RATIONALE : Clinical parameters have been individually studied to know their prognostic roles in non-small-cell lung cancer (NSCLC) patients. In this study, we tried to develop prognostic model using clinical parameters in the patients. METHOD : Eight hundred NSCLC patients who were diagnosed from Jan. 2001 to Dec. 2009 and took pulmonary function testing at diagnosis were enrolled from prospective lung cancer cohort. The patients were treated with platinum doublets or supportive care only. Patients with stage II were 103 (12.9%), stage III of 240 (30.0%), and stage IV of 457 (57.1%). In addition to forced expiratory volume per 1 sec. (% of pred.) (FEV %), demographic data including smoking habits, and weight loss, treatment status (chemotherapy vs. palliative), 1 histological types, stages, and laboratory estimates (C-reactive protein, hemoglobin, albumin, calcium, lactic dehydrogenase, and alkaline phosphatase) at the diagnosis were evaluated. RESULT : We constructed the final model from initial full model using Cox proportional hazard analysis. With the final model, the hazard ratio (95% CI) for the effect of chemotherapy was 0.42 (0.36, 0.49), adenocarcinoma (referent squamous cell carcinoma) was 1.13 (0.95, 1.34), and other cancer was 1.29 (0.98, 1.70), stage III was 1.11 (0.86, 1.44), and stage IV was 1.56 (1.22, 1.99), log C-reactive protein was 1.13 (1.07, 1.20), weight loss was 1.29 (1.10, 1.51), FEV % was 0.94 (0.91, 0.97), albumin was 0.78 (0.66, 0.91). Gonen and Heller's K index was 1 0.66 which measuring the discrimination performance of the model. We created the prognostic model on a derivation dataset and evaluate its predictions on a validation set. We split the dataset at random into equal, each of size 400 patients, and fit the Royston-Parmar model to the first half. We predicted the prognostic index for all patients, and made four prognostic groups for all patients, using cutpoints at the 15 , 50 , and 85 centiles of the prognostic index in the first half. We compute Kaplan-Meier survival curves in the four th th th prognostic groups in the second half, and finally compare predicted and Kaplan-Meier curves in the second half graphically (Figure 1). We compared survival estimates predicted on the first and second halves from the model fit on the first half. The predicted survival curves agree well with the nonparametric estimates in 15th-50th centiles and 50th-85 centiles groups. CONCLUSION : The model using the clinical parameters appears to be validated well subjectively. Therefore, this would be helpful in classification of NSCLC patients. Figure 1. Graphical validation of a prognostic model in non-small-cell lung cancer patients This abstract is funded by: None Am J Respir Crit Care Med 185;2012:A2527 Internet address: www.atsjournals.org Online Abstracts Issue
Background There have been few earlier studies on the efficacy of statins in the prevention of delirium. However, the results were controversial. The aim of this study was to investigate the association between the use of statins and the occurrence of delirium in a large cohort of patients in the intensive care unit (ICU), considering disease severity and statin properties, which were not sufficiently considered in the previous works. Methods We obtained clinical and demographical information from 3604 patients admitted to the ICU of Gangnam Severance Hospital from January 2013 to April 2020. This included information on daily statin use and delirium state, as assessed by the Confusion Assessment Method for ICU. We used inverse probability of treatment weighting and categorized the ICU patients into four groups based on the Acute Physiology and Chronic Health Evaluation II score (group 1: 0-10 - mild; group 2: 11-20 – mild to moderate; group 3: 21-30 – moderate to severe; group 4: > 30 - severe). We analyzed the association between the use of statin and the occurrence of delirium in each group, while taking into account the properties of statins. Results Comparisons between statin and non-statin patient groups revealed that only in group 2, patients who were administered statin showed significantly higher occurrence of delirium (p=0.004, odds ratio [OR]=1.58) compared to the patients who did not receive statin. Regardless of whether statins were lipophilic (p=0.036, OR=1.47) or hydrophilic (p=0.032, OR=1.84), the occurrence of delirium was higher only in patients from group 2. Although both lipophilic and hydrophilic statins in group 2 were associated with delirium, neither showed a greater association than the other. Conclusions The use of statins may be associated with the increases in the risk of delirium occurrence in patients with mild to moderate disease severity, irrespective of statin properties, as revealed by results from a large cohort study.
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