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Background:
The CHADS2 and CHA2DS2 scores are usually applied for stroke prediction in atrial fibrillation patients, and the Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity. The role in assessing mortality with score system in hemodialysis is not clear and comparisons are lacking. We aimed at evaluating CHADS2, CH...
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... The Charlson score is a weighted index predicting the risk of death within one year of hospitalisation created by Charlson et al. in 1987 [100]. The score for each patient was determined by extracting the relevant diagnoses and conditions and calculating the weighted score as per Table 3.1 from Yang et al. [99] summed with the age-dependent weights (50-59: 1 point, 60-69: 2 points, 70-79: 3 points and 80 years old or more: 4 points). ...
... 1: Charlson Score weights. Adapted from Yang et al.[99] ...
Predicting extubation failure in intensive care is challenging due to complex data and the severe consequences of inaccurate predictions. Machine learning shows promise in improving clinical decision-making but often fails to account for temporal patient trajectories and model interpretability, highlighting the need for innovative solutions. This study aimed to develop an actionable, interpretable prediction system for extubation failure using temporal modelling approaches such as Long Short-Term Memory (LSTM) and Temporal Convolutional Networks (TCN). A retrospective cohort study of 4,701 mechanically ventilated patients from the MIMIC-IV database was conducted. Data from the 6 hours before extubation, including static and dynamic features, were processed through novel techniques addressing data inconsistency and synthetic data challenges. Feature selection was guided by clinical relevance and literature benchmarks. Iterative experimentation involved training LSTM, TCN, and LightGBM models. Initial results showed a strong bias toward predicting extubation success, despite advanced hyperparameter tuning and static data inclusion. Data was stratified by sampling frequency to reduce synthetic data impacts, leading to a fused decision system with improved performance. However, all architectures yielded modest predictive power (AUC-ROC ~0.6; F1 <0.5) with no clear advantage in incorporating static data or additional features. Ablation analysis indicated minimal impact of individual features on model performance. This thesis highlights the challenges of synthetic data in extubation failure prediction and introduces strategies to mitigate bias, including clinician-informed preprocessing and novel feature subsetting. While performance was limited, the study provides a foundation for future work, emphasising the need for reliable, interpretable models to optimise ICU outcomes.
... In HD patients, all-cause mortality risk is closely associated with BMI, and the risk is significantly higher in nonobese patients or patients with a lower BMI [41]. In addition, a high CCI score was a substantial risk factor for mortality [42]. In the present studies, we found that mortality risk was more pronounced in patients with CCI score ≥6 or BMI <23 kg/m 2 for FBG <80 mg than those who did not have, and that there was a significant interaction. ...
Background:
Glycemic control is particularly important in hemodialysis (HD) patients with diabetes mellitus (DM). Although fasting blood glucose (FBG) level is an important indicator of glycemic control, a clear target for reducing mortality in HD patients with DM is lacking.
Methods:
A total of 26,162 maintenance HD patients with DM were recruited from the National Health Insurance Database of Korea between 2002 and 2018. We analyzed the association of FBG levels at the baseline health examination with the risk of all-cause and cause-specific mortality.
Results:
Patients with FBG 80100 mg/dL showed a higher survival rate compared with that of other FBG categories (p < 0.001). The risk of all-cause mortality increased with the increase in FBG levels, and adjusted hazard ratios (HRs) were 1.10 (95% confidence interval [CI], 1.04-1.17), 1.21 (95% CI, 1.13-1.29), 1.36 (95% CI, 1.26-1.46), and 1.61 (95% CI, 1.51-1.72) for patients with FBG 100-125, 125-150, 150-180, and ≥180 mg/dL, respectively. The HR for mortality was also significantly increased in patients with FBG < 80 mg/dL (adjusted HR, 1.14; 95% CI, 1.05-1.23). The analysis of cause-specific mortality also revealed a J-shaped curve between FBG levels and the risk of cardiovascular deaths. However, the risk of infection or malignancy-related deaths was not linearly increased as FBG levels increased.
