Browsing by Subject "SCORE"

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Now showing items 21-34 of 34
  • CardShock Investigators; Hongisto, Mari; Kataja, Anu; Tarvasmäki, Tuukka; Holopainen, Anu; Javanainen, Tuija; Jurkko, Raija; Jäntti, Toni; Kimmoun, Antoine; Levy, Bruno; Mebazaa, Alexandre; Pulkki, Kari; Sionis, Alessandro; Tolppanen, Heli; Wollert, Kai C.; Harjola, Veli-Pekka; Lassus, Johan (2019)
    Background: The aim of this study was to assess the levels, kinetics, and prognostic value of growth differentiation factor 15 (GDF-15) in cardiogenic shock (CS). Methods and Results: Levels of GDF-15 were determined in serial plasma samples (0-120 h) from 177 CS patients in the CardShock study. Kinetics of GDF-15, its association with 90-day mortality, and incremental value for risk stratification were assessed. The median GDF-15(0h) level was 9647 ng/L (IQR 4500-19,270 ng/L) and levels above median were significantly associated with acidosis, hyperlactatemia, renal dysfunction, and higher 90-day mortality (56% vs 28%, P7000 ng/L was identified as a strong predictor of death (OR 5.0; 95% CI 1.9-3.8, P=.002). Adding GDF-15(12h) >7000 ng/L to the CardShock risk score improved discrimination and risk stratification for 90-day mortality. Conclusions: GDF-15 levels are highly elevated in CS and associated with markers of systemic hypoperfusion and end-organ dysfunction. GDF-15 helps to discriminate survivors from non-survivors very early in CS.
  • Thorlacius, Elin M.; Wåhlander, Håkan; Ojala, Tiina; Ylänen, Kaisa; Keski-Nisula, Juho; Synnergren, Mats; Romlin, Birgitta S.; Ricksten, Sven-Erik; Castellheim, Albert (2020)
    Objective : We aimed to determine the differential effects of intra-operative administration of milrinone versus levosimendan on myocardial function after pediatric cardiac surgery. Transthoracic echocardiography was employed for myocardial function evaluation, utilizing biventricular longitudinal strain with two-dimensional speckle tracking echocardiography in addition to conventional echocardiographic variables. Design : A secondary analysis of a randomized, prospective, double-blinded clinical drug trial Setting : Two pediatric tertiary university hospitals Participants : Infants between 1-12 months of age diagnosed with ventricular septal defect, complete atrioventricular septal defect, or tetralogy of Fallot who were scheduled for corrective surgery with cardiopulmonary bypass. Interventions : The patients were randomized to receive an infusion of milrinone or levosimendan at the start of cardiopulmonary bypass and for 26 consecutive hours. Measurements and main results : Biventricular longitudinal strain and conventional echocardiographic variables were measured preoperatively, on the first postoperative morning and prior to hospital discharge. The association between perioperative parameters and postoperative myocardial function was also investigated. Images were analyzed for left ventricular (n=67) and right ventricular (n=44) function. The day after surgery, left ventricular longitudinal strain was deteriorated in both the milrinone and levosimendan groups; 33% and 39%, respectively. The difference was not significant. The corresponding deterioration in right ventricular longitudinal strain was 42% and 50% (non-significant difference). For both groups, biventricular longitudinal strain approached their preoperative values at hospital discharge. Preoperative N-terminal pro-brain natriuretic peptide could predict the left ventricular strain on postoperative day one (p=0.014). Conclusions : Levosimendan was comparable to milrinone for left and right ventricular inotropic support in pediatric cardiac surgery.
  • Jaskari, Joel; Myllärinen, Janne; Leskinen, Markus; Rad, Ali Bahrami; Hollmen, Jaakko; Andersson, Sture; Särkkä, Simo (2020)
    Preterm birth is the leading cause of mortality in children under the age of five. In particular, low birth weight and low gestational age are associated with an increased risk of mortality. Preterm birth also increases the risks of several complications, which can increase the risk of death, or cause long-term morbidities with both individual and societal impacts. In this work, we use machine learning for prediction of neonatal mortality as well as neonatal morbidities of bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity, among very low birth weight infants. Our predictors include time series data and clinical variables collected at the neonatal intensive care unit of Children's Hospital, Helsinki University Hospital. We examine 9 different classifiers and present our main results in AUROC, similar to our previous studies, and in F1-score, which we propose for classifier selection in this study. We also investigate how the predictive performance of the classifiers evolves as the length of time series is increased, and examine the relative importance of different features using the random forest classifier, which we found to generally perform the best in all tasks. Our systematic study also involves different data preprocessing methods which can be used to improve classifier sensitivities. Our best classifier AUROC is 0.922 in the prediction of mortality, 0.899 in the prediction of bronchopulmonary dysplasia, 0.806 in the prediction of necrotizing enterocolitis, and 0.846 in the prediction of retinopathy of prematurity. Our best classifier F1-score is 0.493 in the prediction of mortality, 0.704 in the prediction of bronchopulmonary dysplasia, 0.215 in the prediction of necrotizing enterocolitis, and 0.368 in the prediction of retinopathy of prematurity.
