and on tumors of various origins (n = 2; 5.3%) were identified. Seventy-seven models assessing the predictive performance of scoring systems (54 for CC and 23 for OC) were identified with PCI (n = 39/77) and PIV (n = 16/77) being the most common. Twenty models (26.0%) reinterpreted previous scoring systems of which ten (13%) used a modified version of PIV (reclassification). Meta-analyses of models predicting CC based on PCI (n = 21) and PIV (n = 8) provided an AUC estimate of 0.83 (95% confidence interval [CI] 0.79–0.86; Q = 119.6, p = 0.0001; I2 = 74.1%) and 0.74 (95% CI 0.68–0.81; Q = 7.2, p = 0.41; I2 = 11.0%), respectively. Conclusions: Peritoneal Cancer Index models demonstrate an excellent estimate of CC, while PIV shows an acceptable performance. There is a need for high-quality studies to address management differences, establish standardized cutoff values, and focus on non-gynecological malignancies. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion A diabetes‐related foot ulcer (DFU) is a major risk factor for lower‐extremity amputation (LEA). To help clinicians predict the risk of LEA in people with DFU, the Diabetic Foot Risk Assessment (DIAFORA) system was developed but has never been externally validated.In this study, 317 people presenting with a new DFU were included. At baseline, participants were grouped into three groups based on their DIAFORA score: low‐risk (<15), medium‐risk (15–25), and high‐risk (>25). Participants were followed until healing, LEA, death, or at least 3 months. Discriminative accuracy was evaluated using sensitivity, specificity, likelihood ratios (LRs) and the area under the curve (AUC).All 317 participants completed at least 3 months of follow‐up for a median duration of 146 days, during which 12.6% underwent minor amputation and 2.5% major amputation. People in the low‐ and medium‐risk categories had major amputation rates of 0.9% and 2.1%, respectively, and negative LR of major LEA of 0.10 and 0.38, respectively, while the people in the high‐risk category had an amputation rate of 25.0% and a positive LR of 12.9. The DIAFORA risk groups had a sensitivity of 75.0% and a specificity of 65.7%, with a corresponding AUC of 0.78 (95% CI 0.68–0.87) for the prediction of major LEA.The DIAFORA score is a useful tool for risk stratification of people presenting with a newly occurred DFU, with the external validation presenting results similar to those presented in the original study. The DIAFORA score may guide clinicians towards more individualized DFU treatment regimens. [ABSTRACT FROM AUTHOR]

Abstract The evolution of the COVID-19 pandemic has been associated with variations in clinical presentation and severity. Similarly, prediction scores may suffer changes in their diagnostic accuracy. The aim of this study was to test the 30-day mortality predictive validity of the 4C and SEIMC scores during the sixth wave of the pandemic and to compare them with those of validation studies. This was a longitudinal retrospective observational study. COVID-19 patients who were admitted to the Emergency Department of a Spanish hospital from December 15, 2021, to January 31, 2022, were selected. A side-by-side comparison with the pivotal validation studies was subsequently performed. The main measures were 30-day mortality and the 4C and SEIMC scores. A total of 27,614 patients were considered in the study, including 22,361 from the 4C, 4,627 from the SEIMC and 626 from our hospital. The 30-day mortality rate was significantly lower than that reported in the validation studies. The AUCs were 0.931 (95% CI: 0.90–0.95) for 4C and 0.903 (95% CI: 086–0.93) for SEIMC, which were significantly greater than those obtained in the first wave. Despite the changes that have occurred during the coronavirus disease 2019 (COVID-19) pandemic, with a reduction in lethality, scorecard systems are currently still useful tools for detecting patients with poor disease risk, with better prognostic capacity.

Abstract Objective This study aims to assess the performance of various scoring systems in predicting the 28-day mortality of patients with aortic aneurysms (AA) admitted to the intensive care unit (ICU). Methods We utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) to perform a comparative analysis of various predictive systems, including the Glasgow Aneurysm Score (GAS), Simplified Acute Physiology Score (SAPS) III, SAPS II, Logical Organ Dysfunction System (LODS), Sequential Organ Failure Assessment (SOFA), Systemic Inflammatory Response Syndrome (SIRS), and The Oxford Acute Illness Severity Score (OASIS). The discrimination abilities of these systems were compared using the area under the receiver operating characteristic curve (AUROC). Additionally, a 4-knotted restricted cubic spline regression was employed to evaluate the association between the different scoring systems and the risk of 28-day mortality. Finally, we conducted a subgroup analysis focusing on patients with abdominal aortic aneurysms (AAA). Results This study enrolled 586 patients with AA (68.39% male). Among them, 26 patients (4.4%) died within 28 days. Comparative analysis revealed higher SAPS II, SAPS III, SOFA, LODS, OASIS, and SIRS scores in the deceased group, while no statistically significant difference was observed in GAS scores between the survivor and deceased groups (P = 0.148). The SAPS III system exhibited superior predictive value for the 28-day mortality rate (AUROC 0.805) compared to the LODS system (AUROC 0.771), SOFA (AUROC 0.757), SAPS II (AUROC 0.759), OASIS (AUROC 0.742), SIRS (AUROC 0.638), and GAS (AUROC 0.586) systems. The results of the univariate and multivariate logistic analyses showed that SAPS III was statistically significant for both 28-day and 1-year mortality. Subgroup analyses yielded results consistent with the overall findings. No nonlinear relationship was identified between these scoring systems and 28-day all-cause mortality (P for nonlinear > 0.05). Conclusion The SAPS III system demonstrated superior discriminatory ability for both 28-day and 1-year mortality compared to the GAS, SAPS II SIRS, SOFA, and OASIS systems among patients with AA.

Background: Scoring systems play a crucial role in dermatology by providing objective measurements of disease severity, treatment efficacy, and outcome comparisons. In autoimmune blistering diseases (AIBDs), standardized scoring systems are essential for accurate evaluations; however, there is currently a lack of consensus on scoring methods. Objective: This literature review explores scoring systems in AIBDs by tracing their development, addressing challenges, and highlighting their role in defining endpoints, regulatory considerations, and clinical trials. Materials and Methods: Existing scoring systems for AIBDs, such as the Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Pemphigus Oral Lesions Intensity Score, Oral Disease Severity Score, and Pemphigus Vulgaris Activity Score, are examined for their validity, reliability, and responsiveness. The Bullous Pemphigoid Disease Area Index for bullous pemphigoid is also discussed. The concept of minimal clinically important differences is explored to determine clinically significant improvements in disease severity. Conclusion: This review provides a comprehensive understanding of the central role of scoring systems in dermatology and their implications for research and clinical practice in AIBDs.

