1.Prediction of stroke-associated pneumonia in patients with acute ischemic stroke: comparison of 6 scores
Jing HANG ; Xiding PAN ; Niannian GE ; Yang YANG ; Junshan ZHOU ; Youyong TIAN
International Journal of Cerebrovascular Diseases 2017;25(11):972-978
Objective To investigate the predictive values of Kwon's score,Chumbler's score,Age,Atrial Fibrillation,Dysphagia,Sex,Stroke Severity (A2DS2) score,the Preventive ANtibacterial THERapy in Acute Ischemic Stroke (PANTHERIS) score,Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS),and prestroke Independence,Sex,Age,NIHSS (ISAN) score for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled retrospectively.They were grouped according to whether to be complicated with SAP or not.The demography and baseline characteristics were compared between the SAP group and the non-SAP group.Multivariate logistic regression analysis was used to identify the independent risk factors for SAP.Receiver operating characteristic (ROC) curves were used to compare the predictive values of the 6 kinds of scores for SAP.Results A total of 1 427 patients with acute ischemic stroke were enrolled.Three hundred ninety-five patients (27.7%) complicated with SAP within 7 d after onset.There were significant differences in age,gender,past history (pneumonia,atrial fibrillation,smoking),laboratory tests (white blood cell count >11 × 109/L,baseline blood glucose ≥ 11.1 mmol/L),Oxfordshire Community Stroke Project (OCSP) classification,falling at the time of onset,dysphagia,mechanical ventilation and the modifiel Rankin Scale (mRS) score before onset,baseline Glasgow Coma Scale (GCS) score,baseline National Institutes of Health Stroke Scale (NIHSS) score and 6 scores between the SAP group and the non-SAP group (all P < 0.05).Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.034,95% confidence interval [CI] 1.019-1.049;P=0.001),white cell count > 11 × 109/L (OR 4.386,95%CI 2.763-6.905;P=0.001),baseline blood glucose ≥ 11.1 mmol/L (OR 1.933,95 % CI 1.305-2.864;P =0.001),dysphagia (OR 7.839,95% CI 4.892-12.563;P =0.001),baseline NIHSS (OR 1.120,95% CI 1.077-1.165;P =0.001),and baseline GCS score (OR 1.132,95% CI 1.019-1.257;P =0.021) were the independent risk factors for SAP.The areas under the ROC curves of SAP predicted by the Chumbler's,AIS-APS,A2DS2,ISAN,Kwon's and PANTHERIS scores were 0.830 (95% CI 0.805-0.855),0.827 (95% CI 0.802-0.852),0.818 (95% CI 0.792-0.845),0.788 (95% CI 0.762-0.814),0.774 (95%CI 0.774-0.803),and 0.727 (95% CI 0.695-0.758),respectively.There were no significant differences in the area under ROC curves of Chumbler's,A2DS2 and AIS-APS scores between the pairwise comparisons.There were significant differences in the area under ROC curves of the Chumbler's,A2DS2,AIS-APS and ISAN scores between the pairwise comparisons (AIS-APS compared with ISAN:P =0.001;the rests P < 0.001).Conclusions The accuracies of predicting SAP with the Chumbler's,AIS-APS and A2DS2 scores are superior to the ISAN,Known's and PANTHERIS scores,and have higher clinical application value.
2.First-line treatment with tislelizumab for advanced non-small cell lung cancer:a rapid health technology assessment
Wenyan LI ; Xiding PAN ; Qiong JIE ; Yuanyuan LI ; Mufei TANG
Chinese Journal of Pharmacoepidemiology 2024;33(7):790-800
Objective To evaluate the efficacy,safety,and economy of tislelizumab(TIS)as a first-line treatment for advanced non-small cell lung cancer(NSCLC).Methods PubMed,Embase,Cochrane Library,CNKI,WanFang Data,SinoMed databases and health technology assessment(HTA)websites were electronically searched to collect the HTA report,systematic review/Meta-analysis and pharmacoeconomic research of TIS as a first-line treatment for advanced NSCLC from the inception to April 30,2024.Two reviewers independently screened literature,extracted data,and evaluated quality,and qualitative descriptive methods were used for rapid health technology assessment(rHTA).Results A total of 9 articles were included,in which 7 systematic review/Meta-analysis and 2 pharmacoeconomic studies.In terms of effectiveness,compared with chemotherapy(CT),TIS+CT could improve the progression free survival(PFS)and objective response rate(ORR)of advanced NSCLC patients.It could also improve PFS in patients with advanced NSCLC who have the any expression of programmed cell death receptor ligand-1(PD-L1),with or without liver metastasis,aged>65 years or<65 years,and with a history of smoking;Compared with CT,TIS+CT could improve the PFS of advanced non squamous NSCLC patients,and could increase the PFS of advanced non squamous NSCLC patients with PD-L1>50%;Compared with CT,TIS+CT could improve the PFS of patients with advanced squamous cell carcinoma NSCLC in stages ⅢB and IV,with PD-L1 being 1%-49%,PD-L1>50%,male,age>65 years old,smoking history,ECOG score of 1 point.In terms of safety,compared with camrelizumab+CT and atezolizumab+bevacizumab+CT,TIS+CT could reduce the incidence of serious adverse reactions.In terms of economics,for non squamous NSCLC without epidermal growth factor receptor(EGFR)mutations and gradual lymphoma kinase(ALK)rearrangements,TIS+CT had certain cost-effectiveness advantages compared to CT in China.The subgroup analysis results showed that the first-line TIS+CT regimen had greater survival benefits in non squamous NSCLC patients with PD-L1 expression>50%,liver metastasis,and a history of smoking.Conclusion TIS+CT first-line treatment for advanced NSCLC has good efficacy,safety,and economy.