Conclusion:
A J-shaped association was observed between FBG levels and the risk of all-cause mortality, with the lowest risk at FBG 80100 mg/dL in HD patients with DM.
... Recently, the use of CHA 2 DS 2 -VAS C has expanded and was demonstrated to predict the development of atrial fibrillation [4,5], left atrial dysfunction [6], ablation outcomes [7], estimate stroke severity [8,9] and its mechanism [10], and predict the occurrence of stroke in patients without atrial fibrillation [11][12][13][14]. CHA 2 DS 2 -VAS C also correlates with the presence of the coronary artery disease [15][16][17], pulmonary embolism [18], and mortality [14,[19][20][21][22][23][24][25]. In patients with established coronary artery disease, the CHA 2 DS 2 -VAS C score has been demonstrated to predict the development of atrial fibrillation [26][27][28], ischemic severity [29,30], and stroke [27,[31][32][33][34]. CHA 2 DS 2 -VAS C also been shown to estimate the prognosis and predict the mortality of these patients [34][35][36][37][38][39][40][41]. ...
... Although CHADS2 and CHA2DS2-VASC scores were initially developed to predict stroke in patients with atrial fibrillation [1-3], they were later used to predict multiple cardiovascular outcomes in different categories of patients [7,8,[11][12][13][14][18][19][20][21]23,[25][26][27][29][30][31][34][35][36][37][38][39][40][41][42]. ...
... Although CHADS 2 and CHA 2 DS 2 -VAS C scores were initially developed to predict stroke in patients with atrial fibrillation [1-3], they were later used to predict multiple cardiovascular outcomes in different categories of patients [7,8,[11][12][13][14][18][19][20][21]23,[25][26][27][29][30][31][34][35][36][37][38][39][40][41][42]. ...
Background:
The CHA2DS2-VASC score is used to predict the risk of thromboembolic complications in patients with atrial fibrillation (AF). We hypothesized that the CHA2DS2-VASC score can be used to predict mortality in patients undergoing coronary angiography.
Methods and results:
This was a prospective study of 990 patients undergoing coronary angiography. The median follow-up was 2294 days. The patients were categorized into two groups according to their CHA2DS2-VASC score: group I had scores <4 and group II had scores ≥4 (527 (53.2%) and 463 (46.8%), respectively). A Kaplan-Meier analysis demonstrated a significant association between the CHA2DS2-VASC score and mortality (69/527 (13.1%) vs. 179/463 (38.7%) for group I vs. group II, respectively, p < 0.0001). The association remained significant in patients with and without AF, reduced and preserved LVEF, normal and reduced kidney function, and with and without ACS (p < 0.009 to p < 0.0001 for all). In the Cox regression model, which combined the CHA2DS2-VASC score, the presence of AF, LVEF, anemia, and renal insufficiency, an elevated CHA2DS2-VASC score of ≥4 was independently associated with higher mortality (HR 2.12, CI 1.29-3.25, p = 0.001).
Conclusions:
The CHA2DS2VASC score is a simple and reliable mortality predictor in patients undergoing coronary angiography and should be used for the initial screening for such patients.
... Variables considered comorbidities are shown in Supplementary Table S1. The Charlson comorbidity index (CCI) was calculated as the weighted sum of 16 categories of comorbidities [18]. The seventh revision of the Korean Standard Classification of Disease code, which is a modification of the 10th revision of the International Classification of Diseases (ICD-10) code, and the procedure code were used to define the variables (Supplementary Table S1). ...
