Browsing by Subject "Severity"

Now showing 1 - 5 of 5
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    A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions
    (Elsevier, 2022) Dellon, Evan S.; Khoury, Paneez; Muir, Amanda B.; Liacouras, Chris A.; Safroneeva, Ekaterina; Atkins, Dan; Collins, Margaret H.; Gonsalves, Nirmala; Falk, Gary W.; Spergel, Jonathan M.; Hirano, Ikuo; Chehade, Mirna; Schoepfer, Alain M.; Menard-Katcher, Calies; Katzka, David A.; Bonis, Peter A.; Bredenoord, Albert J.; Geng, Bob; Jensen, Elizabeth T.; Pesek, Robert D.; Feuerstadt, Paul; Gupta, Sandeep K.; Lucendo, Alfredo J.; Genta, Robert M.; Hiremath, Girish; McGowan, Emily C.; Moawad, Fouad J.; Peterson, Kathryn A.; Rothenberg, Marc E.; Straumann, Alex; Furuta, Glenn T.; Aceves, Seema S.; Pediatrics, School of Medicine
    Background & aims: Disease activity and severity of eosinophilic esophagitis (EoE) dictate therapeutic options and management, but the decision-making process for determining severity varies among practitioners. To reduce variability in practice patterns and help clinicians monitor the clinical course of the disease in an office setting, we aimed to create an international consensus severity scoring index for EoE. Methods: A multidisciplinary international group of adult and pediatric EoE researchers and clinicians, as well as non-EoE allergy immunology and gastroenterology experts, formed 3 teams to review the existing literature on histology, endoscopy, and symptoms of EoE in the context of progression and severity. A steering committee convened a 1-day virtual meeting to reach consensus on each team's opinion on salient features of severity across key clinicopathologic domains and distill features that would allow providers to categorize disease severity. Results: Symptom features and complications and inflammatory and fibrostenotic features on both endoscopic and histologic examination were collated into a simplified scoring system-the Index of Severity for Eosinophilic Esophagitis (I-SEE)-that can be completed at routine clinic visits to assess disease severity using a point scale of 0-6 for mild, 7-14 for moderate, and ≥15 for severe EoE. Conclusions: A multidisciplinary team of experts iteratively created a clinically usable EoE severity scoring system denominated "I-SEE" to guide practitioners in EoE management by standardizing disease components reflecting disease severity beyond eosinophil counts. I-SEE should be validated and refined using data from future clinical trials and routine clinical practice to increase its utilization and functionality.
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    Comparing Dysmenorrhea Beliefs and Self-Management Techniques Across Symptom-Based Phenotypes
    (Wiley, 2021) Rogers, Sarah K.; Rand, Kevin L.; Chen, Chen X.; Psychology, School of Science
    Objectives: To compare beliefs about dysmenorrhea and self-management techniques across three dysmenorrhea symptom-based phenotypes. Background: Many reproductive-age women experience dysmenorrhea, with varying symptoms and intensity. Dysmenorrhea symptom-based phenotypes have been identified in previous research, defining distinctive phenotypes of mild localised pain, severe localised pain, and multiple severe symptoms. It is unknown if women from different phenotypes hold different beliefs about dysmenorrhea or if they engage in different self-management techniques. Design: Quantitative secondary analysis of cross-sectional survey data. Methods: This online study surveyed 762 women with dysmenorrhea in the United States. Participants reported their dysmenorrhea symptom intensity, beliefs about dysmenorrhea (i.e. beliefs about consequences, timeline, controllability, symptom severity, normalcy, emotional response to symptoms and treatments) and self-management techniques to prevent or treat symptoms. Beliefs regarding dysmenorrhea and types of self-management techniques used were compared across three phenotypes utilising ANOVA tests and Tukey's HSD for pairwise comparisons. Reporting followed the STROBE guidelines. Results: Women with multiple severe symptoms had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with severe localised pain and women with mild localised pain. Women with severe localised pain had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with mild localised pain. Negative beliefs regarding dysmenorrhea included: consequences of dysmenorrhea, timeline of symptoms, personal and treatment control, symptom severity, normalcy of symptoms, emotional response to symptoms and willingness to utilise complementary medicine. Conclusion: Results further support the distinction between dysmenorrhea symptom-based phenotypes. Not only do women in different phenotypes experience different severity and number of dysmenorrhea symptoms, they also perceive and manage their dysmenorrhea differently. Relevance to clinical practice: These findings have implications for tailoring interventions to different dysmenorrhea symptom-based phenotypes.
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    Genetic Risk for Alcohol Use Disorder in Relation to Individual Symptom Criteria: Do Polygenic Indices Provide Unique Information for Understanding Severity and Heterogeneity?