Objective: In this study, we investigated whether scoring systems determine COVID- 19 severity. Materials and Methods: COVID-19 patients hospitalized between 01.09.2020 and 31.04.2021 were retrospectively assessed. The National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), Quick Sequential Organ Failure Assessment Score (q-SOFA), CURB-65, MuLBSTA, and ISARIC 4C scores on admission day were calculated. Scoring systems’ ability to predict mechanical ventilation (MV) need, intensive care unit (ICU) admission, and 30-day mortality were assessed. Results: A total of 292 patients were included; 137 (46.9%) were female, and the mean age was 62.5±15.4 years. 69 (23.6%) patients required ICU admission, 45 (15.4%) needed MV, and 49 (16.8%) died within 30 days. No relationship was found between qSOFA and MV need (p=0.167), but a statistically significant relationship was found between other scoring systems and MV need, ICU admission, and 30-day mortality (p5.5) and NEWS (optimal cut-off >3.5) had the highest area under the curve in ROC curve analyses, whereas qSOFA had the lowest. Conclusion: The severity of COVID-19 could be estimated by using these scoring systems, especially ISARIC-4C and NEWS, at the first admission. Thus, mortality and morbidity would be reduced by making the necessary interventions earlier.

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p Conclusions: The significant mortality predictors were age, fall from

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Background: The aim of the current study is to evaluate the effects of inflammation markers on infection and mortality in patients over 65 years of age monitored in the intensive care unit (ICU). In this study, we attempted to determine the significance of the pan-immune–inflammation value (PIV); the neutrophil–lymphocyte ratio (NLR); the platelet–lymphocyte ratio (PLR); the monocyte–lymphocyte ratio (MLR); the systemic immune–inflammatory index (SII); the systemic immune response index (SIRI); multi-inflammatory indices (MIIs) 1, 2, and 3; and the CRP/albumin ratio (a new biomarker) as prognostic and mortality markers in patients over 65 years of age being monitored in the ICU. Methods: This multicenter, retrospective, cohort study was conducted on patients aged 65 and over who were admitted to two tertiary-level ICUs. Patients with cirrhosis, bone marrow transplantation, hematologic malignancy, steroid intake, current chemotherapy treatment, and neutropenia upon admission to the ICU were excluded from this study. Results: A total of 333 patients were included in this study. The group's 28-day mortality was found to be 31.8%. When each inflammatory marker associated with 28-day mortality was examined, the CRP/albumin ratio was found to be a better indicator than both the NLR and the SIRI, and the results were statistically significant (AUC: 0.665, 95% CI: 0.604–0.726, and p < 0.001). The NLR showed moderate discriminative ability in distinguishing mortality risk (AUC: 0.593, 95% CI: 0.526–0.660, and p = 0.006). Although the SIRI was lower than the NLR, it produced a statistically significant result (AUC: 0.580, 95% CI: 0.514–0.646, and p = 0.019). The CRP/albumin ratio was the most effective inflammatory marker in predicting mortality risk in older patients admitted to the ICU. Conclusions: It is important to monitor inflammatory markers (especially CRP/albumin ratio, NLR, SIRI, and MII 1-2-3) in older patients admitted to the ICU in order to accurately predict 28-day mortality. In the current study, the effects of PIV, MLR, PLR, and SII on the prediction of 28-day mortality in older ICU patients could not be demonstrated. We believe that more clinical studies are needed to determine the effects of PIV, MLR, PLR, and SII on short- and long-term prognoses and survival in older ICU patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Several scoring systems are used to predict prognosis in acute pancreatitis (AP), but their predictive success varies. This study compares the validity of the commonly used Bedside Index of Severity in AP (BISAP) score with the newly developed WL score and the Chinese Simple Scoring System (CSSS) score in predicting mortality and unfavorable prognostic outcomes in AP patients. METHODS: This retrospective descriptive study included all AP patients presenting to the emergency department from June 2, 2019, to June 2, 2022. Patient demographics, vital signs, laboratory values, and imaging findings were recorded, and WL, CSSS, and BISAP scores were calculated. The effectiveness of these scores in predicting adverse outcomes and mortality was compared. RESULTS: Among 357 patients, 53.2% were male, with a median age of 62 years (interquartile range: 48-75). Area under the curve (AUC) values for 7-day outcomes were 0.956 for WL, 0.759 for CSSS, and 0.871 for BISAP; for 30-day outcomes, AUC values were 0.941 for WL, 0.823 for CSSS, and 0.901 for BISAP; and for poor prognostic outcomes, AUC values were 0.792 for WL, 0.769 for CSSS, and 0.731 for BISAP. CONCLUSION: In AP patients, WL, CSSS, and BISAP scores are effective predictors of unfavorable prognosis and mortality. WL score outperforms the CSSS and BISAP scores in predicting 7-day and 30-day mortality and poor prognosis. After WL, BISAP is the second-best system for predicting mortality. For predicting unfavorable prognoses, CSSS is the second-best system after WL. The simplicity of calculating the WL score based on four laboratory parameters makes it a preferable choice. [ABSTRACT FROM AUTHOR]

Introduction: Age Estimation has been considered as a human basic right, carried out through the use of tables for dental age assessment based on the chronology of tooth eruption. As such, the final aim of this investigation is to create tables with applicability to the Portuguese population, for the different scoring systems used and combined different statistical approaches. Materials and methods: For this purpose, dental age assessment was achieved in all four third molars, using different scoring systems, in a total sample of 626 orthopantomograms (324 females, 302 males), aged between 12 and 25 years old, from the database population of Lisbon North University Hospital Center, approved by the Ethic Committee. Results: The values of validation showed excellent results both on precision and on reproducibility. Mostly all methods showed statistically significant differences between the estimated age and the chronological age and, therefore, the presence of estimation errors. Kullman's and Mincer's methods are the ones with best applicability in the Portuguese population, in the lower third molars. The reliability measures (sensitivity, specificity and accuracy) values decrease as age increases. Conclusion: A combination of the scoring systems as a protocol for dental age assessment in Portuguese nationality was established. Tables, for all the scoring systems used, were made with applicability in the Portuguese population. [ABSTRACT FROM AUTHOR]