Individuals with end-stage kidney disease (ESKD) on dialysis are at a high risk of developing foot ulcerations and undergoing subsequent lower extremity amputation (LEA), which can exert significant impacts on their quality of life and contribute to rising healthcare costs. We aimed to identify risk factors associated with LEA in patients with ESKD to predict LEA progression and eventually prevent it. We used 18 years (2002–2019) of data from the Korean National Health Insurance Service (KNHIS). Data were collected from patients with ESKD who underwent renal replacement therapy (RRT) and had no history of amputation caused by trauma or toxins. The risk factors were compared between patients with or without LEA. We collected data from 220,838 patients newly diagnosed with ESKD, including 6348 in the LEA group and 214,490 in the non-LEA group. The total incidence of LEA was 2.9%. Older age, male gender, lower income, non-metropolitan residence, diabetes mellitus, dialysis treatment (compared to kidney transplantation), microvascular disease, peripheral vascular disease, endovascular procedure, and endovascular operation were associated with an increased risk of LEA. Thus, individuals with ESKD who are at a higher risk for LEA should be closely monitored, and kidney transplantation should be considered as a preventative measure.
... A total of 40,108 patients undergoing dialysis were included in the analysis. To reduce baseline differences between study groups, we used 1:4 propensity score matching for variables age, sex, and Charlson comorbidity index score (15). Accordingly, our analysis included patients undergoing HD who had transitioned from PD (n = 1,100) and patients in a matched comparison group (n = 4,400; Figure 1). ...
If a technical failure occurs during peritoneal dialysis (PD), the patients undergoing PD may be transitioned to hemodialysis (HD). However, the clinical outcomes of patients who have undergone such a transition are under studied. This study assessed whether patients undergoing HD who have transitioned from PD have the same clinical outcomes as HD-only patients. This research was a retrospective cohort study by searching a National Health Insurance research database for data on patients in Taiwan who had undergone HD between January 2006 and December 2013. The patients were divided into two groups, namely a case group in which the patients were transitioned from PD to HD and a HD-only control group, through propensity score matching at a ratio of 1:4 (n = 1,100 vs. 4,400, respectively). We used the Cox regression model to estimate the hazard ratios (HRs) for all-cause death, all-cause hospitalization, infection-related admission, and major adverse cardiac events (MACE). Those selected patients will be followed until death or the end of the study period (December, 2017), whichever occurs first. Over a mean follow-up of 3.2 years, 1,695 patients (30.8%) died, 3,825 (69.5%) required hospitalization, and 1,142 (20.8%) experienced MACE. Patients transitioning from PD had a higher risk of all-cause death (HR: 1.36; 95% CI: 1.21–1.53) than HD-only patients. However, no significant difference was noted in terms of MACE (HR: 0.91; 95% CI: 0.73–1.12), all-cause hospitalization (HR: 1.07; 95% CI: 0.96–1.18), or infection-related admission (HR: 0.97, 95% CI: 0.80–1.18) between groups. Because of the violation of the proportional hazard assumption, the piecewise-HRs showed that the risk of mortality in the case group was significant within 5 months of the transition (HR: 2.61; 95% CI: 2.04–3.35) not in other partitions of the time axis. In conclusion, patients undergoing HD who transitioned from PD had a higher risk of death than the HD-only patients, especially in the first 5 months after transition (a 161% higher risk). Therefore, more caution and monitoring may be required for patients undergoing HD who transitioned from PD.
... 3 De nition of endpoint events: cardiovascular events (acute coronary syndrome, fatal arrhythmia, acute heart failure,and PVD required endovascular intervention or vascular surgery) as well as death. 4 According to the patients' past medical history, relevant data after admission and the above evaluation methods, the patients were scored by CHADS2, CHA2DS2-VASc scores [12], and divided into 3 groups: 0-1 points for Group 1, 2-3 points for Group 2, ≥4 points for Group 3. We recorded and analysed the occurrence of and the time of endpoint events during the follow-up period of each group. ...
Background: The risk of mortality and cardiovascular disease is above the average in maintenance hemodialysis (MHD) patients. Nevertheless, there is still no way to assess this risk .
Hypothesis:There may be important value in evaluating the prognosis of MHD by using CHADS2 and CHA2DS2-VASc scores.
