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Admission CT radiomic signatures outperform hematoma volume in predicting baseline clinical severity and functional outcome in the ATACH-2 trial intracerebral hemorrhage population
Haider SP, Qureshi AI, Jain A, Tharmaseelan H, Berson ER, Zeevi T, Majidi S, Filippi CG, Iseke S, Gross M, et al
European journal of neurology. 2021
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Abstract
BACKGROUND Radiomics provides a framework for automated extraction of high-dimensional feature sets from medical images. We aimed to determine radiomics signature correlates of admission clinical severity and medium-term outcome from intracerebral hemorrhage (ICH) lesions on baseline head CTs. METHODS We used the ATACH-2 (Antihypertensive-Treatment-of-Acute-Cerebral-Hemorrhage-II) trial dataset. Patients included in this analysis (n=895) were randomly allocated to discovery (n=448) and independent validation (n=447) cohorts. We extracted 1130 radiomics features from hematoma lesions on baseline non-contrast head CTs and generated radiomics signatures associated with admission Glasgow Coma Scale (GCS), admission National Institutes of Health Stroke Scale (NIHSS), and 3-month modified Rankin Scale (mRS) scores. Spearman's correlation between radiomics signatures and corresponding target variables was compared with hematoma volume. RESULTS In the discovery cohort, radiomics signatures - compared to ICH volume - had significantly stronger association with admission GCS (0.47 vs 0.44, p=0.008), admission NIHSS (0.69 vs 0.57, p<0.001), and 3-month mRS scores (0.44 vs 0.32, p<0.001). Similarly, in independent validation, radiomics signatures - compared to ICH volume - had significantly stronger association with admission GCS (0.43 vs 0.41, p=0.02), NIHSS (0.64 vs 0.56, p<0.001), and 3-month mRS scores (0.43 vs 0.33, p<0.001). In multiple regression analysis adjusted for known predictors of ICH outcome, the radiomics signature was an independent predictor of 3-month mRS in both cohorts. CONCLUSIONS Limited by the enrollment criteria of the ATACH-2 trial, we showed that radiomics features quantifying hematoma texture, density and shape on baseline CT can provide imaging correlates for clinical presentation and medium-term outcome.
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Double volume exchange transfusion in severe neonatal sepsis
Aradhya AS, Sundaram V, Kumar P, Ganapathy SM, Jain A, Rawat A
Indian Journal of Pediatrics. 2016;83((2)):107-13.
Abstract
OBJECTIVES To study the efficacy and safety of double volume exchange transfusion (DVET) in neonates>1000 g birth weight with severe sepsis. METHODS Eighty-three neonates weighing >1000 g with severe sepsis were randomly assigned to DVET or standard therapy (ST) group. Primary outcome was mortality by 14 d from enrollment. RESULTS A 21 % reduction in mortality, albeit non-significant, by 14 d from enrollment was observed in DVET group in comparison to ST group [RR: 0.79 (95 % C.I 0.45-1.3); p 0.4]. A similar trend in mortality reduction was observed with early mortality and mortality by discharge in DVET group. No difference was observed in normalization of dysfunctional organs by 14 d. Cardiovascular and hematological system benefitted the most, followed by renal dysfunction with DVET. A significant improvement in post DVET IgG, IgA, IgM, C3 and base deficit was observed. No serious adverse effects occurred following DVET. CONCLUSIONS In neonates >1000 g with severe sepsis, DVET was associated with a trend towards decrease in mortality by 14 d from enrollment. A significant improvement in immunoglobulin and complement C3 levels and acid base status were observed following DVET. DVET is a safe procedure in severely sick and septic neonates.