Objective: Numerous scoring systems have been developed to assess the risk associated with upper gastrointestinal bleeding (UGIB), and several studies have investigated their comparative accuracy in predicting patient outcomes. This study was undertaken to compare four well-known scoring systems, namely the pre-endoscopy Rockall score, full Rockall score, Glasgow-Blatchford Bleeding score (GBS), and AIMS65, with the aimof predicting five distinct outcomes in cases of non-variceal UGIB. Methods: This prospective observational study was conducted focusing on adult patients with UGIB presenting to the emergency department (ED). The primary endpoints of this study included in-hospital mortality, the need for re-endoscopy, the requirements for packed red blood cell (PRBC) transfusion, massive transfusion, and one-month rebleeding. Results: A total number of 320 patients were enrolled, with 44 (13.75%) in-hospital deaths. Based on the area under the curves (AUC), while certain scores outperformed others in specific outcome prediction, the AIMS65 scoring system demonstrated superior predictive capability for both in-hospital mortality (0.91) and massive transfusion (0.71). Regarding PRBC transfusion requirements, both AIMS65 and GBS exhibited similar predictive capacities (AUC=0.67 and 0.68, respectively). In terms of re-endoscopy and one-month rebleeding, the GBS scoring system displayed slightly better performance compared to the other systems (AUC=0.61 and 0.63, respectively). In the composite outcome, all scores had significant associations, and among them, the AIMS-65 score had the highest AUC (0.76). Conclusion: The AIMS65 scoring system was the most reliable tool for predicting in-hospital mortality and, to a lesser extent, massive transfusion requirements, while GBS and AIMS65 could be moderately and cautiously relied on for preparations regarding the need for PRBC transfusion. [ABSTRACT FROM AUTHOR]

Objective: In this study, we investigated whether scoring systems determine coronavirus disease-2019 (COVID-19) severity. Materials and Methods: COVID-19 patients hospitalized between 01.09.2020 and 31.04.2021 were retrospectively assessed. The national early warning score (NEWS), modified early warning score, rapid emergency medicine score, quick sequential organ failure assessment score (q-SOFA), CURB-65, MuLBSTA, and ISARIC-4C scores on admission day were calculated. Scoring systems' ability to predict mechanical ventilation (MV) need, intensive care unit (ICU) admission, and 30-day mortality were assessed. Results: A total of 292 patients were included; 137 (46.9%) were female, and the mean age was 62.5±15.4 years. 69 (23.6%) patients required ICU admission, 45 (15.4%) needed MV, and 49 (16.8%) died within 30 days. No relationship was found between q-SOFA and MV need (p=0.167), but a statistically significant relationship was found between other scoring systems and MV need, ICU admission, and 30-day mortality (p<0.05). ISARIC-4C (optimal cut-off >5.5) and NEWS (optimal cut-off >3.5) had the highest area under the curve in receiver operating characteristic curve analyses, whereas q-SOFA had the lowest. Conclusion: The severity of COVID-19 could be estimated by using these scoring systems, especially ISARIC-4C and NEWS, at the first admission. Thus, mortality and morbidity would be reduced by making the necessary interventions earlier. [ABSTRACT FROM AUTHOR]

Objective: To assess inter-observer reliability and reproducibility of CROES, Guy’s and S.T.O.N.E. nephrolithometry scoring systems (NSS). Material and Methods: A total of 128 patients who underwent percutaneous nephrolithotomy (PNL) between January 2019 and January 2021 were included in the study. Calculation of the CROES, S.T.O.N.E, and Guy’s NSSs was made by three independent urologists with different academic levels. These were; a very experienced (>500 PCNL cases) endourologist (Rater 1), a urologist who had just finished (>100 PCNL cases) their urology education (Rater 2) and a 3rd year urology resident who had never performed a PCNL operation (Rater 3). All were blinded to the procedure outcomes. Results: An excellent correlation was found between three raters for Guy and S.T.O.N.E. scoring systems (kappa value 0.810-0.962). However, for the CROES score there is an excellent correlation between Rater 1 and Rater 2, but there were good correlations between Rater 1 vs Rater 3 and Rater 2 vs Rater 3 (kappa values 0.910 and 0.698-0.721 respectively). The highest correlation was between Rater 1 and Rater 2 for Guy score (kappa value 0.962) (Table 3). All intra-class correlations were statistically significant (p<0.001). The highest intra-class correlations were seen for the S.T.O.N.E. score (ICC: 0.980). Conclusion: The present study revealed that all three NSS frequently used in current urology practice have reproducible and reliable results. Additionally, we believe that the application of CROES NSS by more experienced clinicians will be effective in obtaining clearer results. [ABSTRACT FROM AUTHOR]

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p Conclusions: The significant mortality predictors were age, fall from

Background: Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods: This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results: A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and probability of survival scores. Factors independently predictive of mortality were increasing age (OR 1.06, p Conclusions: The significant mortality predictors were age, fall from

Purpose: To determine the role of different scoring systems in predicting mortality and morbidity risk of preterms who are younger than 32 weeks and/or have a birth weight of less than 1500 g. Material and Methods: Preterm infants with a gestational age (GA) of less than 32 weeks and/or a birth weight (BW) of less than 1500 grams, who were admitted to the neonatal intensive care unit (NICU) between June 2014 and June 2016, were included in this study. The SNAP-PE-II and CRIB scores in the first 12 hours of life and the NTISS scores at 24, 48, and 72 hours of life were calculated for all newborns. Mortality rate, length of hospital stay, and morbidities were prospectively recorded. The patients were divided into two groups as survivors (Group 1) and non-survivors (Group 2). The data obtained were then statistically compared between the two groups. Results: A total of 120 preterm infants constituted the study group. There were significant differences between the groups with respect to all studied risk scores (p<0.001). All scores showed satisfactory discrimination and calibration abilities for mortality. As for the morbidities, all of the scores were found to be higher in patients with morbidities than those without, but the situation changed when the ROC analyses were performed and sensitivity and specificity values were calculated. Conclusion: This is one of the few studies that evaluated the relationship between the scoring systems used to predict mortality risk and common morbidities in extremely preterm patients. [ABSTRACT FROM AUTHOR]