    (medRxiv, 2024-09-23) Kim, Yongguk; Lane, Sean P.; Miller, Alex P.; Wilhelmsen, Kirk C.; Gizer, Ian R.; Psychiatry, School of Medicine
    Alcohol Use Disorder (AUD) is a heterogenous category with many unique configurations of symptoms. Previous investigations of AUD heterogeneity using molecular genetics methods studied the association between genetic liability and individual AUD symptoms at the latent level or focusing on a small number of genetic variants. Notably, these studies did not investigate potential severity differences between symptoms in their genetic analyses. Therefore, the current study aimed to examine the genetic risk for individual AUD symptom criteria by using a polygenic risk score (PRS) approach to assess the relative severity of each AUD symptom and test for associates with AUD symptoms above and beyond a unidimensional AUD construct. An AUD PRS was created using summary statistics obtained from published genome-wide association studies (GWAS), and Multiple Indicators Multiple Causes (MIMIC) models were employed to examine the effect of the PRS on overall AUD severity as well as on individual symptoms after accounting for this overall effect. The phenotypic severity of AUD symptoms was highly correlated with the genetic severity of AUD symptoms (r = 0.78). Results of MIMIC models indicated that the AUD PRS significantly predicted the AUD factor. Regression paths testing the unique, direct effects of the PRS on individual AUD symptoms, independent of the latent AUD factor, were not significant. These results imply that PRSs derived from GWAS of AUD influence symptom expression through a single genetic factor that is highly correlated with the relative severity of individual symptoms when measured at the phenotypic level. Item-level GWAS of AUD symptoms are needed to further parse heterogeneous symptom expression and allow for more nuanced tests of these conclusions.
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    Incidence and risk factors of oral feeding intolerance in acute pancreatitis: Results from an international, multicenter, prospective cohort study
    (Wiley, 2021-02) Pothoulakis, Ioannis; Nawaz, Haq; Paragomi, Pedram; Jeong, Kwonho; Talukdar, Rupjyoti; Kochhar, Rakesh; Goenka, Mahesh Kumar; Gulla, Aiste; Singh, Vikesh K.; Gonzalez, Jose A.; Ferreira, Miguel; Barbu, Sorin T.; Stevens, Tyler; Gutierrez, Silvia C.; Zarnescu, Narcis O.; Capurso, Gabriele; Easler, Jeffrey; Triantafyllou, Konstantinos; Pelaez-Luna, Mario; Thakkar, Shyam; Ocampo, Carlos; de-Madaria, Enrique; Wu, Bechien U.; Cote, Gregory A.; Abebe, Kaleab; Tang, Gong; Lahooti, Ali; Phillips, Anna E.; Papachristou, Georgios I.; Medicine, School of Medicine
    Background: Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. Objective: We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. Methods: Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. Results: Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83-5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01-2.69) were independent risk factors for oral feeding intolerance. Conclusion: Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.
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    The Modified Pancreatitis Activity Scoring System Shows Distinct Trajectories in Acute Pancreatitis: An International Study
    (Elsevier, 2022) Paragomi, Pedram; Hinton, Alice; Pothoulakis, Ioannis; Talukdar, Rupjyoti; Kochhar, Rakesh; Goenka, Mahesh K.; Gulla, Aiste; Gonzalez, Jose A.; Singh, Vikesh K.; Bogado, Miguel Ferreira; Stevens, Tyler; Barbu, Sorin T.; Nawaz, Haq; Gutierrez, Silvia C.; Zarnescu, Narcis; Archibugi, Livia; Easler, Jeffrey J.; Triantafyllou, Konstantinos; Peláez-Luna, Mario; Thakkar, Shyam; Ocampo, Carlos; de-Madaria, Enrique; Cote, Gregory A.; Lee, Peter J.; Krishna, Somashekar; Lara, Luis F.; Han, Samuel; Wu, Bechien U.; Papachristou, Georgios I.; Medicine, School of Medicine
    Background & aims: The aims of this study were to: (1) assess the performance of the Pancreatitis Activity Scoring System (PASS) in a large intercontinental cohort of patients with acute pancreatitis (AP); and (2) investigate whether a modified PASS (mPASS) yields a similar predictive accuracy and produces distinct early trajectories between severity subgroups. Methods: Data was prospectively collected through the Acute Pancreatitis Patient Registry to Examine Novel Therapies In Clinical Experience (APPRENTICE) consortium (2015-2018) involving 22 centers from 4 continents. AP severity was categorized per the revised Atlanta classification. PASS trajectories were compared between the three severity groups using the generalized estimating equations model. Four mPASS models were generated by modifying the morphine equivalent dose (MED), and their trajectories were compared. Results: A total of 1393 subjects were enrolled (median age, 49 years; 51% males). The study cohort included 950 mild (68.2%), 315 (22.6%) moderately severe, and 128 (9.2%) severe AP. Mild cases had the lowest PASS at each study time point (all P < .001). A subset of patients with outlier admission PASS values was identified. In the outlier group, 70% of the PASS variation was attributed to the MED, and 66% of these patients were from the United States centers. Among the 4 modified models, the mPASS-1 (excluding MED from PASS) demonstrated high performance in predicting severe AP with an area under the receiver operating characteristic curve of 0.88 (vs area under the receiver operating characteristic of 0.83 in conventional PASS) and produced distinct trajectories with distinct slopes between severity subgroups (all P < .001). Conclusion: We propose a modified model by removing the MED component, which is easier to calculate, predicts accurately severe AP, and maintains significantly distinct early trajectories.