Methods: 112 patients who were treated with MHD were enrolled. On the basis of the scores, the investigators divided the patients into 3 groups separately. Kaplan-Meier survival analysis was used as a comparision the of the incidence between all-cause mortality and cardiovascular events. Multivariate COX regression analysis was used to illustrate the influencing elements of all-cause mortality and cardiovascular events. Area under Receiver Operating Characteristic Curve (AUC) was applied to estimate that if CHADS2 and CHA2DS2-VASc scores could predict all-cause mortality and cardiovascular events.
Results: CHADS2 score showed statistical significance in the incidence of all-cause mortality in the 3 groups (P＜0.01). CHA2DS2-VASc score showed statistical significance both in the incidence of cardiovascular events and all-cause mortality in the 3 groups (P＜0.05). CHA2DS2-VASc score and troponin I (cTnI) are both risk factors for MHD patients to predict all-cause mortality.What’s more, CHA2DS2-VASc score is an independent risk factor for cardiovascular events,which were showed by Multivariate COX regression analysis. For all-cause mortality,the scores have great predictive value .
Conclusions: Both CHADS2 scores and CHA2DS2-VASc scores can predict the incidence of all-cause mortality in MHD patients.As for all-cause mortality, CHA2DS2-VASc score and cTnI are dangers. CHA2DS2-VASc score is an independent danger and can predict the occurrence of cardiovascular events.
... The baseline characteristics included sex, age, Charlson comorbidity index, and CHA2DS2-VASc scores (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus (DM), previous stroke or transient ischemic attack (TIA), vascular disease, age 65-74 years, female sex), and comorbidities including peripheral vascular disease (PVD), ischemic stroke or systemic embolism, hypertension (HTN), hyperlipidemia, DM, chronic liver disease, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and TIA. The Charlson comorbidity index score (CCIs) is the classic index in the literature 24 . The comorbidities are weighted from 1 to 6, and a score that reflects long-term outcomes is calculated for patients. ...
Nonvalvular atrial fibrillation (NVAF) and carotid stenosis are important risk factors for stroke. Carotid angioplasty and stent placement (CAS) is recommended for patients with symptomatic high-grade carotid stenosis. The optimal medical management for patients with NVAF after CAS remains unclear. We aimed to clarify this issue using real-world data from the Taiwanese National Health Insurance Research Database (NHIRD). In total, 2116 consecutive NVAF patients who received CAS between January 1, 2010, and December 31, 2016, from NHIRD were divided into groups based on post-procedure medication as follows: only antiplatelet agent (OAP, n = 587); only anticoagulation agent (OAC, n = 477); dual antiplatelet agents (DAP, n = 49); and a combination of antiplatelet and anticoagulation agents (CAPAC, n = 304). Mortality, vascular events, and major bleeding episodes were compared after matching with the Charlson comorbidity index and CHA2DS2-VASc score. The CAPAC and the OAC groups had lower mortality rates than the OAP group ( P = 0.0219), with no statistical differences in major bleeding, ischemic stroke, or vascular events. Conclusively, OAC therapy after CAS appears suitable for NVAF patients. CAPAC therapy might be considered as initial therapy or when there is concern about vascular events.
... Patients who used aspirin within 90 days after use of ESA (n = 3021) were defined as the case group, and the comparison group was selected from patients who did not use aspirin within 90 days after use of ESA (n = 88,723). To reduce baseline difference between two groups, we used 1:3 propensity score matched with age, sex, Charlson comorbidity index scores [16], comorbidities, and medications. Ultimately, we evaluated aspirin users (n = 3021) and 9063 patients in the matched comparison group (Figure 1). ...