Background: Vibrio is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. Vibrio bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. V. vulnificus had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of Vibrio bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of Vibrio bacteremia. Methods: Cases of Vibrio bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk. Results: This study enrolled 36 patients diagnosed with Vibrio bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in V. vulnificus (6/19) and 17.6% in V. non-vulnificus (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) (p = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 (p = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively. Conclusion: The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with Vibrio bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for Vibrio bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates. [ABSTRACT FROM AUTHOR]

Introduction: Alcoholic hepatitis is a major health problem which carries a high mortality despite treatment. Predicting severity of disease is of utmost importance to avoid overzealous and unnecessary treatment with steroids in each and every case. Maddrey’s discriminant function (DF) may not always be reliable in predicting such prognosis. Aim of the Study: To observe the predictive ability of Glasgow alcoholic hepatitis score (GAHS), age, bilirubin, international normalized ratio (INR) and creatinine (ABIC) score, model for end stage liver disease (MELD) score, and Lille’s score in determining the prognosis in severe alcoholic hepatitis. Materials and Methods: Patients of severe alcoholic hepatitis were enrolled in this study as per inclusion and exclusion criteria and a DF score of >32. Once the decision to initiate corticosteroids was made, DF scores, MELD scores, GAHS scores, and ABIC scores were calculated on the day on initiation of therapy. On day 7, patients were re‑assessed and Lille score was calculated in addition. Follow‑up was obtained on repeat out‑patient visit or telephonically after every 2 weeks till 90 days or till mortality, whichever occurred first. Statistical Analysis: The scores were compared among the survival and mortality groups to see association between mortality and severity of scores using Chi‑square test of significance. Cut‑offs providing a composite of best sensitivity, specificity, negative predictive value, and positive predictive value were derived on the basis of data of our study. P value of ≤ 0.05 was taken as a cut‑off for significance. Results: Our study comprised 30 patients with severe alcoholic hepatitis. At the end of 90‑day follow‑up, 23 patients survived with 7 (23%) mortalities because of liver failure and sepsis. On day 7, barring the ABIC score (0.713), the areas under curve of all scores were above 0.8 and were hence of comparable efficacy. Lille score performed the best at assessing treatment response but had the limitation of not being applicable at day 1. Conclusion: Severe alcoholic hepatitis carries a bad prognosis. Cut‑offs of DF and MELD need to be raised, whereas they need to be lowered in the case of GAHS, ABIC, and Lille score to improve the predictive value of score. Steroid‑treated patients should be evaluated preferably with Lille score for a better prediction of survival. [ABSTRACT FROM AUTHOR]

Cardiac surgery presents many challenges for the anaesthetist and intensivist. These multi-comorbid patients have restricted cardiovascular reserve and require careful preoperative assessment to prepare them for the surgical challenges lying ahead. Shared decision-making is paramount and is best performed using recognized scoring systems and comprehensive investigations. [ABSTRACT FROM AUTHOR]

The verdict of the UK Supreme Court in the case of Bellman versus Boojum-Snark Integrated Care Trust (2027) will have profound implications for medical practice, medical education, and medical research, as well as the regulation of medicine and allied healthcare fields. Major changes will result from the definition of person-centred care built into the expanded definition of informed and preference-based consent central to the judgment made in favour of Bellman’s negligence claim. (For the avoidance of doubt this is a vision paper.). [ABSTRACT FROM AUTHOR]

OBJECTIVES: Several scoring systems are used to predict prognosis in acute pancreatitis (AP), but their predictive success varies. This study compares the validity of the commonly used Bedside Index of Severity in AP (BISAP) score with the newly developed WL score and the Chinese Simple Scoring System (CSSS) score in predicting mortality and unfavorable prognostic outcomes in AP patients. METHODS: This retrospective descriptive study included all AP patients presenting to the emergency department from June 2, 2019, to June 2, 2022. Patient demographics, vital signs, laboratory values, and imaging findings were recorded, and WL, CSSS, and BISAP scores were calculated. The effectiveness of these scores in predicting adverse outcomes and mortality was compared. RESULTS: Among 357 patients, 53.2% were male, with a median age of 62 years (interquartile range: 48–75). Area under the curve (AUC) values for 7-day outcomes were 0.956 for WL, 0.759 for CSSS, and 0.871 for BISAP; for 30-day outcomes, AUC values were 0.941 for WL, 0.823 for CSSS, and 0.901 for BISAP; and for poor prognostic outcomes, AUC values were 0.792 for WL, 0.769 for CSSS, and 0.731 for BISAP. CONCLUSION: In AP patients, WL, CSSS, and BISAP scores are effective predictors of unfavorable prognosis and mortality. WL score outperforms the CSSS and BISAP scores in predicting 7-day and 30-day mortality and poor prognosis. After WL, BISAP is the second-best system for predicting mortality. For predicting unfavorable prognoses, CSSS is the second-best system after WL. The simplicity of calculating the WL score based on four laboratory parameters makes it a preferable choice.

BackgroundThe global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease’s severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality.MethodsIn this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk.ResultsThe cohort’s median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively.ConclusionThe study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

Background Acute appendicitis is a typical surgical emergency requiring prompt and accurate diagnosis for timely intervention. This prospective observational comparative study aims to assess the diagnostic efficacy of two scoring systems, the Yash scoring system and the Fenyo-Lindberg scoring system, compared to the gold standard of histopathological diagnosis. The study is conducted at A.V.B.R.H., a tertiary care hospital in Central India, focusing on providing valuable insights into the comparative performance of these scoring systems in the local patient population. Methods The study adopts a prospective observational comparative design, enrolling clinically diagnosed cases of acute appendicitis from the outpatient and inpatient departments of the Surgery department at A.V.B.R.H. Patients willing to undergo surgery are included. At the same time, those with complicating factors or contraindications are excluded. Data collection involves thorough clinical evaluations, scoring system assessments, and comprehensive investigations, with histopathology as the reference standard. Statistical analyses include descriptive statistics, comparative analyses, primary outcome assessments, and regression analyses, ensuring a robust evaluation of the diagnostic efficacy of the scoring systems. Expected Outcome Anticipated outcomes include a comprehensive understanding of the diagnostic efficacy of the Yash and Fenyo-Lindberg scoring systems in acute appendicitis. The study aims to identify which scoring system demonstrates superior accuracy, sensitivity, and specificity, providing valuable information for clinical decision-making. The results will contribute to optimizing diagnostic protocols for acute appendicitis, potentially influencing patient management and surgical interventions. This study’s findings are expected to be relevant to the local setting and broader contexts, enhancing the knowledge surrounding acute appendicitis diagnosis.

