The Impact of Postoperative Pulmonary Complications on Perioperative Outcomes in Patients Undergoing Pneumonectomy: A Multicenter Retrospective Cohort Study of the German Thorax Registry

Semmelmann, Axel; Baar, Wolfgang; Fellmann, Nadja; Moneke, Isabelle; Loop, Torsten

doi:10.3390/jcm13010035

Cited by 3 publications

(1 citation statement)

References 39 publications

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“…Only statistically significant variables with a p < 0.005 in univariate analysis were included in the multivariate logistic regression. The independent risk factors were evaluated by multivariate logistic regression [19]. The receiver operating characteristic (ROC) curves were used to evaluate the predictive value [11].…”

Section: Discussionmentioning

confidence: 99%

CLR (C-Reactive Protein to Lymphocyte Ratio) Served as a Promising Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage (aSAH): A Retrospective Cohort Study

Li,

Khan,

Fischer

et al. 2024

JCM

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Background: Subarachnoid hemorrhage is a devastating disease. Even after state-of-the-art treatment patients suffer from complications, including cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), and chronic hydrocephalus (CH) following aneurysmal subarachnoid hemorrhage (aSAH). The aim of our study is to identify the predictive value of the C-reactive protein to lymphocyte ratio (CLR) for neurological functional outcome and complications after aSAH. Methods: We retrospectively analyzed a total of 166 aSAH patients who met the inclusion criteria enrolled in our study. Multivariate logistic regression analyses were performed to evaluate the independent risk factors. The predictive value of different models was compared by calculating the areas under the receiver operating characteristic (ROC) curve. Results: On-admission levels of CLR in patients with poor outcomes (6 months mRS 3–6), CVS, DCI, and CH were significantly higher than those in patients with good outcomes (6 months mRS 0–2), non-CVS, non-DCI, and non-CH. Multivariate logistic regression analysis revealed that admission CLR was independently associated with CVS (OR [95% CI] 2.116 [1.507–2.971]; p < 0.001), and DCI (OR [95% CI] 1.594 [1.220–2.084]; p = 0.001). In ROC analysis, the area under the curve (AUC) of CLR for poor outcomes (6 months mRS 3–6), CVS, DCI, and CH prediction were (AUC [95% CI] 0.639 [0.555–0.724]; p = 0.002), (AUC [95% CI] 0.834 [0.767–0.901]; p < 0.001), (AUC [95% CI] 0.679 [0.581–0.777]; p < 0.001), and (AUC [95% CI] 0.628 [0.543–0.713]; p = 0.005) revealing that admission CLR had a favorable predictive value for CVS after aSAH. The sensitivity and specificity of admission CLR for CVS prediction were 77.1% and 75.4%. On-admission CLR of 0.757 mg × 10−6 was identified as the best cutoff threshold to discriminate between CVS and non-CVS (CVS: CLR < 0.757 mg × 10−6 11/100 [11.0%] vs. CLR ≥ 0.757 mg × 10−6 37/66 [56.1%]; p < 0.001). Conclusions: High levels of on-admission CLR serve as an independent risk factor for CVS and DCI after aSAH. Admission CLR is an easy-to-quantify laboratory parameter that efficiently predicts the CVS after aSAH, which can provide some guidance for clinicians to evaluate for possible progression and treatment strategies in patients with aSAH.

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Section: Discussionmentioning

confidence: 99%

CLR (C-Reactive Protein to Lymphocyte Ratio) Served as a Promising Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage (aSAH): A Retrospective Cohort Study

Li,

Khan,

Fischer

et al. 2024

JCM

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Prediction modeling of postoperative pulmonary complications following lung resection based on random forest algorithm

Li,

Wu,

Chen

2024

Medicine

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Postoperative pulmonary complications (PPCs) are a significant concern following lung resection due to prolonged hospital stays and increased morbidity and mortality among patients. This study aims to develop and validate a risk prediction model for PPCs after lung resection using the random forest (RF) algorithm to enhance early detection and intervention. Data from 180 patients who underwent lung resections at the Third Affiliated Hospital of the Naval Medical University between September 2022 and February 2024 were retrospectively analyzed. The patients were randomly allocated into a training set and a test set in an 8:2 ratio. An RF model was constructed using Python, with feature importance ranked based on the mean Gini index. The predictive performance of the model was evaluated through analyses of the receiver operating characteristic curve, calibration curve, and decision curve. Among the 180 patients included, 47 (26.1%) developed PPCs. The top 5 predictive factors identified by the RF model were blood loss, maximal length of resection, number of lymph nodes removed, forced expiratory volume in the first second as a percentage of predicted value, and age. The receiver operating characteristic curve and calibration curve analyses demonstrated favorable discrimination and calibration capabilities of the model, while decision curve analysis indicated its clinical applicability. The RF algorithm is effective in predicting PPCs following lung resection and holds promise for clinical application.

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Criteria for continuous neuraxial analgesia associated with reduced mortality in patients undergoing thoracotomy

Semmelmann,

Baar,

Moneke

et al. 2024

Reg Anesth Pain Med

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IntroductionBoth thoracic epidural analgesia and thoracic paravertebral analgesia are effective techniques to control pain and minimize the stress response following thoracic surgery. We hypothesized that continuous neuraxial techniques may be associated with a decrease in the incidence of postoperative mortality after thoracotomy. Additionally, we aimed to identify subgroup populations that may benefit more from neuraxial anesthesia.Method1620 patients who underwent open thoracotomy were included in this retrospective study from the German Thoracic Registry database at four university hospitals. All-cause inpatient mortality was determined for patients who had and did not have neuraxial anesthesia. Logistic regression was used to adjust for and explore various covariates.ResultsContinuous neuraxial analgesia was associated with a lower overall mortality in the postoperative period (2.9%, 23/796 vs 5.3%, 44/824, p=0.02) only after the univariate analysis but not the multivariable analysis (OR 0.49, 95 % CI 0.237 to 1.12, p=0.15). In patients with epidural or paravertebral catheters, mortality was significantly lower in the following subgroups: age >75 (5/113 vs 18/77, OR 0.1, 95% CI 0.02 to 0.67, p=0.02), American Society of Anesthesiologists Performance Score >III (11//97 vs 33/155, OR 0.32, 95% CI 0.11 to 0.89, p=0.03), chronic kidney disease (5/83 vs 16/77, OR 0.16, 95% CI 0.03 to 0.82, p=0.03), and postoperative sepsis (9/21 vs 17/25, OR 0.13, 95% CI 0.07 to 0.44, p<0.01).ConclusionsNeuraxial analgesic techniques are associated with reductions in postoperative mortality after open thoracic surgery in selected patients.

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The Impact of Postoperative Pulmonary Complications on Perioperative Outcomes in Patients Undergoing Pneumonectomy: A Multicenter Retrospective Cohort Study of the German Thorax Registry

Cited by 3 publications

References 39 publications

CLR (C-Reactive Protein to Lymphocyte Ratio) Served as a Promising Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage (aSAH): A Retrospective Cohort Study

CLR (C-Reactive Protein to Lymphocyte Ratio) Served as a Promising Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage (aSAH): A Retrospective Cohort Study

Prediction modeling of postoperative pulmonary complications following lung resection based on random forest algorithm

Criteria for continuous neuraxial analgesia associated with reduced mortality in patients undergoing thoracotomy

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