  • Räty, Silja; Sallinen, Hanne; Virtanen, Pekka; Haapaniemi, Elena; Wu, Teddy Y.; Putaala, Jukka; Meretoja, Atte; Tatlisumak, Turgut; Strbian, Daniel (2021)
    Objectives Posterior location affects the clinical presentation and outcome of ischemic stroke, but little is known about occipital intracerebral hemorrhage (ICH). We studied non-traumatic occipital ICH phenotype, outcome, and post-ICH epilepsy. Materials and Methods Occipital ICH patients were retrospectively identified from the Helsinki ICH Study registry of 1013 consecutive ICH patients treated in our tertiary center in 2005-2010. They were compared to non-occipital ICH patients to evaluate the effect of location on functional outcome at discharge (dichotomized modified Rankin Scale, mRS), 3- and 12-month mortality, and incidence of epilepsy. Results We found 19 occipital ICH patients (5.3% of lobar and 1.9% of all ICH). Compared to non-occipital lobar ICHs, they were younger (median age 63 vs 71 years,P= .007) and had lower National Institutes of Health Stroke Scale on admission (1 vs 8,P<.001), smaller hematoma volume (6.3 vs 17.7 ML,P= .008), and more frequently structural etiology underlying the ICH (26% vs 7%,P= .01). Mortality at both 3 and 12 months was 6%, whereas 84% reached favorable outcome (mRS 0-2) at discharge. Occipital location was associated with favorable outcome at discharge in lobar ICH (OR 11.02, 95% CI 1.55-78.20). Incidence of post-ICH epilepsy (median follow-up 2.7 years) was 18%, equaling to that of non-occipital lobar ICH. Conclusions Occipital ICH patients are younger, have less severe clinical presentation, smaller hematoma volume, more often structural etiology, and better outcome than other ICH patients. They exhibit a similar risk of epilepsy as non-occipital ICHs.
  • Eloranta, Sini; Rantanen, Virpi; Kauppila, Marjo; Hautaniemi, Soili; Vahlberg, Tero; Laasik, Maren; Joronen, Kirsi; Sintonen, Harri; Ala-Nissilä, Seija (2019)
    Objective: The aim of this study was to analyse the prevalence of pelvic floor disorders and to describe health-related quality of life (HRQoL) among older women. We also compared participants' HRQoL with the age-matched general female population and analysed factors associated with HRQoL. Study design: This is a population-based study of a cohort of women born in 1948 and in 1950 (n = 143) which is also part of the Women's Gynaecological Health study in Lieto, Finland. Methods: The data were collected by questionnaires which pertained to socio-demographics, health-related variables, pelvic floor disorders and HRQoL (15D). Linear model was conducted to estimate a model of factors that associated with HRQoL. Results: The prevalence of urinary incontinence, faecal incontinence and pelvic organ prolapse was 50%, 13% and 12%, respectively. The overall HRQoL score of the study cohort is broadly similar to that of the age-matched general Finnish female population (mean +/- SD15D scores 0.905 +/- 0.084 vs 0.912 +/- 0.077). Higher number of medications was the most important explanatory factor for lower HRQoL. Conclusion: Urinary incontinence was common; however, the impact on HRQoL was minor. The overall HRQoL score of the study cohort was broadly similar to that of age-matched general female population. Women who used a higher number of medications had lower HRQoL compared to women who used fewer medications.
  • Heikkila, Arto; Venermo, Maarit; Kautiainen, Hannu; Aarnio, Pertti; Korhonen, Paivi (2016)
    Background: Peripheral, arterial disease (PAD) is an underdiagnosed and undertreated disease because it remains asymptomatic for so long. The ankle brachial index (ABI) is a valid method for detecting PAD: in lower extremities. ABI Methods: A total of 193 subjects with borderline ABI were examined in 2005-2006. None of them had previously diagnosed diabetes, cardiovascular or renal disease or intermittent claudication. They were given conventional treatment for multiple risk factors of cardiovascular diseases (hypertension, hypercholesterolemia, elevated blood glucose, smoking, and overweight). Sixty-four percent of these subjects (n = 1.23) attended a follow-up visit in 2012. Results: Of the 123 subjects with borderline ABI (mean age 59.0 years, 62% female) at baseline, 18 (15%, 95% confidence intervals {Cl] 9%-22%) developed incident PAD during the follow-up. The mean ABI was 0.97 +/- 0.03 at baseline and 1.01 +/- 0.12 at 7-year follow-up visit. The change in mean ABI was 70:04 (95% CI: 0.03-0.07), P <0.001. ABI improved significantly in 25 (20%) subjects. In multivariate ordered logistic regression analyses high and even moderate leisure-time physical activity :(LTPA; odds ratio 6.15; 95% CI: 1.99-19.1) predicted a rise in ABI in comparison to low LTPA. Conclusions: Physical activity seems to improve significantly ABI values among men and women with borderline ABI (0.91-1.00).