Objective To evaluate five types of DIC scoring systems based on sepsis patients, to explore the values of different DIC scoring systems in the occurrence and prognosis of DIC in sepsis patients, and to compare the applicability of different DIC scoring systems for sepsis complicated with DIC. Methods Laboratory indexes and clinical data from sepsis patients who had been hospitalized in Gansu Provincial People's Hospital from December 1, 2019 to December 31, 2021 were retrospectively analyzed within 24 hours. Five types of DIC scoring systems were used to score, and the difference of diagnostic rate and discharge outcome in sepsis patients with different severity was compared. The ROC curves of five DIC scoring systems were established to evaluate the accuracy of DIC in sepsis patients. Results The fatality rate of sepsis increased with the severity of sepsis (P < 0.05). There were statistically significant differences in discharge outcomes between DIC and non-DIC in the five scoring systems (P < 0.05). JMHW, CDSS and part of ISTH were detected in JAAM cases, while ISTH was detected in non-dominant ISTH cases. ISTH, JAAM, JMHW, CDSS, and non-dominant ISTH5 scoring systems were used to diagnose DIC, and absence of full health restoration and death were 3.0, 3.8, 4.2, 3.9, and 3.0 times higher than non-DIC cases, respectively. Conclusion JAAM scoring system has higher diagnostic rate and sensitivity for adult sepsis. CDSS and JMHW scoring systems are more accurate in predicting the prognosis of sepsis patients. [ABSTRACT FROM AUTHOR]

Background: Aeromonas species, Gram-negative, non-sporulating, facultative, and anaerobic bacilli, widely distributed in aquatic environments, derive various infections, including bacteremia. Most of these infections were opportunistic and found in patients with predisposing conditions. Among the infections, bacteremia remains with notable mortality, reported from 15% to 45%. However, predicting systems for assessing the mortality risk of this disease have yet to be investigated. We aimed to validate the performance of specific predictive scoring systems to assess the clinical outcomes of Aeromonas bacteremia and applied the revised systems to predict mortality risk. Methods: A retrospective observational study reviewed patients with bacteremia caused by Aeromonas spp. based on at least one positive blood culture sample collected in the emergency department from January 2012 to December 2020. The outcome was in-hospital mortality. We used seven predictive scoring systems to predict the clinical outcome. According to the effectiveness in predicting mortality, we revised three of the seven predictive scoring systems by specific characteristics to refine their risk-predicting performances. Results: We enrolled 165 patients with bacteremia caused by Aeromonas spp., including 121 males (73.3%) and 44 females (26.7%), with a mean age of 66.1 ± 14.9 years and an average length of hospital stay of 12.4 ± 10.9 days. The overall mortality rate was 32.7% (54/165). The non-survivors had significantly higher scores in MEDS (6.7 ± 4.2 vs. 12.2 ± 3.3, p < 0.001), NEWS (4.0 ± 2.8 vs. 5.3 ± 3.0, p = 0.008), and qSOFA (0.3 ± 0.6 vs. 0.6 ± 0.7, p = 0.007). Regarding mortality risk prediction, the MEDS demonstrated the best predictive power with AUC of ROC measured up to 0.834, followed by NEWS (0.626) and qSOFA (0.608). We revised the MEDS, NEWS, and qSOFA by hemoglobin and lactate. We found that the revised scores had better powerful performance, including 0.859, 0.767, and 0.691 of the AUC of ROC, if the revised MEDS ≥10, revised NEWS ≥8, and revised qSOFA ≥2, respectively. Conclusions: MEDS, NEWS, and qSOFA were good tools for predicting outcomes in patients with Aeromonas spp. bacteremia. The revised MEDS, NEWS, and qSOFA demonstrated more powerful predicting performance than the original scoring systems. We suggested that patients with higher scores in revised MEDS (≥10), revised NEWS (≥8), and revised qSOFA (≥2) received early goal-directed therapy and appropriate broad-spectrum antibiotic treatment as early as possible to reduce mortality. [ABSTRACT FROM AUTHOR]

The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status of the joint at a given time, especially in anatomically deep joints for which clinical assessment is limited. Magnetic resonance imaging (MRI) is of utmost importance for assessment of deep joints and extra-articular soft tissue of the entire body for which ultrasound may be suboptimal. Because the distinction between pathologic and physiologic joint changes on MRI is key for proper diagnosis and treatment of patients with arthropathies, a comprehensive standardized approach is needed to effectively measure outcomes of growing joints of children with JIA. Such an approach is essential for both clinical assessment and to conduct clinical trials in patients with JIA treated in different centers around the world. To meet this need, several international imaging collaborative research groups have been developing MRI scales over the past years, including the MRI in JIA (JAMRI) special interest group within the Outcome Measures in Rheumatology (OMERACT) research network. This manuscript reviews the efforts of the OMERACT JAMRI working group to generate and validate pediatric MRI scoring systems for different joints in children with JIA that can have ubiquitous utilization anywhere in the world. In particular, it describes the different steps of development and validation of an MRI scale using the TMJ as a model. [ABSTRACT FROM AUTHOR]

Crohn's disease is a chronic inflammatory bowel disease. Endoscopic methods are the gold standard for assessing the severity and extent of disease involvement. Their main disadvantage is the invasive nature of the examination. Therefore, non-invasive radiological methods such as magnetic resonance imaging and ultrasonography are used as part of regular follow-up. Their another advantage over colonoscopy is a higher yield in the evaluation of disease complications and other comorbidities. The disadvantage of imaging methods is a certain degree of subjectivity burdening the evaluation and, of course, the need for experience. Currently, there are a number of MR scoring systems that aim to provide the most objective assessment of bowel involvement. The yield of these systems has been demonstrated in a number of studies, and although they are not currently used in clinical practice, they could become a useful tool in the future when the findings are unclear or when assessing the effect of treatment. [ABSTRACT FROM AUTHOR]

