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PROGNOSIS
Possible outcomes of a disease and
the frequency with which they can
be expected to occur.
Recovery
Biologic Clinical
Diagnosis Outcome Disability
onset Death
etc
Clinical courses
(medical intervention)
RISK FACTORS AND PROGNOSTIC FACTORS
Risk factors
Recovery
Biologic Clinical Outcome Disability
onset Diagnosis Death
Etc
Demographic variables
Prognostic factors Disease specific variables
Comorbid factors
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RISK FACTORS Vs PROGNOSTIC FACTORS
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RISK Vs PROGNOSIS
Risk Prognosis
RISK PROGNOSIS
1. Age >> 1. Age >>
2. Male 2. Male
3. LDL>/ HDL< 3. Anterior infarction
4. Cigarette 4. Hypotension
smoking 5. Congestive heart
5. Hypertension failure
6. Inactivity 6. Ventricular arrythmia
Expert opinion
consulting the appropriate specialist
looking it up in a textbook
Clinical experience
Read-up
THE PROGNOSIS QUESTIONS
A qualitative aspect:
which outcomes could happen?
cure, death, survive, etc
A quantitative aspect
how likely are they to happen?
relative risk, hazard ratio, etc
A temporal aspect
over what time period?
5 years, 10 years, etc
RESEARCH DESAIN
Early Recovery
Biologic Clinical Outcome Disability
onset diagnosis Diagnosis
possible Death
Etc
Cohort study
Survival analysis
Case Control study
COHORT STUDY
0 1 2 3 4 5 0 1 2 3 4 5
Years Years
Start cohort Pre-clinical phase Start cohort Pre-clinical phase
Clinical phase Clinical phase
Av. duration of survival= 14.5/5 = 2.9 yrs Av. duration of survival= 11/5 = 2.2 yrs
COHORT STUDY
Ideal follow-up period
Until every patient recovers or has one of the
other outcomes of interest,
Until the elapsed time of observation is of clinical
interest to clinicians or patients.
Death
Disease
Disability
Discomfort
Dissatisfaction
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RATES COMMONLY USED TO DESCRIBE PROGNOSIS
Rate Definition*
5-year Percent of patients surviving 5 years
survival from some point in the course of their
disease
Case fatality Percent of patients with a disease who
die of it
Disease- Number of people per 10,000 (or
specific 100,000) population dying of a specific
mortality disease
Response Percent of patients showing some
evidence of improvement following an
intervention
Remission Percent of patients entering a phase in
which
*Time under observation disease
is either isor
stated noassumed
longertodetectable
be sufficiently
long so that all events that will occur have been
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observed
COMPONENTS OF RATES
Zero time
People at risk
Definition of events
Time to follow-up
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ZERO TIME
A point in time when cohorts are started to
be observed
Should be specified clearly and be the same
Inception cohort:
A group of people who are assembled near the
onset of disease
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SURVIVAL ANALYSIS
Presents information about average time-to-
event for any time in the course of disease
Censoring: patients are lost from the study at
any point in time
drop out
lost to follow-up
have outcome
Survival curves
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SURVIVAL ANALYSIS
% of outcome of interest at a particular
point in time (1 or 5 year survival rates),
Median time to the outcome (e.g. the
length of follow-up by which 50% of
patients have died)
Event curves (e.g. survival curves) that
illustrate, at each point in time, the
proportion of the original study sample
who have not yet had a specified
outcome. Kaplan Meier curves.
Overall survival is a term that denotes the
chances of staying alive for a group of
individuals suffering from a cancer. It denotes
the percentage of individuals in the group who
are likely to be alive after a particular duration
of time. At a basic level, the overall survival is
representative of cure rates.
DFS = disease-free survival:
In cancer, the length of time after primary
treatment for a cancer ends that the patient
survives without any signs or symptoms of that
cancer. In a clinical trial, measuring the
disease-free survival is one way to see how well
a new treatment works. Also called relapse-
free survival (RFS).
Prognosis shown as
survival curves (dashed
line indicates median
survival).
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POTENTIAL BIAS
Prognostic factor Outcomes
Yes
Population Present No
of people
Sample TIME
with the
disease Yes
Absent No
Selection
Potential Sampling Measurement
biases