  • Peake, Sandra L.; Delaney, Anthony; Bailey, Michael; Bellomo, Rinaldo; ARISE Investigators; Pettilä, Ville (2017)
    Study objective: The influence of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) on the conduct of future sepsis research is unknown. We seek to examine the potential effect of the new definitions on the identification and outcomes of patients enrolled in a sepsis trial. Methods: This was a post hoc analysis of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial of early goal-directed therapy that recruited 1,591 adult patients presenting to the emergency department (ED) with early septic shock diagnosed by greater than or equal to 2 systemic inflammatory response syndrome criteria and either refractory hypotension or hyperlactatemia. The proportion of participants who would have met the Sepsis-3 criteria for quick Sequential Organ Failure Assessment (qS0FA) score, sepsis (an increased Sequential Organ Failure Assessment score >= 2 because of infection) and septic shock before randomization, their baseline characteristics, interventions delivered, and mortality were determined. Results: There were 1,139 participants who had a qSOFA score of greater than or equal to 2 at baseline (71.6% [95% confidence interval [Cl) 69.4% to 73.8%]). In contrast, 1,347 participants (84.7% [95% CI 82.9% to 86.4%]) met the Sepsis-3 criteria for sepsis. Only 1,010 participants were both qSOFA positive and met the Sepsis-3 criteria for sepsis (63.5% [95% CI 61.1% to 65.8%]). The Sepsis-3 definition for septic shock was met at baseline by 203 participants (12.8% [95% CI 11.2% to 14.5%]), of whom 175 (86.2% [95% CI 81.5% to 91.0%]) were also qSOFA positive. Ninety-day mortality for participants fulfilling the Sepsis-3 criteria for sepsis and septic shock was 20.4% (95% CI 18.2% to 22.5%) (274/1,344) and 29.6% (95% CI 23.3% to 35.8% [60/203]) versus 9.4% (95% CI 5.8% to 13.1%) (23/244) and 17.1% (95% CI 15.1% to 19.1% [237/1,388]), respectively, for participants not meeting the criteria (risk differences 11.0% [95% CI 6.2% to 14.8%] and 12.5% [95% CI 6.3% to 19.4%], respectively). Conclusion: Most ARISE participants did not meet the Sepsis-3 definition for septic shock at baseline. However, the majority fulfilled the new sepsis definition and mortality was higher than for participants not fulfilling the criteria. A quarter of participants meeting the new sepsis definition did not fulfill the qSOFA screening criteria, potentially limiting its utility as a screening tool for sepsis trials with patients with suspected infection in the ED. The implications of the new definitions for patients not eligible for recruitment into the ARISE trial are unknown.
  • Karihtala, Peeter; Jääskeläinen, Anniina; Roininen, Nelli; Jukkola, Arja (2020)
    Objectives Although novel early breast cancer prognostic factors are being continuously discovered, only rare factors predicting survival in metastatic breast cancer have been validated. The prognostic role of early breast cancer prognostic factors in metastatic disease also remains mostly unclear. Design and setting Prospective cohort study in a Finnish University Hospital. Participants and outcomes 594 women with early breast cancer were originally followed. Sixty-one of these patients developed distant metastases during the follow-up, and their primary breast cancer properties, such as tumour size, nodal status, oestrogen receptor (ER) and progesterone receptor expression, grade, proliferation rate, histopathological subtype and breast cancer subtype were analysed as potential prognostic factors for metastatic disease. Results In multivariate analysis, the presence of lymph node metastases at the time of early breast cancer surgery (HR, 2.17; 95% CI, 1.09-4.31; p=0.027) and ER status (negative vs positive, HR, 2.16; 95% CI, 1.14-4.10; p=0.018) were significant predictors of survival in metastatic disease. Conclusions These results confirm ER status as a primary prognostic factor in metastatic breast cancer. Furthermore, it also suggests that the presence of initial lymph node metastases could serve as a prognostic factor in recurrent breast cancer.