Objectives: Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis. Methods: A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis. Results: The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%. Conclusions: The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions. [ABSTRACT FROM AUTHOR]

Background: Recognizing and determining severe trauma is essential for choosing the appropriate treatment strategy. Objectives: The aim of this study was to find the predictive value of the quick sequential organ failure assessment (qSOFA) score for in-hospital mortality in adult trauma patients. Methods: This prospective observational study was conducted on adult patients with multiple trauma presenting to the emergency department. The qSOFA score was calculated according to the initially recorded variables. The primary outcome was in-hospital mortality. The predictive value of qSOFA was evaluated using the Area Under Receiver Operating Characteristic (AUC) analysis. Results: Finally, 775 multiple trauma patients with a mean age of 38.68±18.74 were admitted. Of these, 34 people (4.39%) died and 741 subjects were discharged from hospital. The mean qSOFA score was 0.41±0.64, significantly higher in the survived patients than in the non-survived patients (P < 0.001). The AUC of qSOFA score to predict in-hospital mortality was 0.878 (95% confidence interval: 0.853-0.900); thus, qSOFA was a good predictor of in-hospital mortality in multiple trauma patients. Conclusion: The qSOFA score can be considered a simple and rapid screening tool for identifying multiple-trauma patients.

Abstract Background This study aimed to construct predictive models for the risk of sepsis in patients with Acute pancreatitis (AP) using machine learning methods and compared optimal one with the logistic regression (LR) model and scoring systems. Methods In this retrospective cohort study, data were collected from the Medical Information Mart for Intensive Care III (MIMIC III) database between 2001 and 2012 and the MIMIC IV database between 2008 and 2019. Patients were randomly divided into training and test sets (8:2). The least absolute shrinkage and selection operator (LASSO) regression plus 5-fold cross-validation were used to screen and confirm the predictive factors. Based on the selected predictive factors, 6 machine learning models were constructed, including support vector machine (SVM), K-nearest neighbour (KNN), multi-layer perceptron (MLP), LR, gradient boosting decision tree (GBDT) and adaptive enhancement algorithm (AdaBoost). The models and scoring systems were evaluated and compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the curve (AUC). Results A total of 1, 672 patients were eligible for participation. In the training set, 261 AP patients (19.51%) were diagnosed with sepsis. The predictive factors for the risk of sepsis in AP patients included age, insurance, vasopressors, mechanical ventilation, Glasgow Coma Scale (GCS), heart rate, respiratory rate, temperature, SpO2, platelet, red blood cell distribution width (RDW), International Normalized Ratio (INR), and blood urea nitrogen (BUN). The AUC of the GBDT model for sepsis prediction in the AP patients in the testing set was 0.985. The GBDT model showed better performance in sepsis prediction than the LR, systemic inflammatory response syndrome (SIRS) score, bedside index for severity in acute pancreatitis (BISAP) score, sequential organ failure assessment (SOFA) score, quick-SOFA (qSOFA), and simplified acute physiology score II (SAPS II). Conclusion The present findings suggest that compared to the classical LR model and SOFA, qSOFA, SAPS II, SIRS, and BISAP scores, the machine learning model-GBDT model had a better performance in predicting sepsis in the AP patients, which is a useful tool for early identification of high-risk patients and timely clinical interventions.

Introduction: Alcoholic hepatitis is a major health problem which carries a high mortality despite treatment. Predicting severity of disease is of utmost importance to avoid overzealous and unnecessary treatment with steroids in each and every case. Maddrey’s discriminant function (DF) may not always be reliable in predicting such prognosis. Aim of the Study: To observe the predictive ability of Glasgow alcoholic hepatitis score (GAHS), age, bilirubin, international normalized ratio (INR) and creatinine (ABIC) score, model for end stage liver disease (MELD) score, and Lille’s score in determining the prognosis in severe alcoholic hepatitis. Materials and Methods: Patients of severe alcoholic hepatitis were enrolled in this study as per inclusion and exclusion criteria and a DF score of >32. Once the decision to initiate corticosteroids was made, DF scores, MELD scores, GAHS scores, and ABIC scores were calculated on the day on initiation of therapy. On day 7, patients were re-assessed and Lille score was calculated in addition. Follow-up was obtained on repeat out-patient visit or telephonically after every 2 weeks till 90 days or till mortality, whichever occurred first. Statistical Analysis: The scores were compared among the survival and mortality groups to see association between mortality and severity of scores using Chi-square test of significance. Cut-offs providing a composite of best sensitivity, specificity, negative predictive value, and positive predictive value were derived on the basis of data of our study. P value of ≤ 0.05 was taken as a cut-off for significance. Results: Our study comprised 30 patients with severe alcoholic hepatitis. At the end of 90-day follow-up, 23 patients survived with 7 (23%) mortalities because of liver failure and sepsis. On day 7, barring the ABIC score (0.713), the areas under curve of all scores were above 0.8 and were hence of comparable efficacy. Lille score performed the best at assessing treatment response but had the limitation of not being applicable at day 1. Conclusion: Severe alcoholic hepatitis carries a bad prognosis. Cut-offs of DF and MELD need to be raised, whereas they need to be lowered in the case of GAHS, ABIC, and Lille score to improve the predictive value of score. Steroid-treated patients should be evaluated preferably with Lille score for a better prediction of survival.