Background: Low-dose aspirin (100 mg) is widely used in preventing cardiovascular disease in chronic kidney disease (CKD) because its benefits outweighs the harm, however, its effect on clinical outcomes in patients with predialysis advanced CKD is still unclear. This study aimed to assess the effect of aspirin use on clinical outcomes in such group. Methods: Patients were selected from a nationwide diabetes database from January 2009 to June 2017, and divided into two groups, a case group with aspirin use (n = 3021) and a control group without aspirin use (n = 9063), by propensity score matching with a 1:3 ratio. The Cox regression model was used to estimate the hazard ratio (HR). Moreover, machine learning method feature selection was used to assess the importance of parameters in the clinical outcomes. Results: In a mean follow-up of 1.54 years, aspirin use was associated with higher risk for entering dialysis (HR, 1.15 [95%CI, 1.10–1.21]) and death before entering dialysis (1.46 [1.25–1.71]), which were also supported by feature selection. The renal effect of aspirin use was consistent across patient subgroups. Nonusers and aspirin users did not show a significant difference, except for gastrointestinal bleeding (1.05 [0.96–1.15]), intracranial hemorrhage events (1.23 [0.98–1.55]), or ischemic stroke (1.15 [0.98–1.55]). Conclusions: Patients with predialysis advanced CKD and anemia who received aspirin exhibited higher risk of entering dialysis and death before entering dialysis by 15% and 46%, respectively.
... The baseline characteristics including sex, age, Charlson comorbidity index, and CHA2DS2-VASc scores (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus (DM), previous stroke or transient ischemic attack (TIA), vascular disease, age 65-74 years, female sex), and comorbidities including peripheral vascular disease (PVD), ischemic stroke or systemic embolism, hypertension (HTN), hyperlipidemia, DM, chronic liver disease, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and TIA. The Charlson comorbidity index score (CCIs) is the classic index in the literature [23]. The comorbidities are weighted from 1 to 6, and a score that re ects long-term outcomes is calculated for patients. ...
Non-valvular atrial fibrillation (NVAF) and carotid stenosis are important risk factors for stroke. Carotid angioplasty and stent placement (CAS) is recommended for patients with symptomatic high-grade carotid stenosis. The optimal medical management for patients with NVAF after CAS remains unclear. We aimed to clarify this issue using real-world data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 2116 NVAF patients who received CAS between January 1, 2010, and December 31, 2016, from NHIRD were divided into groups based on post-procedure medication as follows: only antiplatelet agent (OAP, n = 587); only anticoagulation agent (OAC, n = 477); dual antiplatelet agents (DAP, n = 49); and a combination of antiplatelet and anticoagulation agents (CAPAC, n = 304). Mortality, vascular events, and major bleeding episodes were compared after matching with the Charlson comorbidity index and CHA2DS2-VASc score. The CAPAC and the OAC groups had lower mortality rates than the OAP group (P = 0.0219), with no statistical differences in major bleeding, ischemic stroke, or vascular events. In conclusion, OAC therapy after CAS appears suitable for NVAF patients. CAPAC therapy might be considered as initial therapy or when there is concern about vascular events.
... The mortality of patients with ESRD is 10 to 30 times higher than that of the general population (Msaad, Essadik et al. 2019). According to the USRDS, the range of the expected remaining life span is nearly 8 years for dialysis patients 40-44 years of age and about 4.5 years for those aged between 60-64 years (Yang, Chen et al. 2016). Furthermore, in 2011, the URSDR annual data report showed that only 50% of dialysis patients were still alive three years after the start of ESRD therapy (Yang, Chen et al. 2016). ...
... According to the USRDS, the range of the expected remaining life span is nearly 8 years for dialysis patients 40-44 years of age and about 4.5 years for those aged between 60-64 years (Yang, Chen et al. 2016). Furthermore, in 2011, the URSDR annual data report showed that only 50% of dialysis patients were still alive three years after the start of ESRD therapy (Yang, Chen et al. 2016). Consequently, the instability or aggravation of patients` health plays a key role in provoking anxiety among nurses (Schmidt, Dantas et al. 2011); especially that nurses taking care of such patients usually develop a close bond with them and are in permanent doubts about the effectiveness of dialysis in maintaining their lives (Muthny 1989). ...
Research conducted during COVID times assessing depression and axiety among dialysis departement nurses.