  • Sane, Markus A.; Laukkanen, Jari A.; Graner, Marit A.; Piirilä, Päivi L.; Harjola, Veli-Pekka; Mustonen, Pirjo E. (2019)
    Multiple studies have shown that in approximately half of individuals with pulmonary embolism (PE), the deep venous thrombosis (DVT) is not evident at the moment of PE diagnosis. The underlying factors and the origin of PE in these patients are not completely understood: missed DVT, embolization of DVT in its entirety, or de-novo PE being possible explanations. The aim of this study was to evaluate the differences in PE patient with or without co-existing DVT. Sixty-three consecutive PE patients were included. Whole leg bilateral Doppler compression ultrasound was performed to all patients. The PE location and extension, C-reactive protein, platelet count, hemostatic markers FV, FVIII, FXIIIa, Fibrinogen, von Willebrand factor antigen, thrombomodulin were assessed. Thorough clinical assessment including echocardiography and pulmonary function tests were performed upon arrival and seven months later. The mean age of the patients was 57 years (SD 17.3) and 33 (52%) were women. Thirty-one patients (49.2%) had coexisting DVT. The presence of DVT was associated with the proximal location of the PE (100%), whereas none of the patients (n = 10) with exclusively peripheral PE had coexisting DVT. The PE extension, the measured hemostatic and inflammatory markers or the patient characteristics did not statistically differ between patients with isolated PE and PE with co-existing DVT. In roughly half of the PE patients no DVT could be detected. The location of the PE was associated with the presence of co-existing DVT. There were no differences in the PE extension, hemostatic markers or in the patient characteristic between patients with isolated PE or PE with coexisting DVT. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.
  • Af Björkesten, C. -G.; Jussila, A.; Kemppainen, H.; Hallinen, T.; Soini, E.; Mankinen, P.; Valgardsson, S.; Veckman, V.; Nissinen, R.; Naessens, D.; Molander, P. (2019)
    Background and Aims: A retrospective non-interventional, multi-centre patient chart review study was conducted to investigate the association of faecal calprotectin (FC) 1 year (+/- 2 months) after biological therapy initiation with composite event-free survival (CEFS) consisting of surgical procedures, corticosteroid initiation, treatment failure or dose increase in patients with Crohn's disease (CD). In addition, the correlations of FC and other tests of disease activity were assessed. Materials and methods: Data on Finnish CD patients initiating a biological therapy between 2010 and 2016, were collected. The association of FC and CEFS was analysed with Kaplan-Meier and Cox proportional hazard modelling. The correlations were tested with Pearson's test. Results: Biological therapy was initiated in 186 patients, of which 87 (46.8%) had FC results available at 1 year and 80 had follow-up exceeding 14 months. The characteristics of patients with and without FC results were similar. Patients with elevated FC (>250 mu g/g) had a significantly increased risk of experiencing composite event (HR 3.4, 95% CI: 1.3-8.9; p = .013) when compared to patients with normal FC (FC
  • Repo, Jussi P.; Tukiainen, Erkki J.; Roine, Risto P.; Kautiainen, Hannu; Lindahl, Jan; Ilves, Outi; Järvenpää, Salme; Häkkinen, Arja (2018)
    Background: There have previously been no validated foot and ankle-specific patient-reported outcome measures in Finnish. Methods: The Visual Analogue Scale Foot and Ankle (VAS-FA) was translated and adapted into Finnish. Thereafter, 165 patients who had undergone foot and ankle surgery completed a questionnaire set on two separate occasions. Analyses included testing of floor-ceiling effect, internal consistency, reproducibility, and validity. Results: Minor linguistic differences emerged during the translation. Some structural adjustments were made. The mean (SD) total VAS-FA score was 74 (23). In the three subscales, maximum scores were noted in 2-5% of the responses, and internal consistency ranged from 0.81 to 0.94. Reproducibility was excellent (ICC, 0.97). The total VAS-FA score correlated significantly with the Lower Extremity Functional Scale (r = 0.84) and the 15D Mobility dimension (r = 0.79). The VAS-FA loaded on two factors (pain/movement and problems/limitations). Conclusions: The Finnish version of the VAS-FA has high reliability and strong validity. (C) 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
  • Launonen, Antti P.; Lepola, Vesa; Flinkkila, Tapio; Laitinen, Minna; Paavola, Mika; Malmivaara, Antti (2015)
    Background and purpose - There is no consensus on the treatment of proximal humerus fractures in the elderly. Patients and methods - We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score. Results - After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10-29%). Interpretation - Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.
  • Auråen, Henrik; Schultz, Hans Henrik L.; Hämmäinen, Pekka; Riise, Gerdt C.; Larsson, Hillevi; Hansson, Lennart; Dellgren, Göran; Perch, Michael; Geiran, Odd; Fiane, Arnt E.; Iversen, Martin; Holm, Are Martin (2018)
    BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.
  • Poukkanen, Meri; Koskenkari, Juha; Vaara, Suvi T.; Pettila, Ville; Karlsson, Sari; Korhonen, Anna-Maija; Laurila, Jouko J.; Kaukonen, Kirsi-Maija; Lund, Vesa; Ala-Kokko, Tero I.; FINNAKI Study Grp (2014)