Abstract Background To evaluate the discriminatory ability of imaging modalities' scoring systems in the prediction of COVID‐19 adverse outcomes like ICU admission, ventilatory support, or mortality. Methods We searched PUBMED, EBSCO, WEB OF SCIENCE, and SCOPUS. Two authors independently screened the resulting papers for fulfillment criteria. Meta‐DiSc version 1.4, RevMan version 5.4, and MedCalc version 19.1 were used for test accuracy analysis, sensitivity and specificity analysis, and pooling Area under the curve for discriminatory assessment, respectively. Results Regarding mortality prediction, the computed tomography (CT) showed significantly higher sensitivity [80%; 95% CI 0.74–0.85] and positive likelihood ratio (PLR) [4.41 95% CI 2.94–6.61] relative to the Lung Ultrasound Score (LUS) approach, while the LUS approached the CT scan with specificity of 81% [95% CI 0.78–0.83] and negative likelihood ratio (NLR) of [0.32; 95% CI 0.16–0.64]. The pooled area under ROC for LUS was [AUC = 0.777, 95% CI 0.701–0.852; p

Objective: In this study, the adequacy of the Quick COVID Severity Index (qCSI) and CURB-65 scoring systems in predicting the prognosis and need for intensive care in patients who were admitted to the emergency room and hospitalized due to Coronavirus Disease 2019 (COVID-19) were examined. Methods: The files of all adult patients over the age of 18 years who were hospitalized with the diagnosis of COVID-19 between January 1 and June 1, 2021 were reviewed retrospectively. Patients with negative reverse transcriptase-polymerase chain reaction test results, patients transferred from another hospital, and patients whose data to be used in the two risk scores could not be reached were excluded from the study. Results: A total of 325 people were included in the study, with an average age of 58.2±17.2%, 48.3% male and 51.7% female. As a result of the ROC analysis of the CURB-65 score in estimating the need for hospitalization in the intensive care unit (ICU), the area under the curve (AUC) was found to be 0.843 (95% confidence interval [CI]: 0.799-0.881), and the Youden index was 0.584, p value was 0.001. As a result of the ROC analysis of the qCSI score in estimating the need for ICU hospitalization, the AUC was found to be 0.921 (95% CI: 0.886-0.948), and the Youden's index was 0.7520, p value was 0.001. When the value of the two scores in predicting the need for ICU admission was compared, it was found that the qCSI score was more successful than the CURB-65 score. Conclusion: In this study, the predictive powers of qCSI and CURB-65 scores in predicting the ICU requirement of COVID-19 patients admitted to the emergency department were compared. It was concluded that the qCSI score was superior to CURB-65. [ABSTRACT FROM AUTHOR]

Cryptococcal infection is usually diagnosed in immunocompromised individuals and those with meningeal involvement, accounting for most cryptococcosis. Cryptococcemia indicates a poor prognosis and prolongs the course of treatment. We use the scoring systems to predict the mortality risk of cryptococcal fungemia. This was a single hospital-based retrospective study on patients diagnosed with cryptococcal fungemia confirmed by at least one blood culture collected from the emergency department covering January 2012 and December 2020 from electronic medical records in the Taichung Veterans General Hospital. We enrolled 42 patients, including 28 (66.7%) males and 14 (33.3%) females with a mean age of 63.0 ± 19.7 years. The hospital stay ranged from 1 to 170 days (a mean stay of 44.4 days), and the overall mortality rate was 64.3% (27/42). In univariate analysis, the AUC of ROC for MEWS, RAPS, qSOFA, MEWS plus GCS, REMS, NEWS, and MEDS showed 0.833, 0.842, 0.848, 0.846, 0.846, 0.878, and 0.905. In the multivariate Cox regression analysis, all scoring systems, older age, lactate, MAP, and DBP, indicated significant differences between survivor and non-survivor groups. Our results show that all scoring systems could apply in predicting the outcome of patients with cryptococcal fungemia, and the MEDS displays the best performance. We recommend a further large-scale prospective study for patients with cryptococcal fungemia. [ABSTRACT FROM AUTHOR]

Background: The BENTLEY score (B-S), French thrombotic microangiopathy (TMA) Reference Center score (FTMA-S), and PLASMIC score (PLASMIC-S) have been developed for TMA diagnostic prediction. We retrospectively validated their predictive performances in patients with severe (<10%) disintegrin and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) deficiency in terms of the risk of TMA and response to therapeutic plasma exchange (TPE). Methods: The predictive performances of the three scoring systems were compared in 145 patients with suspected TMA who underwent ADAMTS13 activity tests between January 2014 and September 2022. The response to TPE and mortality in TMA-positive patients were compared after risk stratification, using the Mann–Whitney U and Fisher’s exact tests. Results: The PLASMIC-S, FTMA-S, and B-S showed area under the curve values of 0.820, 0.636, and 0.513, respectively, for predicting TMA positivity in high-risk patients. The PLASMIC-S showed higher sensitivity (81.8%), negative predictive value (91.2%), positive predictive value (PPV; 66.7%), and accuracy (82.1%) than the FTMA-S (72.7%, 82.1%, 41.0%, and 60.0%, respectively) and B-S (4.6%, 70.2%, 50.0%, and 69.7%, respectively). The PLASMIC-S also showed higher specificity than the FTMA-S (82.2% vs. 54.5%). The modified PLASMIC-S, including lactate dehydrogenase/upper limit of normal ratios, increased the specificity, PPV, and accuracy to 97.0%, 92.3%, and 92.4%, respectively. In TMApositive patients, high risk assessed by the PLASMIC-S predicted higher platelet recovery rates and less TPE sessions required for recovery than for those assessed at low-to-intermediate risk. Conclusions: PLASMIC-S is the preferred scoring system for detecting patients with TMA positivity and for prognosis before confirmation of ADAMTS13 activity [ABSTRACT FROM AUTHOR]

Objective:Trauma is an important cause of functional limitation, disability, and mortality. This study investigated the clinical characteristics of trauma patients and the factors affecting mortality in intensive care unit (ICU).Materials and Methods:The data of patients who were followed up due to trauma in the ICU of University of Health Sciences Turkey, İstanbul Kanuni Sultan Süleyman Training and Research Hospital between January 2019-2020 were evaluated retrospectively. Demographic data, comorbidities, trauma etiologies, Glasgow coma score (GCS), Acute Physiology Assessment and Chronic Health Evaluation-II (APACHE-II) score, revised trauma score (RTS), lactate levels, and mortality were investigated.Results:Two hundred fifty (25.2%) patients were followed up in the ICU with a trauma diagnosis. 60.4% of the patients were male, and the median age was 58.5 (1-97). 71.6% of the patients had no systemic disease. While blunt trauma was observed in 94% of the patients, the most common type of trauma was falling, with 64.4%. ICU and mechanical ventilation (MV) stay median lengths were 4 (1-86) and 1 (0-53) days. The median ICU admission GCS was 11 (3-15), APACHE-II score was 22 (5-56), RTS of 7 (2-10) and lactate value was 1.66 (0.7-19.8) mmoL. While 85.6% of the patients were discharged, 14.4% died. Age, duration of stay in ICU and MV, lactate levels, and APACHE-II scores were significantly higher in patients with mortality. GCS and RTS scores were significantly lower (p

Liver cirrhosis is an irreversible stage of chronic liver disease with varying clinical course. Acute decompensation of liver cirrhosis represents a watershed in prognosis and is characterized by the occurrence of clinical complications such as ascites, jaundice, hepatic encephalopathy, infections, or portal-hypertensive hemorrhages. Emergent data indicate that an acute decompensation can be subdivided into stable decompensated cirrhosis (SDC), unstable decompensated cirrhosis (UDC), pre-acute-on chronic liver failure (pre-ACLF) and acute-on chronic liver failure (ACLF), while the mortality risk varies greatly between the respective subgroups. ACLF is the most severe form of acutely decompensated cirrhosis and characterized by the development of organ failure(s) and a high short-term mortality. Due to the dynamic disease course of acute decompensation, it is paramount to detect patients at particular risk for severe complications those at high risk for developing ACLF as early as possible in order to initiate optimal management. This review describes new concepts and perspectives in the definition and classification of decompensated cirrhosis and provides on overview on emerging predictive scoring systems, non-invasive measurement methods and new biomarkers, which allow an early identification of patients with acute decompensation at risk.

Objective: The aim of this study is to analyze the diagnostic value of Quick Sequential Organ Failure Assessment (qSOFA), modified qSOFA, National Early Warning Score (NEWS) and NEWS + Lactate (NEWS + L) scores in the detection of severe community-acquired pneumonia (CAP). Methods: This research is a retrospective cohort study. Patients admitted to the Emergency Department (ED) with the diagnosis of CAP were divided into severe and mild pneumonia regarding their Pneumonia Severity Index (PSI) scores. The accuracies of lactate, procalcitonin (PCT) values, NEWS and qSOFA scores, as well as score combinations (NEWS + L and qSOFA + PCT) in predicting patients with severe CAP were analyzed. Results: Median qSOFA value in the severe CAP group (0 [IQR 0–1]) was found to be higher than median qSOFA value (0 [IQR 0-0]) in the mild CAP group (p

Introduction: Adrenocortical cancer (ACC) is a rare malignant tumor that originates in the adrenal cortex. Despite extensive molecular-genetic, pathomorphological, and clinical research, assessing the malignant potential of adrenal neoplasms in clinical practice remains a daunting task in histological diagnosis. Although the Weiss score is the most prevalent method for diagnosing ACC, its limitations necessitate additional algorithms for specific histological variants. Unequal diagnostic value, subjectivity in evaluation, and interpretation challenges contribute to a gray zone where the reliable assessment of a tumor's malignant potential is unattainable. In this study, we introduce a universal mathematical model for the differential diagnosis of all morphological types of ACC in adults. Methods: This model was developed by analyzing a retrospective sample of data from 143 patients who underwent histological and immunohistochemical examinations of surgically removed adrenal neoplasms. Statistical analysis was carried out on Python 3.1 in the Google Colab environment. The cutting point was chosen according to Youden's index. Scikit-learn 1.0.2 was used for building the multidimensional model for Python. Logistical regression analysis was executed with L1-regularization, which is an effective method for extracting the most significant features of the model. Results: The new system we have developed is a diagnostically meaningful set of indicators that takes into account a smaller number of criteria from the currently used Weiss scale. To validate the obtained model, we divided the initial sample set into training and test sets in a 9:1 ratio, respectively. The diagnostic algorithm is highly accurate [overall accuracy 100% (95% CI: 96%-100%)]. Discussion: Our method involves determining eight diagnostically significant indicators that enable the calculation of ACC development probability using specified formulas. This approach may potentially enhance diagnostic precision and facilitate improved clinical outcomes in ACC management. [ABSTRACT FROM AUTHOR]

The seminar 'Severity and humane endpoints in fish research' organized by the University of Bergen, the Industrial and Aquatic Laboratory, together with Fondazione Guido Bernadini, took place on 4 October 2019 in Bergen, Norway. The seminar was followed by a workshop, 'Establishing score sheets and defining endpoints in fish experiments', held on 28 January 2020, also in Bergen. The purpose of the seminar was to raise awareness about fish ethics together with severity classification and humane endpoints in fish studies, using examples from farmed fish, mainly salmonids and lumpfish. The overall aim of the workshop was to better define humane endpoints in fish experiments, as well as to discuss suggestions for development and use of score sheets for assessing clinical signs related to endpoints. Endpoints for fish should not only be based on what we know about fish diseases and the lesions they induce but should also take into consideration knowledge about fish species and life stage, fish anatomy, physiology and the general state and behaviour of the fish. For this reason, to reinforce that endpoints should come from the animal's perspective and needs, we renamed humane endpoints for fish to piscine endpoints. This paper reports the main messages from the workshop sessions including advice on development and use of score sheets. [ABSTRACT FROM AUTHOR]

Purpose: The most widely used score for assessing the activity of Crohn's disease (CD) is the Magnetic Resonance Index of Activity (MaRIA) score, but it is time-consuming. The aim of this study was to compare the diagnostic accuracy of MaRIA score to the other two easily calculated scores. Methods: Between January 2011 and May 2021, 67 patients with CD who underwent MRE and ileocolonoscopy within 2 weeks were enrolled. The MRE-based scores including the MaRIA score, simplified MaRIA (sMaRIA) score, and Nancy score for each colonic segment and terminal ileum were calculated and correlated with the ileocolonoscopic findings. The simplified endoscopic score for Crohn's disease (SES-CD) was considered the gold standard. Results: A total of 343 intestinal segments were included in the analysis, of which 109 (31.8%) showed active inflammation on ileocolonoscopy. The areas under the receiver operating characteristic curve (AUC) of the MaRIA, sMaRIA, and Nancy scores for detecting active disease were 0.752, 0.764, and 0.765, respectively. In the sub-analysis for different indications, the MaRIA and sMaRIA scores showed a higher AUC (0.721 and 0.741) than the Nancy score (0.652) for disease monitoring. Conclusion: The sMARIA and Nancy scores showed comparable diagnostic accuracy to the MaRIA score, and thus could be used as alternatives to the MaRIA score. Furthermore, considering the range of application, especially for disease monitoring, the sMaRIA score may be more suitable for use in clinical practice. [ABSTRACT FROM AUTHOR]